Role of P-glycoprotein inhibitors in ceramide-based therapeutics for treatment of cancer

Samy A.F. Morad, Traci S. Davis, Matthew R. MacDougall, Su Fern Tan, David J. Feith, Dhimant H. Desai, Shantu G. Amin, Mark Kester, Thomas P. Loughran, Myles C. Cabot

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


The anticancer properties of ceramide, a sphingolipid with potent tumor-suppressor properties, can be dampened via glycosylation, notably in multidrug resistance wherein ceramide glycosylation is characteristically elevated. Earlier works using the ceramide analog, C6-ceramide, demonstrated that the antiestrogen tamoxifen, a first generation P-glycoprotein (P-gp) inhibitor, blocked C6-ceramide glycosylation and magnified apoptotic responses. The present investigation was undertaken with the goal of discovering non-anti-estrogenic alternatives to tamoxifen that could be employed as adjuvants for improving the efficacy of ceramide-centric therapeutics in treatment of cancer. Herein we demonstrate that the tamoxifen metabolites, desmethyltamoxifen and didesmethyltamoxifen, and specific, high-affinity P-gp inhibitors, tariquidar and zosuquidar, synergistically enhanced C6-ceramide cytotoxicity in multidrug resistant HL-60/VCR acute myelogenous leukemia (AML) cells, whereas the selective estrogen receptor antagonist, fulvestrant, was ineffective. Active C6-ceramide-adjuvant combinations elicited mitochondrial ROS production and cytochrome c release, and induced apoptosis. Cytotoxicity was mitigated by introduction of antioxidant. Effective adjuvants markedly inhibited C6-ceramide glycosylation as well as conversion to sphingomyelin. Active regimens were also effective in KG-1a cells, a leukemia stem cell-like line, and in LoVo human colorectal cancer cells, a solid tumor model. In summary, our work details discovery of the link between P-gp inhibitors and the regulation and potentiation of ceramide metabolism in a pro-apoptotic direction in cancer cells. Given the active properties of these adjuvants in synergizing with C6-ceramide, independent of drug resistance status, stemness, or cancer type, our results suggest that the C6-ceramide-containing regimens could provide alternative, promising therapeutic direction, in addition to finding novel, off-label applications for P-gp inhibitors.

Original languageEnglish (US)
Pages (from-to)21-33
Number of pages13
JournalBiochemical Pharmacology
StatePublished - Apr 15 2017

All Science Journal Classification (ASJC) codes

  • Biochemistry
  • Pharmacology


Dive into the research topics of 'Role of P-glycoprotein inhibitors in ceramide-based therapeutics for treatment of cancer'. Together they form a unique fingerprint.

Cite this