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Erschienen in: Annals of Surgical Oncology 2/2010

01.02.2010 | Translational Research and Biomarkers

Glucose-Regulated Protein 78 Is a Novel Contributor to Acquisition of Resistance to Sorafenib in Hepatocellular Carcinoma

verfasst von: Jeng-Fong Chiou, MD, Cheng-Jeng Tai, MD, Ming-Te Huang, MD, Po-Li Wei, MD, Yu-Huei Wang, MS, Jane An, BS, Chih-Hsiung Wu, Tsan-Zon Liu, PhD, Yu-Jia Chang, PhD

Erschienen in: Annals of Surgical Oncology | Ausgabe 2/2010

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Abstract

Background

Sorafenib is a newly established cancer drug found to be an effective systemic treatment for advanced hepatocellular carcinoma (HCC). However, little is known about any potential effectors that modify tumor cell sensitivity towards sorafenib. Here, we present the first evidence that glucose-regulated protein 78 (GRP78) is intimately associated with acquisition of resistance towards sorafenib.

Methods

The role of GRP78 in acquisition of resistance towards sorafenib was determined using HepJ5 (a GRP78-overexpressing subline) and HepG2 as its pair-matched control. RNA interference in cancer cells was applied to determine the influence of GRP78 expression on sensitivity to sorafenib treatment.

Results

We found that HepG2 cells exhibited higher sensitivity toward sorafenib, with 50% inhibition concentration (IC50) >20 μΜ for HepJ5 and 4.8 μM for HepG2. Specifically, when HepG2 cells received 20 μM sorafenib treatment for 24 h, over 80% of cells underwent apoptosis compared with only 32% of HepJ5 cells under similar experimental conditions. Similarly, GRP78 knockdown in HepJ5 cells by small interfering RNA (siRNA) technique enhanced the efficacy of sorafenib-mediated cell death. This was reflected by a shift of IC50 values from >20 μM to 4.8 μM.

Conclusions

GRP78 is a positive modifier for sorafenib resistance acquisition in HCC and represents a prime target for overcoming sorafenib resistance.
Literatur
1.
Zurück zum Zitat Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55:74–108.CrossRefPubMed Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55:74–108.CrossRefPubMed
2.
Zurück zum Zitat Thorgeirsson SS, Grisham JW. Molecular pathogenesis of human hepatocellular carcinoma. Nat Genet. 2002;31:339–46.CrossRefPubMed Thorgeirsson SS, Grisham JW. Molecular pathogenesis of human hepatocellular carcinoma. Nat Genet. 2002;31:339–46.CrossRefPubMed
3.
Zurück zum Zitat Thomas MB, Zhu AX. Hepatocellular carcinoma: the need for progress. J Clin Oncol. 2005;23:2892–9.CrossRefPubMed Thomas MB, Zhu AX. Hepatocellular carcinoma: the need for progress. J Clin Oncol. 2005;23:2892–9.CrossRefPubMed
4.
Zurück zum Zitat Zhu AX. Systemic therapy of advanced hepatocellular carcinoma: how hopeful should we be? Oncologist. 2006;11:790–800.CrossRefPubMed Zhu AX. Systemic therapy of advanced hepatocellular carcinoma: how hopeful should we be? Oncologist. 2006;11:790–800.CrossRefPubMed
5.
Zurück zum Zitat Wu S, Chen JJ, Kudelka A, Lu J, Zhu X. Incidence and risk of hypertension with sorafenib in patients with cancer: a systematic review and meta-analysis. Lancet Oncol. 2008;9:117–23.CrossRefPubMed Wu S, Chen JJ, Kudelka A, Lu J, Zhu X. Incidence and risk of hypertension with sorafenib in patients with cancer: a systematic review and meta-analysis. Lancet Oncol. 2008;9:117–23.CrossRefPubMed
6.
Zurück zum Zitat Bracarda S, Caserta C, Sordini L, Rossi M, Hamzay A, Crino L. Protein kinase inhibitors in the treatment of renal cell carcinoma: sorafenib. Ann Oncol. 2007;18(Suppl 6):vi22–5 Bracarda S, Caserta C, Sordini L, Rossi M, Hamzay A, Crino L. Protein kinase inhibitors in the treatment of renal cell carcinoma: sorafenib. Ann Oncol. 2007;18(Suppl 6):vi22–5
7.
Zurück zum Zitat Llovet JM. Clinical and molecular classification of hepatocellular carcinoma. Liver Transpl. 2007;13:S13–6.CrossRefPubMed Llovet JM. Clinical and molecular classification of hepatocellular carcinoma. Liver Transpl. 2007;13:S13–6.CrossRefPubMed
8.
Zurück zum Zitat Li J, Lee AS. Stress induction of GRP78/BiP and its role in cancer. Curr Mol Med. 2006;6:45–54.CrossRefPubMed Li J, Lee AS. Stress induction of GRP78/BiP and its role in cancer. Curr Mol Med. 2006;6:45–54.CrossRefPubMed
9.
Zurück zum Zitat Lee AS. GRP78 induction in cancer: therapeutic and prognostic implications. Cancer Res. 2007;67:3496–9.CrossRefPubMed Lee AS. GRP78 induction in cancer: therapeutic and prognostic implications. Cancer Res. 2007;67:3496–9.CrossRefPubMed
10.
Zurück zum Zitat Fernandez PM, Tabbara SO, Jacobs LK, Manning FC, Tsangaris TN, Schwartz AM, et al. Overexpression of the glucose-regulated stress gene GRP78 in malignant but not benign human breast lesions. Breast Cancer Res Treat. 2000;59:15–26.CrossRefPubMed Fernandez PM, Tabbara SO, Jacobs LK, Manning FC, Tsangaris TN, Schwartz AM, et al. Overexpression of the glucose-regulated stress gene GRP78 in malignant but not benign human breast lesions. Breast Cancer Res Treat. 2000;59:15–26.CrossRefPubMed
11.
Zurück zum Zitat Jamora C, Dennert G, Lee AS. Inhibition of tumor progression by suppression of stress protein GRP78/BiP induction in fibrosarcoma B/C10ME. Proc Natl Acad Sci USA. 1996;93:7690–4.CrossRefPubMed Jamora C, Dennert G, Lee AS. Inhibition of tumor progression by suppression of stress protein GRP78/BiP induction in fibrosarcoma B/C10ME. Proc Natl Acad Sci USA. 1996;93:7690–4.CrossRefPubMed
12.
Zurück zum Zitat Koong AC, Chen EY, Lee AS, Brown JM, Giaccia AJ. Increased cytotoxicity of chronic hypoxic cells by molecular inhibition of GRP78 induction. Int J Radiat Oncol Biol Phys. 1994;28:661–6.PubMed Koong AC, Chen EY, Lee AS, Brown JM, Giaccia AJ. Increased cytotoxicity of chronic hypoxic cells by molecular inhibition of GRP78 induction. Int J Radiat Oncol Biol Phys. 1994;28:661–6.PubMed
13.
Zurück zum Zitat Tomida A, Tsuruo T. Drug resistance mediated by cellular stress response to the microenvironment of solid tumors. Anticancer Drug Des. 1999;14:169–77.PubMed Tomida A, Tsuruo T. Drug resistance mediated by cellular stress response to the microenvironment of solid tumors. Anticancer Drug Des. 1999;14:169–77.PubMed
14.
Zurück zum Zitat Belfi CA, Chatterjee S, Gosky DM, Berger SJ, Berger NA. Increased sensitivity of human colon cancer cells to DNA cross-linking agents after GRP78 up-regulation. Biochem Biophys Res Commun. 1999;257:361–8.CrossRefPubMed Belfi CA, Chatterjee S, Gosky DM, Berger SJ, Berger NA. Increased sensitivity of human colon cancer cells to DNA cross-linking agents after GRP78 up-regulation. Biochem Biophys Res Commun. 1999;257:361–8.CrossRefPubMed
15.
Zurück zum Zitat Croute F, Poinsot J, Gaubin Y, Beau B, Simon V, Murat JC, et al. Volatile organic compounds cytotoxicity and expression of HSP72, HSP90 and GRP78 stress proteins in cultured human cells. Biochim Biophys Acta. 2002;1591:147–55.CrossRefPubMed Croute F, Poinsot J, Gaubin Y, Beau B, Simon V, Murat JC, et al. Volatile organic compounds cytotoxicity and expression of HSP72, HSP90 and GRP78 stress proteins in cultured human cells. Biochim Biophys Acta. 2002;1591:147–55.CrossRefPubMed
16.
Zurück zum Zitat Tchounwou PB, Wilson BA, Ishaque AB, Schneider J. Atrazine potentiation of arsenic trioxide-induced cytotoxicity and gene expression in human liver carcinoma cells (HepG2). Mol Cell Biochem. 2001;222:49–59.CrossRefPubMed Tchounwou PB, Wilson BA, Ishaque AB, Schneider J. Atrazine potentiation of arsenic trioxide-induced cytotoxicity and gene expression in human liver carcinoma cells (HepG2). Mol Cell Biochem. 2001;222:49–59.CrossRefPubMed
17.
Zurück zum Zitat Tchounwou PB, Ishaque AB, Schneider J. Cytotoxicity and transcriptional activation of stress genes in human liver carcinoma cells (HepG2) exposed to cadmium chloride. Mol Cell Biochem. 2001;222:21–8.CrossRefPubMed Tchounwou PB, Ishaque AB, Schneider J. Cytotoxicity and transcriptional activation of stress genes in human liver carcinoma cells (HepG2) exposed to cadmium chloride. Mol Cell Biochem. 2001;222:21–8.CrossRefPubMed
18.
Zurück zum Zitat Ma Y, Yu J, Chan HL, Chen YC, Wang H, Chen Y, et al. Glucose-regulated protein 78 is an intracellular antiviral factor against hepatitis B virus. Mol Cell Proteomics. 2009 Aug 11 [Epub ahead of print]. Ma Y, Yu J, Chan HL, Chen YC, Wang H, Chen Y, et al. Glucose-regulated protein 78 is an intracellular antiviral factor against hepatitis B virus. Mol Cell Proteomics. 2009 Aug 11 [Epub ahead of print].
19.
Zurück zum Zitat Dong D, Ko B, Baumeister P, Swenson S, Costa F, Markland F, et al. Vascular targeting and antiangiogenesis agents induce drug resistance effector GRP78 within the tumor microenvironment. Cancer Res. 2005;65:5785–91.CrossRefPubMed Dong D, Ko B, Baumeister P, Swenson S, Costa F, Markland F, et al. Vascular targeting and antiangiogenesis agents induce drug resistance effector GRP78 within the tumor microenvironment. Cancer Res. 2005;65:5785–91.CrossRefPubMed
20.
Zurück zum Zitat Wang SK, Liang PH, Astronomo RD, Hsu TL, Hsieh SL, Burton DR, et al. Targeting the carbohydrates on HIV-1: Interaction of oligomannose dendrons with human monoclonal antibody 2G12 and DC-SIGN. Proc Natl Acad Sci USA. 2008;105:3690–5.CrossRefPubMed Wang SK, Liang PH, Astronomo RD, Hsu TL, Hsieh SL, Burton DR, et al. Targeting the carbohydrates on HIV-1: Interaction of oligomannose dendrons with human monoclonal antibody 2G12 and DC-SIGN. Proc Natl Acad Sci USA. 2008;105:3690–5.CrossRefPubMed
21.
Zurück zum Zitat Sowinski S, Jolly C, Berninghausen O, Purbhoo MA, Chauveau A, Kohler K, et al. Membrane nanotubes physically connect T cells over long distances presenting a novel route for HIV-1 transmission. Nat Cell Biol. 2008;10:211–9.CrossRefPubMed Sowinski S, Jolly C, Berninghausen O, Purbhoo MA, Chauveau A, Kohler K, et al. Membrane nanotubes physically connect T cells over long distances presenting a novel route for HIV-1 transmission. Nat Cell Biol. 2008;10:211–9.CrossRefPubMed
22.
Zurück zum Zitat Jou MJ, Jou SB, Chen HM, Lin CH, Peng TI. Critical role of mitochondrial reactive oxygen species formation in visible laser irradiation-induced apoptosis in rat brain astrocytes (RBA-1). J Biomed Sci. 2002;9:507–16.CrossRefPubMed Jou MJ, Jou SB, Chen HM, Lin CH, Peng TI. Critical role of mitochondrial reactive oxygen species formation in visible laser irradiation-induced apoptosis in rat brain astrocytes (RBA-1). J Biomed Sci. 2002;9:507–16.CrossRefPubMed
23.
Zurück zum Zitat LeBel CP, Ischiropoulos H, Bondy SC. Evaluation of the probe 2′,7′-dichlorofluorescin as an indicator of reactive oxygen species formation and oxidative stress. Chem Res Toxicol. 1992;5:227–31.CrossRef LeBel CP, Ischiropoulos H, Bondy SC. Evaluation of the probe 2′,7′-dichlorofluorescin as an indicator of reactive oxygen species formation and oxidative stress. Chem Res Toxicol. 1992;5:227–31.CrossRef
24.
Zurück zum Zitat Carter WO, Narayanan PK, Robinson JP. Intracellular hydrogen peroxide and superoxide anion detection in endothelial cells. J Leukoc Biol. 1994;55:253–8.PubMed Carter WO, Narayanan PK, Robinson JP. Intracellular hydrogen peroxide and superoxide anion detection in endothelial cells. J Leukoc Biol. 1994;55:253–8.PubMed
25.
Zurück zum Zitat Reers M, Smith TW, Chen LB. J-aggregate formation of a carbocyanine as a quantitative fluorescent indicator of membrane potential. Biochemistry. 1991;30:4480–6.CrossRefPubMed Reers M, Smith TW, Chen LB. J-aggregate formation of a carbocyanine as a quantitative fluorescent indicator of membrane potential. Biochemistry. 1991;30:4480–6.CrossRefPubMed
26.
Zurück zum Zitat Smiley ST, Reers M, Mottola-Hartshorn C, Lin M, Chen A, Smith TW, et al. Intracellular heterogeneity in mitochondrial membrane potentials revealed by a J-aggregate-forming lipophilic cation JC-1. Proc Natl Acad Sci USA. 1991;88:3671–5.CrossRefPubMed Smiley ST, Reers M, Mottola-Hartshorn C, Lin M, Chen A, Smith TW, et al. Intracellular heterogeneity in mitochondrial membrane potentials revealed by a J-aggregate-forming lipophilic cation JC-1. Proc Natl Acad Sci USA. 1991;88:3671–5.CrossRefPubMed
27.
Zurück zum Zitat Szilagyi G, Simon L, Koska P, Telek G, Nagy Z. Visualization of mitochondrial membrane potential and reactive oxygen species via double staining. Neurosci Lett. 2006;399:206–9.CrossRefPubMed Szilagyi G, Simon L, Koska P, Telek G, Nagy Z. Visualization of mitochondrial membrane potential and reactive oxygen species via double staining. Neurosci Lett. 2006;399:206–9.CrossRefPubMed
28.
Zurück zum Zitat Zhang YZ, Ouyang YC, Hou Y, Schatten H, Chen DY, Sun QY. Mitochondrial behavior during oogenesis in zebrafish: a confocal microscopy analysis. Dev Growth Differ. 2008;50:189–201.PubMed Zhang YZ, Ouyang YC, Hou Y, Schatten H, Chen DY, Sun QY. Mitochondrial behavior during oogenesis in zebrafish: a confocal microscopy analysis. Dev Growth Differ. 2008;50:189–201.PubMed
29.
30.
Zurück zum Zitat Sridhar SS, Hedley D, Siu LL. Raf kinase as a target for anticancer therapeutics. Mol Cancer Ther. 2005;4:677–85.CrossRefPubMed Sridhar SS, Hedley D, Siu LL. Raf kinase as a target for anticancer therapeutics. Mol Cancer Ther. 2005;4:677–85.CrossRefPubMed
31.
Zurück zum Zitat Beeram M, Patnaik A, Rowinsky EK. Raf: a strategic target for therapeutic development against cancer. J Clin Oncol. 2005;23:6771–90.CrossRefPubMed Beeram M, Patnaik A, Rowinsky EK. Raf: a strategic target for therapeutic development against cancer. J Clin Oncol. 2005;23:6771–90.CrossRefPubMed
32.
Zurück zum Zitat Gridelli C, Maione P, Del Gaizo F, Colantuoni G, Guerriero C, Ferrara C, et al. Sorafenib and sunitinib in the treatment of advanced non-small cell lung cancer. Oncologist. 2007;12:191–200.CrossRefPubMed Gridelli C, Maione P, Del Gaizo F, Colantuoni G, Guerriero C, Ferrara C, et al. Sorafenib and sunitinib in the treatment of advanced non-small cell lung cancer. Oncologist. 2007;12:191–200.CrossRefPubMed
33.
Zurück zum Zitat Morris JA, Dorner AJ, Edwards CA, Hendershot LM, Kaufman RJ. Immunoglobulin binding protein (BiP) function is required to protect cells from endoplasmic reticulum stress but is not required for the secretion of selective proteins. J Biol Chem. 1997;272:4327–34.CrossRefPubMed Morris JA, Dorner AJ, Edwards CA, Hendershot LM, Kaufman RJ. Immunoglobulin binding protein (BiP) function is required to protect cells from endoplasmic reticulum stress but is not required for the secretion of selective proteins. J Biol Chem. 1997;272:4327–34.CrossRefPubMed
34.
Zurück zum Zitat Rao RV, Peel A, Logvinova A, del Rio G, Hermel E, Yokota T, et al. Coupling endoplasmic reticulum stress to the cell death program: role of the ER chaperone GRP78. FEBS Lett. 2002;514:122–8.PubMed Rao RV, Peel A, Logvinova A, del Rio G, Hermel E, Yokota T, et al. Coupling endoplasmic reticulum stress to the cell death program: role of the ER chaperone GRP78. FEBS Lett. 2002;514:122–8.PubMed
35.
Zurück zum Zitat Tsutsumi S, Namba T, Tanaka KI, Arai Y, Ishihara T, Aburaya M, et al. Celecoxib upregulates endoplasmic reticulum chaperones that inhibit celecoxib-induced apoptosis in human gastric cells. Oncogene. 2006;25:1018–29.CrossRefPubMed Tsutsumi S, Namba T, Tanaka KI, Arai Y, Ishihara T, Aburaya M, et al. Celecoxib upregulates endoplasmic reticulum chaperones that inhibit celecoxib-induced apoptosis in human gastric cells. Oncogene. 2006;25:1018–29.CrossRefPubMed
36.
Zurück zum Zitat Reddy RK, Mao C, Baumeister P, Austin RC, Kaufman RJ, Lee AS. Endoplasmic reticulum chaperone protein GRP78 protects cells from apoptosis induced by topoisomerase inhibitors: role of ATP binding site in suppression of caspase-7 activation. J Biol Chem. 2003;278:20915–24.CrossRefPubMed Reddy RK, Mao C, Baumeister P, Austin RC, Kaufman RJ, Lee AS. Endoplasmic reticulum chaperone protein GRP78 protects cells from apoptosis induced by topoisomerase inhibitors: role of ATP binding site in suppression of caspase-7 activation. J Biol Chem. 2003;278:20915–24.CrossRefPubMed
37.
Zurück zum Zitat Lin ZP, Boller YC, Amer SM, Russell RL, Pacelli KA, Patierno SR, et al. Prevention of brefeldin A-induced resistance to teniposide by the proteasome inhibitor MG-132: involvement of NF-kappaB activation in drug resistance. Cancer Res. 1998;58:3059–65.PubMed Lin ZP, Boller YC, Amer SM, Russell RL, Pacelli KA, Patierno SR, et al. Prevention of brefeldin A-induced resistance to teniposide by the proteasome inhibitor MG-132: involvement of NF-kappaB activation in drug resistance. Cancer Res. 1998;58:3059–65.PubMed
38.
Zurück zum Zitat Lang L. FDA approves sorafenib for patients with inoperable liver cancer. Gastroenterology. 2008;134:379. Lang L. FDA approves sorafenib for patients with inoperable liver cancer. Gastroenterology. 2008;134:379.
39.
Zurück zum Zitat Rahmani M, Davis EM, Crabtree TR, Habibi JR, Nguyen TK, Dent P, et al. The kinase inhibitor sorafenib induces cell death through a process involving induction of endoplasmic reticulum stress. Mol Cell Biol. 2007;27:5499–513.CrossRefPubMed Rahmani M, Davis EM, Crabtree TR, Habibi JR, Nguyen TK, Dent P, et al. The kinase inhibitor sorafenib induces cell death through a process involving induction of endoplasmic reticulum stress. Mol Cell Biol. 2007;27:5499–513.CrossRefPubMed
40.
Zurück zum Zitat Liu H, Bowes RC III, van de Water B, Sillence C, Nagelkerke JF, Stevens JL. Endoplasmic reticulum chaperones GRP78 and calreticulin prevent oxidative stress, Ca2+ disturbances, and cell death in renal epithelial cells. J Biol Chem. 1997;272:21751–9.CrossRefPubMed Liu H, Bowes RC III, van de Water B, Sillence C, Nagelkerke JF, Stevens JL. Endoplasmic reticulum chaperones GRP78 and calreticulin prevent oxidative stress, Ca2+ disturbances, and cell death in renal epithelial cells. J Biol Chem. 1997;272:21751–9.CrossRefPubMed
41.
Zurück zum Zitat Lee AS. The glucose-regulated proteins: stress induction and clinical applications. Trends Biochem Sci. 2001;26:504–10.CrossRefPubMed Lee AS. The glucose-regulated proteins: stress induction and clinical applications. Trends Biochem Sci. 2001;26:504–10.CrossRefPubMed
Metadaten
Titel
Glucose-Regulated Protein 78 Is a Novel Contributor to Acquisition of Resistance to Sorafenib in Hepatocellular Carcinoma
verfasst von
Jeng-Fong Chiou, MD
Cheng-Jeng Tai, MD
Ming-Te Huang, MD
Po-Li Wei, MD
Yu-Huei Wang, MS
Jane An, BS
Chih-Hsiung Wu
Tsan-Zon Liu, PhD
Yu-Jia Chang, PhD
Publikationsdatum
01.02.2010
Verlag
Springer-Verlag
Erschienen in
Annals of Surgical Oncology / Ausgabe 2/2010
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-009-0718-8

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