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¹ Department of Pathology, Loyola University of Chicago Medical Center, Chicago, Illinois; ² Children's Memorial Institute for Education and Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ³ Translational Genomics Research Institute, Phoenix, Arizona; ⁴ ISIS Pharmaceuticals, Carlsbad, California; and ⁵ Department of Biopharmaceutical Sciences, University of Illinois, Chicago, Illinois

Request for reprints: Brian J. Nickoloff, Skin Cancer Research Program, Cardinal Bernardin Cancer Center, Building 112, Room 301, 2160 South First Avenue, Maywood, IL 60153. Phone: 708-327-3241; Fax: 708-327-3239. E-mail: bnickol{at}lumc.edu

Once melanoma metastasizes, no effective treatment modalities prolong survival in most patients. This notorious refractoriness to therapy challenges investigators to identify agents that overcome melanoma resistance to apoptosis. Whereas many survival pathways contribute to the death-defying phenotype in melanoma, a defect in apoptotic machinery previously highlighted inactivation of Apaf-1, an apoptosome component engaged after mitochondrial damage. During studies involving Notch signaling in melanoma, we observed a -secretase tripeptide inhibitor (GSI; z-Leu-Leu-Nle-CHO), selected from a group of compounds originally used in Alzheimer's disease, induced apoptosis in nine of nine melanoma lines. GSI only induced G₂-M growth arrest (but not killing) in five of five normal melanocyte cultures tested. Effective killing of melanoma cells by GSI involved new protein synthesis and a mitochondrial-based pathway mediated by up-regulation of BH3-only members (Bim and NOXA). p53 activation was not necessary for up-regulation of NOXA in melanoma cells. Blocking GSI-induced NOXA using an antisense (but not control) oligonucleotide significantly reduced the apoptotic response. GSI also killed melanoma cell lines with low Apaf-1 levels. We conclude that GSI is highly effective in killing melanoma cells while sparing normal melanocytes. Direct enhancement of BH3-only proteins executes an apoptotic program overcoming resistance of this lethal tumor. Identification of a p53-independent apoptotic pathway in melanoma cells, including cells with low Apaf-1, bypasses an impediment to current cytotoxic therapy and provides new targets for future therapeutic trials involving chemoresistant tumors.

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Received 4/30/04; revised 6/16/04; accepted 6/23/04.