Research Papers:

Polymerized human hemoglobin increases the effectiveness of cisplatin-based chemotherapy in non-small cell lung cancer

Alfredo Lucas, Donald A. Belcher, Carlos Munoz, Alexander T. Williams, Andre F. Palmer and Pedro Cabrales _

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Oncotarget. 2020; 11:3770-3781. https://doi.org/10.18632/oncotarget.27776

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Alfredo Lucas1, Donald A. Belcher2, Carlos Munoz1, Alexander T. Williams1, Andre F. Palmer2 and Pedro Cabrales1

1 Department of Bioengineering, University of California San Diego, La Jolla, CA 92093, USA

2 William G. Lowrie Department of Chemical and Biomolecular Engineering, The Ohio State University, Columbus, OH 43210, USA

Correspondence to:

Pedro Cabrales,email: [email protected]

Keywords: chemotherapy; cisplatin; polymerized hemoglobin; non-small cell lung cancer; hypoxia

Received: February 26, 2020     Accepted: June 15, 2020     Published: October 20, 2020

Copyright: © 2020 Lucas et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Cisplatin is a promising therapeutic for the treatment of non-small cell lung cancer (NSCLC). Unfortunately, a significant portion of NSCLC patients relapse due to cisplatin chemoresistance. This chemoresistance is thought to be primarily associated with hypoxia in the tumor microenvironment. Administration of hemoglobin (Hb)-based oxygen (O2) carriers (HBOCs) is a promising strategy to alleviate hypoxia in the tumor, which may make cisplatin more effective. In this study, we administered a high O2 affinity, relaxed state (R-state) polymerized hemoglobin (PolyHb) to three different NSCLC cell lines cultured in vitro and implanted in vivo into healthy mice. The R-state PolyHb administered in this study is unable to deliver O2 unless under severe hypoxia which significantly limits its oxygenation potential. In vitro sensitivity studies indicate that the administration of PolyHb increases the effectiveness of cisplatin under hypoxic conditions. Additional animal studies revealed that co-administration of PolyHb with cisplatin attenuated tumor growth without alleviating hypoxia. Analysis of reactive O2 species production in the presence of hypoxic culture indicates that exogenous ROS production by oxidized PolyHb may the mechanism of chemosensitization. This ROS mechanism, coupled with oxygenation, may be a potential chemosensitizing strategy for use in NSCLC treatment.

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