Metformin and temozolomide act synergistically to inhibit growth of glioma cells and glioma stem cells in vitro and in vivo
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Zhiyun Yu1, Gang Zhao1, Guifang Xie2, Liyan Zhao3, Yong Chen1, Hongquan Yu1, Zhonghua Zhang1, Cai Li4, Yunqian Li1
1Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
2Department of Obstetrics and Gynecology, First Hospital of Jilin University, Changchun, China
3Department of Clinical Laboratory, Second Hospital of Jilin University, Changchun, China
4Department of Experimental Pharmacology and Toxicology, School of Pharmacy, Jilin University, Changchun, China
Yunqian Li, e-mail: firstname.lastname@example.org
Keywords: AMPK, AKT-mTOR, glioma stem cell, metformin, temozolomide
Received: May 20, 2015 Accepted: September 14, 2015 Published: September 26, 2015
Glioblastoma (GBM) is the most frequent and aggressive brain tumor in adults. In spite of advances in diagnosis and therapy, the prognosis of patients with GBM has remained dismal. The fast recurrence and multi-drug resistance are some of the key challenges in combating brain tumors. Glioma stem cells (GSCs) which are considered the source of relapse and chemoresistance, the need for more effective therapeutic options is overwhelming. In our present work, we found that combined treatment with temozolomide (TMZ) and metformin (MET) synergistically inhibited proliferation and induced apoptosis in both glioma cells and GSCs. Combination of TMZ and MET significantly reduced the secondary gliosphere formation and expansion of GSCs. We first demonstrated that MET effectively inhibited the AKT activation induced by TMZ, and a combination of both drugs led to enhanced reduction of mTOR, 4EBP1 and S6K phosphorylation. In addition, the combination of the two drugs was accompanied with a powerful AMP-activated protein kinase (AMPK) activation, while this pathway is not determinant. Xenografts performed in nude mice demonstrate in vivo demonstrated that combined treatment significantly reduced tumor growth rates and prolonged median survival of tumor-bearing mice. In conclusion, TMZ in combination with MET synergistically inhibits the GSCs proliferation through downregulation of AKT-mTOR signaling pathway. The combined treatment of two drugs inhibits GSCs self-renewal capability and partly eliminates GSCs in vitro and in vivo. This combined treatment could be a promising option for patients with advanced GBM.
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