Sonosensitizer Nanoplatforms Augmented Sonodynamic Therapy-Sensitizing Shikonin-Induced Necroptosis Against Hepatocellular Carcinoma

Int J Nanomedicine. 2023 Nov 28:18:7079-7092. doi: 10.2147/IJN.S435104. eCollection 2023.

Abstract

Background: Apoptosis resistance of hepatocellular carcinoma (HCC) often leads to treatment failure. Nonetheless, overcoming the resistance of HCC to apoptosis by inducing necroptosis of tumor cells to bypass the apoptotic pathway may be a promising treatment strategy. Sonodynamic therapy (SDT) has broad prospects in disease treatment because of its noninvasive characteristic and spatiotemporal control. The combination of SDT and shikonin in the treatment of HCC is expected to be a new tumor treatment method that can overcome apoptosis resistance.

Methods: In this study, the antitumor effect was evaluated using normal liver cell line WRL68, HCC cell line HepG2 and HepG2 xenograft mouse models. Indocyanine green (ICG) was loaded on nanobubbles (NBs) to construct ICG-loaded nanobubbles (ICG-NBs). Combined sonosensitizer nanoplatforms with ultrasound (US) to achieve efficient SDT, the combination of SDT and shikonin in treating HCC can activate shikonin-induced necroptosis. As a result, tumor cells that produced apoptosis resistance were destroyed by necroptosis.

Results: The results indicated a successful preparation of ICG-NBs with a uniform particle size of 273.0 ± 118.9 nm spherical structures. ICG-NB-mediated SDT, in combination with shikonin treatment, inhibited the viability, invasion, and migration of tumor cells. SDT + shikonin treatment group caused a substantial increase in necroptotic cells. The increased degree of tumor necrosis and the upregulated expression of receptor-interacting protein 3 kinase were observed in vivo studies, which indicated that the antitumor effect was accompanied by enhanced necroptosis in the SDT + shikonin treatment group.

Conclusion: ICG-NB-mediated SDT combined with shikonin inhibits the growth of HCC by increasing the necroptosis of tumor cells. Therefore, this combination therapy is a promising treatment strategy against the specific cancer.

Keywords: hepatocellular carcinoma; necroptosis; shikonin; sonodynamic therapy; sonosensitizer.

MeSH terms

  • Animals
  • Apoptosis
  • Carcinoma, Hepatocellular* / drug therapy
  • Cell Line, Tumor
  • Humans
  • Indocyanine Green / pharmacology
  • Liver Neoplasms* / drug therapy
  • Mice
  • Necroptosis
  • Reactive Oxygen Species / metabolism

Substances

  • shikonin
  • Indocyanine Green
  • Reactive Oxygen Species

Grants and funding

This research was supported by the National Natural Science Foundation of China (grant number 82171947), and the Heilongjiang Provincial Natural Science Foundation of China (grant number ZD2021H005).