Differentiation induction of human leukemia cells (HL60) by a combination of 1,25-dihydroxyvitamin D3 and retinoic acid (all trans or 9-cis)

1,25(OH)₂D₃ and two stereoisomers of retinoic acid, all trans and 9-cis retinoic acid, are regulators of cell proliferation and differentiation. The aim of this study was to evaluate the effects of a combination of 1,25(OH)₂D₃ and retinoic acid (all trans or 9-cis) on proliferation and cell differentiation of the human promyelocytic leukemia cell line HL60, and to test the reversibility of the induced differentiation. Cell proliferation was inhibited as expected by 1,25(OH)₂D₃ and all trans retinoic acid alone (IC₅₀ of cell survival was 4 × 10^?7 M, 9 × 10^?6 M and 9 × 10^?7 M for 1,25(OH)₂D₃, all trans and 9-cis retinoic acid, respectively). Combination of 1,25(OH)₂D₃ and either form of retinoic acid resulted in a partially additive decrease in cell proliferation. 1,25(OH)₂D₃ induced a monocytic differentiation (100% CD14+ cells with 10^?7 M 1,25(OH)₂D₃), while retinoic acid led to a predominantly granulocytic differentiation (36 and 42% CD67+ cells with 10^?6 M all trans and 9-cis retinoic acid, respectively). Additive effects on differentiation were observed upon combination of subtherapeutical doses of the drugs, achieving a mainly monocytic population, demonstrating the dominant role of 1,25(OH)₂D₃ in determining the direction of differentiation. The effects on proliferation and differentiation of the solitary drugs were reversible, while the proliferation arrest and differentiation induced by the combination persisted and even progressed after withdrawal of the drugs. We conclude that 1,25(OH)₂D₃ and retinoic acid (all trans or 9-cis) exert additive effects on inhibition of proliferation and induction of cell differentiation of HL60 cells, leading to a persistent differentiation, even after drug withdrawal.