Yıl: 2014 Cilt: 38 Sayı: 6 Sayfa Aralığı: 806 - 816 Metin Dili: İngilizce İndeks Tarihi: 29-07-2022

Multidrug resistance in chronic myeloid leukemia

Öz:
Chronic myeloid leukemia (CML) is characterized by the accumulation of Philadelphia chromosome-positive (Ph+) myeloid cells. Ph+ cells occur via a reciprocal translocation between the long arms of chromosomes 9 and 22 resulting in constitutively active Bcr-abl fusion protein. Tyrosine kinase inhibitors (TKIs) are used against the kinase activity of Bcr-abl fusion protein for the effective treatment of CML. However, the development of drug resistance, directed by different genetic mechanisms, is the major problem of clinical applications of TKIs. These mechanisms include mutations in the TKI binding site of Bcr-abl, overexpression of Bcr-abl, overexpression of ATP binding cassette transporters, aberrant ceramide metabolism, inhibition of apoptosis, and changes in expression levels of microRNAs. Recently, many studies have focused on understanding the molecular mechanisms of drug resistance in cancer while targeting therapies providing reversal of resistance. Cancer stem cells also have roles in tumor initiation, maintenance, progression, metastasis, and drug resistance. Uncovering the mechanisms of drug resistance can provide more efficient treatment of cancer since these findings may provide novel targets for a complete cure. In this review, we discuss recent findings on the mechanisms of multidrug resistance and its reversal in CML.
Anahtar Kelime:

Konular: Biyoloji
Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • Agrawal M, Hanfstein B, Erben P, Wolf D, Ernst T, Saussele S, Fabarius A, Purkayasatha D, Woodman RC, Hehlmann R et al (2013). MDR1 gene expression predicts response and progression-free survival Of Ph+ CML patients on second-line nilotinib therapy after imatinib failure - 4-year follow-up. Blood 122: 1494.
  • Al-Achkar W, Wafa A, Moassass F, Othman MAK (2012). A novel dic (17;18) (p13.1;q11.2) with loss of TP53 and BCR/ABL rearrangement in an Imatinib resistant chronic myeloid leukemia. Mol Cytogenet 5: 36.
  • Al-Hajj M, Wicha MS, Benito-Hernandez A, Morrison SJ, Clarke MF (2003). Prospective identification of tumorigenic breast cancer cells. P Natl Acad Sci USA 100: 3983–3988.
  • An X, Tiwari AK, Sun Y, Ding P, Ashby CR, Chen Z (2010). BCR- ABL tyrosine kinase inhibitors in the treatment of Philadelphia chromosome positive chronic myeloid leukemia: a review. Leukemia Res 34: 1255–1268.
  • Baccarani M, Castagnetti F, Gugliotta G, Palandri F, Rosti G (2014). Treatment recommendations for chronic myeloid leukemia. Mediterr J Hematol Infect Dis 6: e2014005.
  • Baran Y, Bielawski J, Gunduz U, Ogretmen B (2011). Targeting glucosylceramide synthase sensitizes imatinib-resistant chronic myeloid leukemia cells via endogenous ceramide accumulation. J Cancer Res Clin Oncol 137: 1535–1544.
  • Baran Y, Salas A, Senkal CE, Gunduz U, Bielawski J, Obeid LM, Ogretmen B (2007a). Alterations of ceramide/sphingosine 1-phosphate rheostat involved in the regulation of resistance to imatinib-induced apoptosis in K562 human chronic myeloid leukemia cells. J Biol Chem 282: 10922–10934.
  • Baran Y, Ural AU, Gunduz U (2007b). Mechanisms of cellular resistance to imatinib in human chronic myeloid leukemia cells. Hematology 12: 497–503.
  • Bonhoure E, Lauret A, Barnes DJ, Martin C, Malavaud B, Kohama T, Melo JV, Cuvillier O (2008). Sphingosine kinase-1 is a downstream regulator of imatinib-induced apoptosis in chronic myeloid leukemia cells. Leukemia 22: 971–979.
  • Bonnet D, Dick JE (1997). Human acute myeloid leukemia is organized as a hierarchy that originates from a primitive hematopoietic cell. Nat Med 3: 730–737.
  • Buchdunger E, Zimmermann J, Mett H, Meyer T, Müller M, Druker BJ, Lydon NB (1996). Inhibition of the Abl protein-tyrosine kinase in vitro and in vivo by a 2-phenylaminopyrimidine derivative. Cancer Res 56: 100–104.
  • Buchdunger E, Zimmermann J, Mett H, Meyer T, Müller M, Regenass U, Lydon NB (1995). Selective inhibition of the platelet-derived growth factor signal transduction pathway by a protein- tyrosine kinase inhibitor of the 2-phenylaminopyrimidine class. P Natl Acad Sci USA 92: 2558–2562.
  • Calderón-Cabrera C, Montero I, Morales RM, Sánchez J, Carrillo E (2013). Differential cytogenetic profile in advanced chronic myeloid leukemia with sequential lymphoblastic and myeloblastic blast crisis. Leukemia Res Rep 2: 79–81.
  • Camgoz A, Gencer EB, Ural AU, Baran Y (2013). Mechanisms responsible for nilotinib resistance in human chronic myeloid leukemia cells and reversal of resistance. Leuk Lymp 54: 1279–1287.
  • Camgoz A, Ural AU, Avcu F, Baran Y (2011). Targeting ceramide metabolism to increase intracellular concentrations of apoptotic ceramide increased cytotoxic effects of nilotinib in human chronic myeloid leukemia cells. Leuk Lymp 52: 1574–1584.
  • Çelik DA, Koşar PA, Özçelik N (2013). MikroRNA’lar ve kanser ile ilişkisi. SDÜ Tıp Fakültesi Dergisi 20: 121–127 (in Turkish).
  • Chan LC, Karhi KK, Rayter SI, Heisterkamp N, Eridani S, Powles R, Lawler SD, Groffen J, Foulkes JG, Greaves MF et al (1987). A novel abl protein expressed in Philadelphia chromosome positive acute lymphoblastic leukaemia. Nature 325: 635–637.
  • Chapuy B, Panse M, Radunski U, Koch R, Wenzel D, Inagaki N, Haase D, Truemper L, Wulf GG (2009). ABC transporter A3 facilitates lysosomal sequestration of imatinib and modulates susceptibility of chronic myeloid leukemia cell lines to this drug. Haematologica 94: 1528–1536.
  • Chen BA, Lai BB, Cheng J, Xia GH, Gao F, Xu WL, Ding JH, Gao C, Sun XC, Xu CR et al (2009). Daunorubicin-loaded magnetic nanoparticles of Fe3O4 overcome multidrug resistance and induce apoptosis of K562-n/VCR cells in vivo. Int J Nanomedicine 4: 201–208.
  • Chen BA, Shan XY, Chen J, Xia GH, Xu WL, Schmit M (2010). Effects of imatinib and 5-bromotetrandrine on the reversal of multidrug resistance of the K562/A02 cell line. Chin J Cancer 29: 591–595.
  • Cheng J, Cheng L, Chen B, Xia G, Gao C, Song H, Bao W, Guo Q, Zhang H, Wang X (2012). Effect of magnetic nanoparticles of Fe3O4 and wogonin on the reversal of multidrug resistance in K562/A02 cell line. Int J Nanomed 7: 2843–2852.
  • Cheng J, Wang J, Chen B, Xia G, Cai X, Liu R, Ren Y, Bao W, Wang X (2011). A promising strategy for overcoming MDR in tumor by magnetic iron oxide nanoparticles co-loaded with daunorubicin and 5-bromotetrandrin. Int J Nanomed 6: 2123–2131.
  • Chim CS, Wong KY, Leung CY, Chung LP, Hui PK, Chan SY, Yu L (2011). Epigenetic inactivation of the hsa-miR-203 in haematological malignancies. J Cell Mol Med 15: 2760–2767.
  • Cirinnà M, Trotta R, Salomoni P, Kossev P, Wasik M, Perrotti D, Calabretta B (2000). Bcl-2 expression restores the leukemogenic potential of a BCR/ABL mutant defective in transformation. Blood 96: 3915–3921.
  • Comert M, Baran Y, Saydam G (2013). Changes in molecular biology of chronic myeloid leukemia in tyrosine kinase inhibitor era. Am J Blood Res 3: 191–200.
  • Conte E, Stagno F, Guglielmo P, Scuto A, Consoli C, Messina A (2005). Survivin expression in chronic myeloid leukemia. Cancer Lett 225: 105–110.
  • Corbin AS, Agarwal A, Loriaux M, Cortes J, Deininger MW, Druker BJ (2011). Human chronic myeloid leukemia stem cells are insensitive to imatinib despite inhibition of BCR-ABL activity. J Clin Invest 121: 396–409.
  • Cortes JE, Kim DW, Kantarjian HM, Brümmendorf TH, Dyagil I, Griskevicius L, Malhotra H, Powell C, Gogat K, Countouriotis AM et al (2012). Bosutinib versus imatinib in newly diagnosed chronic-phase chronic myeloid leukemia: results from the BELA trial. J Clin Oncol 30: 3486–3492.
  • Davies A, Jordanides NE, Giannoudis A, Lucas CM, Hatziieremia S, Harris RJ, Jørgensen HG, Holyoake TL, Pirmohamed M, Clark RE et al (2009). Nilotinib concentration in cell lines and primary CD34+ chronic myeloid leukemia cells is not mediated by active uptake or efflux by major drug transporters. Leukemia 23: 1999–2006.
  • Dean M, Rzhetsky A, Allikmets R (2001). The human ATP-binding cassette (ABC) transporter superfamily. Genome Res 11: 1156–1166.
  • Deininger MW, Goldman JM, Melo JV (2000). The molecular biology of chronic myeloid leukemia. Blood 96: 3343–3356.
  • Eechoute K, Sparreboom A, Burger H, Franke RM, Schiavon G, Verweij J, Loos WJ, Wiemer EA, Mathijssen RH (2011). Drug transporters and imatinib treatment: implications for clinical practice. Clin Cancer Res 17: 406–415.
  • Ekiz HA, Baran Y (2010). Therapeutic applications of bioactive sphingolipids in hematological malignancies. Int J Cancer 127: 1497–1506.
  • Elghannam DM, Ibrahim L, Ebrahim MA, Azmy E, Hakem H (2014). Association of MDR1 gene polymorphism (G2677T) with imatinib response in Egyptian chronic myeloid leukemia patients. Hematology 19: 123–128.
  • Fausel C (2007). Targeted chronic myeloid leukemia therapy: seeking a cure. Am J Health Syst Pharm 64: 9–15.
  • Frazer R, Irvine AE, McMullin MF (2007). Chronic myeloid leukaemia in the 21st century. Ulster Med J 76: 8–17.
  • Fuchs D, Daniel V, Sadeghi M, Opelz G, Naujokat G (2010). Salinomycin overcomes ABC transporter-mediated multidrug and apoptosis resistance in human leukemia stem cell-like KG- 1a cells. Biochem Biophys Res Commun 394: 1098–1104.
  • Gao L, Chen L, Fei XH, Qiu HY, Zhou H, Wang JM (2006). STI571 combined with vincristine greatly suppressed the tumor formation of multidrug-resistant K562 cells in a human-nude mice xenograft model. Chin Med J (Engl) 119: 911–918.
  • Gencer EB, Ural AU, Avcu F, Baran Y (2011). A novel mechanism of dasatinib-induced apoptosis in chronic myeloid leukemia; ceramide synthase and ceramide clearance genes. Ann Hemat 90: 1265–1275.
  • Gilbert SJ, Blain EJ, Jones P, Duance VC, Mason DJ (2006). Exogenous sphingomyelinase increases collagen and sulphated glycosaminoglycan production by primary articular chondrocytes: an in vitro study. Arthritis Res Ther 8: R89.
  • Goldstein AS, Huang J, Guo C, Garraway IP, Witte ON (2010). Identification of a cell of origin for human prostate cancer. Science 329: 568–571.
  • Gorre ME, Mohammed M, Ellwood K, Hsu N, Paquette R, Rao PN, Sawyers CL (2001). Clinical resistance to STI-571 cancer therapy caused by BCR-ABL gene mutation or amplification. Science 293: 876–880.
  • Graham SM, Jørgensen HG, Allan E, Pearson C, Alcorn MJ, Richmond L, Holyoake TL (2002). Primitive, quiescent, Philadelphia-positive stem cells from patients with chronic myeloid leukemia are insensitive to STI571 in vitro. Blood 99: 319–325.
  • Hamad A, Sahli Z, El Sabban M, Mouteirik M, Nasr R (2013). Emerging therapeutic strategies for targeting chronic myeloid leukemia stem cell. Stem Cell Int 2013: 724360.
  • Hannun YA, Obeid LM (2008). Principles of bioactive lipid signalling: lessons from sphingolipids. Nat Rev Mol Cell Biol 9: 139–150.
  • Hiwase DK, Saunders VA, Nievergall E, Ross DD, White DL, Hughes TP (2013). Dasatinib targets chronic myeloid leukemia-CD34+ progenitors as effectively as it targets mature cells. Haematologica 98: 896–900.
  • Hu H, Li Y, Gu J, Zhu X, Dong D, Yao J, Lin C, Fei J (2010). Antisense oligonucleotide against miR- 21 inhibits migration and induces apoptosis in leukemic K562 cells. Leukemia Lymphoma 51: 694–701.
  • Hu Y, Swerdlow S, Duffy TM, Weinmann R, Lee FY, Li S (2006). Targeting multiple kinase pathways in leukemic progenitors and stem cells is essential for improved treatment of Ph+ leukemia in mice. P Natl Acad Sci USA 103: 16870–16875.
  • Huang WC, Tsai CC, Chen CL, Chen TY, Chen YP, Lin YS, Lu PJ, Lin CM, Wang SH, Tsao CW (2011). Glucosylceramide synthesis inhibitor PDMP sensitizes chronic myeloid leukemia T315I mutant to Bcr-abl inhibitor and cooperatively induces glycogen synthase kinase-3-regulated apoptosis. FASEB J 25: 3661–3673.
  • Huang X, Cortes J, Kantarjian H (2012). Estimations of the increasing prevalence and plateau prevalence of chronic myeloid leukemia in the era of tyrosine kinase inhibitor therapy. Cancer 118: 3123–3127.
  • Jabbour E, Lipton JH (2013). A critical review of trials of first-line BCR-ABL inhibitor treatment in patients with newly diagnosed chronic myeloid leukemia in chronic phase. Clin Lymphoma Myeloma Leuk 13: 646–656.
  • Jabbour EJ, Cortes JE, Kantarjian HM (2013). Resistance to tyrosine kinase inhibition therapy for chronic myelogenous leukemia: a clinical perspective and emerging treatment options. Clin Lymphoma Myeloma Leuk 13: 515–529.
  • Jagani Z, Singh A, Khosravi-Far R (2008). FoxO tumor suppressors and BCR–ABL-induced leukemia: a matter of evasion of apoptosis. Biochim Biophys Acta 1785: 63–84.
  • Jarvis WD, Fornari FA, Traylor RS, Martin HA, Kramer LB, Erukulla RK, Bittman R, Grant S (1996). Induction of apoptosis and potentiation of ceramide-mediated cytotoxicity by sphingoid bases in human myeloid leukemia cells. J Biol Chem 271: 8275–8284.
  • Jørgensen HG, Holyoake TL (2007). Characterization of cancer stem cells in chronic myeloid leukaemia. Biochem Soc Trans 35: 1347–1351.
  • Juliano RL, Ling V (1976). A surface glycoprotein modulating drug permeability in Chinese hamster ovary cell mutants. Biochim Biophys Acta 455: 152–162.
  • Kantarjian HM, Talpaz M, Giles F, O’Brien S, Cortes J (2006). New insights into the pathophysiology of chronic myeloid leukemia and imatinib resistance. Ann Intern Med 145: 913–923.
  • Kim CF, Jackson EL, Woolfenden AE, Lawrence S, Babar I, Vogel S, Crowley D, Bronson RT, Jacks T (2005). Identification of bronchioalveolar stem cells in normal lung and lung cancer. Cell 121: 823–835.
  • Kim MJ, Kim HB, Bae JH, Lee JW, Park SJ, Kim DW, Park SI, Kang CD, Kim SH (2009). Sensitization of human K562 leukemic cells to TRAIL-induced apoptosis by inhibiting the DNA- PKcs/Akt-mediated cell survival pathway. Biochem Pharmacol 78: 573–582.
  • Kuribara R, Honda H, Matsui H, Shinjyo T, Inukai T, Sugita K, Nakazawa S, Hirai H, Ozawa K, Inaba T (2004). Roles of Bim in apoptosis of normal and Bcr–Abl-expressing hematopoietic progenitors. Mol Cell Biol 24: 6172–6183.
  • Li C, Lee CJ, Simeone DM (2009). Identification of human pancreatic cancer stem cells. Methods Mol Biol 568: 161–173.
  • Li L, Wang L, Li L, Wang Z, Ho Y, McDonald T, Holyoake TL, Chen W, Bhatia R (2012). Activation of p53 by SIRT1 inhibition enhances elimination of CML leukemia stem cells in combination with imatinib. Cancer Cell 21: 266–281.
  • Lin T, Genestier L, Pinkoski MJ, Castro A, Nicholas S, Mogil R, Paris F, Fuks Z, Schuchman EH, Kolesnick RN et al (2000). Role of acidic sphingomyelinase in Fas/CD95-mediated cell death. J Biol Chem 275: 8657–8663.
  • Liu YY, Gupta V, Patwardhan GA, Bhinge K, Zhao Y, Bao J, Mehendale H, Cabot MC, Li YT, Jazwinski SM (2010). Glucosylceramide synthase upregulates MDR1 expression in the regulation of cancer drug resistance through cSrc and beta- catenin signaling. Mol Cancer 11: 145.
  • Mahon FX, Belloc F, Lagarde V, Chollet C, Moreau-Gaudry F, Reiffers J, Goldman JM, Melo JV (2003). MDR1 gene overexpression confers resistance to imatinib mesylate in leukemia cell line models. Blood 101: 2368–2373.
  • McGahon AJ, Nishioka WK, Martin SJ, Mahboubi A, Cotter TG, Green DR (1995). Regulation of the Fas apoptotic cell death pathway by Abl. J Biol Chem 270: 22625–22631.
  • Mir R, Zuberi M, Ahmad I, Javid J, Yadav P, Farooq S, Masroor M, Guru S, Shanawaz S, Bhat AA (2013). Biological and clinical implications of exon 8 P53 (R282W) gene mutation in relation to development and progression of chronic myeloid leukaemia patients in India population. J Cell Sci Ther 4: 140.
  • Mukai M, Che XF, Furukawa T, Sumizawa T, Aoki S, Ren XQ, Haraguchi M, Sugimoto Y, Kobayashi M, Takamatsu H et al (2003). Reversal of the resistance to STI571 in human chronic myelogenous leukemia K562 cells. Cancer Sci 94: 557–563.
  • Naccarati A, Polakova V, Pardini B, Vodickova L, Hemminki K, Kumar R, Vodicka P (2012). Mutations and polymorphisms in TP53 gene--an overview on the role in colorectal cancer. Mutagenesis 27: 211–218.
  • Nasr R, Bazarbachi A (2012). Chronic myeloid leukemia: “archetype” of the impact of targeted therapies. Pathol Biol 60: 239–245 (article in French with English abstract).
  • Park CH, Bergsagel DE, McCulloch EA (1971). Mouse myeloma tumor stem cells: a primary cell culture assay. J Natl Cancer Inst 46: 411–422.
  • Peng XX, Tiwari AK, Wu HC, Chen ZS (2012). Overexpression of P-glycoprotein induces acquired resistance to imatinib in chronic myelogenous leukemia cells. Chin J Cancer 31: 110–118.
  • Perl A, Carroll M (2011). BCR-ABL kinase is dead; long live the CML stem cell. J Clin Invest 121: 22–25.
  • Press RD, Kamel-Reid S, Ang D (2013). BCR-ABL1 RT-qPCR for monitoring the molecular response to tyrosine kinase inhibitors in chronic myeloid leukemia. J Mol Diagn 15: 565–576.
  • Quintás-Cardama A, Cortes J (2009). Molecular biology of Bcr-abl1 positive chronic myeloid leukemia. Blood 113: 1619–1630.
  • Riccioni R, Dupuis ML, Bernabei M, Petrucci E, Pasquini L, Mariani G, Cianfriglia M, Testa U (2010). The cancer stem cell selective inhibitor salinomycin is a p-glycoprotein inhibitor. Blood Cells Mol Dis. 45: 86–92.
  • Ricci-Vitiani L, Lombardi DG, Pilozzi E, Biffoni M, Todaro M, Peschle C, De Maria R (2007). Identification and expansion of human colon-cancer-initiating cells. Nature 445: 111–115.
  • Rokah OH, Granot G, Ovcharenko A, Modai S, Pasmanik-Chor M, Toren A, Shomoron N, Shpilberg O (2012). Downregulation of Mir-31, Mir-155, and Mir-564 in chronic myeloid leukemia cells. PLoS One 7: e35501.
  • Rumjanek VM, Vidal RS, Maia RC (2013). Multidrug resistance in chronic myeloid leukaemia: how much can we learn from MDR-CML cell lines? Biosci Rep 25: 33.
  • Salas A, Ponnusamy S, Senkal CE, Meyers-Needham M, Selvam SP, Saddoughi SA, Apohan E, Sentelle RD, Smith C, Gault CR (2011). Sphingosine kinase-1 and sphingosine 1-phosphate receptor 2 mediate Bcr-abl1 stability and drug resistance by modulation of protein phosphatase 2A. Blood 117: 5941–5952.
  • Samanta A, Perazzona B, Chakraborty S, Sun X, Modi H, Bhatia R, Priebe W, Arlinghaus R (2011). Janus kinase 2 regulates Bcr-abl signaling in chronic myeloid leukemia. Leukemia 25: 463–472.
  • San José-Enériz E, Román-Gómez J, Jiménez-Velasco A, Garate L, Martin V, Cordeu L, Vilas-Zornoza A, Rodríguez-Otero P, Calasanz MJ, Prósper F et al. (2009). MicroRNA expression profiling in imatinib-resistant chronic myeloid leukemia patients without clinically significant ABL1-mutations. Mol Cancer 2009 8: 69.
  • Sawyers CL, Hochhaus A, Feldman E, Goldman JM, Miller CB, Ottmann OG, Schiffer CA, Talpaz M, Guilhot F, Deininger MW et al (2002). Imatinib induces hematologic and cytogenetic responses in patients with chronic myelogenous leukemia in myeloid blast crisis: results of a phase II study. Blood 99: 3530–3539.
  • Sengupta A, Banerjee D, Chandra S, Banerji SK, Ghosh R, Roy R, Banerjee S (2007). Deregulation and cross talk among Sonic hedgehog, Wnt, Hox and Notch signaling in chronic myeloid leukemia progression. Leukemia 21: 949–955.
  • Shirahama T, Sweeney EA, Sakakura C, Singhal AK, Nishiyama K, Akiyama S, Hakomori S, Igarashi Y (1997). In vitro and in vivo induction of apoptosis by sphingosine and N, N-dimethylsphingosine in human epidermoid carcinoma KB-3-1 and its multidrug-resistant cells. Clin Cancer Res 3: 257–264.
  • Silva KL, de Souza PS, de Moraes GN, Moellmann-Coelho A, da Cunha Vasconcelos F, Maia RC (2013). XIAP and P-glycoprotein co-expression is related to imatinib resistance in chronic myeloid leukemia cells. Leuk Res 37: 1350–1358.
  • Singh SK, Clarke ID, Terasaki M, Bonn VE, Hawkins C, Squire J, Dirks PB (2003). Identification of a cancer stem cell in human brain tumors. Cancer Res 63: 5821–5828.
  • Tiwari AK, Sodani K, Wang SR, Kuang YH, Ashby CR Jr, Chen X, Chen ZS (2009). Nilotinib (AMN107, Tasigna) reverses multidrug resistance by inhibiting the activity of the ABCB1/ Pgp and ABCG2/BCRP/MXR transporters. Biochem Pharmacol 78: 153–161.
  • Traer E, MacKenzie R, Snead J, Agarwal A, Eiring AM, O’Hare T, Druker BJ, Deininger MW (2012). Blockade of JAK2-mediated extrinsic survival signals restores sensitivity of CML cells to ABL inhibitors. Leukemia 26: 1140–1143.
  • Undi RB, Kandi R, Gutti RK (2013). MicroRNAs as haematopoiesis regulators. Adv Hematol 2013: 695754.
  • Vasiliou V, Vasiliou K, Nebert DW (2009). Human ATP-binding cassette (ABC) transporter family. Hum Genomics 3: 281–290.
  • Venturini L, Battmer K, Castoldi M, Schultheis B, Hochhaus A, Muckenthaler MU, Ganser A, Scherr M (2007). Expression of the miR-17-92 polycistron in chronic myeloid leukemia (CML) CD34+ cells. Blood 109: 4399–4405.
  • Wang L, Giannoudis A, Lane S, Williamson P, Pirmohamed M, Clark RE (2008). Expression of the uptake drug transporter hOCT1 is an important clinical determinant of the response to imatinib in chronic myeloid leukemia. Clin Pharmacol Therap 83: 258–264.
  • Wang Z, Li Y, Ahmad A, Azmi AS, Kong D, Banerjee S, Sarkar FH (2010). Targeting miRNAs involved in cancer stem cell and EMT regulation: an emerging concept in overcoming drug resistance. Drug Resist Updat 13: 109–118.
  • Weisberg E, Manley PW, Cowan-Jacob SW, Hochhaus A, Griffin JD (2007). Second generation inhibitors of BCR-ABL for the treatment of imatinib-resistant chronic myeloid leukaemia. Nature Reviews Cancer 7: 345–356.
  • Widmer N, Colombo S, Buclin T, Decosterd LA (2003). Functional consequence of MDR1 expression on imatinib intracellular concentrations. Blood 102: 1142.
  • Yuan H, Wang Z, Li L, Zhang H, Modi H, Horne D, Bhatia R, Chen WY (2012). Activation of stress response gene SIRT1 by BCR- ABL promotes leukemogenesis. Blood 119: 1904–1914.
  • Zhang H, Peng C, Hu Y, Li H, Sheng Z, Chen Y, Sullivan C, Cerny J, Hutchinson L, Higgins A et al (2012). The Blk pathway functions as a tumor suppressor in chronic myeloid leukemia stem cells. Nat Genet 44: 861–871.
  • Zhang Y, Qu XJ, Liu YP, Yang XH, Hou KZ, Teng YE, Zhang JD (2009). Reversal effect of PI3-K inhibitor LY294002 on P-glycoprotein- mediated multidrug resistance of human leukemia cell line K562/DNR and gastric cancer cell line SGC7901/ADR. Ai Zheng 28: 97–99.
  • Zhao C, Blum J, Chen A, Kwon HY, Jung SH, Cook JM, Lagoo A, Reya T (2007). Loss of beta-catenin impairs the renewal of normal and CML stem cells in vivo. Cancer Cell 12: 528–541.
  • Zhao C, Chen A, Jamieson CH, Fereshteh M, Abrahamsson A, Blum J, Kwon HY, Kim J, Chute JP, Rizzieri D et al (2009). Hedgehog signalling is essential for maintenance of cancer stem cells in myeloid leukaemia. Nature 458: 776–779.
  • Zhou H, Zhang Z, Liu C, Jin C, Zhang J, Miao X, Jia L (2012). B4GALT1 gene knockdown inhibits the hedgehog pathway and reverses multidrug resistance in the human leukemia K562/adriamycin-resistant cell line. IUBMB Life 64: 889–900.
APA ÜNLÜ M, Kiraz Y, KACI F, ÖZCAN M, Baran Y (2014). Multidrug resistance in chronic myeloid leukemia. , 806 - 816.
Chicago ÜNLÜ MİRAY,Kiraz Yağmur,KACI Fatma Necmiye,ÖZCAN MEHMET ALİ,Baran Yusuf Multidrug resistance in chronic myeloid leukemia. (2014): 806 - 816.
MLA ÜNLÜ MİRAY,Kiraz Yağmur,KACI Fatma Necmiye,ÖZCAN MEHMET ALİ,Baran Yusuf Multidrug resistance in chronic myeloid leukemia. , 2014, ss.806 - 816.
AMA ÜNLÜ M,Kiraz Y,KACI F,ÖZCAN M,Baran Y Multidrug resistance in chronic myeloid leukemia. . 2014; 806 - 816.
Vancouver ÜNLÜ M,Kiraz Y,KACI F,ÖZCAN M,Baran Y Multidrug resistance in chronic myeloid leukemia. . 2014; 806 - 816.
IEEE ÜNLÜ M,Kiraz Y,KACI F,ÖZCAN M,Baran Y "Multidrug resistance in chronic myeloid leukemia." , ss.806 - 816, 2014.
ISNAD ÜNLÜ, MİRAY vd. "Multidrug resistance in chronic myeloid leukemia". (2014), 806-816.
APA ÜNLÜ M, Kiraz Y, KACI F, ÖZCAN M, Baran Y (2014). Multidrug resistance in chronic myeloid leukemia. Turkish Journal of Biology, 38(6), 806 - 816.
Chicago ÜNLÜ MİRAY,Kiraz Yağmur,KACI Fatma Necmiye,ÖZCAN MEHMET ALİ,Baran Yusuf Multidrug resistance in chronic myeloid leukemia. Turkish Journal of Biology 38, no.6 (2014): 806 - 816.
MLA ÜNLÜ MİRAY,Kiraz Yağmur,KACI Fatma Necmiye,ÖZCAN MEHMET ALİ,Baran Yusuf Multidrug resistance in chronic myeloid leukemia. Turkish Journal of Biology, vol.38, no.6, 2014, ss.806 - 816.
AMA ÜNLÜ M,Kiraz Y,KACI F,ÖZCAN M,Baran Y Multidrug resistance in chronic myeloid leukemia. Turkish Journal of Biology. 2014; 38(6): 806 - 816.
Vancouver ÜNLÜ M,Kiraz Y,KACI F,ÖZCAN M,Baran Y Multidrug resistance in chronic myeloid leukemia. Turkish Journal of Biology. 2014; 38(6): 806 - 816.
IEEE ÜNLÜ M,Kiraz Y,KACI F,ÖZCAN M,Baran Y "Multidrug resistance in chronic myeloid leukemia." Turkish Journal of Biology, 38, ss.806 - 816, 2014.
ISNAD ÜNLÜ, MİRAY vd. "Multidrug resistance in chronic myeloid leukemia". Turkish Journal of Biology 38/6 (2014), 806-816.