Abstract. Arsenic trioxide (ATO) has demonstrated anticancer activity in different malignancies, especially acute promyelocytic leukemia, with a wide array of putative mechanisms. In this study, we aimed to elucidate the activity and mechanisms of ATO in small cell lung cancer (SCLC). A panel of SCLC cell lines (H841, DMS79, H526, H69 and H187) was employed to demonstrate the activity of ATO. Cell viability, apoptosis and mitochondrial membrane depolarization were assessed. Western blotting was performed to determine the alteration of pro-apoptotic and anti-apoptotic mediators. Reactive oxygen species (ROS) (hydrogen peroxide and superoxide) and intracellular glutathione (GSH) were measured. Antioxidants, N-acetyl-L-cysteine (NAC) and butylated hydroxyanisole (BHA), were applied to restore GSH content and reduce production of ROS. All SCLC cell lines were relatively sensitive to ATO with IC 50 values below 10 µM. ATO induced cell death mainly through apoptosis in H841 cells in a dose-dependent manner. Hydrogen peroxide was the major ROS in SCLC cells induced by ATO. Along with GSH depletion and Bcl-2 downregulation, mitochondrial membrane permeabilization was enhanced, followed by release of AIF and SMAC from mitochondria to initiate different cell death pathways. NAC reversed cell death and molecular changes induced by ATO via restoring GSH and reducing ROS content. BHA inhibited hydrogen peroxide production completely and partially restored GSH content accounting for partial reversal of cell inhibition and mitochondrial dysfunction. Nonetheless, ATO reduced both reduced and oxidized form of thioredoxin 1 (Trx1) with no effect on Trx1 redox potential. ATO led to cell death in SCLC mainly through mitochondrial dysfunction, resulting from altered cellular redox homeostasis, namely, hydrogen peroxide generation, GSH depletion and Trx1 downregulation.
IntroductionSCLC, accounting for 15-20% of newly diagnosed lung cancer, is an extremely aggressive malignancy with early metastasis and poor prognosis. Despite a prompt response to chemotherapy, relapses occur in the majority of patients with SCLC. Therefore the development of an alternative therapy against SCLC becomes imperative (1).ATO has been proven to be an effective therapeutic agent in acute promyelocytic leukemia (APL) with high complete remission rate and prolonged survival (2,3). ATO can induce apoptosis through PML-RARα-independent pathways in APL or other cancer cells via p53 activation (4,5), Bcl-2 downregulation (6,7), mitochondrial membrane depolarization and cytochrome c release (8-10), depletion of intracellular reduced glutathione (GSH) content and elevation of reactive oxygen species (11,12). More recently, the application of ATO in lung cancer treatment has been explored in preclinical models, mainly in non-small cell lung cancer (NSCLC). ATO induces growth inhibition and apoptosis in NSCLC cells through G2/M cell cycle arrest (13,14), Bcl-2 downregulation and GSH depletion (15). Recently, downregulation of thymidylate synthase and E2F1 were obser...