Abstract

Multidrug resistance (MDR) due to P-glycoprotein (P-gp) overexpression is a major obstacle to successful leukemia chemotherapy. The combination of anticancer chemotherapy with a chemosensitizer of P-gp inhibitor is promising to overcome MDR, generate synergistic effects, and maximize the treatment effect. Herein, we co-encapsulated a chemotherapeutic drug of mitoxantrone (MTO) and a P-gp inhibitor of β-elemene (βE) in solid lipid nanoparticles (MTO/βE-SLNs) for reversing MDR in leukemia. The MTO/βE-SLNs with about 120 nm particle size possessed good colloidal stability and sustained release behavior. For the cellular uptake study, doxorubicin (DOX) was used as a fluorescence probe to construct SLNs. The results revealed that MTO/βE-SLNs could be effectively internalized by both K562/DOX and K562 cells through the pathway of caveolate-mediated endocytosis. Under the optimized combination ratio of MTO and βE, the in vitro cytotoxicity study indicated that MTO/βE-SLNs showed a better antitumor efficacy in both K562/DOX and K562 cells than other MTO formulations. The enhanced cytotoxicity of MTO/βE-SLNs was due to the increased cellular uptake and blockage of intracellular ATP production and P-gp efflux by βE. More importantly, the in vivo studies revealed that MTO/βE-SLNs could significantly prolong the circulation time and increase plasma half-life of both MTO and βE, accumulate into tumor and exhibit a much higher anti-leukemia effect with MDR than other MTO formulations. These findings suggest MTO/βE-SLNs as a potential combined therapeutic strategy for overcoming MDR in leukemia.

Highlights

  • Multidrug resistance (MDR) accounts for most chemotherapy-related failure in a wide array of malignancies

  • Mitoxantrone dihydrochloride (MTO), a cell cycle non-specific anticancer drug and P-glycoprotein (P-gp) substrate, is a synthetic anthracenedione that is applied for the treatment of acute leukemia, malignant lymphoma [2,3], breast cancer [4], and hepatocellular carcinoma [5]

  • The toxicity of the MTO and βE combination toward K562/DOX cells was investigated in different mass ratios (w/w)

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Summary

Introduction

Multidrug resistance (MDR) accounts for most chemotherapy-related failure in a wide array of malignancies. After internalization into the leukemia cells, βE could function as a chemosensitizer for inhibiting P-gp, preventing the MTO efflux, and improving the anticancer effects (Scheme 1). To fulfill these goals, the synergistic anticancer effect of the combination of MTO and βE in different ratios (w/w) was evaluated. Drug efflux and intracellular adenosine triphosphate (ATP)-binding cassette production assays were determined to evaluate the reversal effect of MDR by MTO/βE-SLNs. the in vivo effects and antitumor activity were investigated in K562/DOX xenografts tumor model mice.

Determination of Combinatorial Effects of MTO and βE
The Preparation of SLNs
The Characterization of SLNs
In Vitro Drug Release
The Cytotoxicity Study of SLNs
Cellular Uptake and Its Mechanism
Drug Efflux Study
Intracellular ATP Production Assay
3.10. Pharmacokinetic and Biodistribution Studies
3.11. In Vivo Antitumor Activity
Combinatorial Effects of MTO and βE
Characterization of SLNs
Cellular Uptake Studies
In Vitro Drug Efflux and Intracellular ATP Production Assay
In Vivo Antitumor Activity
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