Prolonged pemetrexed pretreatment augments persistence of cisplatin-induced DNA damage and eliminates resistant lung cancer stem-like cells associated with EMT

Abstract

BackgroundLung cancer is the leading cause of cancer-related mortality, and new therapeutic options are urgently needed. Non-small cell lung cancer (NSCLC) accounts for approximately 85 % of all lung cancers, with the current standard regimen of care for NSCLC including chemotherapy with pemetrexed as a single agent or in combination with platinum-based agents, e.g. cisplatin. Pemetrexed is a folic acid antagonist that inhibits the synthesis of precursor nucleotides, whereas cisplatin directly induces DNA adducts, the repair of which is dependent on sufficiently high nucleotide levels. In the clinical setting, the pemetrexed-cisplatin combination therapy is administered concomitantly. We hypothesized that prolonged pretreatment with pemetrexed could be beneficial, as prior depletion of nucleotide pools could sensitize cancer cells to subsequent treatment with cisplatin.MethodsNSCLC A549 and H460 cells were treated with pemetrexed for 72 h. In addition, 24 h of cisplatin treatment was initiated at day 1, 2 or 3 resulting in either simultaneous pemetrexed application or pemetrexed pretreatment for 24 or 48 h, respectively. Cell growth and colony formation as well as senescence induction were quantified after treatment. Cell cycle distribution and phosphorylation of histone variant H2AX as a surrogate marker for DNA damage was quantified by flow cytometry. Relative changes in gene expression were determined by quantitative real time PCR.ResultsProlonged pemetrexed pretreatment for 48 h prior to cisplatin treatment maximally delayed long-term cell growth and significantly reduced the number of recovering clones. Moreover, apoptosis and senescence were augmented and recovery from treatment-induced DNA damage was delayed. Interestingly, a cell population was identified that displayed an epithelial-to-mesenchymal transition (EMT) and which had a stem cell phenotype. This population was highly resistant to concomitant pemetrexed-cisplatin treatment but was sensitized by pemetrexed pretreatment.ConclusionsAdaptation of the standard treatment schedule to include pretreatment with pemetrexed optimizes the anticancer efficiency of pemetrexed-cisplatin combination therapy, which correlates with a persistence of treatment-induced DNA damage. Therefore, this study warrants further investigations to elucidate whether such an adaptation could enhance the effectiveness of the standard clinical treatment regimen. In addition, a subpopulation of therapy resistant cells with EMT and cancer stem cell features was identified that was resistant to the standard treatment regimen but sensitive to pemetrexed pretreatment combined with cisplatin.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-2117-4) contains supplementary material, which is available to authorized users.

Metabolic vulnerability of cisplatin‐resistant cancers

“…In line with this notion, the combination of CDDP and raltitrexed, a chemotherapeutic agent that is a folic acid antagonist inhibiting the synthesis of nucleotides precursors, improves overall survival compared with CDDP alone in patients with malignant pleural mesothelioma (van Meerbeeck et al , ). Of note, the pretreatment with pemetrexed (Alimta®), another folate antimetabolite, re‐established in vitro CDDP‐induced killing of a CDDP‐resistant NSCLC cell population (Tieche et al , ).…”

ZNF32 contributes to the induction of multidrug resistance by regulating TGF-β receptor 2 signaling in lung adenocarcinoma

“…1 Approximately 85% of lung cancers are non-small cell lung cancer (NSCLC), 2 and lung AC is the most common histological subtype of NSCLC, making up more than 50% of all NSCLCs. 3 Historically, patients with NSCLC were treated with platinum chemotherapy.…”

TAZ overexpression is associated with epithelial-mesenchymal transition in cisplatin-resistant gastric cancer cells

“…Connexin 43 has been found to reverse the resistance of lung adenocarcinoma cells to cisplatin through inhibition of EMT (42). Further study revealed that prolonged pemetrexed pretreatment enhanced persistence of cisplatin-induced DNA damage and eliminated tumor cells with EMT and cancer stem-like features in lung cancer cells (43). Our study identified that TAZ governed the CR-mediated EMT in gastric cancer cells.…”