Phenylhexyl isothiocyanate has dual function as histone deacetylase inhibitor and hypomethylating agent and can inhibit myeloma cell growth by targeting critical pathways
© Lu et al; licensee BioMed Central Ltd. 2008
Received: 26 March 2008
Accepted: 09 June 2008
Published: 09 June 2008
Histone deacetylase (HDAC) inhibitors are a new class of chemotherapeutic agents. Our laboratory has recently reported that phenylhexyl isothiocyanate (PHI), a synthetic isothiocyanate, is an inhibitor of HDAC. In this study we examined whether PHI is a hypomethylating agent and its effects on myeloma cells. RPMI8226, a myeloma cell line, was treated with PHI. PHI inhibited the proliferation of the myeloma cells and induced apoptosis in a concentration as low as 0.5 μM. Cell proliferation was reduced to 50% of control with PHI concentration of 0.5 μM. Cell cycle analysis revealed that PHI caused G1-phase arrest of RPMI8226 cells. PHI induced p16 hypomethylation in a concentration- dependent manner. PHI was further shown to induce histone H3 hyperacetylation in a concentration-dependent manner. It was also demonstrated that PHI inhibited IL-6 receptor expression and VEGF production in the RPMI8226 cells, and reactivated p21 expression. It was found that PHI induced apoptosis through disruption of mitochondrial membrane potential. For the first time we show that PHI can induce both p16 hypomethylation and histone H3 hyperacetylation. We conclude that PHI has dual epigenetic effects on p16 hypomethylation and histone hyperacetylation in myeloma cells and targets several critical processes of myeloma proliferation.
Despite many recent advances in treatment, multiple myeloma (MM) remains as an incurable disease without an allogeneic hematopoietic cell transplantation. The emergence of drug resistance and incomplete responses have been the major obstacles for improving the treatment results [1, 2]. The new treatment strategies have been based largely upon targeting specific molecules or pathways, such as proteosome inhibitors and thalidomide analogs. Aberrant methylation of gene promoter regions is a widely studied epigenetic process in malignant disorders. Cell cycle inhibitors of p15 and p16 are the tumor suppressor genes frequently affected by this epigenetic change [3, 4]. The aberrant methylation of gene promoter regions is associated with loss of gene function. In addition to gene deletions and mutations, quantitative changes in gene methylation status play a significant role in tumorigenesis . Hypermethylation of p15 and p16 promoter CpG islands has been reported in MM clinical specimens and myeloma cell lines [4, 6, 7]. The methylation status of p15 and p16 genes were not significantly different between MM and MGUS (monoclonal gammopathy of unknown significance) nor in pre-treated and post-treated patients with MM [6–8]. It was further demonstrated in MM patients that p16 hypermethylation is associated with high plasma cell proliferation, higher β2-microglobulin concentration, and shorter survival, whereas no such clear correlation was found with p15 CpG island hypermethylation [4, 7, 9].
The proliferation and survival of myeloma cells are also potentiated by IL-6 and IL-6 receptor signal transduction through autocrine and paracrine stimulation [10, 11]. Exogenous IL-6 was able to block the apoptosis induced by the chemotherapeutic agent dexamethasone [10, 12]. Increased angiogenesis and microvascular density in the bone marrow microenvironment correlate with poor prognosis and drug resistance of myeloma cells [13–15]. Cytokines that augment angiogenesis are known to be present at elevated levels in the bone marrow. The vascular endothelial growth factor (VEGF) is one of those elevated cytokines associated with angiogenesis. Thalidomide and its derivative, lenalidomide (CC-5013, Revlimid; Celgene), are inhibitors of angiogenesis and are widely used for MM therapy .
In the search for novel molecular targets, histone deacetylases (HDACs) that affect epigenetic processes have emerged as one of the potential targets [16, 17]. Recent studies have indicated that the expression of various genes that regulate differentiation, proliferation, and apoptosis are also influenced by HDACs. Aberrant histone acetylation appears to play an important role in the development of numerous malignancies [18, 19]. Agents that modify histone acetylation thus show great promise against various malignancies [20–26]. Vorinostat (Suberoylanilide hydroxamic acid, SAHA, Zolinza; Merck) is among the first HDAC inhibitors approved for clinical treatment of cutaneous T cell lymphoma [27, 28]. Our laboratory has recently reported that a synthetic isothiocyanate, phenylhexyl isothiocyanate (PHI), is an inhibitor of HDACs [29, 30]. We have found that PHI can induce selective histone acetylation and lead to cell cycle arrest and apoptosis in human leukemia cells and prostate cancer cells [29–31]. Oral feeding of PHI to immunodeficient mice inhibited the tumorigenesis of human leukemia cells in vivo [29, 30]. We have further demonstrated that PHI has a selective effect in inducing apoptosis in cancer cells, but not in normal cells [29–31]. In this study we demonstrated, for the first time, that PHI has dual epigenetic effects of causing histone hyperacetylation and p16 hypomethylation in multiple myeloma cell line RPMI8226.
Cell culture and chemicals
The preparation of PHI has been described previously [29, 30]. Human myeloma cell line RPMI 8226 was obtained from American Type Culture Collection (ATCC, Manassas, VA). Cells were seeded at 0.3 × 106 per ml of RPMI-1640 medium, supplemented with 10% heat-inactivated fetal calf serum, 100 IU penicillin/ml and 100 ug streptomycin/ml, and maintained at 37°C in a humidified atmosphere containing 5% CO2. Cells in exponential growth were exposed to PHI at various concentrations prepared in 75% methanol and PBS . The control cultures were supplemented with the methanol-containing medium. Cell viability was determined from at least triplicate cultures by trypan blue exclusion method. Cell density was calculated by the viable cell counts per ml.
Methylation specific PCR
Methylation specific PCR (MS-PCR) was performed using the procedure previously described . RPMI 8226 cells at exponential growth were treated without or with PHI or Decitabine at various concentrations for 10 days. The DNA from the cells was extracted and bisulfite-converted for MS-PCR analyses. The primers for the methylated form of p16 are ttattagagggtggggcggatcgc (sense) and gaccccgaaccgcgaccgtaa (antisense). The primers for unmethylated form are ttattagagggtggggtggattgt (sense) and caaccccaaaccacaaccataa (antisense). The methylated PCR product covers 151 bp extending from bp 167 to bp 317, and the unmethylated product are 152 bp extending from bp 167 to bp 318 . The amplification was performed in a thermocycler unit under the program conditions (Hotstart Kit, Quiaqen) as follows: 95°C for 15 min; then 40 cycles of 95°C for 15 sec, 60°C for 30 sec, 72°C for 30 sec; and finally 10 min at 72°C. At least two independent PCR amplifications were performed for each sample.
Cell cycle and vascular endothelial growth factor (VEGF) measurements
Analysis of cell cycle phases was performed using a Becton-Dickinson FACScan flow cytometer according to the methods described previously  The cells were stained with propium iodide solution (50 μg/ml) on ice, and at least 10,000 cells were analyzed. For VEGF measurement, the RPMI 8226 cells were plated at 0.3 × 106 cells/ml, the cultures were incubated for designated time periods. The contents of VEGF in the culture supernatants were determined with a VEGF ELISA kit (R & D System, Minneapolis, MN, USA). The percent alteration of VEGF contents from PHI-exposed cells was calculated and compared to the control cultures.
Measurements of mitochondrial membrane potential and apoptosis
The effects of PHI treatment on mitochondrial membrane potential was measured using a potential sensitive dye JC-1 (5,5',6,6'-tetrachloro-1,1',3,3'-tetraethylbenzimidazolylcarbocyanine iodide). The JC-1 dye bears a delocalized positive charge and enters the mitochondrial matrix due to the negative charge established by the intact mitochondrial membrane potential [34, 35]. In healthy cells, JC-1 dye stains the mitochondria red due to formation of J-aggregates. In apoptotic cells, JC-1 dye accumulates in the cytoplasm in monomeric form (green fluorescence) due to collapse of the mitochondrial membrane potential. Stock solution of JC-1 (1 mg/ml) was prepared in DMSO and freshly diluted with the supplied assay buffer. RPMI8226 cells were incubated with medium containing JC-1 (10 μg/ml) for 15 min at 37°C. Cells were washed and re-suspended in 0.5 ml assay buffer and the fluorescence was measured using a Becton-Dickinson FACScan flow cytometer. Carbonyl cyanide 4-(trifluoromethoxy)phenylhydrazone (CCCP; 25 μM), an uncoupler of mitochondrial oxidative phosphorylation, was used as a positive control.
Apoptotic cells were determined by the characteristic morphology, and by the presence of DNA strand breaks detected with terminal deoxynucleotidyl transferase-mediated biotinylated UTP nick-end labeling (TUNEL). The TUNEL detection of apoptosis in situ was performed with a cell death detection kit (Roche Diagnostics, Indianapolis, IN). Briefly, cytospin preparations were fixed with 4% paraformaldehyde and incubated in Triton solution for 4 min on ice. Cells incubated with the solution lacking the terminal transferase were used as a negative control. The slides were counter stained with 5% methyl green and evaluated under a light microscope. The percentage of apoptotic cells was calculated by counting at least 500 cells from multiple fields.
Western blot analysis
The expression levels of protein in RPMI 8226 were determined by Western blot analyses using standard procedures as described previously . Total proteins were prepared from each culture condition with a lysis buffer containing freshly prepared protease inhibitors. The protein contents of the lysates were determined by using the BioRad Protein Assay kit (Bio Rad, Hercules, CA, USA) with a BSA standard. Proteins were subjected to SDS-PAGE, electrotransferred to nitrocellulose membrane, and immunoblotted with specific antibodies. Antibodies against acetyl-histone H3 were purchased from Upstate Biotechnology (Lake Placid, NY). Antibodies against p16 and IL-6R were purchased from Santa Cruz (Santa Cruz, CA, USA). β-actin was used as a loading control. Appropriate HRP- conjugated secondary antibodies were used. The reactive proteins were visualized using the ECL system.
The data are presented as mean ± S.D. from multiple independent experiments. Results were evaluated by a two-sided paired Student's t-test for statistical difference.
PHI inhibits proliferation and causes G1 arrest of multiple myeloma cells
To study the effects of PHI on the cell cycle progression, the distribution of cells in different cell cycle phases was analyzed by flowcytometry. Figure 1B reveals a clear decrease of the replicating cells in S- and G2M-phases after PHI exposure for 48 hours at 0.5 μM (Figure 1B). The proportion of S- plus G2M-phases after 96 hr was decreased to 23.9%, as compared to 80.3% in the control cultures, indicating an approximately 3-fold reduction in cell proliferation. Along with the decrease of S- and G2M-phase cells, the cells in G1 phases showed a concomitant increase (Figure 1B). This is consistent with a G1-phase arrest.
PHI induces p16 DNA hypomethylation
PHI inhibits histone deacetylation
PHI inhibits IL-6 receptor expression and reactivates p21 expression
PHI inhibits production of VEGF from myeloma cells
PHI induces disruption of mitochondrial membrane potential
This study demonstrated that PHI can inhibit the proliferation of the myeloma cell line RPMI8226 and induce apoptosis in a concentration as low as 0.5 μM. Most of the cells became apoptotic at a PHI concentration of 5 μM. These concentrations are lower than that required for growth inhibition and apoptosis in HL60 leukemia cells and prostate cancer cells that we have reported [29–31]. At the above concentration we have shown that PHI was nontoxic to normal human blood mononuclear cells . We have initiated a protocol to investigate whether PHI has activities on myeloma cells obtained directly from patients.
In agreement with previous reports, p16 was found to be hypermethylated in RPMI8226 cells [7, 32]. PHI induced hypomethylation of p16 at a concentration-dependent manner. The hypomethylation was comparable to that induced by decitabine, one of the two hypomethylating agents that have been approved for the therapy of myelodysplastic syndrome [36, 37]. The reactivation of the tumor suppressor gene p16 may at least in part be responsible for the G1 arrest and apoptosis of RPMI8226 myeloma cells. There could be other genes and pathways that are activated by PHI-induced hypomethylation, because hypermethylation of tumor suppressor genes, such as SOCS-1, p16, E-cadherin, DAP kinase, MGMT, were frequently detected in myeloma cell lines as well as in clinical specimens from patients with plasma cell disorders [4, 7]. The demethylation of p16 induced by PHI may involve DNA methyltransferase, which is being currently investigated.
Several HDAC inhibitors have been examined as a new class of potential drugs for treating myeloma [19, 24]. We have recently reported that PHI is an inhibitor of HDAC and can induce selective histone acetylation and methylation changes in human leukemia cells [29, 30]. The current study showed that PHI induced histone H3 hyperacetylation and p16 promoter hypomethylation. These findings suggest that PHI has dual effects of epigenetic modulation on both DNA and chromatin. The dual effects on DNA and chromatin from a single agent may provide a synergistic effect in reactivating p16 and other tumor suppressor genes. DNA methylation and histone deacetylation are linked in their actions for silencing gene expression. The methylated CpG-binding protein (MeCP2) recruits HDACs to specific promoter regions that induce the formation of repressive chromatin structure and transcription repression . It would be interesting to study whether the combination of PHI and azacytidine has synergistic activity toward inhibition of myeloma cells. Clinical trials using a combination of HDAC inhibitors and hypomethylating agents are already underway for the therapy of patients with leukemia and myelodysplasia .
It was previously shown that when two HDAC inhibitors, SAHA and TSA, were combined, the cytotoxic effects on multiple myeloma were enhanced, and apoptosis was in part due to the disruption of mitochondrial membrane potential by the HDAC inhibitors . The current study was in agreement with the above report. The combination of PHI and SAHA may enhance even more the cytotoxic effects on the myeloma cells due to the fact that PHI induces DNA hypomethylation as well as histone hyperacetylation.
IL-6 and IL-6 receptor- mediated signaling pathway is critical for the survival and proliferation of myeloma cells . Angiogenesis inhibitors, thalidomide and lenalidomide, are new agents in the therapy of MM . This study showed that PHI can inhibit the expression of IL-6 receptors and also reduce the cytokine VEGF produced by the RPMI 8226 myeloma cells. The latter corroborates a previous report of another HDAC inhibitor, valproic acid, that caused inhibition of VEGF production by RPMI8226 cells . These results indicate that PHI targets several critical processes of myeloma survival and proliferation. One limit of this study is that it focused on one cell line, RPMI8226. Further experiments in more myeloma cell lines and in vivo animal studies would give further insights into the mechanisms and activities of PHI on myeloma cells. More studies are needed to further characterize this promising modulator of epigenetic processes for its potential in clinical applications.
For the first time PHI was shown to induce both p16 hypomethylation and histone H3 hyperacetylation. We conclude that PHI has dual epigenetic effects on p16 hypomethylation and histone hyperacetylation in myeloma cells and targets several critical processes of myeloma proliferation.
This work was supported in part by the New York Medical College Blood Diseases Fund. Dr. Quanyi Lu was partially supported by a grant from Xiamen Zhongshan Hospital.
- Kyle RA, Rajkumar SV: Multiple Myeloma. New Engl J Med. 2004, 351: 1860-1873. 10.1056/NEJMra041875.View ArticlePubMedGoogle Scholar
- Kastrinakis NG, Gorgoulis VG, Foukas PG, Dimopoulos MA, Kittas C: Molecular aspects of multiple myeloma. Ann Oncol. 2000, 11: 1217-1228. 10.1023/A:1008331714186.View ArticlePubMedGoogle Scholar
- Galm O, Yoshikawa H, Esteller M, Osieka R, Herman JG: SOCS-1, a negative regulator of cytokine signaling, is frequently silenced by methylation in multiple myeloma. Blood. 2003, 101: 2784-2788. 10.1182/blood-2002-06-1735.View ArticlePubMedGoogle Scholar
- Galm O, Wilop S, Reichelt J, Jost E, Gehbauer G, Herman JG, Osieka R: DNA methylation changes in multiple myeloma. Leukemia. 2004, 18: 1687-1692. 10.1038/sj.leu.2403434.View ArticlePubMedGoogle Scholar
- Jones PA, Baylin SB: The fundamental role of epigenetic events in cancer. Nat Rev Genet. 2002, 3: 415-428. 10.1038/nrg962.View ArticlePubMedGoogle Scholar
- Guillerm G, Emmanuel G, Wolowiec D, Facon T, Avet-Loiseau H, Kuliczkowski K, Bauters F, Fenaux P, Quesnel B: p16INK4a and p15INK4b gene methylations in plasma cells from monoclonal gammopathy of undetermined significance. Blood. 2001, 98: 244-246. 10.1182/blood.V98.1.244.View ArticlePubMedGoogle Scholar
- Guillerm G, Depil S, Wolowiec D, Quesnel B: Different prognostic values of p15(INK4b) and p16(INK4a) gene methylations in multiple myeloma. Haematologica. 2003, 88: 476-478.PubMedGoogle Scholar
- Ng MHL, Chung YF, Lo KW, Wickham NWR, Lee JCK, Huang DP: Frequent Hypermethylation of p16 and p15 Genes in Multiple Myeloma. Blood. 1997, 89: 2500-2506.PubMedGoogle Scholar
- Mateos MV, García-Sanz R, López-Pérez R, Moro MJ, Ocio E, Hernández J, Megido M, Caballero MD, Fernández-Calvo J, Bárez A, Almeida J, Orfão A, González M, San Miguel F: Methylation is an inactivating mechanism of the p16 gene in multiple myeloma associated with high plasma cell proliferation and short survival. Br J Haematol. 2002, 118: 1034-1040. 10.1046/j.1365-2141.2002.03749.x.View ArticlePubMedGoogle Scholar
- Klein B, Zhang X-G, Content J: Paracrine rather than autocrine regulation of myeloma-cell growth and differentiation by interleukin-6. Blood. 1989, 73: 517-526.PubMedGoogle Scholar
- Hitzler JK, Martinez-Valdez H, Bergsagel DB, Minden MD, Messner HA: Role of interleukin-6 in the proliferation of human multiple myeloma cell lines OCI-My 1 to 7 established from patients with advanced stage of the disease. Blood. 1991, 78: 1996-2004.PubMedGoogle Scholar
- Kawano MM, Mihara K, Huang N, Tsujimoto T, Kuramoto A: Differentiation of early plasma cells on bone marrow stromal cells requires interleukin-6 for escaping from apoptosis. Blood. 1995, 85: 487-494.PubMedGoogle Scholar
- Vacca A, Ribatti D, Presta M, Minischetti M, Lurlaro M, Ria R, Albini A, Bussolino F, Dammacco F: Bone Marrow Neovascularization, Plasma Cell Angiogenic Potential, and Matrix Metalloproteinase-2 Secretion Parallel Progression of Human Multiple Myeloma. Blood. 1999, 93: 3064-3073.PubMedGoogle Scholar
- Vacca A, Ria R, Ribatti D, Semeraro F, Djonov V, Di Raimondo F, Dammacco F: A paracrine loop in the vascular endothelial growth factor pathway triggers tumor angiogenesis and growth in multiple myeloma. Haematologica. 2003, 88: 176-185.PubMedGoogle Scholar
- Sezer O, Niemoller K, Eucker J, Jakob C, Kaufmann O, Zavrski I: Bone marrow microvessel density is a prognostic factor for survival in patients with multiple myeloma. Ann Hematol. 2000, 79: 574-577. 10.1007/s002770000236.View ArticlePubMedGoogle Scholar
- Marks PA, Richon VM, Breslow R, Rifkind RA: Histone deacetylase inhibitors as new cancer drugs. Current Opinion in Oncology. 2001, 13: 477-483. 10.1097/00001622-200111000-00010.View ArticlePubMedGoogle Scholar
- Luo RX, Dean DC: Chromatin remodeling and transcriptional regulation. Journal of the National Cancer Institute. 1999, 91: 1288-1294. 10.1093/jnci/91.15.1288.View ArticlePubMedGoogle Scholar
- Mahlknecht U, Hoelzer D: Histone acetylation modifiers in the pathogenesis of malignant disease. Molecular Medicine. 2000, 6: 623-644.PubMed CentralPubMedGoogle Scholar
- Mitsiades N, Mitsiades CS, Richardson PG, McMullan C, Poulaki V, Fanourakis G, Schlossman R, Chauhan D, Munshi NC, Hideshima T, Richon VM, Marks PA, Anderson KC: Molecular sequelae of histone deacetylase inhibition in human malignant B cells. Blood. 2003, 101: 4055-4062. 10.1182/blood-2002-11-3514.View ArticlePubMedGoogle Scholar
- Futamura M, Monden Y, Okabe T, Fujita-Yoshigaki J, Yokoyama S, Nishimura S: Trichostatin A inhbits both ras-induced neurite outgrowth of P12 cells and morphological transformation of NIH3T3 cells. Oncogene. 1995, 10: 1119-1123.PubMedGoogle Scholar
- Richon VM, Emiliani S, Verdain E, Webb Y, Breslow R, Rifkind RA, Marks PA: A class of hybrid polar inducers of transformed cell differentiation inhibits histone deacetylases. Proc Natl Acad Sci USA. 1998, 95: 3003-3007. 10.1073/pnas.95.6.3003.PubMed CentralView ArticlePubMedGoogle Scholar
- Sandor V, Bakke S, Robey RW, Kang MH, Blagosklonny MV, Bender J, Brooks R, Piekarz RL, Tucker E, Figg WD, Chan KK, Goldspiel B, Fojo AT, Balcerzak SP, Bates SE: Phase I trial of the histone deacetylase inhibitors, depsipeptid (FR901228) in patients with refractory neoplasms. Clinical Cancer Res. 2002, 8 (3): 718-728.Google Scholar
- Melnick A, Licht JD: Histone Deacetylases as therapeutic targets in hematologic malignancies. Current Opinion in Hematology. 2002, 9: 322-332. 10.1097/00062752-200207000-00010.View ArticlePubMedGoogle Scholar
- Catley L, Weisberg E, Tai Y-T, Atadja P, Remiszewski S, Hideshima T, Mitsiades N, Shringarpure R, LeBlanc R, Chauhan D, Munshi N, Schlossman R, Richardson P, Griffin J, Anderson K: NVP-LAQ824 is a potent novel histone deacetylase inhibitor with significant activity against multiple myeloma. Blood. 2003, 102: 2615-2622. 10.1182/blood-2003-01-0233.View ArticlePubMedGoogle Scholar
- Khan SB, Maududi T, Barton K, Ayers J, Alkan S: Analysis of histone deacetylase inhibitor, depsipeptide (FR901228), effect on multiple myeloma. Brit J Haematol. 2004, 125 (2): 156-161. 10.1111/j.1365-2141.2004.04882.x.View ArticleGoogle Scholar
- Kaiser M, Zavrski I, Sterz J, Jakob C, Fleissner C, Kloetzel PM, Sezer O, Heider U: The effects of the histone deacetylase inhibitor valproic acid on cell cycle growth suppression and apoptosis in multiple myeloma. Haematologica. 2006, 91: 248-251.PubMedGoogle Scholar
- Butler LM, Agus DB, Scher HI, Higgins B, Rose A, Cordon-Cardo C, Thaler HT, Rifkind RA, Marks PA, Richon VM: Suberoylanilide hydroxamic acid, an inhibitor of histone deacetylase, suppresses the growth of prostate cancer cells in vitro and in vivo. Cancer Research. 2000, 60: 5165-5170.PubMedGoogle Scholar
- Duvic M, Talpur R, Ni X, Zhang C, Hazarika P, Kelly C, Chiao JH, Reilly JF, Ricker JL, Richon VM, Frankel SR: Phase 2 trial of oral vorinostat (suberoylanilide hydroxamic acid, SAHA) for refractory cutaneous T-cell lymphoma (CTCL). Blood. 2007, 109: 31-39. 10.1182/blood-2006-06-025999.PubMed CentralView ArticlePubMedGoogle Scholar
- Ma X, Fang Y, Beklemisheva A, Dai W, Feng J, Ahmed T, Liu D, Chiao JW: Phenylhexyl isothiocyanate inhibits histone deacetylases and remodels chromatins to induce growth arrest in human leukemia cells. Intl J Oncol. 2006, 28 (5): 1287-93.Google Scholar
- Lu L, Liu D, Ma X, Beklomisheva A, Seiter K, Ahmed T, Chiao JW: The phenylhexyl isothiocyanate induces apoptosis and inhibits leukemia cell growth in vivo. Oncol Reports. 2006, 16 (6): 1363-1367.Google Scholar
- Beklomisheva A, Fang Y, Feng J, Ma X, Dai W, Chiao JW: Epigenetic mechanism of growth inhibition induced by phenylhexyl isothiocyanate in prostate cancer cells. Anticancer Res. 2006, 26: 1225-1230.Google Scholar
- Wong IH, Ng MH, Lee JC, Lo KW, Chung YF, Huang DP: Transcriptional silencing of the p16 gene in human myeloma-derived cell lines by hypermethylation. Brit J Haematol. 1998, 103 (1): 168-175.Google Scholar
- Herman JG, Graff JR, Myohanen S, Nelkin BD, Baylin SB: Methylation-spicific PCR: A novel assay for methylation status of CpG islands. Proc Natl Acad Sci USA. 1996, 93: 9821-9826. 10.1073/pnas.93.18.9821.PubMed CentralView ArticlePubMedGoogle Scholar
- Cossarizza A, Baccarani-Contri M, Kalashnikova G, Franceschi A: A new method for the cytofluorimetric analysis of mitochondrial membrane potentials using the J aggregate forming lipophilic cation 5,5.,6,6.-tetrachloro-1,1.,3,3. tetraethyl benzimidazolyl carbocyanine iodide (JC-1). Biochem Biophys Res Commun. 1993, 197: 40-45. 10.1006/bbrc.1993.2438.View ArticlePubMedGoogle Scholar
- Fandy TE, Shankar S, Ross RD, Sausville E, Srivastava RK: Interactive effects of HDAC inhibitors and trail on apoptosis are associated with changes in mitochondrial functions and expression of cell cycle regulatory genes in multiple myeloma. Neoplasia. 2005, 7: 646-657. 10.1593/neo.04655.PubMed CentralView ArticlePubMedGoogle Scholar
- Kantarjian H, Issa JP, Rosenfeld CS, Bennett JM, Albitar M, DiPersio J, Klimek V, Slack J, deCastro C, Ravandi F, Helmer R, Shen L, Nimer SD, Leavitt R, Raza A, Saba H: Decitabine improves patient outcomes in myelodysplastic syndromes. Cancer. 2006, 106: 1794-1803. 10.1002/cncr.21792.View ArticlePubMedGoogle Scholar
- Silverman LR, Demakos EP, Peterson BL, Kornblith AB, Holland JC, Odchimar-Reissig R, Stone RM, Nelson D, Powell BL, DeCastro CM, Ellerton J, Larson RA, Schiffer CA, Holland J: Randomized controlled trial of azacitidine in patients with the myelodysplastic syndrome: a study of the Cancer and Leukemia Group B. J Clin Oncol. 2002, 20: 2429-2440. 10.1200/JCO.2002.04.117.View ArticlePubMedGoogle Scholar
- Estey E: Acute myeloid leukemia and myelodysplastic syndromes in older patients. J Clin Oncol. 2007, 25: 1908-1915. 10.1200/JCO.2006.10.2731.View ArticlePubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.