Sequential dosing in chemosensitization: targeting the PI3K/Akt/mTOR pathway in neuroblastoma

PLoS One. 2013 Dec 31;8(12):e83128. doi: 10.1371/journal.pone.0083128. eCollection 2013.

Abstract

Breaking resistance to chemotherapy is a major goal of combination therapy in many tumors, including advanced neuroblastoma. We recently demonstrated that increased activity of the PI3K/Akt network is associated with poor prognosis, thus providing an ideal target for chemosensitization. Here we show that targeted therapy using the PI3K/mTOR inhibitor NVP-BEZ235 significantly enhances doxorubicin-induced apoptosis in neuroblastoma cells. Importantly, this increase in apoptosis was dependent on scheduling: while pretreatment with the inhibitor reduced doxorubicin-induced apoptosis, the sensitizing effect in co-treatment could further be increased by delayed addition of the inhibitor post chemotherapy. Desensitization for doxorubicin-induced apoptosis seemed to be mediated by a combination of cell cycle-arrest and autophagy induction, whereas sensitization was found to occur at the level of mitochondria within one hour of NVP-BEZ235 posttreatment, leading to a rapid loss of mitochondrial membrane potential with subsequent cytochrome c release and caspase-3 activation. Within the relevant time span we observed marked alterations in a ∼30 kDa protein associated with mitochondrial proteins and identified it as VDAC1/Porin protein, an integral part of the mitochondrial permeability transition pore complex. VDAC1 is negatively regulated by the PI3K/Akt pathway via GSK3β and inhibition of GSK3β, which is activated when Akt is blocked, ablated the sensitizing effect of NVP-BEZ235 posttreatment. Our findings show that cancer cells can be sensitized for chemotherapy induced cell death - at least in part - by NVP-BEZ235-mediated modulation of VDAC1. More generally, we show data that suggest that sequential dosing, in particular when multiple inhibitors of a single pathway are used in the optimal sequence, has important implications for the general design of combination therapies involving molecular targeted approaches towards the PI3K/Akt/mTOR signaling network.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antineoplastic Agents / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Apoptosis / drug effects
  • Cell Line, Tumor
  • Doxorubicin / administration & dosage
  • Drug Synergism
  • Enzyme Inhibitors / administration & dosage*
  • Glycogen Synthase Kinase 3 / antagonists & inhibitors
  • Glycogen Synthase Kinase 3 beta
  • Humans
  • Imidazoles / administration & dosage
  • Membrane Potential, Mitochondrial / drug effects
  • Neuroblastoma / drug therapy*
  • Neuroblastoma / metabolism*
  • Neuroblastoma / pathology
  • Phosphoinositide-3 Kinase Inhibitors*
  • Proto-Oncogene Proteins c-akt / antagonists & inhibitors*
  • Quinolines / administration & dosage
  • Signal Transduction / drug effects
  • TOR Serine-Threonine Kinases / antagonists & inhibitors*
  • Voltage-Dependent Anion Channel 1 / metabolism

Substances

  • Antineoplastic Agents
  • Enzyme Inhibitors
  • Imidazoles
  • Phosphoinositide-3 Kinase Inhibitors
  • Quinolines
  • VDAC1 protein, human
  • Doxorubicin
  • Voltage-Dependent Anion Channel 1
  • MTOR protein, human
  • GSK3B protein, human
  • Glycogen Synthase Kinase 3 beta
  • Proto-Oncogene Proteins c-akt
  • TOR Serine-Threonine Kinases
  • Glycogen Synthase Kinase 3
  • dactolisib

Grants and funding

This work has been partially supported by grants from Deutsche Krebshilfe (SF and KMD), Deutsche Forschungsgemeinschaft (LN) and the International Graduate School in Molecular Medicine Ulm (CJ). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.