Background: Pancreatic ductal adenocarcinoma (PDAC) remains a highly lethal malignancy, and is highly resistant to conventional chemotherapy. Gemcitabine (G) is the standard therapy for PDAC, with a limited clinical response. Doxorubicin (Dox), docetaxel (DT) and oxaliplatin (OX) have been tested as second line chemotherapy for treatment of PDAC without significant clinical benefit. Endothelial monocyte activating polypeptide II (EMAP, E) is a proinflammatory cytokine with antiendothelial and antiangiogenic properties. It has been shown to inhibit primary and metastatic tumor growth in animal models, and has been able to enhance G effects against PDAC. We tested the combination benefits of EMAP with doxorubicin, docetaxel, oxaliplatin and gemcitabine for enhanced antitumor effects on PaCa. Methods: Human PDAC ASPC cells were grown in RPMI growth medium, and human umbilical vein endothelial cells (HUVECs) were grown in E-stim growth medium. Cell proliferation assay was performed by WST-1 assay. In vivo survival was tested using ASPC cells in intraperitoneal murine xenograft model. Results: In vivo, animal survival study revealed that compared to controls (median survival: 21 days), EMAP alone (20 d) or oxaliplatin (23 d) had no significant effect on survival, while doxorubicin (31 d), docetaxel (35 d) and gemcitabine (32 d) extended the overall survival. Combination treatment of EMAP with docetaxel (44 d) or gemcitabine (38 d) enhanced the resulting survival, but the combination of EMAP with doxorubicin or oxaliplatin had no obvious benefits (31 and 23 days, respectively; p=NS). An in vitro cell proliferation assay showed that in ASPC cells, EMAP had no effect, while doxorubicin and gemcitabine provided a minor (IC50>10 μM), and docetaxel a major inhibitory effect (IC50: 8 μM); at 10 μM concentrations, inhibition in cell proliferation (in %) was 1.4, 26.5, 40 and 60, respectively. Addition of EMAP had no increased antiproliferative effects. In HUVECs, EMAP, doxorubicin, docetaxel and gemcitabine induced significant antiproliferative effects (59%, 79%, 96% and 85% at 10 μM, respectively). These inhibitory effects were significantly increased by EMAP addition to the three cytotoxic agents. Conclusions: In experimental PDAC, there is a differential effect to monotherapy with various cytotoxic agents. Addition of EMAP enhanced docetaxel and gemcitabine effects, but not those after doxorubicin or oxaliplatin. In vitro, EMAP addition increased the antiproliferative effects of doxorubicin, docetaxel and gemcitabine in HUVECs but not in ASPC PDAC cells. This antiendothelial combination therapy may represent an avenue to enhance clinical PDAC therapy with cell-cycle sensitive cytotoxic agents other than gemcitabine.
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