Exposure to low concentrations of etoposide reduces the apoptotic capability of leukaemic cell lines.

The use of topoisomerase inhibitors has been associated with the development of secondary malignancies, suggesting that these agents can induce DNA damage that may be persistent. We have investigated the effect of short exposures (>3 days) to low etoposide concentrations (LC-etoposide, 0.01-0.04 microM) on the ability of leukaemic cells to initiate apoptosis. Results showed that although LC-etoposide had no effect on cell growth characteristics, the pre-culture of cells with LC-etoposide conferred resistance to subsequent exposure to cytotoxic concentrations of etoposide (0.3 microM etoposide in HL60 on day 3: %V: 95.2 +/- 1.6% vs 60.3 +/- 12.1% in control cells with no pre-culture, and %A: 5.1 +/- 0.2 vs 19.0 +/- 0.7%; P < 0.001). This effect was still observed 4 weeks after the initial drug exposure. Associated with these observations was a three-fold increase in genetic instability and a reduction in induced bax protein levels. The anti-cytotoxic effect was also shown to be specific to topoisomerase II (topo II) inhibitors, as the pre-culture of cells with a low doxorubicin concentration also induced resistance, while low cisplatin concentrations did not. The persistence of these alterations in cellular processes following an initial exposure to topo II inhibitors suggests a DNA-based mechanism, and highlights the existence of drug/target interactions even at very low drug concentrations.