Abstract

Recent observations suggest a lower incidence of malignancies in patients infected with HIV during treatment with Highly Active Anti-Retroviral Therapy (HAART) utilizing protease inhibitors. We investigated the effects of ritonavir, a FDA approved HIV protease inhibitor, on proliferation of pancreatic ductal adeno-carcinoma (PDAC) cell lines. Human PDAC cell lines BxPC-3, MIA PaCa-2, and PANC-1 were propagated under standard conditions and treated with serial dilutions of ritonavir. Ritonavir inhibited cell growth in a dose-dependent manner as well as activated the intrinsic apoptotic pathway in human pancreatic ductal adenocarcinoma (PDAC) cell lines. We observed down-modulation of cell-cycle promoting and up-regulation of cell-cycle inhibitory genes; enhanced interaction of retinoblastoma protein (RB) with E2F-1 transcription factor; inhibition of phosphorylation of RB, resulting in sequestration of E2F-1 and subsequent down-regulation of S phase genes; decreased interaction of E2F-1 with its consensus binding sites; inhibition of cell motility and invasiveness; and inhibition of the AKT pathway. Our results demonstrate a potential use of ritonavir as part of combination chemotherapy for PDAC. Since ritonavir is FDA approved for HIV, drug repositioning for PDAC would limit the costs and reduce risks.

Highlights

  • Pancreatic ductal adenocarcinoma (PDAC) is currently the fourth leading cause of cancer death, and more than 80% of patients present with distant metastases at the time of diagnosis, thereby precluding surgical resection

  • Exposure to 5–30 μM ritonavir for 72 h resulted in dose-dependent inhibition of cell proliferation and cell death in all three cell lines tested (Figure 1A–C) with negligible effects on normal human fibroblasts

  • PANC-1 cell death as observed by phase contract microscopy at 48 h increased as a function of ritonavir dose (Figure 1D)

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Summary

Introduction

Pancreatic ductal adenocarcinoma (PDAC) is currently the fourth leading cause of cancer death, and more than 80% of patients present with distant metastases at the time of diagnosis, thereby precluding surgical resection. Systemic chemotherapy still relies on only a few drugs and has not significantly increased overall patient survival [1], underscoring the need for development of novel therapies [2]. Recent observations point to a decreasing incidence of some cancers in patients on protease inhibitors [4], with our previous work demonstrating inhibition of cell growth and induction of apoptosis in ovarian cancer [5]. Along these lines, phase I clinical trials with nelfinavir showed partial remission with acceptable toxicity when used along with radiation and chemotherapy in patients with locally-advanced pancreatic cancer [6].

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