Priority Research Papers:

Targeting multidrug-resistant ovarian cancer through estrogen receptor α dependent ATP depletion caused by hyperactivation of the unfolded protein response

Xiaobin Zheng, Neal Andruska, Michael J. Lambrecht, Sisi He, Amadeo Parissenti, Paul J. Hergenrother, Erik R. Nelson and David J. Shapiro _

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Oncotarget. 2018; 9:14741-14753. https://doi.org/10.18632/oncotarget.10819

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Xiaobin Zheng1, Neal Andruska1,6, Michael J. Lambrecht2, Sisi He3, Amadeo Parissenti4, Paul J. Hergenrother2, Erik R. Nelson3,5 and David J. Shapiro1,5,6

1 Department of Biochemistry University of Illinois, Urbana, IL, USA

2 Department of Chemistry, University of Illinois, Urbana, IL, USA

3 Department of Molecular Integrative Physiology, University of Illinois, Urbana, IL, USA

4 Cancer Research Program, Advanced Medical Research Institute of Canada, Sudbury, ON, Canada

5 University of Illinois Cancer Center, Urbana, IL, USA

6 College of Medicine, University of Illinois, Urbana, IL, USA

Correspondence to:

David J. Shapiro, email:

Keywords: ERα biomodulator; ATP depletion; unfolded protein response (UPR); MDR1/P-glycoprotein/ABCB1; OVCAR-3 ovarian cancer

Received: May 02, 2016    Accepted: July 10, 2016    Epub: July 24, 2016    Published: March 13, 2018


Ovarian cancers often recur and tumors acquire resistance to chemotherapy due to overexpression of the ATP-dependent efflux pump, multidrug resistance protein 1 (MDR1/P-glycoprotein/ABCB1). Nontoxic small molecule inhibitors targeting MDR1 have remained largely elusive. Instead, in a novel application of our recently described estrogen receptor α (ERα) biomodulator, BHPI, we targeted MDR1’s substrate, ATP. BHPI depletes intracellular ATP and nearly blocks MDR1-mediated drug efflux in ovarian cancer cells by inducing toxic hyperactivation of the endoplasmic reticulum stress sensor, the unfolded protein response (UPR). BHPI increased sensitivity of MDR1 overexpressing multidrug resistant OVCAR-3 ovarian cancer cells to killing by paclitaxel by >1,000 fold. BHPI also restored doxorubicin sensitivity in OVCAR-3 cells and in MDR1 overexpressing breast cancer cells. In an orthotopic OVCAR-3 xenograft model, paclitaxel was ineffective and the paclitaxel-treated group was uniquely prone to form large secondary tumors in adjacent tissue. BHPI alone strongly reduced tumor growth. Notably, tumors were undetectable in mice treated with BHPI plus paclitaxel. Compared to control ovarian tumors, after the combination therapy, levels of the plasma ovarian cancer biomarker CA125 were at least several hundred folds lower; moreover, CA125 levels progressively declined to undetectable. Targeting MDR1 through UPR-dependent ATP depletion represents a promising therapeutic strategy.

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