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Synergistic Cytotoxicity of Arsenic Trioxide and Sulindac Against Neuroblastoma

Korean Journal of Pediatrics 2004;47(9):1002-1007.
Published online September 15, 2004.
Synergistic Cytotoxicity of Arsenic Trioxide and Sulindac Against Neuroblastoma
Du Young Choi
Department of Pediatrics, School of Medicine, Wonkwang University, Iksan, Korea
Arsenic Trioxide와 Sulindac에 의한 신경모세포종의 협동적 세포독성
원광대학교 의과대학 소아과학교실
Du Young Choi, Email: CDY8118@wonkwang.ac.kr
: Recent clinical studies have shown that arsenic trioxide(As2O3) at low concentrations induces complete remission without significant toxicity in patients with refractory acute promyelocytic leukemia(APL). Like APL cells, neuroblastoma(NB) cells are thought to be arrested at an early stage of differentiation, and can respond with retinoic acid treatment. Sulindac, a nonsteroidal antiinflammatory drug, was reported to induce antitumor activity against various tumors through induction of apoptosis and inhibition of angiogenesis. There was no data with the effect of sulindac on NB, and the concentration of sulindac for antitumor effect could not be safely used in the clinical field. Therefore, we at first focused the synergistic cytotoxicity of two drugs using CHLA-15, CHLA-20 NB cells with different resistance to anticancer drugs, and then studied the mechanism of synergistic cytotoxicity at a clinically safe concentration of two drugs.
: CHLA-15 and CHLA-20 cells were cultured in IMDM and treated with As2O3 and/or sulindac. Cell viability was measured by methilthiazol-2-yl-2, 5-diphenyl, tetrazolium bromide(MTT) assay. Apoptosis was assessed by DNA fragmentation assay. Apoptotic machinaries including FAS, caspase-3, PARP[poly(ADP-ribose) polymerase] were determined by Western blot analysis.
: As2O3 caused significant cytotoxicity on both CHLA-15 and CHLA-20 cell lines in a dose dependent manner, whereas sulindac had no demonstrable cytotoxic effects. Both drugs in combination induced synergistic cytotoxicity on two cell lines. Especially on a clinically therapeutic level with 2 M of As2O3 and 10 M of sulindac in combination, the viability of CHLA-15 and CHLA-20 cells was decreased to 15%, 60% more than arsenic alone, respectively. The synergistic cytotoxicity occurred by apoptosis through up-regulation of the Fas receptor, activation of caspase-3 and cleavage of PARP, which was a central pathway of induction of apoptosis.
: As2O3 and sulindac induced synergistic cytotoxicity and apoptosis on NB through up- regulation of the FAS receptor, activation of caspase-3 and cleavage of PARP. Taken together, these results indicate that As2O3 and sulindac are therapeutic agent candidates for treatment of NB.
Key Words: Neuroblastoma, Arsenic trioxide, Sulindac, Apoptosis, Fas, Caspase-3, PARP

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