Effect of Uridine on Response of 5-Azacytidine-resistant Human Leukemic Cells to Inhibitors of de Novo Pyrimidine Synthesis

A uridine-cytidine kinase-deficient human promyelocytic leukemic subline (HL-60-5-aza-Cyd) has been isolated which is highly resistant to the antileukemic agent 5-azacytidine. Resistant cells exposed to 10^-5 M 5-azacytidine for 2 hr exhibit a marked reduction in both the total intracellular accumulation of 5-azacytidine (11.9 versus 156.0 pmol/10⁶ cells) as well as its incorporation into RNA (3.1 versus 43.4 pmol/μg D-ribose) compared to the parent line. These biochemical changes are associated with nearly a 100-fold decrease in sensitivity to the growth inhibitory effects of 5-azacytidine (concentration of drug associated with a 50% reduction in cell growth, 3.5 x 10^-5 versus 5.0 x 10^-7 M). 5-Azacytidine-resistant cells exhibit cross-resistance to 3-deazauridine, 6-azauridine, and 5-fluorouridine, but not to 1-β-D-arabinofuranosylcytosine, 2'-deoxyazacytidine, or 5-aza-1-β-D-arabinofuranosylcytosine. Coadministration of 50 μM uridine prevented depletion of pyrimidine nucleoside triphosphates and inhibition of colony formation of HL-60 cells exposed to 3 mM N-(phosphonacetyl)-L-aspartate) or 5 x 10^-6 M pyrazofurin but was not capable of protecting HL-60-5-azacytidine under the same conditions. This uridine concentration was also able to restore control colony formation to normal human bone marrow progenitor cells (granulocyte-macrophage colony-forming units) exposed to de novo pyrimidine biosynthetic blockade. These in vitro studies suggest that 5-azacytidine resistant cells lacking the pyrimidine salvage pathway enzyme uridine-cytidine kinase may be selectively vulnerable to a regimen using pyrimidine antagonists administered in conjunction with the naturally occurring nucleoside uridine.