We investigated the in vitro growth inhibitory and apoptotic effects of clinically achievable concentrations of AS(2)O(3) (0.5 to 2.0 mu mol/L) against human myeloid leukemia cells known to be resistant to a number of apoptotic stimuli. These included chronic myelocytic leukemia (CML) blast crisis K562 and HL-60/Bcr-Abl cells, which contain p210 and p185 Bcr-Abl, respectively, and HL-60 cell types that overexpress Bcl-2 (HL-60/Bcl-2), Bcl-x(L) (HL-60/Bcl-x(L)), MDR (HL-60/VCR), or MRP (HL-60/AR) protein. The growth-inhibitory IC50 values for As2O3 treatment for 7 days against all these cell types ranged from 0.8 to 1.5 mu mol/L, Exposure to 2 mu mol/L As2O3 for 7 days induced apoptosis of all cell types, including HL-60/Bcr-Abl and K562 cells. This was associated with the cytosolic accumulation of cyt c and preapoptotic mitochondrial events, such as the loss of inner membrane potential (Delta psi m) and the increase in reactive oxygen species (ROS). Treatment with As2O3 (2 mu mol/L) generated the activities of caspases, which produced the cleavage of the BH3 domain containing proapoptotic Bid protein and poly (ADP-ribose) polymerase, Significantly, As2O3-induced apoptosis of HL-60/Bcr-Abl and K562 cells was associated with a decline in Bcr-Abl protein levels, without any significant alterations in the revels of Bcl-x(L), Bar, Apaf-1, Fas, and Fast. Although As2O3 treatment caused a marked increase in the expression of the myeloid differentiation marker CD11b, It did not affect Hb levels in HL-60/Bcr-Abl, K562, or HL-60/neo cells. However, In these cells, As2O3 potently induced hyper-acetylation of the histones H3 and H4. These findings characterize As2O3 as a growth inhibiting and apoptosis-inducing agent against a variety of myeloid leukemia cells resistant to multiple apoptotic stimuli. (C) 2000 by The American Society of Hematology.