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Abstract The chimeric anti-CD20 antibody rituximab (Rituxan, IDEC-C2B8) is widely used in the clinical treatment of patients with non-Hodgkin's lymphoma (NHL). Rituximab sensitizes NHL B-cell lines to drug-induced apoptosis via down-regulation of Bcl-xL expression. We hypothesized that the mechanism by which rituximab down-regulates Bcl-xL may be, in part, due to inhibition of constitutive nuclear factor-κB (NF-κB) activity that regulates Bcl-xL expression. This hypothesis was tested in CD20+ drug-resistant Ramos (Bcl-2−/Bcl-xL+) and Daudi (Bcl-2+/Bcl-xL+) cell lines. Rituximab decreased the phosphorylation of NF-κB-inducing kinase, IκB kinase, and IκB-α, diminished IKK kinase activity, and decreased NF-κB DNA binding activity. These events occurred with similar kinetics and were observed 3 to 6 hours post-rituximab treatment. Rituximab significantly up-regulated Raf-1 kinase inhibitor protein expression, thus interrupting the NF-κB signaling pathway concomitant with Bcl-xL and Bfl-1/A1 down-regulation. The role of NF-κB in the regulation of Bcl-xL transcription was shown using promoter reporter assays in which deletion of the two-tandem NF-κB binding sites in the upstream promoter region significantly reduced the luciferase activity. This was further corroborated by using IκB superrepressor cells and by NF-κB–specific inhibitors. The direct role of Bcl-xL in drug resistance was assessed by using Bcl-xL–overexpressing cells, which exhibited higher drug resistance that was partially reversed by rituximab. Rituximab-mediated inhibition of the NF-κB signaling pathway and chemosensitization was corroborated by the use of specific inhibitors. These findings reveal a novel pathway mediated by rituximab through Raf-1 kinase inhibitor protein induction that negatively regulates the constitutive NF-κB pathway and chemosensitization of the NHL B-cells.
Jazirehi et al. (Sat,) studied this question.