Two distinct modes of cell death induced by doxorubicin: apoptosis and cell death through mitotic catastrophe accompanied by senescence-like phenotype

Counting heads in the war against cancer: defining the role of annexin A5 imaging in cancer treatment and surveillance

The unveiling of the heterogeneous nature of cell death modes has compromised the long-lived consensus that cancer treatment typically kills cancer cells through apoptosis. Moreover, it implies that measures of apoptosis may be misleading indicators of treatment efficacy. Simultaneously, it has become clear that phosphatidylserine exposition, traditionally considered a hallmark of apoptosis, is also associated with most other cell death programs, rendering phosphatidylserine an attractive target for overall cell death imaging. Annexin A5 binds with strong affinity to phosphatidylserine and hence offers an interesting opportunity for visualization of aggregate cell death, thus providing a fit benchmark for in vivo monitoring of anticancer treatment. This might be of significant value for pharmacologic therapy development as well as clinical monitoring of treatment success.

Cdc2 and Cdk2 play critical roles in low dose doxorubicin-induced cell death through mitotic catastrophe but not in high dose doxorubicin-induced apoptosis

In Huh-7 hepatoma cells, low dose (LD) doxorubicin treatment induces cell death through mitotic catastrophe accompanying the formation of large cells with multiple micronuclei, whereas high dose (HD) doxorubicin induces apoptosis. In this study, we investigated the role of Cdc2 and Cdk2 kinase in the regulation of the two modes of cell death induced by doxorubicin. During HD doxorubicin-induced apoptosis, the histone H1-associated activities of Cdc2 and Cdk2 both progressively declined in parallel with reductions in cyclin A and cyclin B protein levels. In contrast, during LD doxorubicin-induced cell death through mitotic catastrophe, the Cdc2 and Cdk2 kinases were transiently activated 1 day post-treatment, with similar changes seen in the protein levels of cyclin A, cyclin B, and Cdc2. Treatment with roscovitine, a specific inhibitor of Cdc2 and Cdk2, significantly blocked LD doxorubicin-induced mitotic catastrophe and cell death, but did not affect HD doxorubicin-induced apoptosis in Huh-7, SNU-398, and SNU-449 hepatoma cell lines. Our results demonstrate that differential regulation of Cdc2 and Cdk2 activity by different doses of doxorubicin may contribute to the induction of two distinct modes of cell death in hepatoma cells, either apoptosis or cell death through mitotic catastrophe.