Amiloride.HCl is clinically used as an oral potassium-sparing diuretic, but multiple studies in biochemical, cellular and animal models have shown that the drug also possesses anti-tumour and anti-metastasis activities. The additional effects appear to arise through inhibition of two discrete targets: (i) the sodium-hydrogen exchanger 1 (NHE1), a membrane protein responsible for the characteristically low extracellular pH of tumours and (ii) the urokinase-type plasminogen activator (uPA), a serine protease mediator of cell migration, invasion and metastasis and well-known marker of poor prognosis in cancer. This minireview summarises for the first time the reported anti-tumour/metastasis effects of amiloride in experimental models, discusses the putative molecular mechanisms responsible for these effects and concludes by commenting on the pros and cons of trialling amiloride or one of its structural analogues as potential new anti-tumour/metastasis drugs.Amiloride.HCl is an orally administered potassium-sparing diuretic that has been used clinically for more than three decades. Ironically, its principal clinical use is not as a diuretic per se, since its diuretic effects are relatively mild. It is instead more commonly used in combination with thiazide (e.g., hydrochlorothiazide) or loop diuretics (e.g., frusemide) as an antikaliuretic in patients at risk of hypokalaemia during longterm treatment of hepatic cirrhosis and heart failure. It is also frequently used in combination with other diuretics to control K þ -levels when treating hypertension. 1 The drug is usually well tolerated at normal doses, shows low incidence of side effects and is contraindicated only in patients with impaired renal function, hyperkalaemia or acidosis. Hyperkalaemia and associated arrhythmias are the drug's most serious side effects but when used in combination with thiazide diuretics, the incidence of these is <1-2%. 2 Soon after its discovery, amiloride found additional nonclinical uses as a pharmacological tool for probing sodium transport in many types of tissues and cells-uses which continue to this day. 3 Multiple studies over the past three decades have demonstrated that amiloride also exhibits significant anti-tumour and anti-metastasis activities in biochemical, cellular and animal tumour models. This mini-review begins by summarising the reported anti-cancer activities of amiloride in experimental models, discusses its purported anti-cancer mechanisms of action and concludes by commenting on the possibility that amiloride or a close structural analogue might be worth trialling clinically as an orally administered anticancer drug, either as a stand-alone agent or in combination with current chemotherapeutics.
Anti-Tumour and Anti-Metastasis Effects of Amiloride in Experimental ModelsReports of in vivo anti-tumour properties for amiloride first appeared in 1983 when it was shown to inhibit H6 hepatoma growth and DMA/J mammary adenocarcinoma growth in a dose-dependent fashion in Male A/J mice. Multiple injections (1 mg/kg) of ...