
[Cancer Research 60, 5659-5666, October 15, 2000]
© 2000 American Association for Cancer Research
Biochemistry and Biophysics |
Down-Regulation of X-linked Inhibitor of Apoptosis Protein Induces Apoptosis in Chemoresistant Human Ovarian Cancer Cells1
Hiromasa Sasaki2,
YingLun Sheng2,
Fumikazu Kotsuji and
Benjamin K. Tsang3
Reproductive Biology Unit and Division of Gynaecologic Oncology, Departments of Obstetrics and Gynaecology and Cellular and Molecular Medicine, University of Ottawa, and Loeb Health Research Institute, The Ottawa Hospital, Civic Campus, Ottawa, Ontario, Canada K1Y 4E9 [H. S., Y. S., B. K. T]; and Department of Obstetrics and Gynaecology, Fukui Medical University, Fukui, Japan 910-1193 [F. K.]
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ABSTRACT
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Cisplatin-centeredchemotherapy is a key treatment for ovarian cancer, but resistance to
chemotherapeutic agents remains a major cause of treatment failure.
Multiple factors are known to contribute to the development of this
chemoresistance. Although it has been demonstrated that X-linked
inhibitor of apoptosis protein (Xiap) prevents apoptosis by inhibiting
effector caspases, if and how it is important in chemoresistance in
ovarian cancer has not been studied. The effects of Xiap
down-regulation and/or restoration of wild type p53 by recombinant
adenovirus infection were examined on four ovarian epithelial cancer
cell lines [C13*, A2780-s (wild type p53), A2780-cp (mutant p53), and
SKOV3 (null p53)]. Apoptosis and protein expression
(e.g., Xiap, caspase-3, p53, MDM2, and
p21waf1) were assessed by Hoechst 33258 stain and Western
blot, respectively. We demonstrated that Xiap down-regulation following
adenoviral antisense expression induces apoptosis in the wild-type p53
cells, but not in the mutated or null cells. Xiap down-regulation
resulted in caspase-3 activation, caspase-mediated MDM2 processing, and
p53 accumulation. Restoration of wild type p53 in the p53-mutated or
-null cells significantly enhanced the proapoptotic effect of Xiap
antisense expression. Down-regulation of Xiap induced apoptosis
in chemoresistant ovarian cancer cells, a process dependent on p53
status.
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INTRODUCTION
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Epithelial ovarian cancer is the most lethal gynecological cancer
in the Western world and ranks fourth among the most common female
cancers. As in other forms of cancer, treatment of ovarian cancer has
undergone considerable development during past decades. Chemotherapy
and cytoreductive surgery are current standard modalities of treatment
for ovarian cancer. Recently, gene therapy (e.g., expression
of wild type p53 in patients with p53 mutation) has attracted much
attention as a possible mode of treatment for ovarian cancer and is
under intensive clinical investigation.
Although platinum derivatives (e.g., cisplatin, carboplatin)
and paclitaxel are first-line chemotherapeutic agents for the treatment
of ovarian epithelial cancer, chemoresistance is a major therapeutic
problem, and the molecular mechanisms involved are poorly understood.
The development of resistance may be cell-type specific and related to
the dosing schedule (1)
. The mechanisms of chemoresistance
appear to be multifactorial and are generally thought of in terms of
altered pharmacodynamics and gene expression (including multidrug
resistant genes), modified drug target, increased rate of DNA
repair, or decreased rates of drug-induced DNA or macromolecule damage
(2, 3, 4)
. The effect of cisplatin appears to result from
inhibition of replication by cisplatin-DNA adducts and
G1 arrest with subsequent induction of apoptosis
(5)
. p53 accumulation plays a key role in this cell cycle
arrest. It has been shown that the p53 level is regulated by
MDM24
(6)
and that various mutations of p53 are
frequently detected in cancer cells. Although our knowledge of the
events leading to chemoresistance is incomplete, failure to activate
apoptosis in these cancer cells may confer resistance to these agents
(4)
.
An intensive search for modulators of apoptosis has revealed the
presence of several potent endogenous suppressers in mammalian cells.
The IAP family, originally identified in baculovirus, currently
consists of five members: neuronal apoptosis inhibitory protein [Naip], X-linked inhibitor of apoptosis protein [Xiap
(8, 9, 10)
], ilp (10)
], human inhibitor
of apoptosis protein-1 [Hiap-1 (8
, 9
, 11)
], human
inhibitor of apoptosis protein-2 [Hiap-2 (8
, 9
, 11)
],
and survivin (12)
. Hiap 1 and Hiap-2 have been suggested
to suppress TNF-receptor signaling by binding to the TNF
receptor-associated factor (11)
, and Xiap suppresses
apoptosis via caspase-3 and -7 inhibition (13)
. It has
been reported that IAPs play a central role in the regulation of a
number of physiological and pathological processes. Naip is believed to
be involved in the pathogenesis of spinal muscular atrophy, in which
apoptosis in the spinal ventral neurones is precipitated by the loss of
this inhibitor (7)
. Survivin is highly expressed in
various malignant tissues (12
, 14)
and has been suggested
to be an important etiological factor of carcinogenesis and potential
new sites for apoptosis-based therapy in cancer (15)
.
Recent studies from our laboratory have demonstrated that cisplatin is
capable of decreasing Xiap protein content in chemosensitive, but not
in resistant, hOSE cancer cells, and that over-expression of Xiap in
the sensitive cells by adenoviral Xiap sense cDNA delivery prevented
the cisplatin-induced apoptosis.5
These findings suggest
that.cisplatin-resistance in hOSE cancer may be due to an inability of this
chemotherapeutic agent to suppress Xiap protein content and to induce
apoptosis.
In the present study, we have examined this possibility by studying the
influence of Xiap down-regulation on apoptosis in cisplatin-resistant
hOSE cancer cells. Transient infection with adenoviral antisense Xiap
cDNA significantly decreased the cellular content of this protein and
induced apoptotic cell death as well as enhanced cisplatin-induced cell
death in p53 wild-type (C13*) but not in mutated (A2780-cp)
resistant cells. Mechanistic investigations indicate that antisense
Xiap-induced apoptosis in the chemoresistant hOSE cancer cells was
associated with caspase-3-mediated MDM2 cleavage and increased p53
content. These findings suggested that Xiap is not only regulating
down-stream events of caspase-3, but also is triggering p53-dependent
pathway when down-regulated by antisense and/or cisplatin treatment.
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MATERIALS AND METHODS
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Reagents.
Human polyclonal caspase-3 antibodies and recombinant active caspase-3
were purchased from PharMingen Canada (Mississauga, Ontario,
Canada). Horseradish peroxidase-conjugated antimouse and
antirabbit antibodies and MDM2 monoclonal antibody for Western blot
were obtained from Bio-Rad Canada (Mississauga, Ontario, Canada) and
Santa Cruz Biotechnology (Santa Cruz, CA), respectively. p53 antimouse
monoclonal antibody was obtained from Transduction Laboratories
(Lexington, KY). Hoechst 33248 was purchased from Sigma (St. Louis,
MO). DEVD-CHO (3)
was obtained from BIOMOL Research
Laboratories, Inc. Adenoviral wild type sense p53 was provided
by Dr. F. L. Graham (McMaster University, Hamilton, Ontario,
Canada). Adenoviral LacZ and antisense Xiap constructs, and rabbit
polyclonal antihuman Xiap antibody were generous gifts from Dr. R.
Korneluk (Apoptogen, Inc., Ottawa, Ontario, Canada). Rabbit polyclonal
anti-Xiap antibody was raised against a glutathione S-transferase
fusion protein that was expressed in Escherichia coli using
pGEX vector (Amersham Pharmacia Biotech, Arlington Heights, IL)
containing full-length Xiap cDNA. The antibody was affinity-purified by
passing through a glutathione S-transferase -Xiap glutathione-Sepharose
column. Specificity was confirmed on Western blots (using the
antibody-depleted elute from the affinity column), and cross-reactivity
with other IAPs was not noted. Construction of recombinant adenovirus
and its delivery was carried out as described previously
(16)
. Briefly, the open reading frame of Xiap was
PCR-amplified, cloned in the pCR2.1 vector (Invitrogen, Carlsbad CA),
and sequenced. The open reading frame was cut out and ligated into the
Swa-1 site of pAdex1CAwt cosmid DNA. The vector was packaged with the
Promega cosmid packaging extracts and used to infect E.
coli. Colonies were picked and screened for the presence of the
insert in the antisense orientation relative to the chicken ß-actin
promoter. CsCl purified cosmid DNA was cotransfected with wild-type
adenovirus DNA that was allowed to generate infectious adenovirus DNA
only when homologous recombination with cosmid DNA occurred. The final
recombinant adenovirus contained a linear, double-stranded genome of
44,820 bp plus the antisense Xiap insert (
1,500 bp). Adenoviral
expression system was generated with an Ad E1 insertion vector. Virus
titer was determined by the plaque assay.
Cell Culture.
Cisplatin-sensitive (A2780-s), -resistant (C13*, A2780-cp, and SKOV3)
human ovarian epithelial cancer cell lines were gifts from Drs. R. Goal
and B. Vanderhyden (Ottawa Regional Cancer Center, Ottawa, Ontario,
Canada) and were maintained at 37°C and 5%
CO2, 95% atmosphere in RPMI 1640 medium (C13*),
DMEM/F12 (A2780-s and A2780-cp), or McCoy 5A (SKOV3; Life Technologies,
Inc./BRL, Burlington, Ontario, Canada) supplemented with fetal bovine
serum (10%), streptomycin (50 µg/ml), penicillin (50 units/ml), and
Fungizone (0.625 µg/ml; Life Technologies, Inc./BRL). These cell
lines were established from a patient with serous cystoadenocarcinoma
and have been well-characterized in terms of their cisplatin
sensitivity (17
, 18)
. C13* and A2780-cp cells carry wild
type p53 and mutant p53, respectively (19
, 20) . SKOV3 is a
null p53 cell line (21)
. Cells, plated in 5 x 104
cells/cm2, were
treated with adenoviral expression vectors (see below) or freshly
prepared cis-Platinum (II) Diammine Dichloride [cisplatin
0100 µM (Sigma)] under serum-free
conditions. Serum withdrawal had no significant effect on cell
viability during the experimental period, as confirmed by
3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay.
Hoechst 33248 Staining.
At the end of the culture period, cells attached to the growth surface
were removed by trypsin treatment [trypsin (0.05%), EDTA (0.53
mM); 37°C, 1 min]. Attached and detached cells were
pooled, pelleted, and resuspended in neutral-buffered formalin (10%)
containing Hoechst 33248 dye (12.5 ng/ml). Cells were spotted onto
slides and assessed for typical apoptotic nuclear morphology (nuclear
shrinkage, condensation, and fragmentation) with Hoechst dye under a
Zeiss fluorescence microscope with appropriate filter combination. At
least 200 cells/treatment group were counted and assessed randomly
selected fields and blinded slides to avoid experimental bias.
Protein Extraction and Immunodetection.
Cells were pelleted and lysed in ice-cold lysis buffer [NaCl (137
mM), Na2HPO4
(8.1 mM), KCl (2.68 mM),
KH2PO4 (1.47
mM), NP40 (1%; v/v), sodium deoxycholate (0.05%; w/v),
SDS (0.1%; w/v) containing phenylmethylsulfonyl fluoride (10
µM), aprotinin (57 µg/ml), leupeptin (5 µg/ml), and
pepstatin (5 µg/ml)]. Cell lysates were sonicated briefly (5
s/cycle, 3 cycles; 0°C), incubated on ice (1 h), and centrifuged
(15,000 x g; 20 min). The supernatant was
saved and stored at -20°C for subsequent analyses. Protein
concentration was determined using Bio-Rad DC protein assay kit. Equal
amounts of proteins (70100 µg) were loaded and resolved on SDS-PAGE
(815%) and electroblotted (30V; 12 h) onto nitrocellulose
membranes (Bio-Rad Canada). After Western transfer, uniform protein
loading was confirmed by comparing the intensity of stained total
proteins between lanes of nitrocellulose membranes previously stained
with SYPRO Ruby protein stain (Molecular Probes, Eugene, OR). The
images were scanned and stored electronically, and the intensity of the
protein stain in each lane was quantified for future reference or for
normalization of Western blot results. Membranes were then blocked
(room temperature, 1 h) with 5% Blotto [Tris-HCl (10
mM; pH 8.0), NaCl (150 mM),
Tween 20 (0.05%; v/v; TBS-Tween 20) containing skim milk (5%; w/v)],
incubated with primary antibody [Xiap (1:4,000); caspase-3 (1:3000);
MDM2 (1:1000); p53 (1:2000)]; p21waf1 (1:2000);
room temperature, 1 h] and subsequently with horseradish
peroxidase-conjugated secondary antibody [1:2,000 in 5% Blotto; room
temperature, 30 min.]. Peroxidase activity was visualized with an ECL
kit (Amersham Pharmacia Biotech, Arlington Heights, IL) after a wash
with TBS-Tween 20 or TBS [Tris-HCl (10
mM; pH 8.0), NaCl (150
mM)]. Signal intensity was determined
densitometrically and normalized against those of total proteins
present in the corresponding lane on the membrane using Molecular
Analyst software, version 1.5 (Bio-Rad Canada).
Adenoviral Infection.
After 24 h of plating (106 cells/60-mm
culture dish), cells were infected with adenoviral antisense
full-length Xiap and/or sense p53 at MOIs of 5, 10, 20, or 40
for C13*, 50, 100, or 200 for A2780-cp; 200 or 400 for SKOV3 (Xiap);
and 5, 10, or 20 (p53). Infection with an equivalent concentration
(MOI) of LacZ was carried out to provide proper control. LacZ was also
used to adjust the total concentration of adenovirus when two different
viral preparations were used in the same experiment (double infection).
To test the changes on cisplatin sensitivity, infected cells were
treated with or without cisplatin (10 µM; 24 h)
after a 72-h infection period. The number of apoptotic cells was
determined by Hoechst stain. Xiap and p53 protein contents as well as
caspase-3 and MDM2 contents and cleavage were assessed by Western blot.
The infection efficiency over 48 h, as determined by X-gal assay,
was >90% in all cell lines, and the expression of Xiap was confirmed,
if necessary, by Western blot before cisplatin treatment.
In Vitro Caspase Treatment.
Whole cell lysate (50 µg of total protein) of C13* cells was
incubated with PIPES assay buffer [PIPES (20 mM; pH 7.2),
NaCl (100 mM), DTT (10 mM), EDTA (1
mM),
3-[(3-cholamidopropyl)dimethylammonio]-1-propanesulfonic acid
(0.1%; w/v), and sucrose (10%; w/v)] containing recombinant active
caspase-3 in the presence or absence of DEVD-CHO. The incubation was
terminated by the addition of equal volumes of 2 x sample buffer [Tris-HCl (100 mM; pH 6.8), DTT (200
mM), SDS (4%; w/v), glycerol (20%; v/v), and Bromphenol
blue (0.2%)]. MDM2 cleavage in the cell lysate was assessed by
Western blot.
Statistical Analysis.
All experiments were repeated at least three times. Data were subjected
to one- or two-way ANOVA (PRISM software, version 3.0; GraphPad, San
Diego, CA). Differences between experimental groups were determined by
the Tukey or Bonferroni post-test.
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RESULTS
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Induction of Apoptosis in Cisplatin-resistant Wild Type p53 hOSE
Cancer Cells by Adenoviral Xiap Antisense in Vitro.
Previous studies have shown that down-regulation of Xiap by Xiap
antisense cDNA induced apoptosis in OV2008 cells, a cisplatin-sensitive
wild type p53 hOSE cancer cell.5
In the present study,
antisense Xiap delivered by an adenovirus significantly induced
apoptosis in its resistant variant, C13*, which also has the wild type
p53 genotype. Without treatment, these cells displayed excellent health
and growth characteristics, i.e., polygonal shape with round
large nucleus featuring prominent multiple nucleoli and well-spread on
the growth surface. Whereas infection of this cell line with an
adenovirus carrying LacZ alone (Fig. 1
A, a and b) had no apparent effects on
cell morphology, down-regulation of Xiap with adenovirus antisense
(MOI = 10; 72 h) evoked typical apoptotic features
such as membrane blebbing (arrow), cell shrinkage and
detachment (Fig. 1
A, c) and nuclear condensation
and fragmentation (Fig. 1
A, d).

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Fig. 1. Influence of adenoviral antisense Xiap on C13* cells.
A, C13* cells were infected (MOI = 20)
with adenoviral LacZ (a and b) or
antisense Xiap (c and d). Representative
pictures of phase-contrast (general morphology; a and
c, x100) and fluorescent (nuclear morphology;
b and d, x200) images are shown.
B, C13* cells were infected with various concentrations
of adenoviral LacZ ( ) or antisense Xiap ( ) (MOI = 0, 5, 10, or 20; 72 h; panel a), or for various
durations (24, 48, 60, or 72 h; MOI = 20,
panel b).
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The proapoptotic effect of adenoviral antisense Xiap infection on C13*
cells was concentration (MOI)- and time-dependent. Compared with
nontreated control, adenoviral LacZ infection (MOI = 520) had no significant effect on apoptosis. However, antisense Xiap
significantly increased the number of apoptotic cells at MOIs of 10
(27.0 ± 4.6%; P < 0.05) and
20 (64.3 ± 10.9%; P < 0.001) 72 h after adenoviral infection when compared with
equivalent concentrations of LacZ (6.8 ± 1.2% and
9.9 ± 3.8%, respectively). Two-way ANOVA indicates
that the effects of antisense Xiap (P < 0.001) and concentration (P < 0.001) were
statistically significant, as was the interaction between the two
factors (P < 0.0001; Fig. 1
B,
a). Although antisense Xiap infection (MOI = 10) resulted in a statistically nonsignificant (10.9 ± 2.8% versus 5.9 ± 0.5%;
P > 0.05) increase in the number of
apoptotic cells at 24 h, significant and much larger increases
were noted at 48 h (21.3 ± 3.4% versus
5.2 ± 0.3%; P < 0.01),
60 h (29.3 ± 3.2% versus 7.1 ± 2.1%; P < 0.001) and 72 h
(32.6 ± 4.0% versus 10.2 ± 4.3%; P < 0.001) when compared with LacZ
controls (Fig. 1
B, b).
Xiap Down-Regulation Sensitizes Cisplatin-resistant C13* Cells to
the Cytotoxic Action of Cisplatin.
Whereas C13* cells failed to respond to cisplatin at concentrations as
high as 30 µM, a higher concentration (100
µM) was capable of inducing apoptosis in 16.4 ± 3.9% and 16.6 ± 3.0% of these cells.
Antisense Xiap treatment sensitized the resistant cells to the
proapoptotic action of cisplatin. The number of apoptotic cells in the
antisense Xiap treatment group was significantly higher than the LacZ
group at 30 (14.7 ± 3.5%; P < 0.05) and 100 (48.7 ± 4.9%;
P < 0.001) µM
cisplatin and the cisplatin concentration-response curve was shifted to
the left by antisense Xiap expression (Fig. 2A)
. Significant effects of antisense Xiap
(P < 0.001) and cisplatin concentration
(P < 0.001) as well as their interaction
(P < 0.001) were confirmed by two-way ANOVA.
The effect of antisense Xiap was concentration-dependent, as
demonstrated in studies with C13* cells infected with various
concentrations (MOI = 040) of LacZ or antisense Xiap
and then challenged with cisplatin (10 µM;
24 h). Antisense Xiap-treated cells showed increased sensitivity
to cisplatin at MOIs of 20 (P < 0.05) and 40
(P < 0.001) compared with LacZ-treated
cells. Two-way ANOVA indicates significant antisense
(P < 0.001) and concentration
(P < 0.001) effects and interaction
(P < 0.001; Fig. 2
B).
To confirm the effectiveness of adenoviral Xiap antisense in Xiap
down-regulation, extracts from C13* cells previously infected with
adenoviral LacZ or antisense Xiap were subjected to Western analysis
72 h after infection. Whereas Xiap protein content in C13* cells
was not significantly affected by LacZ (P > 0.05), it was significantly decreased by antisense Xiap (approximately
40% at MOI = 20; P < 0.05).
Two-way ANOVA indicates significant antisense Xiap
(P < 0.05) and concentration
(P < 0.05) effects (Fig. 3
A, a and b). Xiap down-regulation was
associated with cleavage of procaspase-3, a 32-kDa member of the
cysteine protease family involved in the execution of apoptosis and
activated by proteolytic cleavage to form 20- and 18-kDa fragments
(prodomain + large subunit and large subunit alone,
respectively) by the other upstream caspases (22)
. The
cleavage of procaspase-3 was dependent on the antisense concentration,
and significant increases of p20 and p17 protein contents were
observable at MOIs of 10 (P < 0.001) and 20
(P < 0.001; Fig. 3
A). Significant
antisense (P < 0.001) and concentration
(P < 0.001) effects as well as interaction
between these factors (P < 0.001) were
noted. Consistent with the observed onset of apoptosis, p20
(P < 0.01) and p17 (P < 0.05) levels were significantly increased (compared with LacZ)
as early as 48 h after adenoviral Xiap antisense infection (Fig. 3
B, a and b). A significant
interaction (P < 0.05) existed between
antisense Xiap and the duration of infection, which was brought about
by the significantly higher levels of these active cleavage fragments
after 24 h of infection with the antisense. Interestingly,
procaspase-3 levels were decreased, though not consistently, by
antisense Xiap treatment.

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Fig. 3. Influence of Xiap down-regulation on pro-caspase-3
cleavage in C13* cells. C13* cells were infected with adenoviral LacZ
( ) or antisense Xiap ( ) (A, MOI = 0, 5, 10, or 20 for 72 h; B, MOI = 10 for 24, 48, 60, or 72 h). Xiap protein content and
pro-caspase-3 cleavage were analyzed by Western blot. Representative
membranes (a in A and B), and
densitometric analysis (b in A and B),
are shown. Results represent means ± SE of three
independent experiments.
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Caspase-3-mediated MDM2 Cleavage and p53 Accumulation Associated
with Xiap Down-Regulation.
MDM2 is known to play a key regulatory role in p53 stability and is
cleaved during apoptosis (23)
. Whereas the involvement of
caspase-3 has been suggested in MDM2 processing (23
, 24)
,
the possibility of Xiap being important in the control of p53 content
by maintaining MDM2 integrity (25
, 26)
, remains to be
determined. Instead of the 92-kDa intact MDM2 protein previously
reported present in high abundance in mammalian cells, a 60-kDa
fragment was found to be the dominant isoform in the resistant
hOSE cancer cells. Whereas LacZ had no significant influence on the
60-kDa protein content and its cleavage, a decrease of this protein and
the appearance of cleaved product (30 kDa) were noted after Xiap
down-regulation (Fig. 4A, a)
. Furthermore, p53 accumulation following
Xiap down-regulation at a MOI of 10 (P < 0.05) or 20 (P < 0.001) was associated with
MDM2 cleavage when compared with respective LacZ controls (Fig. 4
A, b). The addition of recombinant active
caspase-3, but not of caspase-7, to C13* whole cell lysate elicited a
concentration- and time-dependent MDM2 cleavage pattern identical to
that observed in extracts from cells following Xiap down-regulation
(Fig. 4
B, a). MDM2 cleavage by caspase-3 was
blocked by the presence of the caspase-3 inhibitor, DEVD-CHO (Fig. 4
B, b). Because C13* cells possess wild type p53
(27)
, these findings suggest that Xiap down-regulation not
only induces caspase-3 cleavage and activation, but possibly also
activates a p53-dependent apoptotic pathway.

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Fig. 4. Influence of Xiap down-regulation on MDM2 cleavage and
p53 protein content and caspase-3 on MDM2 processing. A,
C13* cells were infected with various concentrations of adenoviral LacZ
or Antisense Xiap (MOI = 5, 10, or 20). Representative
Western blots for MDM2 cleavage and p53 (a) are
presented. Densitometric analysis for p53 content are shown on
b. Results represent means ± SE of three
independent experiments]. B, C13* cell whole-cell
lysate was incubated with various concentrations of human recombinant
active caspase-3 or caspase-7 (5, 10, and 20 ng/ml) in the absence
(a) or presence (b; 25 µM)
of DEVD-CHO. Representative Western blots showing MDM2 cleavage in C13*
whole-cell lysate are shown: 60-kDa MDM2 isoform (closed
arrow), 30-kDa fragment (open arrow).
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p53-dependent Induction of Apoptosis in Cisplatin Resistant hOSE
Cancer Cells by Adenoviral Antisense Xiap Expression.
To further examine the involvement of p53 in the Xiap regulated
caspase-3 pathway, a pair of human ovarian epithelial adenocarcinoma
cell lines (A2780-s and A2780-cp) were also subjected to antisense Xiap
expression. In 24-h cultures of A2780-s [a parental,
cisplatin-sensitive wild type p53 cell line (19)
],
cisplatin significantly decreased Xiap content and induced apoptosis in
a concentration-dependent manner (P < 0.001;
Fig. 5
A, a and b), whereas it was ineffective
in its p53-mutated resistant variant, A2780-cp (Ref. 19
;
P > 0.05; Fig. 5
A, c
and d). Contrary to the wild type p53 C13* cells, Xiap
down-regulation in A2780-cp alone failed to significantly induce
apoptosis (P > 0.05) even at a concentration
of the adenoviral Xiap antisense as high as a MOI of 200, which
effectively decreased Xiap content after 72 h (Fig. 6
A, a and b). In contrast,
overexpression of wild type p53 alone in these p53 mutants by
adenoviral sense cDNA resulted in a concentration (MOI)-dependent
increase in apoptosis (P < 0.001; Fig. 6
A, c and d). Whereas expression of
wild type p53 with low concentration of sense p53 (MOI = 10) had a slight, but nonsignificant, effect on apoptosis
(P > 0.05), a higher concentration
(MOI = 40) markedly increased the population of
apoptotic cells (25.0 ± 6.0% versus
0.8 ± 0.3%; P < 0.001)
compared with corresponding LacZ-treated cells.

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Fig. 5. Influence of cisplatin on Xiap content and apoptosis in
cisplatin-sensitive wild type p53 (A2780-s) and -resistant p53 mutated
(A2780-cp) hOSE cancer cells. A, cells were treated for
24 h with various concentrations of cisplatin (0, 10, 20, and 30
µM). Apoptosis () and densitometric value of Xiap
content ( ) in A2780-s (A) and A2780-cp
(C) are shown. B and D,
are representative Western blots for Xiap in A2780-s and A2780-cp
cells, respectively.
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Fig. 6. Influence of Xiap down-regulation and/or wild type p53
restoration on apoptosis in p53 mutated hOSE cancer cells.
A, A2780-cp cells were infected with adenoviral LacZ
( ) or antisense Xiap () [MOI = 0, 50, 100, or
200; 72 h; a and b)] or sense p53
(; MOI = 0, 5, 10, 20, or 40; 48 h;
c and d). Apoptosis is shown in
a and c. Panels b and
d show representative Western blots for Xiap and p53,
respectively. B, synergistic effect of adenoviral wild
type p53 sense (MOI = 10) and antisense Xiap
(MOI = 100; 72 h) expression on apoptosis. Total
concentration of adenovirus was adjusted with LacZ to a final
concentration of MOI = 110. C,
concentration effects of sense p53 (MOI = 0, 5, 10, or
20) on LacZ,( ) and antisense Xiap () (MOI = 100;
72 h) -induced apoptosis in A2780-cp. Results represent
means ± SE of three independent experiments.
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Although neither Xiap down-regulation (MOI = 100) nor
wild type p53 over- expression (MOI = 10) alone was
effective in inducing significant apoptosis [5.0 ± 1.1% (antisense Xiap alone) or 9.8 ± 1.9% (sense p53
alone) versus 2.2 ± 1.0% (LacZ);
P > 0.05], coinfection of antisense Xiap
and sense p53 led to a marked increase in the number of apoptotic cells
(35.3 ± 5.32%; P < 0.01;
Fig. 6
B). Moreover, the proapoptotic effects of Xiap
down-regulation (antisense Xiap; MOI = 100) were
dependent on the concentration of sense p53 (Fig. 6
C).
Expression of antisense Xiap significantly enhanced the sensitivity of
the cells to wild type p53 resulting in a shift of the p53 sense
concentration-apoptosis response curve to the left. Two-way ANOVA
indicates significant antisense Xiap and p53 sense concentration
effects, and interaction between the two factors
(P < 0.01).
Upon wild type p53 restoration (MOI = 10), the
proapoptotic effect of antisense Xiap treatment was
concentration-dependent (P < 0.01), and
significant increases in the number of apoptotic cells were evident
with adenoviral Xiap antisense at MOIs of 50 (37.8 ± 5.3%) and 100 (51.4 ± 0.4%) compared with LacZ
(7.7 ± 3.6% and 11.1 ± 7.0%,
respectively; P < 0.01; Fig. 7A, a
). Adenoviral Xiap antisense expression
resulted in a concentration-dependent Xiap down-regulation, however a
greater decrease in Xiap level was observed when the A2780-cp cells
were coinfected with Xiap antisense and wild type p53 sense (Fig. 7
A, b and c). Expression of
p21waf1 and 90-kDa MDM2 protein were found
predominantly in cells in which wild type p53 was reconstituted. Xiap
down-regulation significantly increased p53 content (about three-fold)
in p53 mutant reconstituted with wild type p53 and marked by decreased
p53-induced p90 and p60 MDM2 levels (approximately 50% and 30%,
respectively; Fig. 7
A, d). These results
suggested that caspase-3 activation is necessary, but not sufficient,
for the induction of apoptosis in p53-deficient cells, and that a
functional p53 may be involved in the completion of the apoptotic
process.

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|
Fig. 7. The effect of Xiap down-regulation and wild type p53
restoration, alone or combined on MDM2 processing,
p53/p21waf1 contents, and apoptosis in hOSE cancer cell
lines. A, A2780-cp cells were infected with various
concentrations of adenoviral antisense Xiap (MOI = 0,
50, or 100; 72 h), alone or with adenoviral LacZ or p53 sense
(MOI = 10). a, apoptosis [LacZ ( );
sense p53 ()]. b, representative Western blots
showing Xiap, p21waf1, MDM2 cleavage [90-kDa intact form
(closed arrow); 60-kDa isoform (open
arrow)], and p53 contents. Densitometric analysis of changes
in Xiap [c, LacZ ( ) and sense p53 ( )
expression], MDM2 and p53 (d) contents are shown.
Results represent means ± SE of three independent
experiments. B, SKOV3 cells were infected with
adenoviral wild type p53 sense (MOI = 10) and/or
antisense Xiap (MOI = 400; 72 h). Total
concentration of adenovirus was adjusted with LacZ to a final
concentration of MOI = 410. Representative Western blots
for Xiap, MDM2, and p53 are shown. Open arrow indicates
cleaved MDM2.
|
|
To further examine this hypothesis, the effect of antisense Xiap and/or
sense p53 delivery on the null p53 cell line (SKOV3) was tested
(28)
. A significant accumulation of p53 protein was
detected in the cells treated concurrently with antisense Xiap and
sense p53 (Fig. 7
B). Induction of intact MDM2 protein was
observed in cells with sense p53 expression, irrespective of antisense
Xiap delivery, and a caspase-mediated MDM2 fragment was evident
in the cells treated with antisense Xiap and sense p53 constructs.
Although the proportions of apoptotic cells induced by adenoviral gene
delivery were smaller than in C13* and A2780-cp cell lines,
adenoviral infection of cells with antisense Xiap and sense p53
significantly induced apoptosis (3.4 ± 0.39%)
compared with viral LacZ (0.6 ± 0.3%;
P < 0.001), antisense Xiap (1.7 ± 0.1%; P < 0.05), and sense p53
(0.47 ± 0.27%; P < 0.001)
alone.
 |
DISCUSSION
|
|---|
It is well established that cisplatin induces DNA damage through
formation of inter- and intra-strand cross-linkages and activation of
p53-dependent apoptotic pathways. Alterations in cisplatin cellular
retention or excretion, DNA repair mechanism, or apoptotic machinery
have been considered important etiological factors in chemoresistance.
We have demonstrated previously that the addition of cisplatin to hOSE
cancer cell cultures decreased Xiap protein content and induced
apoptosis in cisplatin-sensitive cells (OV2008 and A2780-s) but not in
their respective resistant variants (C13* and A2780-cp).5
In addition, over-expression of Xiap in the sensitive cells (OV2008) by
adenoviral sense Xiap infection effectively attenuated
cisplatininduced apoptosis, suggesting that Xiap may be an
important determinant in cisplatin sensitivity. We hereby have extended
these studies to further investigate this concept and have shown that
Xiap down-regulation in wild type p53-resistant hOSE cancer cells
(C13*) by antisense Xiap expression sensitizes the cells to cisplatin,
with a significant shift of the concentration-apoptotic response curve
to the left. Although low cellular cisplatin retention is believed to
be an important factor in chemoresistance in this cell line
(29)
, our present findings represent the first
demonstration of a possible role of Xiap in chemoresistance in cancer
cells and offer a new target for the development of a novel gene
therapeutic approach. These results also suggest that cisplatin
resistance may be a multifactorial phenomenon.
We have also shown in the present studies that antisense Xiap
expression alone in cisplatin-resistant wild type p53 hOSE cancer cells
(C13*) results in a concentration- and time-dependent decrease in Xiap
content and an increase in apoptosis. These findings not only
demonstrate a key regulatory role of Xiap in apoptosis in these cells,
but also suggest that, despite being resistant to cisplatin,
they are capable of and committed to apoptosis but are prevented from
undergoing the death process due to the presence of Xiap. Xiap has a
strong affinity for caspase-3, a cysteine protease involved in the
execution of apoptosis (13
, 30)
and is an inhibitor of
caspase-3 activation (cleavage by upstream caspases) and activity. The
physiological role of Xiap has been considered as a final guardian for
preventing and regulating this cell-death process. Thus, removal of the
antiapoptotic factor would be expected to have resulted in unleashing
of the apoptotic process, probably mediated by the release of caspase-3
from its inhibition. However, our present observations are that Xiap
down-regulation alone was only effective in p53 wild type cells, and
failed to induce apoptosis in p53 mutated and null cell lines.
The mechanism(s) by which caspase-3 elicits its proapoptotic action in
hOSE cancer cells is unclear. It has been suggested that proteins
involved in DNA breakdown [e.g., inhibitor of caspase
activated DNase (31)
] and signal transduction
[e.g., focal adhesion kinase, mitogen-activated protein
kinase/extracellular signal-regulated kinase kinase
(32)
] and cytoskeletal proteins [e.g., actin
(33)
] are possible physiological substrates for
caspase-3, and that this death protease mediates the apoptotic signal
by disrupting survival signals and/or cellular integrity. In the
present studies, we have observed that pro-caspase-3 cleavage following
Xiap down-regulation in wild type p53 hOSE cancer cells was temporally
associated with MDM2 cleavage. In both C13* and A2780-cp cells, the
60-kDa MDM2 was the dominant isoform. MDM2 were undetectable in SKOV3
cells, although a 90-kDa native protein became detectable after wild
type p53 over-expression. Whereas the 60-kDa isoform is believed to be
a caspase cleavage product of the 90-kDa protein and is frequently
found in cancer cells (34)
, our in vitro
studies with C13* whole-cell lysate and human recombinant active
caspase-3 and -7 indicate that MDM2 may be a physiological substrate
for caspase-3. We demonstrated the caspase-3-mediated cleavage of the
60-kDa MDM2 to a smaller fragment (30 kDa), as well as the 90- to
60-kDa cleavage when the 90-kDa protein was up-regulated.
Although how the conversion of the 60-kDa protein to the 30-kDa form
(but not of the 90- to 60-kDa form) is suppressed in the
nonapoptotic cells is unclear, the possible involvement of
Xiap-independent caspases in the initial processing of the 90-kDa
protein cannot be excluded. These findings are, however, consistent
with the fact that MDM2 has caspase-sensitive sites (23)
,
and are in good agreement with previously published observations
(24
, 35) . The physiological significance of the observed
caspase-3 specificity is not known.
MDM2 is an oncoprotein that binds p53 and facilitates
ubiquitin-mediated degradation of the tumor suppresser protein
(6)
. It has been reported that a decrease in MDM2 content
stabilizes p53, whereas the opposite is true when the oncoprotein is
over-expressed (36)
. Wild type p53 accumulation is known
to induce cell cycle arrest and apoptosis, and p53 mutation is
frequently identified in various cancer cells (37)
. In the
present investigations, we have demonstrated Xiap down-regulation is
associated with significant cleavage of caspase-3 and MDM2, p53
accumulation, and increased apoptosis in wild type p53-expressing C13*
cells. When wild type p53 was supplemented, accumulation of p53 was
also evident in p53 mutated (A2780-cp) and null (SKOV3) cells treated
with antisense Xiap. Xiap down-regulation together with wild type p53
reconstitution (by sense p53 expression), however, not only further
increased p53 content, but significantly increased apoptosis in these
otherwise p53-deficient cells. These studies provide the first evidence
for a role of Xiap in the regulation of cellular p53 level and suggest
that caspase-3-mediated MDM2 processing may be an additional regulatory
point for the antiapoptotic protein in promoting survival of wild type
p53-expressing hOSE cancer cells.
The regulation of Xiap levels in hOSE cancer cells remains to be
investigated. In the present studies, over-expression of wild type p53
decreased basal Xiap content and enhanced the effect of antisense Xiap
expression, suggesting a possible involvement of p53 in the
transcriptional control of Xiap expression. On the other hand,
posttranscriptional processing of Xiap may also be an important
determinant of the steady-state levels of Xiap and, thus, of apoptosis.
Our present studies indicate that at least 6072 h are required to
sufficiently decrease Xiap content following antisense expression,
suggesting that the antiapoptotic protein may have a relatively long
half-life. This is consistent with the observation that, although
adenoviral infection efficiency was close to 100%, only about 60% of
the cells were apoptotic 72 h after infection (MOI = 20).
In summary, we have shown that Xiap plays an important role of
regulation of apoptosis in hOSE cancer cells and is an important
determinant in cisplatin resistance. In addition to its
well-established inhibitory action on caspase-3 activity, this
antiapoptotic protein appears to be central in the control of p53
accumulation and p53-mediated apoptosis, possibly via the
MDM2-p53-ubiquitin degradation pathway. Xiap down-regulation not only
induces apoptosis but also sensitizes chemoresistant wild type p53 hOSE
cancer cells to the proapoptotic action of cisplatin. In p53 mutant
cancer cells, coexpression of Xiap antisense and wild type p53 sense is
more effective than wild type p53 restoration alone. These findings
provide a new concept for the development of novel therapeutic
approaches in the treatment of chemoresistant hOSE cancer. Studies with
xenograft models are required to establish whether these strategies are
indeed applicable in vivo.
 |
ACKNOWLEDGMENTS
|
|---|
We thank Dr. Robert Korneluk (Apoptogen, Inc., Ottawa, Ontario,
Canada) for providing Xiap antibody, adenoviral LacZ, and antisense
Xiap used in the present studies, and Dr. F. L. Graham (McMaster
University, Hamilton, Ontario, Canada) for the gift of adenoviral wild
type sense p53. We thank the China Scholarship Council and the
Japan-North America Medical Exchange Foundation for providing
fellowship awards to Y. S. and H. S., respectively.
 |
FOOTNOTES
|
|---|
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
1 Supported by grants from the Canadian Institutes
of Health Research (MT-15691, to B. K. T), Grant-in-Aid for
International Scientific Research from the Ministry of Education,
Science, Sports and Culture of Japan (Joint Research 10044255, to F. K
and B. K. T.), and the Ottawa Hospital Foundation. 
2 These authors contributed equally in the present
investigations. 
3 To whom requests for reprints should be
addressed, at Loeb Health Research Institute, 725 Parkdale Avenue,
Ottawa, Ontario, K1Y 4E9, Canada. Phone: (613) 761-4081; Fax:
(613) 761-5365; E-mail: btsang{at}lri.ca 
4 The abbreviations used are: MDM2, murine double
minute 2; IAP, inhibitor of apoptosis proteins; Xiap, X-linked
inhibitor of apoptosis protein; hOSE, human ovarian surface epithelial;
DEVD-CHO, N-acetyl-Asp-Glu-Val-Asp-CHO (aldehyde); TBS,
Tris-buffered saline; MOI, multiplicity of infection. 
5 J-L. Li, Q. Feng, J-M. Kim, D. Schneiderman, P.
Liston, M. Li, B. Vanderhyden, W. Faught, M. F. K. Fung, M.
Senterman, R. G. Korneluk and B. K. Tsang. Human ovarian cancer and
cisplatin resistance: possible role of inhibitor of apoptosis proteins,
Endocrinology, in press. 
Received 2/18/00.
Accepted 8/16/00.
 |
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