Abstract. Tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) specifically kills cancer cells without destroying the majority of healthy cells. However, numerous types of cancer cell, including gastric cancer cells, tend to be resistant to TRAIL. The bioactive product 3,3'-diindolylmethane (DIM), which is derived from cruciferous vegetables, is also currently recognized as a candidate anticancer agent. In the present study, a Cell Counting Kit 8 cell growth assay and an Annexin V-fluorescein isothiocyanate apoptosis assay were performed to investigate the potentiating effect of DIM on TRAIL-induced apoptosis in gastric cancer cells, and the possible mechanisms of this potentiation. The results obtained demonstrated that, compared with TRAIL or DIM treatment alone, co-treatment with TRAIL (25 or 50 ng/ml) and DIM (10 µmol/l) induced cytotoxic and apoptotic effects in BGC-823 and SGC-7901 gastric cancer cells. Furthermore, western blot analysis revealed that the protein expression levels of death receptor 5 (DR5), CCAAT/enhancer binding protein homologous protein (CHOP) and glucose-regulated protein 78 (GRP78) were upregulated in the co-treated gastric cancer cells. To the best of our knowledge, the present study is the first to provide evidence that DIM sensitizes TRAIL-induced inhibition of proliferation and apoptosis in gastric cancer cells, accompanied by the upregulated expression of DR5, CHOP and GRP78 proteins, which may be involved in endoplasmic reticulum stress mechanisms.
IntroductionDespite advancements in the prevention and treatment through multimodal approaches, including targeted therapies, gastric cancer is one of the most common types of malignant tumor and remains the second leading cause of carcinoma-associated mortality worldwide (1).Few agents exist that are truly cancer cell specific with regards to the induction of cell death. For example, tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) is an agent that is preferentially cytotoxic to cancer cells over healthy cells (2). However, the effectiveness of TRAIL is significantly impeded by drug resistance, resulting in poor survival outcomes of patients with cancer (3,4). Emerging evidence provides support for the potential anticancer effect of bioactive products derived from cruciferous vegetables, such as brussel sprouts, broccoli, cabbage and cauliflower (5). Among these compounds, 3,3'-diindolylmethane (DIM) is generated in the acidic environment of the stomach via dimerization of the indole-3-carbinol monomers present in these vegetables (6).A number of cellular stress conditions, including nutrient deprivation, hypoxia and treatment with a variety of pharmacological agents which inhibit glycosylation or deplete endoplasmic reticulum (ER) calcium stores, may lead to the accumulation and aggregation of unfolded and/or misfolded proteins in the ER lumen, which is termed ER stress. Notably, ER-induced apoptotic cell death has been identified as an important apoptotic pathway (7). Various mechanisms have been hypothesi...