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ATO-dependent PML-RARA SUMOylation and degradation. ATO triggers PML-RARA degradation leading to APL remission. This process requires the PIAS1 SUMO E3-ligase and the ubiquitin E3-ligase RNF4. ATO is thought to directly bind to the PML moiety of PML-RARA. This event causes a conformational change that allows PML-RARA poly-SUMOylation and its interaction with RNF4. ATO, arsenic trioxide; S, SUMOylation; Ub, ubiquitination.
