Introduction: Despite improvements in the survival of patients with colorectal cancers (CRC), systemic metastasis remains a significant cause of morbidity and mortality. 5-fluorouracil (5-FU) is one of the most widely used chemotherapeutic agents for advanced CRC, yet overall response rates are as low as 10-20%. TNF-related apoptosis-inducing ligand (TRAIL) is a novel member of the TNF family which selectively induces apoptosis in many transformed cells; however, recent studies indicate that many cancers are resistant to TRAIL. We have shown that activation of phosphatidylinositol 3-kinase (PI3K), a ubiquitous lipid kinase composed of regulatory (p85) and catalytic (p110) subunits, and its downstream effector protein, Akt, is associated with growth and progression of CRC; inhibition of PI3K/Akt may sensitize resistant cancers to current therapies. The purpose of this study was to determine whether selective inhibition of PI3K/Akt can sensitize resistant CRC to either 5-FU or TRAIL. Methods: (1) In initial experiments, human colon cancer cells KM20, KM12C and KML4A were treated with increasing concentrations of 5-FU or TRAIL. Cytotoxicity assays were performed using the WST-1 and sulforhodamine B techniques representing the percentage of cell growth compared to a control after exposure to increasing drug concentrations. As an indicator of apoptosis, DNA fragmentation was measured by ELISA. (2) To determine whether direct inhibition of PI3K/Akt could sensitize resistant CRC, synthetic chemically-modified siRNA duplexes directed to p85α, p110α, Akt2 or non-targeting control (NTC) were transfected into KM20 cells via electroporation. Morphologic changes were assessed by phase-contrast microscopy; cytotoxicity was determined by sulforhodamine B assay. Results: (1) KM20 cells were resistant to TRAIL treatment, with IC50 > 1 mg · L-1 and dose-independent cytotoxicity. KM12C and KM12L4A cells were relatively sensitive to TRAIL, with IC50 > 0.05 mg · L-1. The partial response of KM12C and KM12L4A cells to TRAIL treatment was due to increased apoptosis detected by DNA fragmentation assay. KM20, KM12C and KM12L4A cells were not sensitive to 5-FU treatment; an increase in DNA fragmentation was observed only in KM12L4A cell line. (2) Combination treatment showed significant TRAIL sensitization of KM20 cells with IC50 > 0.0125 mg · L-1 with transfection of Akt2 siRNA and IC50 > 0.05 mg · L-1 with p110α siRNA. Combination treatment with 5-FU resulted in increased cytotoxicity in KM20 cells transfected with either p110α or Akt2 siRNA in a time-dependent fashion. Conclusions: Selective targeting of the PI3K pathway components enhances the effects of standard chemotherapeutic agents and TRAIL and provides a novel adjuvant treatment strategy for selected colon cancers.
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