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Ann Thorac Surg 2004;78:1207-1214
© 2004 The Society of Thoracic Surgeons

Original article: general thoracic

Proteasome Inhibition Sensitizes Non–Small-Cell Lung Cancer to Gemcitabine-Induced Apoptosis

Chadrick E. Denlinger, MDa, Brian K. Rundall, DOa, Michael D. Keller, BSa, David R. Jones, MDa,*

a Department of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA

Accepted for publication April 5, 2004.

* Address reprint requests to Dr Jones, Department of Surgery, Box 800679, University of Virginia, Charlottesville, VA, USA 22908-0679
djones{at}virginia.edu

Presented at the Fortieth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 26–28, 2004.

BACKGROUND: My colleagues and I have previously shown that chemotherapy activates the antiapoptotic transcription factor nuclear factor (NF)-{kappa}B in non–small-cell lung cancer (NSCLC). We hypothesized that inhibition of NF-{kappa}B by using the proteasome inhibitor bortezomib (Velcade) would sensitize NSCLC to gemcitabine-induced apoptosis.

METHODS: Tumorigenic NSCLC cell lines (H157 and A549) were treated with nothing, gemcitabine, bortezomib, or both compounds. NF-{kappa}B activity was determined by nuclear p65 protein levels, electrophoretic mobility shift assays, and reverse transcription-polymerase chain reaction of the NF-{kappa}B–regulated genes interleukin-8, c-IAP2, and Bcl-xL. The p21 and p53 protein levels were determined in similarly treated cells. Cell-cycle dysregulation was assessed by fluorescence-activated cell sorting analysis. Cell death and apoptosis were quantified by clonogenic assays, caspase-3 activation, and DNA fragmentation. NSCLC A549 xenografts were generated and treated as noted previously. Tumor growth was assessed over a 4-week treatment period. Statistical analysis was performed with analysis of variance.

RESULTS: Gemcitabine enhanced nuclear p65 levels, NF-{kappa}B binding to DNA, and transcription of all NF-{kappa}B–regulated genes. Bortezomib inhibited each of these effects. Combined gemcitabine and bortezomib enhanced p21 and p53 expression and induced S-phase and G2/M cell-cycle arrests, respectively. Combined treatment killed 80% of the NSCLC cells and induced apoptosis, as determined by caspase-3 activation (p = 0.05) and DNA fragmentation (p = 0.02). NSCLC xenografts treated with combination therapy grew significantly slower than xenografts treated with gemcitabine alone (p = 0.02).

CONCLUSIONS: Bortezomib inhibits gemcitabine-induced activation of NF-{kappa}B and sensitizes NSCLC to death in vitro and in vivo. This combined treatment strategy warrants further investigation and may represent a reasonable treatment strategy for select patients with NSCLC given the current clinical availability of both drugs.




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