During multidrug combination chemotherapy, activation
of the nuclear receptor and the transcription factor human pregnane
xenobiotic receptor (hPXR) has been shown to play a role in the development
of chemoresistance. Mechanistically, this could occur due to the cancer
drug activation of hPXR and the subsequent upregulation of hPXR target
genes such as the drug metabolism enzyme, cytochrome P450 3A4 (CYP3A4).
In the context of hPXR-mediated drug resistance, hPXR antagonists
would be useful adjuncts to PXR-activating chemotherapy. However,
there are currently no clinically approved hPXR antagonists in the
market. Gefitinib (GEF), a tyrosine kinase inhibitor used for the
treatment of advanced non-small-cell lung cancer and effectively used
in combinational chemotherapy treatments, is a promising candidate
owing to its hPXR ligand-like features. We, therefore, investigated
whether GEF would act as an hPXR antagonist when combined with a known
hPXR agonist, rifampicin (RIF). At therapeutically relevant concentrations,
GEF successfully inhibited the RIF-induced upregulation of endogenous
CYP3A4 gene expression in human primary hepatocytes and human hepatocells.
Additionally, GEF inhibited the RIF induction of hPXR-mediated CYP3A4
promoter activity in HepG2 human liver carcinoma cells. The computational
modeling of molecular docking predicted that GEF could bind to multiple
sites on hPXR including the ligand-binding pocket, allowing for potential
as a direct antagonist as well as an allosteric inhibitor. Indeed,
GEF bound to the ligand-binding domain of the hPXR in cell-free assays,
suggesting that GEF directly interacts with the hPXR. Taken together,
our results suggest that GEF, at its clinically relevant therapeutic
concentration, can antagonize the hPXR agonist-induced CYP3A4 gene
expression in human hepatocytes. Thus, GEF could be a potential candidate
for use in combinational chemotherapies to combat hPXR agonist-induced
chemoresistance. Further studies are warranted to determine whether
GEF has sufficient hPXR inhibitor abilities to overcome the hPXR agonist-induced
chemoresistance.