Statins, prescribed for decades to control cholesterol, have more recently been shown to have promising anticancer activity. Statins induce tumor-selective apoptosis by inhibiting the mevalonate (MVA) pathway. In addition, we have recently demonstrated that lovastatin modulates drug accumulation in a MVA-independent manner in multidrug-resistant (MDR) tumor cells overexpressing the P-glycoprotein (P-gp) multidrug transporter. P-gp-mediated drug efflux can contribute to chemotherapy failure. However, direct statin-mediated inhibition of P-gp in human MDR tumor cells at clinically achievable concentrations remains unexplored. An understanding of these interactions is crucial, both to appreciate differences in the anticancer potential of different statins and to safely and effectively integrate statins into traditional chemotherapy regimens that include P-gp substrates. Here we evaluate interactions between 4 statins (lovastatin, atorvastatin, fluvastatin and rosuvastatin) and P-gp, at both the molecular level using purified P-gp and at the cellular level using human MDR tumor cells. Lovastatin bound directly to purified P-gp with high affinity and increased doxorubicin accumulation in MDR tumor cells, potentiating DNA damage, growth arrest and apoptosis. By contrast, while atorvastatin inhibited substrate transport by purified P-gp in proteoliposomes, it had no effect on doxorubicin transport in MDR tumor cells. Finally, fluvastatin and rosuvastatin only interacted with P-gp in vitro at high concentrations and did not inhibit doxorubicin transport in MDR cells. These differential interactions should be considered when combining statins with traditional chemotherapeutic drugs.

Resistance to multiple drugs is a serious limitation to chemotherapy treatment of human cancers. In addition, many clinically useful drugs show limited uptake in the intestine and cannot gain access to the brain. Three multidrug efflux pumps of the ABC superfamily (P-glycoprotein/ABCB1, MRP1/ABCC1, and BCRP/ABGG2) are responsible for most drug transport out of mammalian cells. P-glycoprotein is the best characterized of the ABC drug transporters. However, the lipophilic nature of its substrates has made it difficult to directly quantitate drug binding to the protein by classical biochemical methods, and the measurement of drug transport rates has also proved challenging. In recent years, fluorescence spectroscopic approaches have proved very useful in overcoming these problems. This chapter focuses on the use of fluorescence tools to quantitate the affinity of binding of various drugs to purified P-glycoprotein and to measure its drug transport activity in reconstituted proteoliposomes in real time. The ability of various drugs to inhibit P-glycoprotein mediated transport can also be assessed using this approach.