Hyperoxia resensitizes chemoresistant human glioblastoma cells to temozolomide

Abstract

Temozolomide (TMZ) is standard chemotherapy for glioblastoma multiforme (GBM). Intratumoral hypoxia is common in GBM and may be associated with the development of TMZ resistance. Oxygen therapy has previously been reported to potentiate the effect of chemotherapy in cancer. In this study, we investigated whether hyperoxia can enhance the TMZ-induced cytotoxicity of human GBM cells, and whether and how it would resensitize TMZ-resistant GBM cells to TMZ. TMZ-sensitive human GBM cells (D54-S and U87-S) were treated with TMZ to develop isogenic subclones of TMZ-resistant cells (D54-R and U87-R). All cell lines were then exposed to different oxygen levels (1, 21, 40, or 80 %), with or without concomitant TMZ treatment, before assessment of cell cytotoxicity and morphology. Cell death and survival pathways elicited by TMZ and/or hyperoxia were elucidated by western blotting. Our results showed that TMZ sensitivity of both chemo-sensitive and resistant cells was enhanced significantly under hyperoxia. At the cell line-specific optimum oxygen concentration (D54-R, 80 %; U87-R, 40 %), resistant cells had the same response to TMZ as the parent chemosensitive cells under normoxia via the caspase-dependent pathway. Both TMZ and hyperoxia were associated with increased phosphorylation of ERK p44/42 MAPK (Erk1/2), but to a lesser extent in D54-R cells, suggesting that Erk1/2 activity may be involved in regulation of hyperoxia and TMZ-mediated cell death. Overall, hyperoxia enhanced TMZ toxicity in GBM cells by induction of apoptosis, possibly via MAPK-related pathways. Induced hyperoxia is a potentially promising approach for treatment of TMZ-resistant GBM.

Fig. 1

TMZ-resistant D54-R and U87-R cells. (a) Representative dishes from clonogenic assay of the four cells 14 days after TMZ treatment. (b) Clonogenic percentage survival of TMZ-sensitive (D54-S and U87-S) and TMZ-resistant (D54-R and U87-R) cells after rechallenge with TMZ. Each experiment was repeated three times and performed in triplicate. Columns, mean results from triplicate assay; bars, SD; *P < 0.05 and **P < 0.01

Fig. 2

Morphology changed after 72 h treatment at different oxygen saturation with or without concomitant TMZ. a D54, b U87 cells

Fig. 3

Survival curves for a D54 and b U87 cells under different oxygen saturation conditions. c Alteration of TMZ IC₅₀ values and their respective ratio to normoxia under different oxygen saturation conditions for TMZ-sensitive (D54-S and U87-S) and TMZ-resistant (D54-R and U87-R) cells

Fig. 4

Western blotting shows upregulation of apoptotic mediators. Activation of caspase 3 and increased Bax:Bcl-2 ratio are positively associated with increased oxygen saturation and concomitant TMZ. a D54 and b U87. HP, hyperoxia; N, normoxia; H, hypoxia; S, TMZ-sensitive GBM cells; R, TMZ-resistant GBM cells

Fig. 5

Activation of the Erk1/2 MAPK signal transduction pathway after exposure to hyperoxia and TMZ treatment. Increased phosphorylation of Erk1/2 proteins under hyperoxia and concomitant TMZ conditions as demonstrated by western blotting. a D54 and b U87