Sabtu, 6 Julai 2013

Betulinic acid inhibits colon cancer cell and tumor growth


Betulinic acid inhibits colon cancer cell and tumor growth and induces proteasome-dependent and -independent downregulation of specificity proteins (Sp) transcription factors


Sudhakar Chintharlapalli1,3, Sabitha Papineni1,4, Ping Lei1, Satya Pathi2 and Stephen Safe2*


Abstract

Background

Betulinic acid (BA) inhibits growth of several cancer cell lines and tumors and the effects of BA have been attributed to its mitochondriotoxicity and inhibition of multiple pro-oncogenic factors. Previous studies show that BA induces proteasome-dependent degradation of specificity protein (Sp) transcription factors Sp1, Sp3 and Sp4 in prostate cancer cells and this study focused on the mechanism of action of BA in colon cancer cells.

Methods

The effects of BA on colon cancer cell proliferation and apoptosis and tumor growth in vivo were determined using standardized assays. The effects of BA on Sp proteins and Sp-regulated gene products were analyzed by western blots, and real time PCR was used to determine microRNA-27a (miR-27a) and ZBTB10 mRNA expression.

Results

BA inhibited growth and induced apoptosis in RKO and SW480 colon cancer cells and inhibited tumor growth in athymic nude mice bearing RKO cells as xenograft. BA also decreased expression of Sp1, Sp3 and Sp4 transcription factors which are overexpressed in colon cancer cells and decreased levels of several Sp-regulated genes including survivin, vascular endothelial growth factor, p65 sub-unit of NFκB, epidermal growth factor receptor, cyclin D1, and pituitary tumor transforming gene-1. The mechanism of action of BA was dependent on cell context, since BA induced proteasome-dependent and proteasome-independent downregulation of Sp1, Sp3 and Sp4 in SW480 and RKO cells, respectively. In RKO cells, the mechanism of BA-induced repression of Sp1, Sp3 and Sp4 was due to induction of reactive oxygen species (ROS), ROS-mediated repression of microRNA-27a, and induction of the Sp repressor gene ZBTB10.

Conclusions

These results suggest that the anticancer activity of BA in colon cancer cells is due, in part, to downregulation of Sp1, Sp3 and Sp4 transcription factors; however, the mechanism of this response is cell context-dependent.

Background

Colorectal cancer is a leading cause of death in most developed countries including the United States, and in 2010 it is estimated that over 102,700 new cases will be diagnosed and 51,370 deaths will occur in the United States [1]. Genetic susceptibility accounts for 15 - 25% of colon cancer cases, and genetic markers provide important insights on factors important for the molecular and genetic changes that result in development of this disease [2]. Familial adenomatous polyposis syndromes [3,4], hereditary non-polyposis colorectal cancer [5-8], and other polyposis syndromes which increase the incidence of colorectal cancer including Peutz Jegher's syndrome, familial juvenile polyposis, and hereditary mixed polyposis syndrome, are linked to mutations in LKB1, STK11, SMAD4, PTEN, E-cadherin, cyclin D1, and transforming growth factor β receptors [2].

The incidence rates of sporadic colon cancer are highly variable among different regions of the world and the changes in incidence of this disease in migrants suggests that environmental factors related to diet contribute to development of colon cancer [9,10]. Fruits, nuts and vegetables contain diverse anticarcinogenic phytochemicals; however, epidemiological studies give variable results with respect to their chemopreventive effects and similar variability among studies has been reported for the protective effects of dietary folate [11-14]. Most colon cancer patients present with localized disease which is treated with curative surgery; however, disease relapse is experienced by up to 40% of patients [15-17]. Cytotoxic drugs are primarily used for colon cancer chemotherapy and there is a increasing need to develop mechanism-based drugs for treating this disease.

Specificity protein (Sp) transcription factors Sp1, Sp3 and Sp4 are overexpressed in colon and other cancer cell lines [18-23], and Sp1 is a negative prognostic factor for survival of pancreatic and gastric cancer patients [24,25]. The potential importance of Sp transcription factors as drug targets is due not only to their overexpression in multiple tumor types but also to their relatively low expression in non-tumor rodent and human tissues, and this is consistent with the reported decrease of Sp1 expression with increasing age [26-28]. RNA interference studies which knockdown Sp1, Sp3 and Sp4 (individually or combined) have identified several Sp-regulated gene-products that are themselves individual targets for new mechanism-based drugs. Sp-regulated genes include several that are important for cancer cell proliferation [cyclin D1, epidermal growth factor receptor (EGFR), hepatocyte growth factor receptor (c-MET)], survival (bcl-2 and survivin), angiogenesis [vascular endothelial growth factor (VEGF) and its receptors (VEGFR1/R2) and pituitary tumor-transforming gene 1 (PTTG-1)], and inflammation (p65 subunit of NFκB) [23,29-38].

Betulinic acid (BA) is a naturally occurring triterpenoid which inhibits growth of multiple tumors [39,40]. Studies in this laboratory show that BA inhibits prostate cancer cell and tumor (xenograft) growth and this is due, in part, to proteasome-dependent downregulation of Sp1, Sp3, Sp4 and several Sp-regulated genes [20]. In this study, we show that BA inhibits growth of colon cancer cells and tumors and downregulates Sp transcription factors through activation of proteasome-dependent (SW480 cells) and proteasome-independent (RKO cells) pathways.

Methods

Cell proliferation and cell cycle progression assays

The RKO and SW480 colon cancer cell lines were previously characterized at the M.D. Anderson Cancer Center (Houston, TX) and kindly provided by Dr. Stanley Hamilton. RKO and SW480 colon cancer cells (2 × 104 per well) were plated in 12-well plates and allowed to attach for 24 h. The medium was then changed to DMEM/Ham's F-12 medium containing 2.5% charcoal-stripped FBS, and either vehicle [dimethyl sulfoxide (DMSO)] or different concentrations of the compound were added. Fresh medium and compounds were added every 48 h, and cells were then trypsinized and counted after 48 and 96 h using a Coulter Z1 cell counter. Results are expressed as means ± SE for at least 3 replicate determinations for each treatment group. RKO and SW480 cells were treated with either the vehicle (DMSO) or BA for 24 h. Cells were trypsinized, centrifuged and resuspended in staining solution containing 50 μg/ml propidium iodide, 4 mmol/L sodium citrate, and 30 units/ml RNase. After incubation at room temperature for 1 h, cells were analyzed on a FACS Vantage SE DiVa made by Becton Dickinson, using FACSDiva Software V4.1.1. Propidium iodide (PI) fluorescence was collected through a 610SP bandpass filter, and list mode data were acquired on a minimum of 50,000 single cells defined by a dot plot of PI width vs. PI area. Data analysis was performed in BD FACSDiva Software V4.1.1 using PI width vs. PI area to exclude cell aggregates.

Plasmids, transfection assay and antibodies

Sp1 and Sp3 promoter constructs were kindly provided by Drs. Carlos Cuidad and Veronique Noe (University of Barcelona, Barcelona, Spain). The pVEGF-2068 construct contains a VEGF promoter insert (positions -2068 to +54) linked to luciferase reporter gene. The pSurvivin-269 was kindly provided by Dr. M. Zhou (Emory University, Atlanta, GA). The PTTG-1-luc construct containing the -1373 to +3 region of the PTTG-1 promoter was provided by Dr. Kakar (University of Louisville, Louisville, KY). Colon cancer cells (1.5 × 105) were seeded in 12-well plates using DMEM:Ham's F-12 media containing 2.5% charcoal stripped serum. After 24 h, cells were transfected with 0.4 μg of reporter gene constructs and 0.04 μg of β-Gal using Lipofectamine 2000 according to manufacturer's protocol. Reporter lysis buffer and luciferase reagent for luciferase studies were supplied by Promega (Madison, WI). Five h after transfection, cells were treated with control or BA for 22-24 h and luciferase activity (normalized to β-galactosidase) was determined using Lumicount luminometer (PerkinElmer Life and Analytical Sciences). For RNA interference assays with iSp, a mixture of oligonucleotides containing siRNAs against Sp1, Sp3 and Sp4 (combined) was used as previously described [20,21,34]. Antibodies for Sp1, Sp3, Sp4, cyclin D1, EGFR, NFκB (p65), VEGF and VEGFR1 were purchased from Santa Cruz Biotechnology (Santa Cruz, CA). c-PARP and survivin antibodies were purchased from Cell Signaling Technology (Danvers, MA). Monoclonal β-actin antibody was purchased from Sigma-Aldrich. Western blots were determined with whole cell lysates essentially as described [20-23].

Northern blot analysis

For miRNA analysis, 20 μg total RNA per lane was electrophoresed on 15% TBE urea polyacrylaminde gel (Invitrogen), electrophoretically transferred in 0.5 × TBE at 300 mÅ for 45 min to GeneScreen Plus membrane (PerkinElmer, Boston, MA), UV cross-linked and hybridized in ULTRAhyb-Oligo hybridization buffer (Ambion, Austin, TX) at 42°C with 32P end-labeled DNA oligonucleotides complementary to miR-27a. Blots were washed at 42°C in 2X SSC and 0.5% SDS for 30 min with gentle agitation.

Semiquantitative reverse transcription and real time PCR

RKO and SW480 colon cancer cells were treated with BA at different concentrations for 24 h. Total RNA was extracted using RNeasy Mini Kit (Qiagen), and 2 μg of RNA was used to synthesize cDNA using Reverse Transcription System (Promega). Primers were obtained from IDT and used for amplification were as follows: ZBTB10 (sense 5'-GCT GGA TAG TAG TTA TGT TGC-3'; antisense 5'-CTG AGT GGT TTG ATG GAC AGA G-3'). PCR products were electrophoresed on 1% agarose gels containing ethidium bromide and visualized under UV transillumination. Real time PCR for determining miR-27a, ZBTB10 and Myt-1 RNA levels were determined essentially as described [20-23].

Reactive oxygen species (ROS) and mitochondrial membrane potential assays

Cellular ROS levels were evaluated with the cell permeant probe CM-H2DCFDA (5-(and-6)-chloromethyl-2'7'-dichlorodihydrofluorescein diacetate acetyl ester) from Invitrogen. Following 36 h treatment, cells plated on a 6-well cell culture plate were loaded with 10 μM CM-H2DCFDA for 1 h, washed once with serum-free medium, and analyzed for ROS levels using Beckman Coulter XL four-color cytometer. Each experiment was done in triplicate and results are expressed as mean ± S.E. for each treatment group. Mitochondrial membrane potential (MMP) was measured with Mitochondrial Membrane Potential Detection Kit (Stratagene) according to the manufacturer's protocol using JC-1 dye, and mitochondrial membrane potential shift was measured using FACS Calibur flow cytometer using CellQuest acquisition software (BD Biosciences). J-aggregates were detected as red fluorescence and J-monomers are detected as green fluorescence.

Xenograft studies in athymic mice

Female athymic nude mice were purchased from Harlan Laboratories (Indianapolis, IN) and were cared for and used in accordance with institutional guidelines. To produce tumors, RKO cells (5 × 106; ≥ 90% viable) were subcutaneously injected into the flanks of individual mice. Tumors were allowed to grow for 6 days until palpable and mice were then randomized into two groups (6 mice/group) and dosed by oral gavage with corn oil or BA (25 mg/kg/day) every second day for 22 days. The mice were weighed, and tumor size was measured every second day with calipers to permit calculation of tumor volumes: V = LW2/2, where L and W were length and width, respectively. After BA treatment, the animals were sacrificed; final body and tumor weights were determined, and major visceral organs were collected and lysates were used for western blot analysis of Sp proteins.

Results

1. BA inhibits colon cancer cell growth and induces apoptosis   

BA inhibits growth of multiple cancer cell lines [39,40], and results in Figure 1A demonstrate that BA inhibited RKO and SW480 cell proliferation after treatment for 48 or 96 h. Growth inhibition was observed at concentrations of ≥ 5 μM in both cell lines at the two time points. The effects of BA on distribution of cells in G0/G1, S and G2/M phases of the cell cycle was cell context-dependent (Figures 1B and 1C). In RKO cells, BA dramatically decreased the percentage of cells in G0/G1 and S phase and increased the percent in G2/M, whereas in SW480 cells, there was a slight decrease in G0/G1 and S phase and a parallel increase in the percentage of cells in G2/M. Treatment of RKO and SW480 cells with BA also enhanced PARP cleavage (Figure 1D) which is consistent with induction of apoptosis in these cell lines; however, after treatment of the cells for only 24 hr, < 10% of the cells were sub-G1 in FACS analysis.

Figure 1. BA inhibits growth and induces apoptosis in colon cancer cells. (A) Inhibition of cell proliferation. Cells were treated with BA for 48 or 96 h and then counted as described in the Materials and Methods. Cell cycle progression in RKO (B) and SW480 (C) cells. Cells were treated with DMSO (0), 10 or 15 μM BA for 24 h and analyzed by FACS analysis as described in the Materials and Methods. (D) Induction of PARP cleavage. RKO and SW480 cells were treated with BA for 24 h and whole cell lysates were analyzed for cleaved PARP as described in the Materials and Methods. Results in (A) - (C) are expressed as means ± SE for at least 3 replicate experiments and significant (p < 0.05) differences from controls (0, DMSO) are indicated (*).

2. BA decreases expression of Sp1, Sp3, Sp4 and Sp-regulated gene products in colon cancer cells

Previous studies showed that BA decreases Sp1, Sp3 and Sp4 protein expression in prostate and bladder cancer cells [20,32], and results in Figure 2A confirm that similar effects were observed in RKO and SW480 cells. These results were similar to that observed for CDODA-Me and GT-094 in these cell lines [38,40]. Moreover, BA also induced cleaved PARP and decreased expression of survivin, an inhibitor of apoptosis in RKO and SW480 cells, and VEGF (Figure 2B). These results are consistent with previous studies showing that both survivin and VEGF are Sp-regulated genes [20,29]. RNA interference studies which knockdown Sp1, Sp3 and Sp4 (individually or combined) have identified EGFR, p65 subunit of NFκB, PTTG1 and cyclin D1 as Sp-regulated genes [32-35], and results in Figure 2C show that BA decreased expression of their corresponding gene products in RKO and SW480 cells. Moreover combined knockdown of Sp1, Sp3 and Sp4 using an oligonucleotide cocktail (iSp) [20,21,32-34] also decreased expression of p65, PTTG-1, EGFR and cyclin D1 in RKO cells (Figure 2C) confirming their regulation by Sp transcription factors in colon cancer cells.

Figure 2. BA decreases Sp proteins and Sp-regulated genes. BA decreases Sp proteins in RKO and SW480 cells (A) and Sp-regulated genes (B). Cells were treated with DMSO (0) or BA for the indicated times and whole cell lysates were analyzed by western blots as described in the Materials and Methods. (C) BA and Sp1/Sp3/Sp4 (iSp) knockdown decrease Sp-regulated genes. Cells were either treated with BA or transfected with iSp and whole cell lysates were analyzed by western blots as described in the Materials and Methods. (D) Effects of proteasome inhibitors. Cells were treated with BA ± proteasome inhibitors MG132 or lactacystin for 24 h and whole cell lysates were analyzed by western blots as described in the Materials and Methods.

Treatment of RKO cells with the proteasome inhibitor MG132 alone was cytotoxic; however, in RKO cells treated with BA or the proteasome inhibitor lactacystin alone or in combination, BA-induced downregulation of Sp1, Sp3, and Sp4 was not inhibited indicating that the effects were proteasome-independent (Figure 2D). MG132 was not toxic to SW480 cells and BA-induced downregulation of Sp1, Sp3 and Sp4 was reversed in cells cotreated with BA plus MG132 (and lactacystin; data not shown), demonstrating a proteasome-dependent pathway in this cell line as previously observed in LNCaP cells treated with BA [20].

3. BA decreases Sp and Sp regulated gene expression in RKO cells through disruption of miR-27a:ZBTB10

We further investigated BA-mediated repression of Sp and Sp-regulated genes in RKO cells by determining the effects of BA on a series of GC-rich constructs containing promoter inserts from the Sp1, Sp3, VEGF, survivin and PTTG-1 which are downregulated after loss of Sp proteins [18-21,29,30]. Results in Figures 3A and 3B show that BA decreased luciferase activity in RKO cells transfected with pSp1-FOR4-luc, pSp1-FOR2-luc, pSp3-FOR5-luc and pSp3-FOR2-luc constructs which contain the GC-rich -751 to -20 and -281 to -20 region of the Sp1 gene promoter and the GC-rich -417 to -38 and -213 to -38 regions of the Sp3 promoter, respectively [36]. BA also decreased luciferase activity in RKO cells transfected constructs containing VEGF (-2018 to +5), survivin (-259 to +49), and PTTG-1 (-1373 to +3) promoter inserts (Figure 3C), and these results are also consistent with previous studies using agents or RNA interference that downregulate Sp protein expression [19,20,30].

Figure 3. BA inhibits luciferase activity in RKO cells transfected with GC-rich constructs. Transfection with constructs containing Sp1 (A), Sp3 (B) and Sp-regulated (C) gene promoter constructs. RKO cells were transfected with the indicated constructs, treated with DMSO or BA, and luciferase activity (normalized to β-galactosidase) was determined as described in the Materials and Methods. Results are expressed as means ± SE for at least 3 replicated determinations as significant (p < 0.05) is indicated (*).

ROS and hydrogen peroxide (H2O2) play a role in downregulation of Sp1, Sp3 and Sp4 in pancreatic and bladder cancer cells [34,37] and treatment of RKO cells with BA for 36 h induced ROS as determined by FACS analysis using the fluorescent ROS scavenger H2DCFDA (Figure 4A). Moreover, in cells treated with BA plus catalase, there was a decrease in fluorescence indicating that catalase inhibited ROS formation. Treatment of RKO cells with BA decreased expression of Sp1, Sp3 and Sp4 proteins and this effect was partially reversed in RKO cells cotreated with BA plus catalase (Figure 4B). BA-decreased MMP was indicated by increased green/red fluorescence associated with the JC-1 monomer and aggregates, respectively; moreover, BA-induced growth inhibition was also reversed in RKO cells cotreated with BA plus catalase (Figure 4C), thus confirming an important role for ROS (H2O2) in mediating the growth inhibitory effects of BA.

Figure 4. BA decreases MMP and induces ROS in RKO cells. (A) Induction of ROS. RKO cells were treated with 15 μM BA, catalase or BA plus catalase for 36 h and ROS production was determined using the fluorescent probe H2DCFDA as described in the Materials and Methods. Role of ROS in BA-induced Sp downregulation (B) and growth inhibition and BA effects on MMP (C). Cells were treated with DMSO (control), BA, catalase or BA plus catalase and Sp proteins (in whole cell lysates), MMP and cell growth were determined as described in the Materials and Methods. Results (C) are expressed as means ± SE for 3 replicate experiments and significant (p < 0.05) growth inhibition by BA (*) and rescue by catalase (**) are indicated. BA-induced inhibition of MMP was not affected by cotreatment with catalase (data not shown).

Previous studies show that ROS-dependent disruption of miR-27a:ZBTB10 is important for Sp downregulation [33,38] and Figure 5A shows that BA decreased miR-27a, as determined by Northern blot analysis, and semi-quantitative RT-PCR confirmed induction of ZBTB10. Moreover, downregulation of miR-27a was also paralleled by decreased luciferase activity in RKO cells transfected with a construct (pmiR-27a-luc) containing the -639 to +36 region of the promoter for the miR-23a-miR-27a-miR-24-2 [41] cluster (Figure 5B). Using real time PCR, BA significantly decreased miR-27a and induced ZBTB10 (Figure 5C) expression and these responses were all significantly attenuated in RKO cells cotreated with BA plus catalase. These results confirm that BA-induced suppression of Sp1, Sp3 and Sp4 is linked to induction of ROS and ROS-mediated disruption of miR-27a:ZBTB10. The Myt-1 gene is associated with G2/M arrest and is repressed by miR-27a in colon and breast cancer cells [22,36]. BA induced Myt-1 mRNA in RKO cells; this response was also attenuated in cells cotreated with BA plus catalase (Figure 5D) and this was consistent with ROS-mediated regulation of miR-27a and ZBTB10 (Figure 5C).

Figure 5. Role of miR-27a in regulation of BA-mediated responses. (A) Repression of miR-27a and induction of ZBTB10. RKO cells were treated with DMSO or BA and miR-27a and ZBTB10 expression were determined by Northern blot and semi-quantitative RT-PCR, respectively, as described in the Materials and Methods. (B) BA decreases miR-27a promoter activity. RKO cells were transfected with pMiR-27a(-639/+36)-luc, treated with DMSO or BA and luciferase activity determined as described in the Materials and Methods. Role of BA-induced ROS on expression of miR-27a and ZBTB10 (C) and Myt-1 (D). RKO cells were treated with DMSO, BA, catalase or BA plus catalase for 36 h and miR-27a, ZBTB10 and Myt1 mRNA levels were determined by real time PCR as described in the Materials and Methods. Results in (B) - (D) are expressed as means ± SE for at least 3 replicate determinations and significant (p < 0.05) effects by BA (*) and reversal by catalase (**) are indicated.

4. BA inhibits colon tumor growth

Athymic nude mice bearing RKO cells as xenografts were treated with corn oil (control) or BA (25 mg/kg/d). Treatment with BA significantly decreased tumor growth and volume and this was accompanied by decreased tumor weights measured after sacrifice (Figures 6A and 6B). Lysates from control and BA-treated tumors were analyzed by western blot analysis for Sp1, Sp3 and Sp4 protein expression, and quantitated (relative to β-actin). The results showed that BA significantly decreased expression of Sp1, Sp3 and Sp4 (Figure 6C) and these results were consistent with comparable effects observed in vitro (Figure 2A).

Figure 6. BA inhibits colon tumor growth in vivo. Inhibition of tumor growth (A) and weights (B). BA (25 mg/kg/d) was administered (orally) to athymic nude mice every second day and tumor volumes and weights were determined as described in the Materials and Methods. (C) Downregulation of Sp1, Sp3 and Sp4. Tumor lysates from individual mice were analyzed by western blots as described in the Materials and Methods and Sp1, Sp3 and Sp4 protein levels were normalized to β-actin. Results in (A) - (C) are means ± SE for at least 8 mice in the control (corn oil) and BA-treated groups and significant (p < 0.05) inhibition by BA is indicated (*).

Discussion

The anticancer activity of BA initially showed high potency against melanoma in cell culture and animal models, and subsequent studies show the effectiveness of this compound against multiple tumor types [39,40,42]. The low in vivo toxicity of BA coupled with supporting in vitro and in vivo results suggest that this compound or some derivative has potential for clinical applications in cancer chemotherapy. However, BA is a highly lipophilic molecule with limited water solubility and this may decrease in vivo uptake of this compound; therefore, development of specialized formulations/carriers such as liposomes may help to enhance the in vivo efficacy of BA as an anticancer agent [43]. Previous studies in this laboratory showed that BA inhibits prostate cancer cell and tumor growth and this is accompanied by proteasome-dependent degradation of Sp1, Sp3 and Sp4 and several Sp-regulated pro-oncogenic gene products [20]. Several other anticancer agents including tolfenamic acid, curcumin, arsenic trioxide, a nitro-NSAID (GT-094), and two synthetic triterpenoid derivatives, CDDO-Me and CDODA-Me, also induce Sp downregulation in various cancer cell lines via proteasome-dependent and -independent pathways [19,21,33-38].

BA inhibits colon cancer cell growth and induces caspase-dependent PARP cleavage in RKO and SW480 colon cancer cells (Figure 1) and these results are consistent with other reports on the effects of BA on colon cancer cell lines [39,40,44-46]. Moreover, BA also inhibited tumor growth in athymic nude mice bearing RKO cells as xenografts (Figure 6). We observed that BA decreased expression of Sp1, Sp3 and Sp4 proteins in both RKO and SW480 colon cancer cells and tumors (Figures 2A and 6C) and this was accompanied by parallel decreases in survivin and VEGF (Figures 2A and 2B), and these results are comparable to those observed in LNCaP prostate and KU7 bladder cancer cells treated with BA [20,32]. Recent RNA interference studies show that p65 (NFκB subunit), EGFR, cyclin D1, and pituitary tumor transforming gene-1 (PTTG-1) are also Sp-regulated genes [32-35], and results in Figure 3C demonstrate that BA decreased expression of these gene products in RKO and SW480 cells. Moreover, knockdown of Sp1, Sp3 and Sp4 (in combination) in RKO colon cancer cells also decreased expression of EGFR, cyclin D1, p65 and PTTG-1, confirming the role of Sp transcription factors in regulating expression of these genes. These results are consistent with the induction of apoptosis by BA since many of these Sp-regulated genes are important for survival pathways.

Previous studies showed that BA-induced downregulation of Sp1, Sp3 and Sp4 was proteasome-dependent in LNCaP cells but proteasome-independent in KU7 bladder cancer cells [20,32]. Similar variability was observed in RKO and SW480 colon cancer cells (Figure 2D) where BA-induced downregulation of Sp proteins was proteasome-independent and -dependent, respectively. This demonstrates that, for BA and possibly other drugs that downregulate Sp1, Sp3, Sp4 and Sp-regulated genes, the pathways required for this response are variable and dependent not only on tumor type but also cell context within the same tumor. At least two of these pathways, namely induction of proteasome- and caspase-dependent degradation of Sp proteins, involve activation of post-transcriptional processes [20,21,37]; however, their mechanisms have not been determined and are currently being investigated in this laboratory.

We have previously reported that the synthetic triterpenoid CDODA-Me and the NO-NSAID GT-094 decrease Sp protein expression in SW480 and RKO colon cancer cells through a transcriptional repression pathway in which miR-27a is decreased and this results in the induction of ZBTB10, a transcriptional repressor [36,38]. BA decreased luciferase activity in RKO cells transfected with constructs containing several GC-rich promoter inserts (Figures 3B-D) and also decreased expression of miR-27a and induced expression of ZBTB10 in RKO cells (Figures 5A-C). Since overexpression of ZBTB10 and antisense-miR-27a also decreases expression of Sp1, Sp3, Sp4 and Sp-regulated genes in colon cancer cells [36], the mechanism of action of BA in RKO cells is linked to disruption of miR-27a:ZBTB10 as previously reported for CDODA-Me and GT-094 in colon cancer cells [36,38].

BA is known to be a mitochondriotoxic drug and decreases the mitochondrial membrane potential in several different cancer cell lines leading to induction of apoptosis [39,40,44] and BA also decreased MMP in RKO cells (Figure 4C). Previous studies have demonstrated that at least four agents that are mitochondriotoxic and induce ROS also downregulate Sp proteins; this effect is ROS-dependent and reversible with antioxidants or catalase, and compounds activating this pathway include arsenic trioxide (bladder), curcumin and CDDO-Me (pancreatic), and GT-094 (colon) [33,37,38]. Moreover, for GT-094 and CDDO-Me, the mechanism of ROS-dependent downregulation of Sp1, Sp3, and Sp4 involves disruption of miR-27a:ZBTB10 [33,38]. Results of this study show that BA also induced ROS-downregulated Sp1, Sp3, Sp4 and miR-27a and induced ZBTB10 in RKO cells, and all of these responses were significantly attenuated in cells cotreated with BA plus catalase (Figure 4). Moreover, catalase also reversed the growth inhibitory effects of BA (Figure 4C), further demonstrating the importance of ROS activation for the anticancer activity of this compound in RKO cells. In contrast to previous studies showing that CDODA-Me and GT-094 activated transcriptional repression of Sp proteins in both RKO and SW480 cells [33,36], BA induced transcriptional repression in RKO cells but activated the proteasome pathway for degradation of Sp proteins in SW480 cells. The mitochondrial or extra-mitochondrial origins of ROS in cancer cells treated with BA and other agents that downregulate Sp transcription factors is currently being investigated.

Conclusions

In summary, we have shown that the anticancer activity of BA in colon cancer cells is due, in part, to downregulation of Sp1, Sp3, Sp4 and Sp-regulated prooncogenic gene products. The upstream mechanisms associated with decreased expression of Sp1, Sp3 and Sp4 are cell context-dependent and involves proteasome-dependent (SW480) and proteasome-independent (RKO) pathways. The response in RKO cells involves loss of MMP and induction of ROS as previously reported for BA in other studies [39,40] and this is coupled with ROS-dependent disruption of miR-27a:ZBTB10. BA also decreased luciferase activity in RKO cells transfected with a construct containing the -639 to +39 region of the miR-27a promoter, and we are currently examining the mechanisms associated with ROS-dependent effects on critical transcription factors interacting with the promoter and also the functional significance of ROS-dependent downregulation of miR-23a and miR-24-2 which form part of the miR-23a-miR-27a-miR24-2 cluster. These results coupled with several recent reports demonstrate potential clinical applications for BA and related compounds alone or in combination with other anticancer agents [47-49].

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

SC carried out and supervised the in vitro studies on BA-induced downregulation of Sp proteins and Sp-regulated genes and also the RNA interference studies. SP carried out the in vitro studies on downregulation of Sp1, Sp3 and Sp4 and Sp-regulated genes. PL carried out some of the in vitro experiments including the studies on miR-27a:ZBTB10. SP carried out the in vivo study and analyzed the tumor tissue. SS carried out the experimental design and drafted the manuscript. All authors have read and approved the final manuscript.

Acknowledgements

This research was supported by funding from the National Institutes of Health (R01-CA136571) and Texas AgriLife.

 

 

 

Betulinic Acid for cancer treatment and prevention


Betulinic Acid for cancer treatment and prevention.




University Children's Hospital, Ulm, Germany.

International Journal of Molecular Sciences (impact factor: 1.39). 07/2008; 9(6):1096-107. DOI:10.3390/ijms9061096

Source: PubMed

ABSTRACT Betulinic acid is a natural product with a range of biological effects, for example potent antitumor activity. This anticancer property is linked to its ability to induce apoptotic cell death in cancer cells by triggering the mitochondrial pathway of apoptosis. In contrast to the cytotoxicity of betulinic acid against a variety of cancer types, normal cells and tissue are relatively resistant to betulinic acid, pointing to a therapeutic window. Compounds that exert a direct action on mitochondria present promising experimental cancer therapeutics, since they may trigger cell death under circumstances in which standard chemotherapeutics fail. Thus, mitochondrion-targeted agents such as betulinic acid hold great promise as a novel therapeutic strategy in the treatment of human cancers.

 

Betulinic acid, a natural compound with potent anticancer effects


Mullauer, Franziska B.a; Kessler, Jan H.a b; Medema, Jan Paula


Abstract


New therapies using novel mechanisms to induce tumor cell death are needed with plants playing a crucial role as a source for potential anticancer compounds. One highly promising class of natural compounds are the triterpenoids with betulinic acid (BetA) as the most prominent representative. In-vitro studies have identified this agent as potently effective against a wide variety of cancer cells, also those derived from therapy-resistant and refractory tumors, whereas it has been found to be relatively nontoxic for healthy cells. In-vivo preclinically applied BetA showed some remarkable anticancer effects and a complete absence of systemic toxicity in rodents. BetA also cooperated with other therapies to induce tumor cell death and several potent derivatives have been discovered. Its antitumor activity has been related to its direct effects on mitochondria where it induces Bax/Bak-independent cytochrome-c release.

  
Betulinic acid exerts immunoregulation and anti-tumor effect on cervical carcinoma (U14) tumor-bearing mice


Abstract:

Phytochemicals used in cancer therapy and prevention are an important source. Betulinic acid (BetA), a lupine-type pentacyclic triterpenoid saponin from plants, has shown anti-tumor activity in some cell lines in previous studies. In this paper, its anti-tumor effect and the possible mechanisms were investigated in U14 tumor-bearing mice. The results showed that BetA (100 mg/kg and 200 mg/kg) effectively suppressed tumor growth in vivo. Compared with the control group, BetA significantly improved the levels of IL-2 and TNF- in tumor-bearing mice and increased the number of CD4+ lymphocytes subsets, as well as the ratio of CD4+/CD8+ at a dose of 200 mg/kg. Furthermore, treatment with BetA induced cells apoptosis in dose-dependent manner in tumor bearing mice, and inhibited the expression of Bcl-2 and Ki-67 protein while upregulated the expression of caspase-8 protein. The mechanisms by which BetA exerted anti-tumor effects might involve the induction of tumor cell apoptosis. This process is also related to improvement of body's immune response.

 

 

 

 

 

Asid Betulinik ubat barah


Asid Betulinik ubat barah


Abstract


 

Betulinic Acid (BetA) and its derivatives have been extensively studied in the past for their anti-tumor effects, but relatively little is known about its precursor Betulin (BE). We found that BE induces apoptosis utilizing a similar mechanism as BetA and is prevented by cyclosporin A (CsA). BE induces cell death more rapidly as compared to BetA, but to achieve similar amounts of cell death a considerably higher concentration of BE is needed. Interestingly, we observed that cholesterol sensitized cells to BE-induced apoptosis, while there was no effect of cholesterol when combined with BetA. Despite the significantly enhanced cytotoxicity, the mode of cell death was not changed as CsA completely abrogated cell death. These results indicate that BE has potent anti-tumor activity especially in combination with cholesterol.

Citation: Mullauer FB, Kessler JH, Medema JP (2009) Betulin Is a Potent Anti-Tumor Agent that Is Enhanced by Cholesterol. PLoS ONE 4(4): e1. doi:10.1371/journal.pone.0005361

Editor: Mikhail V. Blagosklonny, Ordway Research Institute, United States of America

Received: February 12, 2009; Accepted: March 23, 2009; Published: April 28, 2009

Copyright: © 2009 Mullauer et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: The work is supported by the “stichting nationaal fonds tegen kanker” http://www.tegenkanker.nl/. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

 
Introduction

Triterpenoids are extensively studied for the potential use as anticancer agents. One of the most promising compounds in this class is Betulinic Acid (BetA), but its effect is limited by the poor solubility of the compound. A lot of effort is therefore put into the development of derivatives of BetA with the goal to develop even more powerful compounds and to achieve better solubility for enhanced in vivo administration [1][3]. BetA has been modified at many different positions including C1-4, C-20, C-28 and A-, D- and E ring with different outcomes [2], [4]. For example, Kvasanica et al found 3beta-O-phthalic esters from BetA more cytotoxic and polar in comparison to BetA itself [5]. In contrast, generation of different C-28 ester derivatives did not result in enhanced cytotoxicity [4]. On the other hand, C-28 amino acid conjugates made by Jeong et al showed improved selective toxicity and solubility [6] and a C-3 modified BetA derivative has shown promising results in a human colon cancer xenograft model [2].

BetA can be found in numerous different plants, but it can also be obtained by a simple 2 step reaction from its more abundantly available precursor molecule Betulin (BE) [3]. BE is easily isolated and therefore plays an important role as raw material for the production of BetA and other biologically active compounds [7]. BE itself has been shown in the past to only possess limited or no cytotoxic effects on cancer cells [5], [8]. For example it was shown to be inactive against MEL-2 (melanoma) cells when compared to other BetA derivatives [9]. Several other melanoma lines (G361, SK-MEL-28) leukemia lines (HL60, U937, K562), and neuroblastoma (GOTO, NB-1) cell lines were also found to be more resistant to BE than to other tested lupane triterpenes [10]. In contrast, a recent report found BE to be active against colorectal (DLD-1), breast (MCF7), prostate ( PC-3) and lung (A549 ) cancer cell lines [11], and for A549 it was shown that apoptosis was induced [12]. Apoptosis is one of the major cell death pathways induced by anti tumor agents. In principle, two main pathways can be distinguished, the extrinsic or death receptor pathway and the intrinsic or mitochondrial pathway with the latter being regulated by the Bcl-2 family of proteins [13]. Numerous studies have shown that BetA induces apoptosis via the mitochondrial pathway [14][17], however, to our knowledge, it is currently not clear how BE induces cell death. Here we show that apoptosis induction by BE does not involve the death receptor pathway, but is dependent on the mitochondria. Nevertheless, similar as we have previously shown for BetA [17], cytochrome c release and caspase activation occur independently of the Bcl-2 family proteins but are blocked in the presence of cyclosporin A (CsA), an inhibitor of the mitochondrial permeability transition (PT) pore. Furthermore we found that cholesterol strongly enhances the cytotoxic effects induced by BE but not BetA. Our results suggest that BE should not be regarded as an inactive precursor, but as a potent anti-tumor agent.

Materials and Methods

Chemicals

Betulin (≥98% pure; Sigma-Aldrich, St Louis, MO, USA) and Betulinic Acid (≥99% pure; BioSolutions Halle, Germany) were dissolved in DMSO at 4 mg/ml, cholesterol (Sigma-Aldrich) was dissolved at 5 mM in DMSO. Aliquots were kept frozen. Propidium iodide (PI), zVAD.fmk (benzyloxycarbonyl-Val-Ala-Asp-fluoromethylketone),etoposide and cyclosporin A were purchased from Sigma-Aldrich, Mitosox was obtained from Invitrogen (Carlsbad, CA, USA).

Antibodies

Anti-PARP (#9542; Cell Signaling Technology, Danvers, MA, USA) and anti-cytochrome c (clone 6H2.B4; BD Biosciences, San Diego, CA, USA) were used.

Cell lines: A549 and Hela were obtained from the ATCC, FADD-deficient, Caspase 8- deficient and control Jurkat cells (JA3) were kindly provided by Dr John Blenis (Harvard Medical School, Boston), Jurkat cells over-expressing Bcl-2 by Dr Jannie Borst (NKI, Amsterdam) and Bax/Bak double knockout (DKO) mouse embryonic fibroblasts (MEFs) and wild-type control MEFs were from Dr Stanley Korsmeyer.

Cell death analysis

Overall cell death was assessed as previously described [18] by PI exclusion assay. Briefly, cells were incubated with 1 µg/ml PI and measured by flow cytometry.

DNA fragmentation

Cells were incubated in Nicoletti buffer containing 50 µg/ml PI for at least 24 hours before analysis via flow cytometry.

Western blot analysis (immunoblotting)

Cells were lysed using Triton X-100 buffer and for protein quantification a BCA kit from PIERCE was used. SDS-PAGE was performed and proteins were transferred onto a PVDF transfer membrane (Amersham Biosciences). Blocking of unspecific binding sites was achieved by incubation of the membrane in 5% low fat milk powder in PBS/0.2% Tween-20 (blocking buffer) for 1 hour at room temperature. Primary antibody incubation was performed overnight at 4°C and secondary antibody (HRP labeled) incubation for 2 hours at room temperature. For chemiluminescent detection ECL from Amersham Biosciences was used in combination with a LAS-3000 imaging system.

ROS detection

For ROS measurements the highly selective dye for mitochondrial superoxide Mitosox was used. Cells were incubated with 5 µM Mitosox in pre-warmed tissue culture medium at 37°C for 10 min before flow cytometry analysis.

Cytochrome c release by FACS staining

Cytochrome c release was measured as previously described by Waterhouse et al [19]. First, outer cell membrane permeabilization was achieved by incubation for 5–10 minutes with 50 µg/ml digitonin in PBS containing 100 mM KCl. Cells were then fixed in 4% paraformaldehyde for 30 minutes at room temperature, washed and incubated in blocking buffer (3% BSA, 0.05% saponin, 0.02% azide in PBS supplemented with normal goat serum, dilution 1:200). Anti cytochrome c incubation was done overnight at 4°C and for flow cytometric detection a FITC conjugated secondary antibody was applied.

MTT assay

cells were incubated in the presence of 40 µg/ml MTT reagent for 2 hours at 37°C. During the incubation period appearance of purple formazan structures was followed by phase-contrast light microscopy.

Results

Cholesterol strongly enhances cytotoxic effects of BE but not BetA

Previously we have shown that BetA induces cell death in Jurkat T leukemia cells in a concentration and time-dependent fashion [18]. Here we show that low concentrations (5 µg/ml) of BetA are non toxic up to 48 hours incubation and show limited cell death after 72 hours (Figure 1A). In contrast, when 7.5 µg/ml BetA or more is used almost all cells are PI positive after 48 to 72 hours (Figure 1A). To analyze whether Betulin (BE), the precursor of BetA, is capable of inducing cell death we titrated BE on Jurkat T Leukemia cells. In contrast to previous reports we show here that BE is capable of killing cells, but required higher concentrations than BetA. However, it appeared that cell death induced by BE is more efficient after 12 hours when compared to BetA and maximum cell death is achieved after 24 hours (Figure 1C).


Figure 1. Cholesterol strongly enhances cytotoxic effects of BE but not BetA.

Jurkat cells were treated with the indicated concentrations of BetA (A), BetA in combination with 5 µM cholesterol (B), BE (C), BE in combination with 5 µM cholesterol (D) or various concentrations of cholesterol only (E). Cell death was monitored after 12, 24, 48 and 72 hours using PI exclusion. A549 lung cancer (F) and HeLa cervix carcinoma (G) cell lines were treated with 5 µM cholesterol (chol), 5 µg/ml BE (5 BE) or the combination of 5 µg/ml BE with 5 µM cholesterol (5 BE+chol) and after 24 hours cell death was analyzed via PI exclusion.

doi:10.1371/journal.pone.0005361.g001

We have found previously that when using the MTT (3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazoliumbromide) assay to measure BetA [18] or BE (unpublished data) induced cytotoxicity, results were much more pronounced when compared to other assays such as PI exclusion and clonogenic survival [18]. This decrease in MTT conversion is likely the result of a direct effect of BetA on the mitochondria and was accompanied by a different morphological appearance of the formazan precipitates. While normal formazan formation shows a punctuate appearance, BetA and BE-induced formazan formation shows the rapid appearance of needle-like structures on the cell surface (Figure S1). Interestingly, cholesterol, which shares some structural similarities with BE and BetA, has been reported to have a comparable effect in the MTT assay [20][22] (Figure S1). This suggests that cholesterol, BetA and BE may share common targets in the cell. To clarify if this feature is related to the cytotoxicity of these compounds we decided to analyze the effect of cholesterol on cell death and combine cholesterol with either BetA or BE and measure PI exclusion after various time points. Cholesterol itself did not induce cell death in Jurkat cells (Figure 1E) and it did not enhance cytotoxicity of BetA at all time points measured (Figure 1B). However, the combination of BE with cholesterol resulted in massive cell death in Jurkat cells even when very small concentrations of BE were used (2.5 and 5 µg/ml BE, Figure 1D). To rule out that this is a cell type specific effect we analyzed cell death in A549 (lung carcinoma) and HeLa (cervical carcinoma) cells exposed to either BE or BE in combination with cholesterol. Similar to what was observed with the Jurkat cells, both solid cancer cell lines displayed massive cell death when treated with the combination of BE and cholesterol, whereas BE by itself showed only minor toxicity at the concentration used (Figure 1F and 1G).

BE/Cholesterol induces apoptosis in Jurkat cells

To identify the nature of cell death induced by BE/Cholesterol we investigated the apoptotic pathway. Apoptosis has been previously reported to be the cell death pathway induced by BE in A549 lung cancer cells [12]. We assessed DNA fragmentation as an apoptosis read-out in Jurkat cells treated for 24 hours with either cholesterol, BE or the combination of both. In cells treated with cholesterol only, DNA fragmentation was completely absent (Figure 2A), consistent with the lack of cell death. BE, at 5 µg/ml, induced only moderate DNA fragmentation. However, when combined with cholesterol DNA was clearly fragmented (Figure 2A). To verify these results we performed immunoblotting for the classical caspase target PARP and observed similar effects: Upon BE treatment PARP was processed to some extent and this was strongly enhanced by addition of cholesterol (Figure 2B). Importantly, both, DNA fragmentation and PARP cleavage were blocked when cells were pre-treated with zVAD.fmk (a pan-caspase inhibitor) confirming that both are caspase-mediated events (Figure 2A and 2B).

 
Figure 2. BE/cholesterol induces apoptosis in Jurkat cells.

(A) Jurkat cells were pretreated with 20 µM zVAD.fmk for at least one hour prior to addition of either DMSO, 5 µM cholesterol (5 Chol), 5 µg/ml BE (5 BE) or 5 µg/ml BE in combination with 5 µM cholesterol (5 BE+chol). After 24 hours DNA fragmentation was assessed by FACS analysis of propidium iodide (PI) stained nuclei. (B) Jurkat cells were treated as described in (A) but after 24 hours PARP cleavage was assessed by immunoblotting. The protein kinase ERK was used as a loading control.

 
The death receptor pathway is not involved in BE/cholesterol induced apoptosis

Cholesterol is an important constituent of cell membranes where it plays a crucial role in maintaining integrity and fluidity [23]. In addition, cholesterol-enriched micro-domains, so called lipid rafts, are important signal transduction platforms [24], which have been related to apoptosis [25] and changes in plasma cholesterol levels have been associated with Fas-FADD complex formation and caspase-8 activation [26], [27]. BetA has been shown to induce apoptosis independently of the extrinsic pathway [28]. However, because of the strong apoptosis-enhancing effects of cholesterol when combined with BE, we decided to investigate the involvement of this pathway by applying BE/cholesterol on Jurkat cells either deficient for FADD or caspase-8. Recently we showed that the FADD and caspase-8 deficient cells were completely resistant to Fas-induced apoptosis [17]. Here this resistance was further confirmed using TRAIL (Figure 3A). Despite the resistance towards the extrinsic pathway, neither cell line showed decreased DNA fragmentation when treated with BE/cholesterol (Figure 3B), indicating that the death receptor pathway is not involved in BE/cholesterol-induced apoptosis.



Figure 3. The death receptor pathway is not involved in BE/cholesterol induced apoptosis.

Jurkat control (JA3), FADD deficient (FADD ko) or caspase-8 deficient (Casp-8 ko) cells were treated with TRAIL (0.5 µg/ml plus 1 µg/ml anti-FLAG) (A) or with either 5 µM cholesterol (chol) or 5 µg/ml BE in combination with 5 µM cholesterol (5 BE+chol) and after 24 hours DNA fragmentation was analyzed.

BE/cholesterol induced apoptosis is mechanistically related to BetA induced apoptosis

BetA induced apoptosis has been clearly linked to the mitochondria [14][17] with the consistently described features of cytochrome c release and induction of reactive oxygen species (ROS) [28][31]. These events were initially described to be Bcl-2 family dependent [15], [16], however, our recent evidence suggests only a minor role for the Bcl-2 family proteins. Instead we proposed a direct effect on the PT-pore [17]. To test if BE/cholesterol induces apoptosis via similar mechanisms as BetA we investigated the mitochondrial pathway of apoptosis.

BE/cholesterol showed clear cytochrome c release in Jurkat cells. Importantly, there was only a slight difference in cytochrome c release in the Bcl-2 over-expressing cells (Figure 4A), but this difference was statistically not significant (paired t-test). Jurkat cells over-expressing Bcl-2 were completely resistant to etoposide (Figure. 4A). In contrast to the lack of effect of Bcl-2 over-expression, CsA provided almost complete protection (Figure 4A). To determine if ROS are produced upon BE/cholesterol treatment we used a dye specifically detecting mitochondrial superoxide. Both wildtype as well as Bcl-2 over-expressing cells showed clear increase in ROS, strikingly this was again abolished in the presence of CsA (Figure 4B). To verify that these events resemble the amount of apoptosis and overall cell death we measured DNA fragmentation and PI exclusion respectively. Bcl-2 over-expression did not provide any protection whereas CsA effectively prevented both, apoptosis and cell death (Figure 4C and 4D). In order to find out if Bcl-2 over-expression causes a delay in apoptosis as is the case with BetA [17], we performed a kinetic analysis. Cell death and DNA fragmentation were measured after various time points from 0–24 hours. At all time points we did not observe any difference in sensitivity to BE/cholesterol, further underscoring the lack of inhibition by Bcl-2 (Figure 4E and 4F). These results suggest that BE/cholesterol kills Jurkat cells by inducing mitochondrial damage that leads to cytochrome c release and apoptosis which is completely independent of Bcl-2.

 
Figure 4. BE/cholesterol induced apoptosis is not affected by Bcl-2 over-expression but is inhibited in the presence of cyclosporin A.

(A) Jurkat control (wt) or Bcl-2 over-expressing cells (Bcl-2) were treated as indicated (5BE = 5 µg/ml BE; chol = 5 µM cholesterol; CsA = 5 µg/ml cyclosporin A), after 24 hours intracellular staining for cytochrome c release was performed. (B, C, D) Jurkat control (wt) or Bcl-2 over-expressing cells were treated with 5 µg/ml BE/ 5 µM cholesterol either in the absence or presence of 5 µg/ml cyclosporin A. After 24 hours ROS (B), DNA fragmentation (C) and overall cell death (D) were assessed by FACS analysis. (E, F) Jurkat control (wt) or Bcl-2 over-expressing cells were treated with 5 µg/ml BE/ 5 µM cholesterol and PI exclusion (E) or DNA fragmentation (F) were measured after 0, 4, 8, 16 and 24 hours.

To further determine the efficacy of BE/cholesterol and to find out if Bax and Bak are involved in BE/cholesterol induced cytotoxicity we used Bax/Bak double-knockout (DKO) mouse embryonic fibroblasts (MEFs). DKO MEFs are resistant to drugs such as etoposide, staurosporine, UVC or actinomycin D, all targeting the Bcl-2 family regulated mitochondrial pathway [32]. We measured PI exclusion and found DKO MEFs to be sensitive to BE/cholesterol, as a control for the functionality of the cells etoposide was included (Figure 5A). We assessed if apoptosis was induced like in BetA treated cells by analyzing PARP cleavage. PARP was clearly processed in wildtype as well as in DKO MEFs, suggesting that Bax and Bak are not essential in BE/cholesterol induced apoptosis (Figure 5B). Also cytochrome c release was not prevented in DKO MEFs (Figure 5C), further substantiating that Bax and Bak are not required for BE/cholesterol mediated cytotoxicity. Similar to Jurkat cells, CsA provided complete protection against cell death (Figure 5A), apoptosis (Figure 5B) and cytochrome c release (Figure 5C), confirming the crucial role for the mitochondrial permeability transition in BE/cholesterol induced cytotoxicity.

Figure 5. BE/cholesterol induced apoptosis is independent of Bax/Bak.

(A) Wildtype (wt) or Bax/Bak double knockout (DKO) mouse embryonic fibroblasts (MEFs) were treated as indicated and after 24 hours cell death was assessed by PI exclusion. Etoposide was included as a control for functionality of the cells. (B) Wt or DKO MEFs were treated as indicated and after 24 hours cells were subjected to immunoblotting to determine PARP processing. ERK was used as control for equal protein amounts. (C) Wt and DKO MEFs were treated as indicated for 24 hours before measuring cytochrome c release by intracellular FACS staining.

 
Discussion

BE is a natural compound, which contains derivatives that have been shown to possess strong anti-tumor properties [7], [33]. Here we provide evidence that BE itself, especially in combination with cholesterol (BE/cholesterol), is very potent in killing cancer cells in vitro (Figure 1). BE/cholesterol induces apoptosis in a similar manner as BetA and does not involve the extrinsic pathway of apoptosis (Figure 3), but instead apoptosis depends on the mitochondrial pathway (Figure 4). However, as we reported for BetA, this pathway is activated in an unconventional manner as cytochrome c release and apoptosis are induced in cells over-expressing Bcl-2 (Figure 4) or in cells deficient for Bax/Bak (Figure 5), while both events are blocked by CsA (Figure 4 and Figure 5). This indicates that permeability transition is pivotal in the process of BE/cholesterol induced cytotoxicity.

Despite the strong similarities, and the almost identical structure of BE and BetA, there are also important differences in comparison to BetA induced apoptosis. We previously showed that Bcl-2 over-expression delayed BetA-induced apoptosis[17], but curiously in the case of BE/cholesterol it has very limited effect on the amount of cytotoxicity induced (Figure 4). Furthermore, CsA by itself provides much stronger protection in the case of BE/cholesterol in Jurkat cells, while BetA treated Jurkat cells are only completely protected when a combination of CsA with Bcl-2 over-expression is used.

This difference between BetA and BE/cholesterol is even more remarkable when considering the time dependency of cytotoxicity of both molecules: For BetA the maximum effect requires around 48–72 hours and a dose of 7.5–10 µg/ml (Figure 1A and 1B), while BE/cholesterol induced death is already maximum at 24 hours. Nevertheless, CsA is capable of providing efficient protection.

Striking is the fact, that cholesterol strongly enhances the cytotoxic effects of BE but not BetA (Figure 1B and 1D) whilst being completely non-toxic on its own, even at very high concentrations (Figure 1E). Currently we do not know the mechanism by which cholesterol acts as a “cytotoxicity-amplifier” for BE but it likely involves membrane integrity. Cholesterol is abundantly present in the plasmamembrane and it is possible that changes in cholesterol content can affect the amount of BE that is taken up by a cell.

The effect on MTT conversion to formazan (MTT measures mitochondrial enzymatic activity [20], [34]) by all three compounds, BetA, BE and cholesterol, suggests a common target in the mitochondria. Even though this is clearly not directly related to cytotoxicity, as cholesterol on its own is completely non-toxic, it may point to a mechanism that sensitizes cells to BE. It is not clear how this is orchestrated but it could involve the mitochondrial membrane, for instance mitochondrial PT pore opening. The exact composition of the pore has yet to be established but adenine-nucleotide-translocator (ANT), voltage-dependent-anion-channel (VDAC) and cyclophilin D are discussed as core components in the currently accepted model [35]. PT pore opening is influenced by the amount of cholesterol present in the mitochondrial membrane, cholesterol affects VDAC function [35] and impairs ANT mediated PT through altered membrane fluidity [36]. So cholesterol-induced effects on the PT pore may facilitate BE-induced opening. Why this then does not influence BetA-induced opening is unclear at this point and will require further investigation. In this light it is also important to realize that Bcl-2 over-expression delays BetA-induced apoptosis [17], while CsA can only partially prevent the induction of apoptosis. This suggests that BetA may has a direct effect on the PT pore, which is blocked by CsA and maybe also induces a more classical Bcl-2-dependent pathway to cytochrome c release. This latter seems absent when using BE and may be the reason these compounds react slightly different to CsA and potentially also cholesterol.

To further evaluate the anti-tumor properties of BE/cholesterol in vivo studies will be required. Preliminary results from a pharmacokinetic study using triterpene extract (TE) mainly consisting of Betulin suggest that it is safe; no signs of toxicity were observed in rats or dogs in a subchronic toxicity study [37]. Another study investigated the effects of BE on the central nervous system (CNS) with the conclusion that there was no effect of BE on muscle tone and coordination in mice; doses up to 100 mg/kg bodyweight were used [38]. Interestingly another study explored the antinociceptive properties of Betulin in mice and results suggest that it is even more active than aspirin and paracetamol [39].

It will be interesting to explore the combined effects of BE and cholesterol in vivo. Because cholesterol is ubiquitously present in the body it is unlikely that additional applied cholesterol is useful for in vivo effects of BE as an anti-tumor agent. Our results indicate that the amount of cholesterol necessary (5 µM) for enhanced in vitro effects of BE are about 1000 times lower than normal plasma cholesterol levels in humans (5 mM). However the fast majority of this cholesterol is contained in LDL or HDL and it is therefore difficult to assess whether there is sufficient free cholesterol available to potentiate BE-induced apoptosis in vivo. Adding more cholesterol may not bear any significance though, but application of cholesterol containing Betulin-liposomes may be an interesting mode of applying this cytotoxic agent. In summary we conclude that Betulin by itself and in combination with cholesterol is a potent anti-cancer agent in vitro and warrants further investigation in vivo.

 

Betulinic Acid sebagai anti barah


Betulinic Acid sebagai anti barah



White Birch


Other common name(s): white birch, silver birch; compounds made from the bark include butalin and betulinic acid, also called bet a

Scientific/medical name(s): Betula pendula, Betula alba

Description


White birch is a tree that grows in northern Europe and North America. The bark, leaves, and buds from this and related birch trees are used in herbal and folk medicines. One of the chemicals that has been isolated from birch bark is called betulin. Betulinic acid, which is made from betulin, is being studied as a possible cancer treatment. Betulin has also been found in many other plants.

Overview


Birch bark, buds, and leaves are used in folk medicine but have not been studied to find out whether they are safe or effective. However, betulinic acid may hold promise as an anticancer agent. Some laboratory and animal studies of betulinic acid have reported antitumor activity. Additional studies are under way to find out whether it has a role in treating several forms of cancer, including melanoma and certain brain cancers. Clinical trials are needed to determine what effect, if any, betulinic acid may have in treating cancer in humans.

How is it promoted for use?


Birch bark or white birch (which contains betulinic acid and other compounds) is used on the skin to treat warts, eczema, and other skin conditions. Promoters say that birch tea can be taken internally as a diuretic or a mild sedative and that it can be used as a treatment for rheumatism, gout, and kidney stones. The leaves are sometimes used on the scalp to help with hair loss and dandruff. Birch tar (an oil distilled from birch bark) is used on the skin for skin irritations and parasites. Other claims for birch bark include the treatment of diarrhea, dysentery, and cholera.

Some researchers believe that betulin, which can be extracted from birch bark and other sources, causes some types of tumor cells to start a process of self-destruction called apoptosis. They also believe that betulinic acid slows the growth of several types of tumor cells and the human immunodeficiency virus (HIV). Some researchers also think it has antibacterial properties.

What does it involve?


Pure betulinic acid is not directly available for public use, but birch bark flakes, powder, capsules, oil, sap, and liquid extracts are sold in herbal medicine shops and on the Internet. Birch bark, buds, or leaves are used internally or externally. Tea can be made by steeping a teaspoon of the birch bark in a cup of boiling water for 15 minutes. Proponents recommend drinking from 2to 5 cups of tea per day. Birch leaves or powder can also be used to make tea. For skin conditions, birch leaf tea may be used as a wash or added to bath water. Birch bark or leaves can be applied directly to the skin as well. Birch oil is sometimes used in ointments or liniments and is considered a substitute for wintergreen. Some people also drink small amounts of fresh or bottled birch sap as a tonic.

What is the history behind it?


White birch bark has been used by Native Americans as a folk remedy for some time. It was used in tea and other beverages to treat stomach and intestinal problems such as diarrhea and dysentery. In Russia, it has been used since 1834. In Europe, birch sap was fermented into beer, wine, and other spirits. Its inner bark was sometimes eaten as food.

In 1994, scientists at the University of North Carolina reported that chemicals found in white birch bark slowed the growth of HIV. The following year, a researcher at the University of Illinois reported that betulinic acid killed melanoma cells in mice. Since then, a number of researchers have conducted laboratory tests on betulinic acid to determine its antitumor properties. Since that time, betulin has been found in several other plant sources.

What is the evidence?


There has not been enough scientific study of white birch in humans to draw conclusions about its usefulness in treating illness, although some birch extracts have been studied for safety. Xylitol, a type of sugar, can be made from birch and has been approved to flavor food. Several other compounds extracted from birch have also been approved by the US Food and Drug Administration (FDA) for use as food additives.

Betulinic acid has not been studied in humans, but several laboratory studies have looked at its effects when it is added to cancer cells growing in laboratory dishes. These studies, using the pure chemical betulinic acid rather than birch bark, have been published in peer-reviewed medical journals and suggest that betulinic acid holds some promise for patients with melanoma, certain nervous system tumors, and other forms of cancer. Three German studies concluded that betulinic acid showed anti-tumor activity against cells from certain types of nervous system cancers in children. Two laboratory studies conducted at the University of Illinois indicated that betulinic acid may prove useful as an antitumor drug.

Several studies have found that betulinic acid increases sensitivity of cancer cells in laboratory dishes or in rodents to chemotherapy drugs such as vincristine, 5-fluorouracil, irinotecan, and oxaliplatin. Some researchers are testing synthetic chemicals related to betulinic acid to determine which are the strongest in killing cancer cells or preventing their growth. Studies are still going on to find out whether these results can be applied to humans.

Results from a German nonrandomized clinical trial published in 2006 indicated that birch bark extract may be an effective treatment for actinic keratosis, a pre-cancerous skin condition. However, birch bark extract cannot be recommended for actinic keratoses until further studies have compared it with conventional treatments already known to be safe and effective.

Are there any possible problems or complications?


This product is sold as a dietary supplement in the United States. Unlike companies that produce drugs (which must provide the FDA with results of detailed testing showing their product is safe and effective before the drug is approved for sale), the companies that make supplements do not have to show evidence of safety or health benefits to the FDA before selling their products. Supplement products without any reliable scientific evidence of health benefits may still be sold as long as the companies selling them do not claim the supplements can prevent, treat, or cure any specific disease. Some such products may not contain the amount of the herb or substance that is written on the label, and some may include other substances (contaminants). Though the FDA has written new rules to improve the quality of manufacturing processes for dietary supplements and the accurate listing of supplement ingredients, these rules do not take full effect until 2010. And, the new rules do not address the safety of supplement ingredients or their effects on health when proper manufacturing techniques are used.
Most such supplements have not been tested to find out if they interact with medicines, foods, or other herbs and supplements. Even though some reports of interactions and harmful effects may be published, full studies of interactions and effects are not often available. Because of these limitations, any information on ill effects and interactions below should be considered incomplete.

Birch products that are sold as supplements have not been studied for safety. However, people who are sensitive to aspirin should not use birch products, because birch contains large amounts of aspirin-like compounds. Birch may also pose a hazard to people with poor heart or kidney function. The full range of effects is not well known. Pregnant women, breastfeeding women, and children should not use birch products. Birch has been reported to cause skin rashes and, like most plants, may cause allergic reactions.

Researchers are still studying betulinic acid. Further testing is needed to find out whether it is safe for humans.

Relying on this type of treatment alone and avoiding or delaying conventional medical care for cancer may have serious health consequences.

Additional resources


More information from your American Cancer Society


The following information on complementary and alternative therapies may also be helpful to you. These materials may be found on our Web site (www.cancer.org) or ordered from our toll-free number (1-800-ACS-2345).



The ACS Operational Statement on Complementary and Alternative Methods of Cancer Management