Cancer continues to pose a significant global health challenge, impacting millions of lives each year. Among the many types, acute promyelocytic leukemia (APL) is particularly notable due to a genetic mutation that triggers the rapid, uncontrolled accumulation of abnormal white blood cells in the bone marrow. This mutation leads to life-threatening symptoms, requiring innovative treatment approaches for effective management and potential cure.
In recent years, epigenetics has emerged as a pivotal area of cancer research, shedding light on how environmental and cellular factors influence gene expression and contribute to cancer progression. A study published in the Journal of Ginseng Research by researchers at Nanjing University of Chinese Medicine focused on the potential of ginseng-derived compounds to address resistance to all-trans retinoic acid (ATRA), a cornerstone of APL treatment.
ATRA has transformed APL therapy, achieving a remarkable complete remission rate of 94%. However, resistance to ATRA remains a significant obstacle, limiting its effectiveness and negatively impacting patient outcomes. Recent findings highlight the role of epigenetic mechanisms, particularly m6A methylation and histone lactylation, as critical contributors to this resistance. At the center of ATRA resistance is METTL3, an m6A methyltransferase that regulates RNA methylation. Elevated METTL3 levels are associated with increased resistance to therapies, while lactic acid accumulation in APL cells enhances histone lactylation, further boosting METTL3 expression and complicating treatment efforts.
This study explored ginsenoside Rh2 (GRh2), an active compound in ginseng, for its potential to induce beneficial epigenetic modifications in ATRA-resistant APL cells. Researchers discovered that GRh2 acts as a natural histone deacetylase inhibitor, promoting histone acetylation while decreasing histone lactylation. This dual action sensitized resistant cells to ATRA therapy and induced apoptosis in leukemia stem cells (LSCs). Additionally, GRh2 directly binds to METTL3, significantly inhibiting its expression in a concentration-dependent manner. In preclinical models, GRh2 treatment resulted in smaller tumor sizes and reduced METTL3 levels, highlighting its promise as a natural therapy to combat ATRA resistance through epigenetic modulation.
In the study, the researchers effectively examined how m6A methylation affects APL and its resistance by using our Epigenase™ m6A Methylase Activity/Inhibition Assay Kit to measure the activity of m6A methyltransferases. They confirmed that lactate and GRh2 significantly impact METTL3 enzyme activity in ATRA-resistant APL cells.

Overall, the study suggests that targeting METTL3 and RNA methylation could help reduce ATRA resistance in APL. GRh2 may work as an inhibitor of lactylation-modified METTL3, making APL cells more responsive to ATRA treatment.
Integrating epigenetics into cancer research presents exciting opportunities for advancing treatment options. This study underscores the critical role of epigenetic modifications, particularly RNA methylation, in overcoming drug resistance. By utilizing EpigenTek kits to explore these changes, researchers can deepen their investigations, potentially paving the way for innovative treatments that could transform the future of cancer therapy.
Source: Cheng S et. al. (May 2024). 20(S)-ginsenoside Rh2 ameliorates ATRA resistance in APL by modulating lactylation-driven METTL3. J Ginseng Res. 48(3):298-309.