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Sturm S, Niegisch G, Windolf J, Suschek CV. Exposure of Bladder Cancer Cells to Blue Light (λ = 453 nm) in the Presence of Riboflavin Synergistically Enhances the Cytotoxic Efficiency of Gemcitabine. Int J Mol Sci 2024; 25:4868. [PMID: 38732087 PMCID: PMC11084806 DOI: 10.3390/ijms25094868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/25/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
Non-muscle invasive bladder cancer is a common tumour in men and women. In case of resistance to the standard therapeutic agents, gemcitabine can be used as off-label instillation therapy into the bladder. To reduce potential side effects, continuous efforts are made to optimise the therapeutic potential of drugs, thereby reducing the effective dose and consequently the pharmacological burden of the medication. We recently demonstrated that it is possible to significantly increase the therapeutic efficacy of mitomycin C against a bladder carcinoma cell line by exposure to non-toxic doses of blue light (453 nm). In the present study, we investigated whether the therapeutically supportive effect of blue light can be further enhanced by the additional use of the wavelength-specific photosensitiser riboflavin. We found that the gemcitabine-induced cytotoxicity of bladder cancer cell lines (BFTC-905, SW-1710, RT-112) was significantly enhanced by non-toxic doses of blue light in the presence of riboflavin. Enhanced cytotoxicity correlated with decreased levels of mitochondrial ATP synthesis and increased lipid peroxidation was most likely the result of increased oxidative stress. Due to these properties, blue light in combination with riboflavin could represent an effective therapy option with few side effects and increase the success of local treatment of bladder cancer, whereby the dose of the chemotherapeutic agent used and thus the chemical load could be significantly reduced with similar or improved therapeutic success.
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Affiliation(s)
- Sofia Sturm
- Department of Orthopedics and Trauma Surgery, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Günter Niegisch
- Department of Urology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Joachim Windolf
- Department of Orthopedics and Trauma Surgery, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Christoph V. Suschek
- Department of Orthopedics and Trauma Surgery, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
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Cuperus FJC, Claudel T, Gautherot J, Halilbasic E, Trauner M. The role of canalicular ABC transporters in cholestasis. Drug Metab Dispos 2014; 42:546-60. [PMID: 24474736 DOI: 10.1124/dmd.113.056358] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Cholestasis, a hallmark feature of hepatobiliary disease, is characterized by the retention of biliary constituents. Some of these constituents, such as bile acids, inflict damage to hepatocytes and bile duct cells. This damage may lead to inflammation, fibrosis, cirrhosis, and eventually carcinogenesis, sequelae that aggravate the underlying disease and deteriorate clinical outcome. Canalicular ATP-binding cassette (ABC) transporters, which mediate the excretion of individual bile constituents, play a key role in bile formation and cholestasis. The study of these transporters and their regulatory nuclear receptors has revolutionized our understanding of cholestatic disease. This knowledge has served as a template to develop novel treatment strategies, some of which are currently already undergoing phase III clinical trials. In this review we aim to provide an overview of the structure, function, and regulation of canalicular ABC transporters. In addition, we will focus on the role of these transporters in the pathogenesis and treatment of cholestatic bile duct and liver diseases.
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Affiliation(s)
- Frans J C Cuperus
- Hans Popper Laboratory of Molecular Hepatology, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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Pagliarulo V, Ancona P, Niso M, Colabufo NA, Contino M, Cormio L, Azzariti A, Pagliarulo A. The interaction of celecoxib with MDR transporters enhances the activity of mitomycin C in a bladder cancer cell line. Mol Cancer 2013; 12:47. [PMID: 23705854 PMCID: PMC3669624 DOI: 10.1186/1476-4598-12-47] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 05/02/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An in vitro model was developed to understand if celecoxib could synergize with Mitomycin C (MMC), commonly used for the prevention of non-muscle invasive bladder cancer recurrence, and eventually elucidate if the mechanism of interaction involves multi drug resistance (MDR) transporters. METHODS UMUC-3, a non COX-2 expressing bladder cancer cell line, and UMUC-3-CX, a COX-2 overexpressing transfectant, as well as 5637, a COX-2 overexpressing cell line, and 5637si-CX, a non COX-2 expressing silenced 5637 cell line, were used in the present study. The expression of COX-2 and MDR pumps (P-gp, MDR-1 and BCRP) was explored through western blot. The anti-proliferative effect of celecoxib and MMC was studied with MTT test. Three biological permeability assays (Drug Transport Experiment, Substrate Transporter Inhibition, and ATP cell depletion) were combined to study the interaction between MDR transporters and celecoxib. Finally, the ability of celecoxib to restore MMC cell accumulation was investigated. RESULTS The anti-proliferative effect of celecoxib and MMC were investigated alone and in co-administration, in UMUC-3, UMUC-3-CX, 5637 and 5637si-CX cells. When administered alone, the effect of MMC was 8-fold greater in UMUC-3. However, co-administration of 1 μM, 5 μM, and 10 μM celecoxib and MMC caused a 2,3-fold cytotoxicity increase in UMUC-3-CX cell only. MMC cytotoxicity was not affected by celecoxib co-administration either in 5637, or in 5637si-CX cells. As a result of all finding from the permeability experiments, celecoxib was classified as P-gp unambiguous substrate: celecoxib is transported by MDR pumps and interferes with the efflux of MMC. Importantly, among all transporters, BCRP was only overexpressed in UMUC-3-CX cells, but not in 5637 and 5637si-CX. CONCLUSIONS The UMUC-3-CX cell line resembles a more aggressive phenotype with a lower response to MMC compared to the wt counterpart. However, the administration of celecoxib in combination to MMC causes a significant and dose dependent gain of the anti-proliferative activity. This finding may be the result of a direct interaction between celecoxib and MDR transporters. Indeed, BCRP is overexpressed in UMUC-3-CX, but not in UMUC-3, 5637, and 5637si-CX, in which celecoxib is ineffective.
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Affiliation(s)
- Vincenzo Pagliarulo
- Sezione di Urologia e Andrologia, Dipartimento dell'Emergenza e dei Trapianti di Organi (DETO), Università Aldo Moro di Bari, Bari 70124, Italy.
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Pogliani L, Mameli C, Cattaneo D, Clementi E, Meneghin F, Radice S, Bruno S, Zuccotti GV. Acute kidney injury in a preterm infant homozygous for the C3435T polymorphism in the ABCB1 gene given oral morphine. Clin Kidney J 2012; 5:431-3. [PMID: 26019822 PMCID: PMC4432415 DOI: 10.1093/ckj/sfs099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 07/13/2012] [Indexed: 01/04/2023] Open
Abstract
A 34-week infant born from a mother with a history of drug abuse developed neonatal abstinence syndrome (NAS) in the first hours of life. Urine drug screening was positive for cocaine and heroin. The infant developed acute kidney injury and bilateral hydronephrosis while receiving oral morphine for control of NAS. Cessation of morphine therapy and urinary catheterization resulted in a rapid and complete resolution of the symptoms. Our patient was homozygous for the C3435T polymorphism in the ABCB1 gene, a polymorphism previously associated with impaired P-glycoprotein activity. We hypothesize that acute renal toxicity was related to accumulation of morphine within urothelial cells due to genetically determined impaired P-glycoprotein activity.
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Affiliation(s)
- Laura Pogliani
- Department of Pediatrics , L. Sacco Hospital, University of Milan , Milan , Italy
| | - Chiara Mameli
- Department of Pediatrics , L. Sacco Hospital, University of Milan , Milan , Italy
| | - Dario Cattaneo
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences , Consiglio Nazionale delle Ricerche Institute of Neuroscience, L. Sacco Hospital, University of Milan , Milan , Italy
| | - Emilio Clementi
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences , Consiglio Nazionale delle Ricerche Institute of Neuroscience, L. Sacco Hospital, University of Milan , Milan , Italy ; E. Medea Scientific Institute , Bosisio Parini , Italy
| | - Fabio Meneghin
- Department of Pediatrics , L. Sacco Hospital, University of Milan , Milan , Italy
| | - Sonia Radice
- Unit of Clinical Pharmacology, Department of Biomedical and Clinical Sciences , Consiglio Nazionale delle Ricerche Institute of Neuroscience, L. Sacco Hospital, University of Milan , Milan , Italy
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Superhigh-magnetization nanocarrier as a doxorubicin delivery platform for magnetic targeting therapy. Biomaterials 2011; 32:8999-9010. [DOI: 10.1016/j.biomaterials.2011.08.014] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Accepted: 08/07/2011] [Indexed: 11/18/2022]
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Cheng MH, Cheng HT, Lin SS, Young SC, Pai CJ, Liao PH, Chen SC, Chou MY, Yang JJ, Yang CC. Apoptotic death mode of mitomycin C-treated HeLa cells and cellular localization of mitomycin C-induced P-glycoprotein. Drug Chem Toxicol 2010; 32:158-68. [PMID: 19514952 DOI: 10.1080/01480540802594491] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Mitomycin C (MMC) is an active antineoplastic agent and is suggested to induce apoptosis in a caspase- dependent manner in human gastric, bladder, and breast cancer cells. In this study, the death mode of human cervical cancer cells (HeLa) induced by MMC and the cellular localization of MMC-induced P-glycoprotein (P-gp) were investigated. The results of caspase-3 activity, Annexin V binding, and DNA fragmentation suggested that the degree of caspase-dependent apoptosis induced by MMC was in a dose-, but not time-dependent, manner. Further, in low-dose (0.0299 microM) and long-term (2 months) treatment with MMC, P-gp is itself extruded from the cells and colocalized with nuclear DNA and the overexpression was achieved.
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Affiliation(s)
- Min-Hsiung Cheng
- School of Dentistry, Chung Shan Medical University, Taichung, Taiwan, ROC
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Featherstone JM, Lwaleed BA, Speers AG, Hayes MC, Birch BR, Cooper AJ. Time-lapse Live Cell Imaging and Flow Analysis of Multidrug Resistance Reversal by Verapamil in Bladder Cancer Cell Lines. Urology 2009; 74:378-84. [DOI: 10.1016/j.urology.2009.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Revised: 01/26/2009] [Accepted: 03/02/2009] [Indexed: 10/20/2022]
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Speers AG, Lwaleed BA, Featherstone JM, Cooper AJ. Multidrug resistance in a urothelial cancer cell line after 3, 1-hour exposures to mitomycin C. J Urol 2007; 178:2171-5. [PMID: 17870115 DOI: 10.1016/j.juro.2007.06.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2007] [Indexed: 11/20/2022]
Abstract
PURPOSE The development of multidrug resistance is a problem in chemotherapy for many tumors. In vitro models of multidrug resistance require adapted cell strains that are conventionally produced from parental lines by chronic low dose drug exposure. Because adjunctive intravesical chemotherapy for superficial bladder cancer uses short courses of high dose treatment, we investigated whether such exposure of the RT112 cell line (Catalogue No. ACC 418, Deutsche Sammlung von Mikroorganismen und Zellkulturen, Braunschweig, Germany) to mitomycin C, which is a common intravesical agent, would elicit multidrug resistance. MATERIALS AND METHODS Three 1-hour exposures to graded concentrations were done at 3-week intervals. The highest mitomycin C concentrations permitting recovery in cultures and, therefore, available for examination were 3.13 and 1.06 microg/ml. Cross-resistance to epirubicin in surviving cultures was visualized by confocal microscopy and quantified by MTT residual viable biomass assay. Spheroids were made by the agarose technique and exposed to high dose mitomycin C to assess the probability that the relevant concentrations might be found clinically in some cell layers of a superficial lesion. RESULTS Resistance was induced by 3 short drug exposures. The evidence for this was functional (MTT assay) and by intracellular localization. Toxicity to an alternative multidrug resistance class drug was lowered in surviving clones and nuclear exclusion of the drug was noted. Spheroid experiments showed sharp gradients of incorporated drug across the outermost layers of cells, suggesting that a proportion of cells in clinical superficial bladder cancer would be exposed to drug at concentrations that generated the resistant clones in these experiments. CONCLUSIONS We report multidrug resistance induction using 2 independent methodologies. The results have implications for the development of experimental models and the likelihood of resistance resulting from clinical regimens. Brief exposure can elicit detectable resistance. It is arguable that selective rather than instructive mechanisms are involved, and the levels of drug required are likely to exist in a superficial transitional cell carcinoma frond exposed at its surface to high drug concentrations.
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MESH Headings
- Antibiotics, Antineoplastic/administration & dosage
- Antibiotics, Antineoplastic/pharmacokinetics
- Carcinoma, Transitional Cell/drug therapy
- Carcinoma, Transitional Cell/metabolism
- Carcinoma, Transitional Cell/pathology
- Cell Line, Tumor
- Dose-Response Relationship, Drug
- Drug Resistance, Neoplasm
- Epirubicin/administration & dosage
- Epirubicin/pharmacokinetics
- Follow-Up Studies
- Humans
- Intracellular Fluid/metabolism
- Mitomycin/administration & dosage
- Mitomycin/pharmacokinetics
- Phenotype
- Spheroids, Cellular/metabolism
- Spheroids, Cellular/pathology
- Time Factors
- Urinary Bladder Neoplasms/drug therapy
- Urinary Bladder Neoplasms/metabolism
- Urinary Bladder Neoplasms/pathology
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Affiliation(s)
- Alan G Speers
- Solent Department of Urology, St. Mary's Hospital, University of Portsmouth, UK. United Kingdom
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Lewin JM, Lwaleed BA, Cooper AJ, Birch BR. The direct effect of nuclear pores on nuclear chemotherapeutic concentration in multidrug resistant bladder cancer: the nuclear sparing phenomenon. J Urol 2007; 177:1526-30. [PMID: 17382772 DOI: 10.1016/j.juro.2006.11.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2006] [Indexed: 11/20/2022]
Abstract
PURPOSE Multidrug resistance commonly limits effectiveness in treating malignancy with chemotherapy. Multidrug resistance has classically been described as a cell membrane phenomenon. Multidrug resistant cells are known to specifically exclude chemotherapy from the nucleus, resulting in lower nuclear concentrations than in the cytoplasm. This phenomenon is known as nuclear sparing and little is known of its etiology. We hypothesized that a component of the nuclear membrane, the nuclear pore, is responsible for this phenomenon. MATERIALS AND METHODS In this in vitro study we used the drug sensitive urothelial cancer cell line Massachusetts General Hospital urothelial 1 sensitive and its multidrug resistant subline Massachusetts General Hospital urothelial 1 resistant. After quantitative assessment of nuclear pores resistant and sensitive cells were fused using polyethylene glycol and laser scanning confocal microscopy was used to identify if drug resistant and sensitive nuclei can coexist within the same cell. The effect of inhibiting nuclear pore function using the specific pore inhibitor, wheat germ agglutinin, was assessed in whole cells using confocal microscopy and cytotoxicity assay as well as in isolated nuclei. RESULTS Nuclear pores appeared more numerous in multidrug resistance cells. Cell fusion experiments showed that multidrug resistance and sensitive nuclei could coexist with the same cell milieu. Wheat germ agglutinin reversed multidrug resistance in whole cells and isolated nuclei. CONCLUSIONS Multidrug resistance is a complex phenomenon occurring at many cellular levels, of which all may be potential therapeutic targets. The nuclear pore is involved in this process, which is to our knowledge a previously undescribed phenomenon. These experiments suggest that it may act to export drug from the nucleus, which is a process inhibited by wheat germ agglutinin.
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Affiliation(s)
- Jonathan M Lewin
- MDR Research Group, Southampton University Hospitals, Southampton, United Kingdom.
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Speers AG, Lwaleed BA, Featherstone JM, Sallis BJ, Cooper AJ. Furosemide reverses multidrug resistance status in bladder cancer cells in vitro. J Clin Pathol 2006; 59:912-5. [PMID: 16556663 PMCID: PMC1860466 DOI: 10.1136/jcp.2005.033100] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2005] [Indexed: 11/04/2022]
Abstract
BACKGROUND Multidrug resistance (MDR) has a potentially serious influence on cancer treatment and should be taken into consideration in the design and application of therapeutic regimens. It is mediated through the activity of cellular pumps. AIM To investigate whether furosemide, itself a pump-blocker, reverses MDR in an in vitro model. MATERIALS AND METHODS An MDR bladder cancer cell line (MGH-u 1R) and its parental (drug sensitive) clone were exposed to epirubicin and furosemide, with the concentration of one drug fixed and that of the other serially diluted in a 96-well plate format. Both drugs formed the variable component in separate experiments. After a 1-h exposure, the cells were washed and replenished with fresh medium. To examine the toxicity of epirubicin and furosemide separately and in combination, monotetrazolium-based assays were carried out. Intracellular epirubicin distribution was assessed by confocal microscopy as a second index of resistance status after in vitro exposure. RESULTS MGH-u 1R cells incubated with furosemide showed distribution of drug similar to that in the parental cells (MGH-u 1 sensitive). Controls (without furosemide) continued to show a resistant pattern of fluorescence. In cytotoxicity assays furosemide appeared substantially non-toxic. Resistant cells in the toxicity titration experiments showed increased resistance to levels of furosemide over 500 mug/ml. Parental cells were made only marginally more sensitive against increased background toxicity. CONCLUSION Furosemide is effective in reversing MDR status in bladder cancer cell lines in vitro. It may also have an increment of intrinsic cytotoxicity, but only at higher concentrations. We propose a potential for further investigation of furosemide as an adjunct to chemotherapy for superficial bladder cancer.
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Affiliation(s)
- A G Speers
- Department of Biomedical Sciences, University of Portsmouth, Portsmouth, UK
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Burgués Gasión JP, Pontones Moreno JL, Vera Donoso CD, Jiménez Cruz JF, Ozonas Moragues M. [Cell cycle and apoptosis mechanisms implicated in intravesical chemotherapy resistances in superficial bladder cancer]. Actas Urol Esp 2005; 29:846-59. [PMID: 16353771 DOI: 10.1016/s0210-4806(05)73356-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
It is well documented the effectiveness of intravesical chemotherapy following transurethral resection to prevent recurrences of superficial bladder cancer. But it is also known that efficacy may be limited by tumour cell resistance to one or several of the drugs available for instillation. In addition to the genetically determined unicellular mechanisms classically described in the literature such as glycoprotein P-170 expression (mdr-1), overexpression of Bcl-2 or glutation S-transferase activity, it has been recently shown that multicellular mechanisms may also be involved in drug resistance. Multicellular resistance can only be demonstrated in three-dimensional cultures and fails to be shown in monolayers or cell suspensions. This is explained by the fact that cell-to-cell and cell-to-stroma adhesion limits drug penetration and by the variable susceptibility to cytotoxicity determined by oxygen and tissue proliferation gradients. A better understanding of the molecular mechanisms involved in drug resistance is necessary to increase intravesical chemotherapy effectiveness. Current research includes improving drug penetration, searching resistance reversing agents and developing in vitro chemosensitivity tests to identify drug resistance.
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Affiliation(s)
- J P Burgués Gasión
- Servicio de Urologia, Hospital Universitario Son Dureta Palma de Mallorca, Hospital Universitario La Fe, Valencia.
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Featherstone JM, Speers AG, Lwaleed BA, Hayes MC, Cooper AJ, Birch BR. The nuclear membrane in multidrug resistance: microinjection of epirubicin into bladder cancer cell lines. BJU Int 2005; 95:1091-8. [PMID: 15839939 DOI: 10.1111/j.1464-410x.2005.05473.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess whether microinjecting epirubicin into cells showing multidrug resistance (MDR, common to many cancers, including bladder cancer, with resistance to, e.g. anthracyclines and mitomycin C) spares the nucleus, as when these drugs accumulate, distribution in MDR cells characteristically spares the nucleus, suggesting that the nuclear membrane is responsible for excluding cytotoxic drugs from MDR nuclei. MATERIALS AND METHODS Nuclear exclusion of drugs is an important feature of resistance in MDR cells, as many MDR-susceptible drugs have cytotoxic actions within the nucleus. Drug accumulation in 'classical' P-glycoprotein-mediated MDR cells is greatly reduced by efflux. Microinjection of epirubicin into the cytoplasm of MDR cells bypasses the P-glycoprotein efflux pump on the plasma membrane. Nuclear sparing would directly implicate the nuclear membrane in this phenomenon. Because of their fluorescence properties, which allow study by confocal microscopy and flow cytometry, anthracyclines have also been used extensively to investigate MDR. Thus sensitive (MGH-U1 and RT112) and MDR (MGH-U1R and MGH-U1-MMC) bladder cancer cell lines were used. Adherent cells from each cell line were individually microinjected with epirubicin (0.5 mg/mL) and a 77 kDa fluorescein isothiocyanate (FITC)-dextran (0.5 mg/mL). The pattern of nuclear epirubicin uptake in injected cells was then evaluated by confocal microscopy. The 77 kDa FITC-dextran allowed easier identification of injected cells and was also excluded from their nuclei. RESULTS Sensitive bladder cancer cell lines all showed a nuclear accumulation pattern of epirubicin, consistent with their normal uptake after exposure to epirubicin. The MDR cell lines showed the characteristic nuclear-sparing pattern of epirubicin uptake, similar to the normal uptake pattern after epirubicin exposure. The 77 kDa FITC-dextran showed clearly which cells had been microinjected, and was excluded from the nuclei of all injected cells. Cell viability was confirmed by acridine-orange staining after initial visualization of injected cells. CONCLUSION The nuclear membrane is responsible for the nuclear exclusion of epirubicin in MDR cells. Further work is necessary to determine the mechanisms involved.
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Shelley MD, Wilt TJ, Court J, Coles B, Kynaston H, Mason MD. Intravesical bacillus Calmette-Guerin is superior to mitomycin C in reducing tumour recurrence in high-risk superficial bladder cancer: a meta-analysis of randomized trials. BJU Int 2004; 93:485-90. [PMID: 15008714 DOI: 10.1111/j.1464-410x.2003.04655.x] [Citation(s) in RCA: 247] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess, in a systematic review and meta-analysis, the relative effectiveness of intravesical mitomycin C and bacillus Calmette-Guérin (BCG) for tumour recurrence, disease progression and overall survival in patients with medium- to high-risk Ta and T1 bladder cancer. METHODS The major medical databases were searched comprehensively up to June 2003, and relevant journals hand-searched for randomized controlled trials, in any language, that compared intravesical mitomycin C with BCG in medium- to high-risk patients with Ta or T1 bladder cancer. RESULTS Twenty-five articles were identified but only seven were considered eligible for the analysis. This represented 1901 evaluable patients in all, 820 randomized to mitomycin C and 1081 to BCG. Six trials had sufficient data for meta-analysis and included 1527 patients, 693 in the mitomycin and 834 in the BCG arm. There was no significant difference between mitomycin C and BCG for tumour recurrence in the six trials, with a weighted mean log hazard ratio, LHR, (variance) of -0.022 (0.005). However, there was significant heterogeneity between trials (P = 0.001). A subgroup analysis of three trials that included only high-risk Ta and T1 patients indicated no heterogeneity (P = 0.25) and a LHR for recurrence of -0.371 (0.012). With mitomycin C used as the control in the meta-analysis, a negative ratio is in favour of BCG and, in this case, was highly significant (P < 0.001). The seventh trial (in abstract form only) used BCG in low doses for two arms of the trial (27 mg and 13.5 mg) compared with a standard dose of mitomycin C (30 mg), and reported a significantly lower recurrence rate with BCG (27 mg) than for mitomycin C (P = 0.001). Only two trials included sufficient data to analyse disease progression and survival, representing 681 patients (338 randomized to BCG and 343 to mitomycin C). There was no significant difference between mitomycin C and BCG for disease progression, with a LHR of 0.044 (0.04) (P = 0.16), or survival, at -0.112 (0.03) (P = 0.50). Adverse events were slightly more frequent with BCG. Local toxicity (dysuria, cystitis, frequency and haematuria) were associated with both mitomycin C (30%) and BCG (44%). Systemic toxicity, e.g. chills, fever and malaise, occurred with both agents (12% and 19%, respectively) although skin rash was more common with mitomycin C. CONCLUSION Tumour recurrence was significantly lower with intravesical BCG than with mitomycin C only in those patients at high risk of tumour recurrence. However, there was no difference in disease progression or survival, and the decision to use either agent might be based on adverse events and cost.
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Affiliation(s)
- M D Shelley
- Cochrane Prostatic Diseases and Urologic Cancers Group, Velindre NHS Trust, Cardiff, UK.
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