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Blood, Vol. 95 No. 7 (April 1), 2000:
pp. 2378-2385
HMBA induces activation of a caspase-independent cell death
pathway to overcome P-glycoprotein-mediated multidrug resistance
Astrid A. Ruefli,
Mark J. Smyth, and
Ricky W. Johnstone
From the Austin Research Institute, Austin Hospital,
Heidelberg, Victoria, Australia.
Multidrug resistance (MDR) is often characterized by the expression
of P-glycoprotein (P-gp), a 170-kd ATP-dependent drug efflux protein.
As well as effluxing xenotoxins, functional P-gp can confer resistance
to caspase-dependent apoptosis induced by a range of different stimuli,
including Fas ligand, tumor necrosis factor, UV irradiation, and serum
starvation. However, P-gp-positive cells remain sensitive to
caspase-independent death induced by cytotoxic T-cell granule proteins,
perforin, and granzyme B. It is, therefore, possible that agents that
induce cell death in a caspase-independent manner might circumvent
P-gp-mediated MDR. We demonstrated here that hexamethylene bisacetamide
(HMBA) induced equivalent caspase-independent cell death in both
P-gp-positive and -negative cell lines at concentrations of 10 mmol/L
and above. The HMBA-induced death pathway was marked by release of
cytochrome c from the mitochondria and reduction of Bcl-2 protein
levels. In addition, we show that functional P-gp specifically inhibits the activation of particular caspases, such as caspases-8 and -3, whereas others, such as caspase-9, remain unaffected. These studies
greatly enhance our understanding of the molecular cell death events
that can be regulated by functional P-gp and highlight the potential
clinical use of drugs that function via a caspase-independent pathway
for the treatment of MDR tumors.

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