Clinical and Translational Research Group, Department of Biology, Institut Universitari d'Investigacions en Ciències de la Salut (IUNICS), University of the Balearic Islands, Palma de Mallorca, Spain.
PLoS One. 2012;7(5):e37735. doi: 10.1371/journal.pone.0037735. Epub 2012 May 25.
The therapeutic effect of doxorubicin (DXR) in the treatment of soft tissue sarcomas (STS) is limited by its toxicity and the development of multidrug resistance (MDR), the latter mainly induced by high expression of efflux pumps (e.g., P-glycoprotein [P-gp]). Therefore, the search for alternative therapies, which sensitize these tumors to chemotherapy while maintaining a low toxicity profile, is a rational approach. We assessed efficacy and molecular mechanisms involved in the antiproliferative effects of the tyrosine kinase inhibitors, nilotinib and imatinib, as single agents or in combination with DXR, in human synovial sarcoma SW982 and leiomyosarcoma SK-UT-1 cells. As single compound nilotinib (1-10 µM) was more potent than imatinib inhibiting the growth of SK-UT-1 and SW982 cells by 33.5-59.6%, respectively. Importantly, only nilotinib synergized the antitumoral effect of DXR (0.05-0.5 µM) by at least 2-fold, which clearly surpassed the mere sum of effects according to isobolographic analysis. Moreover, nilotinib in combination with DXR had a sustained effect on cell number (-70.3±5.8%) even 12 days after withdrawal of drugs compared to DXR alone. On the molecular level, only nilotinib fully blocked FBS-induced ERK1 and p38 MAPK activation, hence, reducing basal and DXR-induced up-regulation of P-gp levels. Moreover, efflux activity of the MDR-related proteins P-gp and MRP-1 was inhibited, altogether resulting in intracellular DXR retention. In high-risk STS tumors 53.8% and 15.4% were positive for P-gp and MRP-1 expression, respectively, with high incidence of P-gp in synovial sarcoma (72.7%). In summary, nilotinib exhibits antiproliferative effects on cellular models of STS and sensitizes them to DXR by reverting DXR-induced P-gp-mediated MDR and inhibiting MRP-1 activity, leading to a synergistic effect with potential for clinical treatment.
多柔比星(DXR)在软组织肉瘤(STS)治疗中的疗效受到其毒性和多药耐药(MDR)的限制,后者主要由外排泵(如 P-糖蛋白[P-gp])的高表达引起。因此,寻找替代疗法是一种合理的方法,这些疗法可以在保持低毒性的同时使这些肿瘤对化疗敏感。我们评估了酪氨酸激酶抑制剂尼罗替尼和伊马替尼作为单一药物或与 DXR 联合治疗人滑膜肉瘤 SW982 和平滑肌肉瘤 SK-UT-1 细胞的增殖抑制作用及其分子机制。作为单一化合物,尼罗替尼(1-10 μM)比伊马替尼更有效地抑制 SK-UT-1 和 SW982 细胞的生长,抑制率分别为 33.5-59.6%。重要的是,只有尼罗替尼能使 DXR(0.05-0.5 μM)的抗肿瘤作用协同增强至少 2 倍,这明显超过根据等效应分析的单纯相加效应。此外,与单独使用 DXR 相比,尼罗替尼与 DXR 联合使用对细胞数量的抑制作用具有持续效果(-70.3±5.8%),甚至在停药 12 天后也是如此。在分子水平上,只有尼罗替尼能完全阻断 FBS 诱导的 ERK1 和 p38 MAPK 激活,从而降低基础和 DXR 诱导的 P-gp 水平上调。此外,MDR 相关蛋白 P-gp 和 MRP-1 的外排活性也受到抑制,导致细胞内 DXR 保留增加。在高危 STS 肿瘤中,P-gp 和 MRP-1 的表达阳性率分别为 53.8%和 15.4%,滑膜肉瘤中 P-gp 的阳性率较高(72.7%)。总之,尼罗替尼对 STS 的细胞模型具有增殖抑制作用,并通过逆转 DXR 诱导的 P-gp 介导的 MDR 和抑制 MRP-1 活性使它们对 DXR 敏感,从而产生协同作用,具有临床治疗的潜力。