Original Article

Naunyn-Schmiedeberg's Archives of Pharmacology

, Volume 378, Issue 5, pp 471-481

Toxic-dose warfarin-induced apoptosis and its enhancement by gamma ionizing radiation in leukemia K562 and HL-60 cells is not mediated by induction of oxidative stress

  • Ilhan OnaranAffiliated withDepartment of Medical Biology, Cerrahpasa Medical Faculty, Istanbul University Email author 
  • , Sevide SencanAffiliated withDepartment of Medical Biology and Genetics, Medical Faculty, Erciyes University
  • , Halil DemirtaşAffiliated withDepartment of Medical Biology and Genetics, Medical Faculty, Erciyes University
  • , Birsen AydemirAffiliated withDepartment of Biophysics, Cerrahpaşa Medical Faculty, İstanbul University
  • , Turgut UlutinAffiliated withDepartment of Medical Biology, Cerrahpasa Medical Faculty, Istanbul University
  • , Murat OkutanAffiliated withOncology Institute, Istanbul University

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access


The purpose of this study was to test the hypothesis that warfarin may enhance free radical production and oxidative damage on cancer cells. We examined the possible concentration-dependent effect of warfarin on cytotoxicity with respect to oxidative stress on leukemia cell lines (K562 and HL-60) and normal human peripheral blood mononuclear cells (PBMC). Gamma radiation was used as a positive control agent for oxidative stress. At all concentrations of warfarin (5–200 μM), 5-amino-2,3-dihydro-1,4-phthalazinedione (luminol)- and bis-N-methylacridinium nitrate (lucigenin)-amplified chemiluminescence responses and lipid peroxidation and protein oxidation were stable after 72 h incubation at 37°C. However, The 2′,7′-dichlorofluorescein diacetate (DCFH-DA) oxidation was increased when cells were incubated with high concentrations (50–200 μM) of warfarin. In these concentration ranges, warfarin reduced cell growth in a dose-dependent manner, producing apoptosis. Our results also revealed that at concentrations above 5 μM, warfarin had a potentiating effect on radiation-mediated growth inhibition and apoptosis. Furthermore, marked effects were observed on leukemic cells compared with PBMC. We report here that the increase of DCFH oxidation might be due to the increase in the release of cytochrome C caused by warfarin, as cytosolic cytochrome C content was significantly elevated in the warfarin-treated cells compared with control cells, and because cotreatment with antioxidants N- acetylcysteine or 4,5-dihydroxy-1,3-benzene-disulfonic acid (Tiron) was unable to prevent cytochrome C release and DCFH oxidation induced by the drug. Taken together, these results suggest that high warfarin concentrations may be toxic to leukemic cells in vitro through apoptosis, although at the pharmacological concentrations (<50 μM), warfarin has no prooxidant or cytotoxic effect on PBMC, K562, and HL-60 cells. In addition, when the treatment of leukemic cells with warfarin at concentrations above 5 μM is combined with radiation, we observed an increase in radiation-induced cytotoxicity. The mechanism by which warfarin potentiates this cytotoxicity is unclear, but it may not be directly due to toxic damage induced by warfarin-generated free radicals.


Warfarin Oxidative stress Apoptosis Human peripheral blood mononuclear cells K562 HL-60 Radiation