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Vol. 296, Issue 3, 797-805, March 2001
Departments of Neurology (L.L.M., S.L.W., L.C.B., E.A.N.),
Neurosurgery (E.A.N.), and Cell and Developmental Biology (L.L.M.),
Oregon Health Sciences University, Portland, Oregon; Veterans
Administration Medical Center, Portland, Oregon (E.A.N.); and Portland
State University, Portland, Oregon (C.H., S.E.P.)
Modulation of glutathione has been proposed as a mechanism to
alter the efficacy and toxicity of chemotherapeutic agents. We
investigated in vitro cytoenhancement of chemotherapy toxicity by
reducing cellular glutathione levels with
L-buthionine-[S,R]-sulfoximine (BSO), and
chemoprotection with small molecular weight sulfur-containing agents
that mimic or replace glutathione. Cytotoxicity, caspase-2 enzymatic
activity, and in situ DNA staining for apoptosis were assessed in
cultured human small cell lung carcinoma cells and fibroblasts. BSO
treatment reduced the half-maximal cytotoxic dose of the alkylating
chemotherapeutics melphalan, carboplatin, and cisplatin, and increased
the total magnitude of cell death. Melphalan was more sensitive than
carboplatin or cisplatin to BSO. The chemoprotective agents sodium
thiosulfate, N-acetylcysteine, and glutathione ethyl
ester reduced the cytotoxicity of all three alkylating
chemotherapeutics regardless of BSO treatment, but D-methionine was effective only against the platinum
agents. N-Acetylcysteine was the most effective
protectant tested. Chemoprotection against melphalan toxicity was
maximally effective only if administered concurrent with chemotherapy,
whereas chemoprotection for the platinum agents remained effective if
delayed 4 h after chemotherapy. BSO enhancement and
N-acetylcysteine chemoprotection for melphalan toxicity
occurred at least partially through an apoptotic mechanism. Modulation
of glutathione levels will be valuable in the clinical setting if
chemotherapy and chemoprotectant can be physically and/or temporally
separated. Cytoenhancement and chemoprotection may be particularly
useful in the central nervous system where the blood-brain barrier of
the cerebral vasculature creates two compartments, for
cytoenhancement in brain tumors and systemic chemoprotection.
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