Mechanisms of the in vivo resistance to adriamycin and modulation by calcium channel blockers in mice.

A sensitive fluorometric assay using Hoechst 33258 and a modified alkaline elution procedure were used to quantitate DNA single-strand breaks following an in vivo drug treatment of mice bearing P-388/S and P-388/R cells. After an i.p. treatment of mice with 1 to 20 mg/kg Adriamycin (DOX), the following differences between sensitive and resistant P-388 cells were observed: (a) at 2 h following drug treatment the net intracellular accumulation of Adriamycin in sensitive cells was 2- to 3-fold higher than resistant cells at all doses tested; (b) utilizing a therapeutic dose of DOX (10 mg/kg), the amount of single-strand breaks of DNA in sensitive and resistant cells was significantly different, K x 10(2) = 13.6 +/- 1.1 (SD) versus 3.6 +/- 0.9, respectively; (c) the 10 and 50% lethal doses for verapamil (VEP) were 10 and 23 mg/kg and for a tiapamil analogue, N-(3,4-dimethoxyphenethyl)-N-methyl-2-(2-naphthyl)-m-dithiane-2-propylam ine hydrochloride (DMDP), were 107 and 126 mg/kg, respectively; (d) while the in vivo intracellular accumulation and retention of DOX in sensitive cells were not affected by DMDP or VEP treatment, complete restoration of DOX accumulation and retention was achieved in resistant cells treated with well-tolerated doses of DMDP of 30 and 60 mg/kg. In contrast, utilizing the optimally tolerated dose of VEP (5 mg/kg), only partial restoration of DOX accumulation and retention in resistant cells was achieved; (e) DMDP or VEP did not alter the high level of DNA single-strand breaks induced by DOX in sensitive cells; in resistant cells, however, an increase in single-strand breaks of DNA was observed following treatment with DOX in combination with DMDP and to a lesser extent with VEP; and (f) the rapid DNA repair in resistant cells was inhibited by DMDP but not by VEP. These data demonstrate that DMDP but not VEP can effectively restore the in vivo intracellular accumulation of DOX in resistant cells at achievable nontoxic plasma concentrations. Previous studies have demonstrated that the in vitro intracellular concentrations and retention of DOX by resistant cells can be restored by VEP. The results reported herein demonstrated that similar effects can be achieved, however, in vivo by using a new calcium channel blocker, DMDP, with less in vivo toxicity and more efficacy than VEP in restoring cellular drug concentration, retention, and repair of DNA damage in the resistant cells.

The effects of verapamil and a tiapamil analogue, DMDP, on adriamycin-induced cytotoxicity in P388 adriamycin-resistant and -sensitive leukemia in vitro and in vivo.

DMDP [N-(3,4-dimethoxyphenethyl)-N-methyl-2-(2-naphthyl-m-dithane- 2-propylamine] a recently developed calcium antagonist analogue, caused a greatly increased intracellular retention of adriamycin and concomitant enhanced cytotoxicity in adriamycin-resistant P388 leukemia cells in vitro. These effects of DMDP were greater than those of another calcium channel blocker, verapamil, and occurred at one-half the dosage levels. Only slight enhancement in adriamycin toxicity was observed for either of these agents in the adriamycin-sensitive parental cell line. However, no significant therapeutic potentiation of adriamycin activity occurred with either verapamil or DMDP treatment in vivo. In vivo maximum DMDP tumor intracellular concentrations, as analyzed by HPLC, were the same in vitro tumor cell levels required to overcome adriamycin resistance. This inability to overcome drug resistance in vivo at acceptable levels of host toxicity is not only a function of maintaining necessary calcium antagonist concentrations in resistant tumor cells.

Relationship between cytotoxicity, drug accumulation, DNA damage and repair of human ovarian cancer cells treated with doxorubicin: modulation by the tiapamil analog RO11-2933.

The effect of N-(3,4-dimethoxyphenyl) N-methyl-2-(naphthyl)-m-dithiane-2-propylamine hydrochloride (RO11-2933), an analog of the calcium channel blocker tiapamil, on doxorubicin (DOX)-induced cytotoxicity and DNA damage in human ovarian cancer cells sensitive and resistant to DOX was investigated. A2780-DX2, A2780-DX3, and A2780-DX6 cell sublines were characterized by 7-, 26-, and 48-fold resistance after 2 h DOX exposure and 30-, 50-, and 500-fold resistance after 72 h DOX exposure, respectively. Increased drug efflux resulting in a lower intracellular drug accumulation, decreased DOX-induced DNA single-strand breaks (DNA SSBs), and rapid DNA repair correlated with the degree of resistance. In addition, DNA SSBs were rapidly repaired within 8 h in A2780-DX3 cells, whereas no significant repair of DNA SSBs was observed in sensitive cells. In comparison with verapamil, RO11-2933 was found to reverse DOX resistance at lower and nontoxic concentrations (2 microM as compared with 10 microM verapamil). This reversion was complete in cells with a low degree of resistance (A2780-DX1 and A2780-DX2) but partial in highly resistant cells (A2780-DX3 and A2780-DX6), and continuous exposure to RO11-2933 was essential for optimal reversal of drug resistance. Interestingly, RO11-2933 was found to inhibit the repair of DNA SSBs induced by DOX but not those induced by X-ray. These results suggest that the potentiation of DNA SSBs and the specific inhibition of DNA repair by RO11-2933 in multidrug-resistant cells could be of particular value in overcoming MDR in the clinic.

Modulation of doxorubicin-induced DNA lesions by verapamil, DMDP and dipyridamole in resistant P388 cell lines.

Lymphoid cell lines resistant to doxorubicin, P388/R, were characterized by: 1) decreased intracellular acumulatin and retention of DOX; 2) decreased amount of DOX-induced DNA lesions; and 3) rapid repair of DOX-induced DNA lesions. Using the highest noncytotoxic concentrations of three modulators; 2 calcium channel blockers, Verapamil (VEP) and DMDP and a nucleoside transport inhibitor, Dipyridamole (DIP), restoration of Doxorubicin (DOX) sensitivity in vitro against P388/R cells was partial; resistance was reduced from approximately 200 to 10 fold, although DOX accumulation in the resistant cells in the presence of the modulators was completely restored. The DNA single-strand break (SSB) level induced by DOX in P388/S cells (1371 +/- 144 rad equivalents) was significantly higher than in P388/R cells (74 +/- 17 rad equivalents). The effects of VEP, DMDP and DIP on the induction of DNA SSBs by DOX in P388/R were different. DMDP and DIP potentiated the DOX-induced DNA SSBs by 30% each and VEP by 15%. Furthermore, while VEP and DIP had no significant effects on the rapid repair of DOX-induced SSBs, no significant repair of DNA lesion was observed in P388/R treated with DMDP at 1.2 microM, a non-cytotoxic concentration. These data indicate that although these modulators can effectively restore the intracellular accumulation and retention of DOX, these conditions although essential are not sufficient for the complete restoration of DOX sensitivity in this highly resistant cll line. The ability of a calcium antagonist, DMDP, to circumvent DOX resistance might be related not only to the modulation of drug retention, but also to the ability to retard the repair of DOX-induced DNA SSBs.

Enhancement of adriamycin-induced cytotoxicity by increasing retention and inhibition of DNA repair in DOX-resistant P388 cell lines with new calcium channel blocker, DMDP.

The effect of DMDP, N-(3,4-dimethoxyphenethyl)-N-methyl-2-(2-naphthyl)-m-dithiane-2-propylam ine hydrochloride, on DOX-induced cytotoxicity, drug uptake, DNA damage and repair was investigated in adriamycin sensitive and resistant P388 cell lines. In vitro, the DOX-resistant P388 cells used are about 300-fold more resistant than the sensitive cells. Resistant cells were characterized by lower DOX accumulation, rapid drug efflux, significant decrease of DNA single and double strand breaks and rapid repair of the induced single strand breaks. DMDP, a calcium channel blocker, is an effective modulator of DOX resistance in P388 cells. This modulation was found to be highly dependent of the concentration of the modulators, optimal at the maximally moncytotoxic concentrations of 1-4 microM, and the duration of exposure to the modulator, optimal under conditions of continuous exposure to the modulator. Under the optimal conditions in the presence of the modulator, DMDP, both intracellular concentration and retention of DOX were restored in the resistant P388 cells to the value comparable to those found in DOX sensitive P388 cells. Even though DOX accumulation and retention were at a comparable level in both the sensitive and resistant cells in the presence of DMDP, the amount of DNA single strand breaks achieved in the resistant cells was only about 30% of the amount of damage observed in the sensitive cells. The data indicate that if P388/R cells were only exposed to DOX for about 2 h, the induced DNA single strand breaks were repaired rapidly within 8 h thereafter, while no significant repair was seen in the resistant cells exposed to DOX in combination with DMDP. In contrast, the repair of the extensive DNA single strand breaks induced by DOX in P388/S cells was not effected by DMDP. These data clearly demonstrated that resistance to DOX in P388 cells are multifactorial. Restoration of intracellular accumulation and retention of DOX by DMDP in the resistant cells are although necessary but not sufficient for complete restoration of the sensitivity of the highly resistant cells.