Research Papers:

Serotonergic system antagonists target breast tumor initiating cells and synergize with chemotherapy to shrink human breast tumor xenografts

William D. Gwynne _, Robin M. Hallett, Adele Girgis-Gabardo, Bojana Bojovic, Anna Dvorkin-Gheva, Craig Aarts, Kay Dias, Anita Bane and John A. Hassell

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Oncotarget. 2017; 8:32101-32116. https://doi.org/10.18632/oncotarget.16646

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William D. Gwynne1, Robin M. Hallett1, Adele Girgis-Gabardo1, Bojana Bojovic1, Anna Dvorkin-Gheva2, Craig Aarts1, Kay Dias2, Anita Bane2 and John A. Hassell1,2

1Department of Biochemistry and Biomedical Sciences, McMaster University, Canada

2Department of Pathology and Molecular Medicine, McMaster University, Canada

Correspondence to:

John A. Hassell, email: [email protected]

Keywords: breast cancer stem cells, tumor-initiating cells, serotonin antagonists, antidepressants, cytotoxic chemotherapy

Received: November 25, 2016     Accepted: March 01, 2017     Published: March 29, 2017


Breast tumors comprise an infrequent tumor cell population, termed breast tumor initiating cells (BTIC), which sustain tumor growth, seed metastases and resist cytotoxic therapies. Hence therapies are needed to target BTIC to provide more durable breast cancer remissions than are currently achieved. We previously reported that serotonergic system antagonists abrogated the activity of mouse BTIC resident in the mammary tumors of a HER2-overexpressing model of breast cancer. Here we report that antagonists of serotonin (5-hydroxytryptamine; 5-HT) biosynthesis and activity, including US Federal Food and Drug Administration (FDA)-approved antidepressants, targeted BTIC resident in numerous breast tumor cell lines regardless of their clinical or molecular subtype. Notably, inhibitors of tryptophan hydroxylase 1 (TPH1), required for 5-HT biosynthesis in select non-neuronal cells, the serotonin reuptake transporter (SERT) and several 5-HT receptors compromised BTIC activity as assessed by functional sphere-forming assays. Consistent with these findings, human breast tumor cells express TPH1, 5-HT and SERT independent of their molecular or clinical subtype. Exposure of breast tumor cells ex vivo to sertraline (Zoloft), a selective serotonin reuptake inhibitor (SSRI), reduced BTIC frequency as determined by transplanting drug-treated tumor cells into immune-compromised mice. Moreover, another SSRI (vilazodone; Viibryd) synergized with chemotherapy to shrink breast tumor xenografts in immune-compromised mice by inhibiting tumor cell proliferation and inducing their apoptosis. Collectively our data suggest that antidepressants in combination with cytotoxic anticancer therapies may be an appropriate treatment regimen for testing in clinical trials.

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