ANTICANCER RESEARCH 37 : 161-168 (2017) doi:10.21873/anticanres.11301 Hyperforin Inhibits Cell Growth by Inducing Intrinsic and Extrinsic Apoptotic Pathways in Hepatocellular Carcinoma Cells I-TSANG CHIANG 1,2,3* , WEI-TING CHEN 4* , CHIH-WEI TSENG 5, YEN-CHUNG CHEN 2,6 , YU-CHENG KUO 7, BI-JHIH CHEN 8, MAO-CHI WENG 9, HWAI-JENG LIN 10,11# and WEI-SHU WANG 2,12,13# Departments of 1Radiation Oncology, 6Pathology, and 13 Medicine, and 2Cancer Medical Care Center, National Yang-Ming University Hospital, Yilan, Taiwan, R.O.C.; 3Department of Radiological Technology, Central Taiwan University of Science and Technology, Taichung, Taiwan, R.O.C.; 4Department of Psychiatry, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan, R.O.C.; 5Division of Gastroenterology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan, R.O.C.; 7Radiation Oncology, Show Chwan Memorial Hospital, Changhua, Taiwan, R.O.C.; 8Department of Laboratory Medicine, Changhua Christian Hospital, Changhua Christian Medical Foundation, Changhua, Taiwan, R.O.C.; 9Institute of Nuclear Energy Research, Atomic Energy Council, Taoyuan, Taiwan, R.O.C.; 10 Department of Internal Medicine, Division of Gastroenterology and Hepatology, College of Medicine, School of Medicine, Taipei Medical University, Taipei, Taiwan, R.O.C.; 11 Department of Internal Medicine, Division of Gastroenterology and Hepatology, Shuang-Ho Hospital, New Taipei, Taiwan, R.O.C.; 12 National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C. Abstract. The aim of the present study was to investigate the (c-FLIP), X-linked inhibitor of apoptosis protein (XIAP), antitumor effect and mechanism of action of hyperforin in myeloid cell leukemia 1(MCL1), and cyclin-D1] were hepatocellular carcinoma (HCC) SK-Hep1 cells in vitro. Cells investigated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetra- were treated with different concentrations of hyperforin for zolium bromide assay, flow cytometry, and western blotting. different periods of time. Effects of hyperforin on cell viability, Hyperforin significantly inhibited cell viability and expression apoptosis signaling, and expression of anti-apoptotic and of anti-apoptotic and proliferative proteins. We also found that proliferative proteins [cellular FLICE-like inhibitory protein hyperforin significantly induced accumulation of cells in sub- G1 phase, loss of mitochondrial membrane potential, and increased levels of active caspase-3, and caspase-8. Taken *# together, our findings indicate that hyperforin triggers These Authors contributed equally to this study. inhibition of tumor cell growth by inducing intrinsic and Correspondence to: Professor Wei-Shu Wang, M.D., Ph.D., extrinsic apoptotic pathways in HCC SK-Hep1 cells. Department of Medicine, National Yang-Ming University Hospital, No.152, Xinmin Rd., Yilan City, Yilan County 260, Taiwan, R.O.C. Apoptosis, or programmed cell death, can be divided into Tel: +886 39325192 ext. 1621, Fax: +886 39351838, e-mail: initiation, effector, and degradation phases (1). The process [email protected] and Hwai-Jeng Lin, M.D., Department of of apoptosis is activated by a variety of physiologic and non- Internal Medicine, Division of Gastroenterology and Hepatology, physiological stimuli through extrinsic and intrinsic pathways. Shuang-Ho Hospital, No.901, No. 291 Zhongzheng Rd. Zhonghe Morphological characteristics of apoptosis include cell District, New Taipei City, 23561, Taiwan, R.O.C. Tel: +886 52648000 ext: 5333, Fax: +886 52838370, e-mail: shrinkage, surface blebbing, chromatin condensation, [email protected] chromosomal DNA fragmentation, and formation of apoptotic bodies (2). Anticancer agents kill cancer cells by inducing Key Words: Hepatocellular carcinoma, hyperforin, apoptosis. extrinsic and intrinsic apoptotic pathways. Tumoricidal effects 0250-7005/2017 $2.00+.40 161 ANTICANCER RESEARCH 37 : 161-168 (2017) of anticancer agents can be inhibited by anti-apoptotic Hyperforin and MTT were purchased from Sigma-Aldrich (St. Louis, proteins in cancer cells and these result in treatment failure MO, USA). RNase was obtained from Fermentas (St. Leon-Rot, (3). Hepatocellular carcinoma (HCC) is among the most Baden-Württemberg, Germany). Primary antibodies to c-FLIP and cyclin D1 were bought from Cell Signaling Technology (Beverly, common lethal types of cancer worldwide and resistant to MA, USA). Primary antibody to XIAP was obtained from Thermo conventional chemotherapy through high expression of anti- Fisher Scientific (Fremont, CA, USA). Primary antibody to β- actin apoptotic proteins such as cellular FLICE-like inhibitory was purchased from Santa Cruz Biotechnology (Santa Cruz, CA, protein (c-FLIP), myeloid cell leukemia 1 (MCL1), and X- USA). Primary antibody to MCL1 was bought from BioVision linked inhibitor of apoptosis protein (XIAP). Therefore, (Milpitas, CA, USA). Secondary antibodies were bought from development of agents facilitating induction of apoptosis may Jackson ImmunoResearch (West Grove, PA, USA). be beneficial for patients with HCC (4-7). Cell culture. SK-Hep1 cells were obtained from Professor Jing- Antidepressants can improve mood disorders, such as Gung Chung at the Department of Biological Science and major depression, anxious disorder, and dysthymia by Technology, China Medical University, Taichung, Taiwan. Cells altering the reuptake of neurotransmitters at the synapse. were cultured in DMEM containing 10% FBS, 2 mM L-glutamine, Several recent studies indicated that antidepressants not only and PS (100 U/ml and 100 μg/ml) at 37˚C in a humidified alleviate mood disorders but also influence tumor atmosphere containing 5% CO 2 (17). et al. progression (8, 9). Frick suggested that antidepressants 4 are able to modulate apoptotic mechanism and activate MTT assay. SK-Hep1 cells were plated into 96-well plates at 3×10 cells/well and incubated overnight. Cells were treated with different antitumor immunity to inhibit tumor growth (8). Fluoxetine, concentration of hyperforin [0-10 μM in 0.1% dimethyl sulfoxide a selective serotonin reuptake inhibitor, has been found to (DMSO)] for 24 or 48 h. The effects of hyperforin on cell viability suppress tumor growth by inducing apoptosis of HCC and was evaluated with MTT assay, as described by Chen et al. (18). glioblastoma cells (10, 11). Fang et al. suggested that mirtazapine, a noradrenergic and specific serotonergic Analysis of sub-G 1 population. SK-Hep1 were plated into 12-well 5 antidepressant, increases expression of interlukin-12 (IL12) plates at 2×10 cells/well and incubated overnight then treated with 5 μM hyperforin for different time intervals. Cells were harvested and interferon-gamma (INF γ) in addition to enhancing CD4 + + by centrifugation and fixed with 70% ethanol and incubated and CD8 T-cell infiltration within cancer tissue, and inhibits overnight at −20˚C. Cells were washed twice with phosphate- tumor growth in colorectal cancer in vivo (12). buffered saline (PBS) and then re-suspended in 500 μl of PI Hyperforin, a polyprenylated acylphloroglucinol isolated working solution (40 μg/ml PI, 100 μg/ml RNase, and 1% Triton from St. John’s wort, has antidepressant activity by blocking X-100 in PBS) in the dark at room temperature for 1 h. Analysis of the reuptake of serotonin, dopamine, noradrenaline, γ- cell-cycle distribution was performed by using flow cytometry aminobutyric acid, and glutamate. In addition, hyperforin has (FACS101, Becton Dickinson FACScan, Franklin Lakes, NJ, USA) as described by Ma et al. (19). antitumor effect in various types of cancer cells (13). Donà et al. found that hyperforin inhibits expression of metastasis- Detection of active caspase-3. SK-Hep1 were plated into 12-well associated proteins, such as urokinase-type plasminogen plates at 2×10 5 cells/well and incubated overnight then treated with activator , and matrix metalloproteinases (MMPs) 2 and 9 5 μM hyperforin for different time intervals. Cells were collected by while reducing lung metastasis (14). Hyperforin also acts as centrifugation and washed with PBS, and re-suspended in 300 μl of an apoptotic inducer to promote caspase-mediated apoptosis Asp(OCH 3)-Glu(OCH 3)-Val-Asp(OCH 3)-fluoromethyl ketone (DEVD-FMK), conjugated to fluorescein isothiocyanate (FITC) in breast cancer and myeloid tumor cells (15, 16). However, working solution (1 μl FITC-DEVD-FMK in 300 μl PBS) for 0.5 h whether hyperforin can inhibit tumor cell growth by inducing at 37˚C in a humidified atmosphere containing 5% CO 2. Cells were apoptosis in HCC is not known. The aim of the present study then harvested by centrifugation and washed twice with wash buffer was to investigate the antitumor effect and mechanism of and then re-suspended in 300 μl of wash buffer. Detection of active action of hyperforin in HCC SK-Hep1 cells by 3-(4, 5- caspase-3 was performed by using flow cytometry (FACS101, dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide Becton Dickinson FACScan; Becton Dickinson, Franklin Lakes, NJ, (MTT), flow cytometry, and western blotting. USA) with FL-1 channel (20). Detection of mitochondrial membrane potential (MMP). SK-Hep1 Materials and Methods were plated into 12-well plates at 2×10 5 cells/well and incubated overnight then treated with 5 μM hyperforin for different time Chemicals and agents. Dulbecco’s modified Eagle’s medium intervals. Cells were collected by centrifugation and washed with (DMEM), fetal bovine serum (FBS), L-glutamine, and penicillin- PBS, and