Background
Fermented wheat germ extract (FWGE) with the trade name Avemar is a licensed medical nutriment for cancer patients [
1]. The anticarcinogenic potential of FWGE has been demonstrated in vitro and in vivo [
2,
3] and confirmed in two clinical trials: an open-label cohort trial with 170 colorectal cancer patients [
4], and a randomized phase II trial with 46 stage III melanoma patients [
5] receiving continuous supplementation of FWGE along with standard treatment. In both trials, FWGE was found to be beneficial in terms of overall and progression-free survival compared to standard therapy alone.
FWGE is produced as an aqueous extract, which contains the antitumor compounds 2,6-dimethoxy-1,4-benzoquinone (DMBQ) and 2-methoxy-benzoquinone in a concentration of approximately 400 μg/g (0.04 %) crude extract [
2]. Quinones are cyclic organic compounds containing two carbonyl groups (C = O) linked to the cyclic structure of a conjugated system. Some clinical anti-cancer compounds, e.g. Mitomycin C, Mitoxantran, Doxorubicin, and Daunorubicin are quinone derivatives [
6,
7]. In the 1970s, Bachur et al. described intracellular activation of benzoquinones to free radicals that irreversibly damage biomolecules, e.g. nucleic acids and proteins, but the benzoquinone-mediated production of reactive oxygen species represented the primary source of cell damage [
8]. In the mid-1980s, the team of Nobel Prize winner Albert Szent-Györgyi examined the electrochemical and cytotoxic properties of benzoquinones: they injected DMBQ into the peritoneal cavity of mice harboring Ehrlich ascites tumor cells and found a complete elimination of tumor cells [
9].
Reactive oxygen species (ROS) represent a broad range of chemically distinct reactive species of radicals with a single unpaired electron, including the superoxide anion radical (O
2
−) and the hydroxyl radical (OH
−), as well as non-radical ROS such as hydrogen peroxide (H
2O
2). A marked increase in intracellular ROS can cause oxidative stress with irreversible cell damage [
10]. Mammalian cells contain different types of intracellular non-enzymatic and enzymatic antioxidants, e.g. the tripeptide glutathione [
11], catalase, and DT-diaphorase that protect them from unwanted oxidative damage [
12]. DT-diaphorase plays an important role in protecting cells against endogenous and exogenous quinones [
13].
FWGE influences the metabolism of cancer cells [
14] which utilize glucose in a way distinct from normal cells [
15]. A better understanding of how FWGE influences cancer cell metabolism could improve our understanding of its anticancer activity. The first objective of the present study was to further elucidate the antimetabolic properties of FWGE in cancer cells. The anticancer compound DMBQ appears to be the bioactive molecule in FWGE responsible for its antiproliferative and antimetabolic properties [
2]. This assumption has not yet been confirmed experimentally. The second objective of this study, therefore, was to compare the antiproliferative properties of FWGE and the DMBQ compound (at a concentration equal to that in FWGE) in nine human cancer cell lines.
Methods
Cell lines
Human malignant cell lines (Table
1) were routinely cultured in RPMI 1640 medium at 37 °C and 5 % CO
2 supplemented with 10 % (v/v) heat-inactivated fetal calf serum (FCS), 100 U/ml penicillin, 100 μg/ml streptomycin, 2 mmol/l glutamine, 50 mmol/l mercaptoethanol, and 1 % non-essential amino acids in final concentrations (Invitrogen Life Technologies GmbH, Karlsruhe, Germany).
Table 1
IC
50 values of FWGE for different human cancer cell lines. IC
50 values in mg/ml are shown as mean ± standard deviation (SD) of three independent experiments, each performed in triplicate and calculated as described [
21]. Cancer cells were treated for 24 h with different concentrations of FWGE (0.1, 1.0, 10, 50 mg/ml) in medium with 10 % (v/v) fetal calf serum (FCS) and cell viability was determined by crystal violet (CV)
MDA-MB-468a
| Adenocarcinoma of the breast [ 33] | 3.8 | 1.77 |
ASPC-1b
| Adenocarcinoma of the pancreas [ 34] | 4.0 | 0.37 |
BxPC-3b
| Adenocarcinoma of the pancreas [ 34] | 4.4 | 0.66 |
MDA-MB-231a
| Adenocarcinoma of the breast [ 33] | 5.5 | 0.08 |
23132/87b
| Adenocarcinoma of the stomach [ 35] | 7.9 | 2.05 |
HT-29a
| Adenocarcinoma of the colon [ 36] | 10.9 | 6.36 |
BT-20c
| Adenocarcinoma of the breast [ 37] | 13.3 | 7.41 |
HRT-18b
| Adenocarcinoma of the colon [ 38] | 15.8 | 7.83 |
MCF-7a
| Invasive breast ductal carcinoma [ 37] | 19.3 | 17.66 |
Drugs and chemicals
FWGE powder from Biropharma, Hungary, was used. For each experiment, a fresh stock solution containing 100 mg/ml FWGE was prepared with RPMI 1640 medium and passed through a 0.2 μm filter. FWG contains benzoquinones in a concentration of approx. 400 μg/g (0.04 %) crude extract as described previously [
2]. The antitumor compound DMBQ (molecular weight: 168 g/mol) at 97 % purity (Sigma-Aldrich, Germany) was used in the same molar concentration of 24 μmol/l as described for FWGE (Avemar) [
2]. The DMBQ concentration for 10 mg/ml FWGE (=24 μmol/l) was calculated as follows: [10 mg/ml (10 g/l) x 0.04 %]/168 g/mol. For each experiment, a fresh stock solution of 0.1 mg/ml (595 μmol/l) DMBQ was set-up in RPMI 1640 medium at 37 °C for 10 min to improve solubility. After passing the stock solution through a 0.2 μm filter, no DMBQ sediment was observed. A fresh and sterile stock solution of 2.4 mmol/l ascorbic acid in RPMI 1640 medium was prepared as described [
16].
Measurement of FWGE effects on cell growth
Cells (1.5×10
4) were seeded in 200 μl culture medium per well into 96-well flat-bottom tissue plates (Greiner bio-one, Germany). The next day, cells were incubated for 24 h with fresh culture medium containing the final concentrations of 0.1, 1.0, 10, 50 mg/ml FWGE according to published data [
17‐
19]. The tissue plates were cultured at 37 °C in a humidified atmosphere of 5 % CO
2 in air and cellular viability was determined by crystal violet (CV) staining as described previously [
20]. The absorbance (optical density, OD) was measured with a microplate reader (MRX, Dynatech Laboratories) at a wave length of 570 nm which is directly proportional to the number of viable cells. Dose–response curves were used to calculate IC
50 values as described [
21]. After a 24 h-exposure with 10 mg/ml FWGE, the following three antiproliferative effects (which influence the number of viable cells) were observed: cytotoxic, cytostatic, and growth delay. By definition, a cytotoxic effect is a reduction in initial viable cell count >15 %, a cytostatic effect a change in initial viable cell count ±15 %, and delayed growth effect an increase in initial viable cell count >15 %.
Determination of cellular ATP content and NADH/NAD+ ratio
Cellular ATP content was determined with the Colorimetric/Fluorometric Assay Kit (K354-100) from BioVision, USA according to the manufacturer’s instructions. ATP content was given in pg/106 cells for 24 h. The NADH/NAD+ ratio, determined with the quantitation colorimetric kit (K337-100) from BioVision, was given for 104 cells.
Measuring cellular redox state
The OxiSelect™ lntracellular ROS Assay Kit (Gell Biolabs, USA; STA-342) is a cell-based assay for measuring the activity of hydroxyl, peroxyl, and other reactive oxygen species within a cell. The assay employs the redox-sensitive fluorogenic dye DCFH-DA, which diffuses into cells and is deacetylcated by cellular esterases into the non-fluorescent DCFH. ln the presence of ROS, DCFH is rapidly oxidized to highly fluorescent DCF. Fluorescence was quantified 12 h and 24 h after incubation with FWGE and DMBQ on a standard fluorescence plate reader at 480/530 nm. Results are presented as relative fluorescence units normalized for 104 cells.
Glucose consumption and lactic acid production
Cells (1.5×104) were seeded in 200 μl culture medium per well into 96-well flat-bottom tissue plates (Greiner bio-one). After 24 h, 48 h, and 72 h of culture, cell-free supernatant was analyzed for glucose consumption and lactic acid production by the central laboratory of the University Hospital of Würzburg using the Cobas 8000 modular analyzer series (Roche Diagnostics, Germany). Glucose consumption was calculated from the difference between glucose concentration in cellfree control medium and glucose concentration remaining in the supernatant of cell cultures after incubation. Lactic acid production was calculated from the difference between lactic acid concentrations in the supernatant of cell cultures before and after incubation. Results were correlated to the cell count and displayed as consumption/production per 104 cells.
Western blotting
Western blotting was performed as described earlier [
22,
23]. ln brief, 1 × 10
6 cells each were lysed in pre-cooled RIPA buffer (Pierce, USA) containing phosphatase and proteinase inhibitors and 2.5 mmol/l dithiothreitol (Sigma-Aldrich). Equal amounts of proteins (30 μg) were loaded on a 10 % polyacrylamide gel (SDS-PAGE), electrophoresed, and then blotted by semi-dry transfer onto a nitrocellulose membrane (Schleicher & Schuell, Germany). After a blocking step with 5 % non-fat milk (Merck, Germany), membranes were incubated with either a rabbit anti-DT diaphorase primary antibody (NQ01, N5288, Sigma-Aldrich; diluted 1:2,000) or a rabbit anti-LC3-I/-II primary antibody (AHP2167T; AbD Serotec GmbH, Germany; diluted 1:1,000). After washing with phosphate buffered saline (PBS), membranes were incubated with a horseradish peroxidaseconjugated goat anti-rabbit secondary antibody (KPL, USA; diluted 1:10,000) for 60 min at room temperature. A monoclonal mouse anti-β-actin primary antibody (Abcam, UK; diluted 1:10,000) was used as loading control and visualized with the goat anti-mouse secondary antibody (KPL, diluted 1: 10,000). lmmunoblots were visualized by enhanced chemiluminescence western blotting substrate (Pierce, Thermo Scientific, USA) with subsequent exposure on an X-ray film (Fuji Super RX medical X-ray films; Fuji, Germany) for 30 s.
Cell cycle analysis
For cell cycle analysis, 1×106 cells were fixed in suspension with 70 % ice-cold ethanol (−20 °C) and incubated for 2 h at 4 °C. Subsequently, ice-cold PBS was added and the cells were pelleted at 250 xg for 6 min at 4 °C. Cell pellets were resuspended with PBS. RNase (lnvitrogen GmbH, Germnay) was added for a final concentration of 50 μg/ml and incubated at 37 °C for 30 min in the dark. Then propidium iodide (Sigma-Aldrich; stock solution: 1 mg/ml, final concentration: 50 μg/ml) was added. After 5 min of incubation, the cells were measured for their DNA amount with a FACScan (Becton Dickinson, Germany). Data (10,000 events per acquisition) were recorded with BD CellQuest™ Pro software (Version 5.1.1) and data were analyzed with WinMDI software (Version 2.9).
Statistical analysis
The experiments were performed at least three times with triplicate samples. The means were compared using analysis of variance (ANOVA) plus Bonferroni’s t-test. A P-value of <0.05 was considered to indicate a statistically significant result.
Discussion
ln this study we analyzed the antiproliferative and antimetabolic effects of fermented wheat germ (FWGE) sold under the trade name Avemar. Because FWGE contains the anticancer compound DMBQ, which is thought to be responsible for the antiproliferative and antimetabolic properties of FWGE [
2], we investigated whether FWGE and DMBQ exhibit similar antiproliferative effects. For this purpose, the DMBQ compound was used in a molar concentration of 24 μmol/l equal to its concentration in FWGE [
2,
3]. FWGE and DMBQ were tested on nine human cancer cell lines derived from different cancer types (Table
1). ln addition, the effect of Avemar was also tested on normal human dermal fibroblasts (PromoCell, Germany) with an IC
50 value of 35.5 ± 20.5 mg/ml (not shown). 24 μmol/l of the DMBQ compound was found to be cytotoxic for all cancer cell lines tested within 24 h (Additional file
1: Figure S1), whereas 10 mg/ml FWGE (mean IC
50 value) exhibited additional cytostatic and growth delay effects. In this context, it is worth mentioning that 10 mg/ml FWGE in continuous culture with cancer cells was cytotoxic (Fig.
3), as was 50 mg/ml FWGE for 24 h (not shown). The treatment of cells with 10 mg/ml FWGE for 24 h allowed us to investigate the antimetabolic mechanisms of FWGE in detail.
DMBQ-mediated ROS-induced cytotoxicity is well known [
8,
9,
24,
25]. We found that DMBQ-induced cell damage was linked to increased intracellular DCF fluorescence. A comparable increase in DCF fluorescence was also found in BXPC-3 cells incubated with FWGE and indicates the production of intracellular ROS. Detection of ROS based on DCF fluorescence is the most widely used assay but various caveats apply [
26]. Our present findings provide further evidence for DMBQ/FWGE-induced ROS production, showing that exogenous glutathione (GSH) protected BxPC3 cells against DMBQ/FWGE-induced cell damage. Cellular glutathione levels are maintained by
de novo synthesis, reduction of glutathione disulfide, and glutathione uptake from exogenous sources [
11], underlining the role of glutathione as a free radical scavenger in cell cultures as described elsewhere [
25]. In addition, the thiolic antioxidant N-acetylcysteine and catalase both displayed protective effects and prevented DMBQ/FWGE-induced cell damage (not shown). In contrast to its cytotoxic effect, the cytostatic and growth delay effects of FWGE appear to be independent of oxidative stress and glutathione had no observable effect on cell viability.
A review of the literature shows that intracellular flavoenzymes play an important role in quinone bioactivation [
25]. In addition, activation of DMBQ outside the cell with ROS-induced lipid peroxidation is described as a possible mechanism for quinone cytotoxicity [
25,
27]. The barrier function of the plasma membrane is lost and DMBQ diffuses through the open plasma membrane into the cytoplasm with intracellular ROS production. With the exception of BxPC3 and ASPC-1 cells, DMBQ showed a need for ascorbic acid in order to induce DMBQ-mediated ROS production. Ascorbic acid acts as electron donor and reduces DMBQ to semiquinone radicals [
9]. It can be transported across the plasma membrane into the cell via the sodium-dependent vitamin C transporter or, in its oxidized form, via glucose transporter, including the ubiquitously expressed Glut1 [
28]. In contrast to DMBQ, the antiproliferative effect of FWGE was not influenced by ascorbic acid (not shown).
Some of the mechanisms of action for FWGE can be classified as metabolic effects [
14]. For example, FWGE prevents glucose uptake into cells and inhibits key enzymes of glycolysis such as hexokinase and lactate dehydrogenase [
17,
18]. Under sufficient oxygenation, normal cells direct glucose predominantly to mitochondrial oxidative phosphorylation to generate ATP, while cancer cells often exhibit nonoxidative glucose utilization, which enhances lactic acid production by lactate dehydrogenase (LDH). The reaction of LDH leads to the oxidization of NADH to NAD
+, necessary to support glycolytic flux [
15]. The exact role and regulation of a hyperactivated glycolytic pathway in cancer cells, termed aerobic glycolysis or the Warburg effect, is still not fully understood. Its major benefit to cancer cells is rapid ATP production and increased supply with anabolic substrates [
29]. To determine FWGE-induced alterations in cancer cell metabolism, we measured glucose consumption and generation of lactic acid during cell culture. FWGE impaired glucose consumption of 23132/87 cells and HRT-18 cells caused a low NADH/NAD
+ ratio, an indication of decreased glucose flux through glycolysis. In contrast to 23132/87 cells, FWGE-treated HRT-18 cells formed more lactic acid than would be expected from the low glucose consumption. An alternative pathway for the generation of lactic acid independent of glucose utilization is glutaminolysis. This pathway is involved in the conversion of cytosolic malic acid into pyruvic acid by malic enzymes [
30], where excess pyruvic acid is then depleted by LDH. The impact of glutamine on formation of lactic acid independent of glycolysis by FWGE-treated HRT-18 cells was not an object of this study and will be addressed in further studies.
FWGE-treated HRT-18 cells exhibited autophagic activity as demonstrated by the presence of the autophagy marker LC3-II [
31]. Autophagy is a self-degradation process which is proposed to have a pro-survival effect for cancer cells under metabolic stress by shifting the energy production from glycolysis towards degradation of unneeded proteins and fatty acids to feed the citric acid cycle for generating ATP [
32]. In this context, we found unchanged ATP levels in FWGE-treated HRT-18 cells, indicating that they are able to compensate the impaired glucose utilization during incubation with FWGE and maintain glycolysis-independent ATP production. In addition, HRT-18 cells had prolonged cell survival during continuous culture with FWGE in comparison to 23132/87 cells, which did not exhibit autophagy (Fig.
3). Taken together, the antiproliferative properties of FWGE display a complex interaction with cancer cell metabolism.
Abbreviations
ATP, adenosine triphosphate; CV, crystal violet; DCFH-DA, 2′,7′-dichlorofluorescin diacetate; DMBQ, 2,6-dimethoxy-1,4-benzoquinone; FWGE, fermented wheat germ extract; IC50, half maximal inhibitory concentration; NAD, nicotinamide adenine dinucleotide; PBS, phosphate buffered saline; RFU, relative fluorescence units; ROS, reactive oxygen species.
Acknowledgements
The authors are grateful to Sabine Gahn, Manuela Hofmann, Michaela Kapp, Monika Koospal, and Bettina Mühling for their skillful assistance with the experiments.