Abstract

Simple SummaryAmong various kinds of treatment strategies for cancers, combination therapy has attracted significant attention due to its beneficial effects than the individual effects of the same compounds. Based on this idea, this study has investigated the synergistic effects of combination treatment of a natural anti-cancer agent flavokawain B (FKB) and a chemotherapeutic agent Doxorubicin on human gastric cancer cells and the underlying molecular mechanisms were deciphered through in vitro and in vivo approaches. Experimental data obtained in this study provided promising application prospects of FKB + Doxrubicin combination treatment in human gastric cancer cells.Chalcone flavokawain B (FKB) possesses a chemopreventive and anti-cancer activity. Doxorubicin is a chemotherapeutic DNA intercalating agent widely used in malignancy treatment. The present study investigated whether synergistic effects exist between the combination of FKB (1.25–5 µg/mL) and doxorubicin (0.5 µg/mL) on the apoptosis and autophagy in human gastric cancer (AGS) cells, and the possible in vitro and in vivo mechanisms. The MTT assay measured cell viability. Various apoptotic-, autophagy-associated protein expression was determined by the Western blot technique. FKB+doxorubicin synergy was estimated by the Chou-Talalay combination index (CI) method. In vivo studies were performed on BALB/c mice. Results showed that compared to FKB/doxorubicin treatments, low doses of FKB+doxorubicin suppressed AGS cell growth. FKB potentiated doxorubicin-induced DNA fragmentation, apoptotic cell death, and enhanced doxorubicin-mediated mitochondrial, death receptor pathways. FKB+doxorubicin activated increased LC3-II accumulation, p62/SQSTM1 expression, and AVO formation as compared to the FKB/doxorubicin alone treatments indicating autophagy in these cells. The death mechanism in FKB+doxorubicin-treated AGS cells is due to the activation of autophagy. FKB+doxorubicin-mediated dysregulated Bax/Bcl-2, Beclin-1/Bcl-2 ratios suggested apoptosis, autophagy induction in AGS cells. FKB+doxorubicin-induced LC3-II/AVOs downregulation was suppressed due to an apoptotic inhibitor Z-VAD-FMK. Whereas, 3-methyladenine/chloroquine weakened FKB+doxorubicin-induced apoptosis (decreased DNA fragmentation/caspase-3). Activation of ERK/JNK may be involved in FKB+doxorubicin-induced apoptosis and autophagy. FKB+doxorubicin-triggered ROS generation, but NAC attenuated FKB+doxorubicin-induced autophagic (LC3 accumulation) and apoptotic (caspase-3 activation and PARP cleavage) cell death. FKB+doxorubicin blocked gastric cancer cell xenografts in nude mice in vivo as compared to FKB/doxorubicin alone treatments. FKB and doxorubicin wielded synergistic anti-tumor effects in gastric cancer cells and is a promising therapeutic approach.

Highlights

  • Gastric cancer is a common malignant cancer and the second leading cause of death around the world

  • Consistent with previous reports, data obtained from the current study demonstrated that the Flavokawain B (FKB)+doxorubicin co-treatment of autophagy in human gastric cancer (AGS) cells triggered the autophagy by increasing light chain 3 (LC3)-II accumulation, acidic vesicular organelles (AVOs) formation, and p62/SQSTM1 expression levels

  • FKB+doxorubicin-induced cell death was reversed by pretreatment with early (3-MA) or late (CQ) autophagy inhibitors. These results suggest that cell death caused by FKB+doxorubicin is mediated in AGS cells by autophagy and apoptosis

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Summary

Introduction

Gastric cancer is a common malignant cancer and the second leading cause of death around the world. Data from the cancer registry annual report of Taiwan has indicated that gastric cancer is a leading cause of cancer deaths in Taiwan [1]. Due to its asymptomatic nature, this cancer type is being diagnosed only at the advanced stages frequently leading to deaths. Chemotherapy is the most commonly used method to treat this cancer type. This treatment method showed certain side effects, such as hepatotoxicity, immunosuppression, myelosuppression, etc. Effective chemotherapeutic agents from the herbal origin would be a treatment strategy in the management of gastric cancer

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