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Open Access Research article

P-gp activity is a critical resistance factor against AVE9633 and DM4 cytotoxicity in leukaemia cell lines, but not a major mechanism of chemoresistance in cells from acute myeloid leukaemia patients

Ruoping Tang12*, Simy Cohen2, Jean-Yves Perrot1, Anne-Marie Faussat2, Claudia Zuany-Amorim3, Zora Marjanovic1, Hamid Morjani4, Fanny Fava12, Elise Corre1, Ollivier Legrand12 and Jean-Pierre Marie12

Author Affiliations

1 Assistance Publique – Hôpitaux de Paris, Hôpital Hôtel Dieu, 1 place du Parvis de Notre-Dame, 75181 Paris cedex 04, France

2 Université Pierre et Marie Curie, UMRs 872, Equipe 18, 1 place du Parvis de Notre-Dame, 75181 Paris cedex 04, France; INSERM, 1 place du Parvis de Notre-Dame, 75181 Paris cedex 04, France

3 SANOFI-AVENTIS, Vitry-sur-Seine, France

4 JE Onco-Pharmacologie, IFR53; UFR de Pharmacie, 51096 Reims cedex, France

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BMC Cancer 2009, 9:199  doi:10.1186/1471-2407-9-199

Published: 23 June 2009



AVE9633 is a new immunoconjugate comprising a humanized monoclonal antibody, anti-CD33 antigen, linked through a disulfide bond to the maytansine derivative DM4, a cytotoxic agent and potent tubulin inhibitor. It is undergoing a phase I clinical trial. Chemoresistance to anti-mitotic agents has been shown to be related, in part, to overexpression of ABC proteins. The aim of the present study was to investigate the potential roles of P-gp, MRP1 and BCRP in cytotoxicity in AVE9633-induced acute myeloid leukaemia (AML).


This study used AML cell lines expressing different levels of P-gp, MRP1 or BCRP proteins and twenty-five samples from AML patients. Expression and functionality of the transporter protein were analyzed by flow cytometry. The cytotoxicity of the drug was evaluated by MTT and apoptosis assays.


P-gp activity, but not MRP1 and BCRP, attenuated AVE9633 and DM4 cytotoxicity in myeloid cell lines. Zosuquidar, a potent specific P-gp inhibitor, restored the sensitivity of cells expressing P-gp to both AVE9633 and DM4. However, the data from AML patients show that 10/25 samples of AML cells (40%) were resistant to AVE9633 or DM4 (IC50 > 500 nM), and this was not related to P-gp activity (p-Value: 0.7). Zosuquidar also failed to re-establish drug sensitivity. Furthermore, this resistance was not correlated with CD33 expression (p-Value: 0.6) in those cells.


P-gp activity is not a crucial mechanism of chemoresistance to AVE9633. For patients whose resistance to conventional anthracycline AML regimens is related to ABC protein expression, a combination with AVE9633 could be beneficial. Other mechanisms such as microtubule alteration could play an important role in chemoresistance to AVE9633.