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Repurposing of triamterene as a histone deacetylase inhibitor to overcome cisplatin resistance in lung cancer treatment

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Abstract

Purpose

Cisplatin is the core chemotherapeutic drug used for first-line treatment of advanced non-small cell lung cancer (NSCLC). However, drug resistance is severely hindering its clinical efficacy. This study investigated the circumvention of cisplatin resistance by repurposing non-oncology drugs with putative histone deacetylase (HDAC) inhibitory effect.

Methods

A few clinically approved drugs were identified by a computational drug repurposing tool called “DRUGSURV” and evaluated for HDAC inhibition. Triamterene, originally indicated as a diuretic, was chosen for further investigation in pairs of parental and cisplatin-resistant NSCLC cell lines. Sulforhodamine B assay was used to evaluate cell proliferation. Western blot analysis was performed to examine histone acetylation. Flow cytometry was used to examine apoptosis and cell cycle effects. Chromatin immunoprecipitation was conducted to investigate the interaction of transcription factors to the promoter of genes regulating cisplatin uptake and cell cycle progression. The circumvention of cisplatin resistance by triamterene was further verified in a patient-derived tumor xenograft (PDX) from a cisplatin-refractory NSCLC patient.

Results

Triamterene was found to inhibit HDACs. It was shown to enhance cellular cisplatin accumulation and potentiate cisplatin-induced cell cycle arrest, DNA damage, and apoptosis. Mechanistically, triamterene was found to induce histone acetylation in chromatin, thereby reducing the association of HDAC1 but promoting the interaction of Sp1 with the gene promoter of hCTR1 and p21. Triamterene was further shown to potentiate the anti-cancer effect of cisplatin in cisplatin-resistant PDX in vivo.

Conclusion

The findings advocate further clinical evaluation of the repurposing use of triamterene to overcome cisplatin resistance.

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Data availability

All data are available from the corresponding author upon reasonable request.

Abbreviations

ChIP:

Chromatin immunoprecipitation

CI:

Combination index

HDAC:

Histone deacetylase

NSCLC:

Non-small cell lung cancer

SAHA:

Vorinostat

SRB:

Sulforhodamine B

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Acknowledgements

This work was supported by a research grant from Food and Health Bureau of Hong Kong (Health and Medical Research Fund 07180316).

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Authors and Affiliations

  1. School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Room 801N, Lo Kwee-Seong Integrated Biomedical Sciences Building, Area 39, Shatin, New Territories, Hong Kong SAR, China

    Kenneth K. W. To

  2. Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China

    Ka M. Cheung & William C. S. Cho

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  1. Kenneth K. W. To
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Contributions

KT: conceptualization, resources, supervision, projection administration, funding, investigation, formal analysis, writing—original draft, review and editing. KC: resources, investigation. WC: conceptualization, resources, investigation, writing—review and editing. All authors read and approved the final manuscript.

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Correspondence to Kenneth K. W. To.

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The authors declare that there are no conflicts of interest.

Ethical approval

The animal experiment protocol was approved by the CUHK Animal Experimentation Ethics Committee (approval number 20-009-HMF).

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Supplementary Information

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432_2023_4641_MOESM1_ESM.tif

Supplementary file1 Fig. S1. (A) Histone H3 acetylation was increased to different extent by the tested drug candidates in H1299 cells. Western blot analysis showing the increase in histone H3 acetylation (Lys 9,14) in H1299 cells after treatment with different drug candidates at 10 µM for 24 h. SAHA (1 µM) was used as control for comparison. Total histone H3 protein was used as loading control. (B) Concentration-dependent increase of AcH3 by the 3 HDAC inhibitory drug candidates (1.25, 2.5, 5, or 10 µM) after 24 h drug treatment in A549 cells. (C) Time-dependent increase in AcH3 by the 3 HDAC inhibitory drug candidates at a fixed concentration of 10 µM after 0, 4, 12, or 24 h treatment in A549 cells (TIF 154 KB)

432_2023_4641_MOESM2_ESM.tif

Supplementary file2 Fig. S2. Common cisplatin resistance mechanisms were examined in the two cisplatin-resistant NSCLC models: (A) A549/CDDP and (B) H1299/CDDP. Parental and cisplatin-resistant cells were treated with a range of different concentrations of cisplatin as indicated for 24 h. Cell lysates were harvested from the treated cells and subjected to Western blot analysis for the DNA damage marker (γH2AX), cell cycle regulation (p21), and Bcl-2 (anti-apoptotic protein). Representative immuno-blot data from 3 reproducible experiments is shown (TIF 132 KB)

432_2023_4641_MOESM3_ESM.tif

Supplementary file3 Fig. S3. Concentration response curves showing the anti-proliferation effect of cisplatin alone, triamterene alone, or the combination of cisplatin + triamterene in a normal human bronchial epithelial cell line BEAS-2B and a porcine kidney epithelial cell line LLC-PK1. For the drug combination, the curve plots the respective concentration of cisplatin in the drug combination. Representative data from 3 reproducible experiments is shown (TIF 142 KB)

Supplementary file4 (DOCX 17 KB)

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To, K.K.W., Cheung, K.M. & Cho, W.C.S. Repurposing of triamterene as a histone deacetylase inhibitor to overcome cisplatin resistance in lung cancer treatment. J Cancer Res Clin Oncol 149, 7217–7234 (2023). https://doi.org/10.1007/s00432-023-04641-1

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