T-ALL is a malignant hyperplastic disease of the hematopoietic system and it is the most common tumor in children and adolescents (
14). Considering the development of chemoresistance in leukemia cells, most patients, exposed to standard treatments, show relapse following the initial treatment or fail to achieve complete remission (
15-
17). Improvement of treatment methods has caused a significant increase in survival; nevertheless, the survival of adult T-ALL is very low (< 40% for > 60 years). These studies show that non-toxic medicines and new strategies are required to improve therapy and increase survival in T-ALL patients (
14). Gene therapy is an effective molecular targeted therapy. In recent years, RNAi technology has been the most common and simple genetic tool (
18).
For instance, siRNA, which disrupts the target gene expression, is an overexpressed specific gene in tumor cells. It can inhibit tumor formation, growth, and proliferation (
19-
22).
Overexpression of some oncogenes regulates cellular proliferation and inhibits apoptosis in different cancers, such as leukemia and breast cancer (
23-
26).
Apoptosis is controlled by 2 signaling pathways. The extrinsic pathway, which is activated by extracellular death receptors, causes caspase-8 activation, while the intrinsic mitochondrial pathway is stimulated by many signals, leading to mitochondrial outer membrane permeabilization (MOMP), caspase-9 activation, and cytochrome C release to the cytoplasm. These 2 pathways activate the proteolytic cascade and induce cell death. Therefore, MOMP is majorly involved in the intrinsic pathway and regulated by BCL-2 proteins (
27,
28).
The protein-protein interactions between Bcl-2 members can regulate apoptosis (
29). Mcl-1 from the antiapoptotic Bcl-2 family has shown overexpression in different cancers, including leukemia (
27). On the outer mitochondrial membrane, Mcl-1 neutralized the proapoptotic members of the Bcl-2 family, including Bax, Bim, and Bak; in this way, it could block the mitochondrial pathway apoptosis (
30). Researchers have demonstrated that Mcl-1 downregulation can result in apoptosis and prevent tumor cell proliferation (
31-
33).
The suppressive effects of specific siRNA on Mcl-1 proteins in the Jurkat cell line (T-ALL) were evaluated. In this study, quantification of mRNA by qRT-PCR confirmed that Mcl-1 siRNA transfection could significantly reduce Mcl-1 mRNA expression in Jurkat cells. Karami et al. showed that siRNA knockdown of Mcl-1 notably stimulated apoptosis and prevented proliferation in AML (
23). In addition, another study on siRNA MCL-1 found it to be a proper target for CLL and ALL; its silencing could significantly increase the therapeutic effect of rituximab (
34). The findings of the present study are consistent with previous research on leukemia. The therapeutic method of this study using siRNA could significantly downregulate Mcl-1 mRNA in Jurkat cells. Consequently, inhibition of Mcl-1 expression by siRNA, in combination with other cancer treatments (e.g., immunotherapy with antibodies), could enhance the sensitivity of chemotherapy drugs. However, further studies on combination therapy for leukemia are suggested.
According to the MTT assay, Mcl-1 siRNA had a major contribution to the survival of leukemia cells. Based on the result of this study, the negative control scramble siRNA and reagent caused no changes in gene expression and cellular survival. According to a study by Hao et al. On the human gastric cancer cell, SGC-7901, cell proliferation was examined by MTT assay. The results revealed that Bcl-2 expression knockdown by siRNA reduced gastric cancer cell growth (
35). Based on the present study, Mcl-1 siRNA hindered Mcl-1 expression as an antiapoptotic agent in lymphocyte leukemia, and after transfection with specific siRNA, leukemia cell survival decreased.
On the other hand, another study by Meng et al. on pediatric patients with A-BLL demonstrated that transfection of Bcl-2-siRNA into leukemic cells significantly increased the apoptosis rate (
36).
Another study in 2013 showed that using Bcl-2 siRNA could significantly increase apoptosis and mortality rate in the gastric cancer cell, BGC823. In addition, they indicated that by treatment with siRNA Bcl-2, a notable increase was observed in the sensitivity of cancer cells to X-ray (
37). It is likely that downregulation of Mcl-1 can reduce resistance to X-ray irradiation in the Jurkat cell line. Therefore, further studies are recommended to identify the effects of antiapoptotic proteins on resistance to chemotherapy or radiotherapy.
Moreover, a recent study in 2013 on breast cancer indicated that miR-26a, which is a potential tumor suppressor, inhibited tumor migration, proliferation, and triggered apoptosis via Mcl-1 targeting (
38). Similarly, based on the present study, Mcl-1 expression by siRNA could be suppressed and reduce cell survival in leukemia cells. If this method affects tumor migration, further research on tumor migration is needed.
5.1. Conclusions
Collectively, the present study showed that downregulation of Mcl-1 by specific siRNAs can give rise to death in T-ALL cells. Likewise, this study demonstrated that specific siRNAs can be suggested as an effective complementary therapeutic agent for the treatment and management of T-ALL.