Abstract. Bufalin, an active component of the Chinese medicine chan'su, has been reported to have an inhibitory effect on the growth of various types of cancer cells. In the present study, we investigated whether gemcitabine combined with bufalin enhanced the antitumor efficacy in pancreatic cancer. Three pancreatic cancer cell lines (Bxpc-3, Mia PaCa-2 and Panc-1) were treated with gemcitabine and/or bufalin in vitro. The combination treatment demonstrated greater inhibition of cellular growth and apoptosis. The activity of apoptosis signal-regulating kinase 1 (ASK1)/JNK was upregulated in gemcitabine-induced apoptosis when combined with bufalin. We also observed that tumor growth was significantly inhibited by the combination therapy in a tumor-bearing mouse model, and upregulation of ASK1 activity was validated by immunohistochemical staining. These results suggest that bufalin may be a potential chemotherapeutic agent for pancreatic cancer, which could enhance the antitumor efficacy of gemcitabine when used in combination, possibly through the activation of ASK1/JNK.
IntroductionPancreatic cancer is one of the most devastating malignant tumors and the fifth most common cause of cancer-related mortality in developed countries (1). Due to the difficulties of early diagnosis and highly aggressive behavior (2), 85% of patients already have local infiltration or metastasis at the time of diagnosis. Less than 20% of patients have the option of radical tumor resection following the initial diagnosis (3). Thus, the 5-year survival rate of patients with pancreatic cancer is less than 5% (4,5). Apart from surgery, chemotherapy is an essential auxiliary treatment for the management of advanced pancreatic cancer. As the first-line chemotherapy drug for pancreatic cancer, gemcitabine has been widely used in the clinic (6).However, due to a high degree of acquired and inherent resistance to pancreatic cancer chemotherapy (7), up to 20% of pancreatic cancer patients show no obvious effect following treatment with gemcitabine monotherapy (8). Thus, combined therapy with gemcitabine has gained considerable attention in the attempt to improve the outcome of pancreatic cancer (9).Bufalin, an significant active component of the Chinese medicine chan'su (10), has widely demonstrated antitumor effects on human leukemia as well as ovarian, prostate and lung cancer (10-13). A possible mechanism of the antitumor effect of bufalin may be through the regulation of the MAPK signaling pathway and activation of a variety of transcription factors and protein kinases (14-16). It has been demonstrated that bufalin induces apoptosis in these cells via the activation of AP-1, the c-Jun N-terminal protein kinase (JNK), as well as by the induction of bcl-2 and the inhibition of protein kinase A. However, the effect of bufalin on pancreatic cancer cells has not yet been thoroughly evaluated.Apoptosis signal-regulating kinase 1 (ASK1), also known as mitogen-activated protein kinase kinase kinase 5 (MAP3K5), a member of the MAPK family, is a serin...