肺癌中多药耐药因子的表达相关性及临床意义的研究

目的 探讨多药耐药因子在肺癌中表达与共表达的水平、相关性及临床意义.方法 采用免疫组化SP技术检测60例肺癌患者组织芯片中P-糖蛋白(P-gp)、多药耐药相关蛋白(MRP)、肺耐药蛋白(LRP)、谷胱苷肽-S转移酶-π(GST-π)等多药耐药因子的表达水平.结果 ①P-gp、MRP、LRP、GST-π阳性表达率分别为53.3%(32/60)、63.3%(38/60)、70.0%(42/60)、80.0%(48/60).②耐药因子在不同病理类型中表达差异有统计学意义(P＜0.05),在NSCLC中表达高于SCLC;在不同TNM分期、不同分化程度间表达差异无统计学意义(P＞0.05).③各耐药因子之间阳性共表达的结果分别为P-gp+MRP:41.6%,P-gp+LRP:35.0%,MRP+LRP:53.3%,MRP+GST-π:50.0%,LRP+GST-π:58.3%,P-gp+GST-π:45.0%,P-gp +MRP+LRP+GST-π:20.0%.其中P-gp与MRP间具有相关性(r=0.756,P＜0.01),P-gp与LRP间具有相关性(r=0.689,P＜0.01),MRP与LRP间具有相关性(r=0.669,P＜0.01),MRP与GST-π间具有相关性(r=0.546,P＜0.01),LRP与GST-π间具有相关性(r=0.848,P＜0.01),P-gp与GST-π具有相关性(r=0.535,P＜0.01).结论 肺癌的多药耐药现象是由多个耐药因子共同参与作用的结果,肺癌多药耐药的发生在肿瘤细胞的病理分型间有差异性,在不同分化程度、不同TNM分期间无差异性.

Abstract：

Objective To study the expression,co-expression, and clinical significance of four multi-drug resistance factors in lung cancer. Methods The P-glycoprotein (P-gp), mullidrug resistance-associated protein ( MRP, lung resistance protein ( LRP), glutathione-S-transferase (GST-π) of 60 lung cancer patients were detected by immunohistochemical methods. Results The positive drug resistance rate of P-gp, MRP, LRP, GST-π was 53.3% (32/60) ,63.3% (38/60) ,70.0% (42/60) ,80.0% (48/60) respectively. Patients with NSCLC had significantly higher expression of the drug resistance factors than those with SCLC. No relation was observed among the expression of drug resistance factors and TNM stage and cell differentiation. The-expression rate was as follows: Pgp + MRP :41.6%, P-gp + LRP :35.0%, MRP + LRP :53.3%, MRP + GST-π:50.0%, LRP + GST-π: 58.3%, Pgp + GST-π:45.0%. P-gp + MRP + LRP + GST-π:20.0%. Among them, significant relation was detected between P-gp and MRP ( rs = 0.756, P ＜ 0. 0 ), between P-gp and LRP ( rs = 0.689, P ＜ 0.01 ), between MRP and LRP (rs = 0.669, P ＜ 0.01 ), between MRP and GST-π( rs = 0.546, P ＜ 0.01 ), between LRP and GST-π ( rs = 0.848, P ＜0.01 ), between P-gp and LRP( rs =0.535 ,P ＜0.01 ). Conclusions The Multi-drug resistance in lung cancer patients is affected by various multidrug resistance factors. The drug resistance factors' expression is related to histology, but not to TNM stage end cell differentiation.     

温下方逆转A549/DDP细胞的多药耐药及对膜表面蛋白表达的影响

目的运用血清药理学方法,体外研究温下方对A549/DDP细胞多药耐药的逆转作用及机制。方法正常血清及不同浓度的温下方含药血清作用于A549/DDP细胞,四甲基偶氮唑蓝(MTT)法检测温下方含药血清对A549/DDP细胞的逆转作用;运用免疫荧光技术,激光共聚焦显微镜及流式细胞仪检测肺耐药相关蛋白(LRP)、多药耐药相关蛋白(MRP)和P-糖蛋白(P-gp)的表达。结果温下方含药血清能明显逆转A549/DDP细胞的多药耐药,增敏倍数为2～2.5倍。并可明显降低P-gp、LRP、MRP蛋白表达。结论温下方通过降低P-gp、LRP、MRP的表达以增强A549/DDP对化疗药的敏感性,逆转肺腺癌细胞的多药耐药。     

Low-level doxorubicin resistance in benzo[a]pyrene-treated KB-3-1 cells is associated with increased LRP expression and altered subcellular drug distribution

The P-glycoprotein (P-gp)-negative epidermoid pharyngeal carcinoma cells KB-3-1 were grown in 0.25 mM benzo[a]pyrene (BaP) for 3 months and increased resistance to doxorubicin, but not to vinblastine, colchicine, or cisplatin, was found. Doxorubicin resistance was not altered by cyclosporin, the P-gp inhibitor. Intracellular accumulation of BaP or calcein, a substrate for P-gp and multidrug resistance protein (MRP), was not altered by inhibitors of the P-gp and MRP. The expression of cytochrome P450 (CYP) 1A1, lung-resistance-related protein (LRP), P-gp, and MRP was investigated. Overexpression of CYP1A and LRP, on the mRNA and protein levels, was found. BaP-treated KB-3-1 cells remained P-gp negative while the level of MRP was not altered. Subcellular accumulation of BaP was found to be localized in the cytoplasm and minimal in the nuclei in BaP treated cells. In contrast, even penetration of BaP to the nuclei and cytoplasm was found in untreated cells. Subcellular distribution of doxorubicin was altered following BaP treatment with localized accumulation of the cancer drug in cytoplasmic organelles but not in the nuclei. Our data suggested that LRP might play a protective role against toxic compounds. The correlation of increased expression of LRP, but not P-gp nor MRP, with decreased doxorubicin accumulation in the nuclear target suggests a pivotal role of this perinuclear transporter in the MDR phenotype of P-gp-negative cancer cells. These results also propose an alternative mechanism of cancer drug resistance emergence, namely, induction of LRP activity following treatment with BaP, an environmental toxicant and a carcinogen.     

Pegylated phosphotidylethanolamine inhibiting P-glycoprotein expression and enhancing retention of doxorubicin in MCF7/ADR cells

The failure of the clinical treatment of cancer patients is often attributed to drug resistance of the tumor to chemotherapeutic agents. P-glycoprotein (P-gp) contributes to drug resistance via adenosine 5'-triphosphate (ATP)-dependent drug efflux pumps and is widely expressed in many human cancers. Up to date, a few of nanomaterials have shown the effects on P-gp function by different ways. To study the mechanism of the increased cytotoxicity of doxorubicin (DOX) by pegylated phosphotidylethanolamine (PEG-PE) in drug-resistant cancer cells, a series of in vitro cell assays were performed, including identification of P-gp function, quantitative studies on uptake and efflux of DOX, inhibitory effects of blank PEG-PE micelles on mRNA and protein levels of P-gp, and intracellular ATP content alteration. Finally, combining MDR-1 RNA interference (siRNA) with DOX encapsulated in PEG-PE micelles (M-DOX) to improve cytotoxicity of DOX was also studied. M-DOX showed fivefold lower the concentration that caused 50% killing tumor cell than that of free DOX in the P-gp-overexpressing MCF-7 breast cancer (MCF-7/ADR) cells. M-DOX enhanced the cellular uptake and retention of DOX in MCF-7/ADR cells. PEG-PE block molecules can inhibit P-gp expression through downregulating MDR-1 gene. Cytotoxicity of M-DOX was further improved by knocking down the MDR-1 gene using siRNA in the multidrug-resistant cells. We conclude that the increased cytotoxicity of DOX encapsulated in PEG-PE micelle is due to the reduced P-gp expression by PEG-PE block molecules, and accordingly enhancing the cellular accumulation of DOX. To overcome drug resistance of tumor cells, the combination of nanotechnology and biotechnology could be an effective strategy such as PEG-PE formed micelles and siRNA.     

The association of increased lung resistance protein expression with acquired etoposide resistance in human H460 lung cancer cell lines

Chemoresistance remains the major obstacle to successful therapy of cancer. In order to understand the mechanism of multidrug resistance (MDR) that is frequently observed in lung cancer patients, here we studied the contribution of MDR-related proteins by establishing lung cancer cell lines with acquired resistance against etoposide. We found that human H460 lung cancer cells responded to etoposide more sensitively than A549 cells. Among MDR-related proteins, the expression of p-glycoprotein (Pgp) and lung resistance protein (LRP) were much higher in A549 cells compared with that in H460 cells. When we established H460-R1 and -R2 cell lines by progressive exposure of H460 cells to increasing doses of etoposide, the response against etoposide as well as doxorubicin was greatly reduced in R1 and R2 cells, suggesting MDR induction. Induction of MDR was not accompanied by a decrease in the intracellular accumulation of etoposide and the expression of MDR-related proteins that function as drug efflux pumps such as Pgp and MRP1 was not changed. We found that the acquired resistance paralleled an increased expression of LRP in H460 cells. Taken together, our data suggest the implicative role of LRP in mediating MDR in lung cancer.     

槐耳颗粒逆转人乳腺癌细胞MCF-7耐药的初步机制

目的研究槐耳颗粒逆转乳腺癌细胞株MCF-7耐药的初步机制。方法使用四甲基偶氮唑蓝（MTT）比色法测定敏感／耐药乳腺癌细胞MCF-7-S／A对单药阿霉素（ADM）和槐耳颗粒的药物毒性,耐药倍数和槐耳颗粒对MCF-7／A的耐药逆转倍数,分别采用荧光定量逆转录-聚合酶链反应和免疫组化SP法测定多药耐药基因mdr1、多药耐药相关蛋白基因MRP的mRNA和其相应的表达产物P-gp、MRP蛋白,在MCF-7／S及非细胞毒性剂量的槐耳颗粒处理前后MCF-7／A上的表达。结果非细胞毒性剂量（0．01mg／ml）的槐耳颗粒能显著降低ADM对MCF-7／A的IC50（5．06μm）,与逆转前MCF-7／A的IC50（25．8μm）,相比差异有统计学意义（P〈0．01）,其逆转倍数为5．1倍;0．01mg／ml的槐耳颗粒使MCF-7／A细胞的耐药基因mdr1、MDR-1的mRNA以及相应的P-gp、MRP蛋白的表达水平均下调,与未加槐耳颗粒处理的对照组MCF-7／A相比有显著性差异（P〈0．01）。结论非细胞毒性剂量槐耳颗粒具有逆转MCF-7／A细胞耐药性的作用,逆转机制和其耐药基因mdr1、MDR-1的mRNA以及相应的P-gp、MRP蛋白的表达水平下调相关,暗示槐耳颗粒是一种有潜力的耐药逆转剂。     

雷公藤甲素对肺癌A549/DDP细胞多药耐药的逆转作用及机制

目的：探讨雷公藤甲素对肺癌A549/DDP多药耐药的逆转作用及机制。方法：雷公藤甲素作用于肺癌A549/DDP细胞后,应用MTS法检测细胞生长抑制率,流式细胞术检测细胞内罗丹明-123（Rhodamine-123,Rh-123）及细胞表面P-糖蛋白（P-glycoprotein,P-gp）表达,应用Western blot法和real time PCR检测肿瘤细胞多药耐药蛋白 （MDR1）和肺耐药相关蛋白（LRP）表达变化,应用报告基因技术检测细胞NF-κB启动子活性,应用Western blot法检测肿瘤细胞Akt磷酸化。结果：雷公藤甲素可提高肺癌A549/DDP细胞药物敏感性,经2μM和10μM雷公藤甲素作用后,顺铂逆转倍数（RF）分别为2.09倍和2.93倍,肿瘤细胞中Rh-123含量分别提高了1.38倍和2.88倍,P-gp表达分别是对照组的57.1%和32.1%,MDR1和LRP蛋白表达水平显著下降,MDR1 mRNA表达分别是对照组的64.2%和22.6%,LRP mRNA表达分别是对照组的54.8%和34.7%, NF-κB启动子活性分别是对照组的55.6%和23.6%,Akt磷酸化水平显著下降。结论：雷公藤甲素可逆转肺癌A549/DDP细胞多药耐药性,提高肿瘤细胞药物敏感性,抑制药物外排,降低细胞MDR1和LRP表达,其机制可能与抑制Akt磷酸化水平,下调NF-κB启动子活性有关。     

Naringenin Enhances the Anti-Tumor Effect of Doxorubicin Through Selectively Inhibiting the Activity of Multidrug Resistance-Associated Proteins but not P-glycoprotein

Purpose  Naringenin has shown paradoxical results to modulate the function of multidrug resistance-associated proteins (MRPs). The aim of this study is to interpret whether naringenin can reverse intrinsic and/or acquired resistance of cancer cells to chemotherapeutic agents. Methods  The effects of naringenin on the uptake, retention and cytotoxicity of doxorubicin were investigated in A549, MCF-7, HepG2 and MCF-7/DOX cells. Cellular efflux pathways modulated by naringenin were assessed with their specific substrates and inhibitors. The improved antitumor activity of doxorubicin in combination with naringenin was also investigated in vivo. Results  The IC₅₀ values of doxorubicin in combination with naringenin in A549 and MCF-7 cells were approximately 2-fold lower than that of doxorubicin alone. The increased sensitivity to doxorubicin by naringenin in HepG2 and MCF-7/DOX cells was not observed. Naringenin increased the cellular doxorubicin accumulation through inhibiting doxorubicin efflux in the cells expressing MRPs but not P-gp. In contrast to doxorubicin alone, doxorubicin in combination with naringenin enhanced antitumor activity in vivo with low systemic toxicity. Conclusion  Naringenin enhances antitumor effect of doxorubicin by selective modulating drug efflux pathways. Naringenin will be a useful adjunct to improve the effectiveness of chemotherapeutic agents in treatment of human cancers.     

功劳木中异汉防己碱对P-糖蛋白介导的人乳腺癌细胞多药耐药性的逆转作用

本文探讨了异汉防己碱对P-糖蛋白(P-gp)介导的人乳腺癌细胞多药耐药性的逆转作用。首先以RT-PCR和免疫组化方法分别从RNA和蛋白水平检测MCF-7/DOX细胞P-gp表达情况，以明确MCF-7/DOX细胞的耐药特征；然后采用MTT法检测异汉防己碱的内在细胞毒性及其对阿霉素(DOX)的增敏作用，并以RF(reversal fold)值评价其逆转效果；同时应用流式细胞仪(FCM)对细胞内DOX的蓄积量进行了分析；再以免疫组化方法检测异汉防己碱对MCF-7/DOX细胞P-gp表达水平的影响；最后采用罗丹明蓄积和外排试验检测了异汉防己碱对P-gp功能的影响。整个试验以维拉帕米作为阳性对照。实验结果表明：MCF-7/DOX细胞是具有多药耐药表型且P-gp表达阳性的细胞株；无毒剂量异汉防己碱可明显增强DOX对MCF-7/DOX细胞的细胞毒性(RF=3.89)，明显高于维拉帕米(RF=2.54)的逆转活性(P<0.05)，但其几乎不影响DOX对MCF-7细胞的抑制作用；异汉防己碱对MCF-7/DOX细胞P-gp表达水平无明显影响，但其可有效抑制P-gp的药物外排功能。因此，异汉防己碱可有效逆转P-gp介导的人乳腺癌细胞的多药耐药性，它可能成为有效多药耐药逆转剂的候选药物。     

低频超声联合微泡对比剂通过PI3K/AKT通路对乳腺癌耐药株MCF-7/ADR多药耐药的逆转机制研究

目的 探索低频超声联合微泡（LFUSMB）通过磷脂酰肌醇3激酶（PI3K）/蛋白激酶B（AKT）通路对乳腺癌 耐药株MCF-7/阿霉素（ADR）多药耐药的逆转效果及机制。方法 CCK-8法筛选LFUSMB作用时间并测定ADR对 MCF-7/ADR 细胞的半抑制浓度（IC50）。将 MCF-7/ADR 细胞分组为：对照（C）组,采用 MCF 细胞培养基正常培养; ADR组,采用加入ADR（终质量浓度20 mg/L）的MCF细胞培养基培养;LFUSMB+ADR组,采用加入ADR（终质量浓度 20 mg/L）的MCF细胞培养基培养并经LFUSMB处理30 s;LFUSMB+ADR+740 YP（PI3K/AKT通路活化剂）组,采用加 入 ADR（终质量浓度 20 mg/L）和 740 YP（终质量浓度 50 mg/L）的 MCF 细胞培养基培养并经 LFUSMB 处理 30 s。 Annexin V-FIFC/PI 法检测 MCF-7/ADR 细胞凋亡率,Western blot 检测 P 糖蛋白（P-gp）、抗多药耐药蛋白（MRP）1、 MRP2、乳腺癌抗性蛋白（BCRP/ABCG2）、PI3K、AKT、p-PI3K、p-AKT蛋白表达。结果 采用LFUSMB干预30 s进行 后续研究。LFUSMB 30 s组ADR对MCF/ADR细胞的IC50低于未超声处理组,相对耐药逆转倍数约为8.20倍。ADR 组细胞凋亡率较C组增高（P＜0.05）,MRP1、MRP2、P-gp、BCRP/ABCG2、p-PI3K/PI3K和p-AKT/AKT 蛋白水平无明 显变化;LFUSMB+ADR组细胞凋亡率较ADR组增高,MRP1、MRP2、P-gp、BCRP/ABCG2、p-PI3K/PI3K和p-AKT/AKT 蛋白水平显著下调（P＜0.05）。与 LFUSMB+ADR 组比较,LFUSMB+ADR+740 YP 组细胞凋亡率显著降低,MRP1、 MRP2、P-gp、BCRP/ABCG2 蛋白水平显著增高（P＜0.05）。结论 LFUSMB 可通过抑制 PI3K/AKT 通路活化,下调 MRP1等腺苷三磷酸结合盒（ABC）家族蛋白表达,逆转乳腺癌MCF-7/ADR细胞耐药性。     

Establishment and characterization of adriamycin-resistant human colorectal adenocarcinoma HCT-15 cell lines with multidrug resistance

The multidrug resistance (MDR) phenotype, either intrinsic and/or acquired, is discussed in relation to several MDR-associated markers such as P-glycoprotein (P-gp) encoded by mdr1, multidrug-resistance-associated protein (MRP) encoded by MRP and lung-resistance-associated protein (LRP) encoded by LRP. Well-characterized in vitro models are required to elucidate the mechanisms of MDR. The aim of the present study is the establishment of a drug-resistant subline from human colorectal adenocarcinoma HCT-15 that intrinsically expresses moderate levels of P-gp, MRP and LRP. Three adriamycin-resistant sublines (HCT-15/ADM1, HCT-15/ADM2 and HCT-15/ADM2-2) were established by stepwise exposure in growth medium that was supplemented with 25-200 ng/ml adriamycin-resulting in a 2.2- to 7.8-fold increase in IC(50) values by using the XTT assay. They were cross-resistant to MDR-related drugs, epirubicin, mitoxantrone, vincristine, etoposide and taxol, but not the MDR-unrelated drug, mytomycin C. The resistance to adriamycin was confirmed in vivo by a lack of sensitivity in athymic nude mice. Gene expression data for mdr1/P-gp, MRP/MRP and LRP/LRP on both mRNA and protein levels demonstrated that the molecules contributing to MDR in resistant sublines are mainly P-gp and partially MRP. The newly established adriamycin-resistant sublines of HCT-15 will provide clinically relevant tools to investigate how to overcome drug resistance and elucidate possible mechanisms of acquired MDR in human colon cancer.     

荜茇酰胺对人肺癌A549/DDP细胞耐药性的逆转作用

目的:研究荜茇酰胺对人肺癌A549/顺铂(DDP)细胞耐药性的逆转作用。方法:A549/DDP细胞经0、20、30μmol/L荜茇酰胺作用48 h后,用MTS法检测肿瘤细胞抑制率;流式细胞术检测肿瘤细胞凋亡、细胞周期、P-糖蛋白(P-gp)表达和肿瘤细胞内罗丹明Rht123含量的变化;Western blotting法检测多药耐药基因(MDR)1、多药耐药相关蛋白(MRP)1、DNA拓扑异构酶(Top)Ⅱ、谷胱甘肽S-转移酶(GST)-π、凋亡抑制蛋白Survivin、周期蛋白依赖性蛋白激酶(CDK)1和蛋白激酶(PK)Cζ蛋白表达;实时荧光聚合酶链反应(RT-PCR)法检测MDR1、MRP1、Top-II、GST-π、Survivin和CDK1 m RNA表达;酶标仪检测含半胱氨酸的天冬氨酸蛋白水解酶(Caspase)-3、8活性。结果:A549/DDP细胞经0、20、30μmol/L荜茇酰胺作用48 h后,DDP对肿瘤细胞增殖的抑制率明显升高;与0μmol/L比较,20、30μmol/L荜茇酰胺作用48 h后,DDP导致的细胞凋亡率和G2期/M期明显升高,P-gp表达明显减弱,Rh-123浓度明显增加,MDR1、MRP1、Top-II、GST-π、Survivin、CDK1和PKCζ蛋白表达明显减弱,MDR1、MRP1、Top-Ⅱ、GST-π、Survivin、CDK m RNA表达明显减弱,Caspase-3、8的活性明显增强。结论:荜茇酰胺可逆转人肺癌A549/DDP细胞DDP耐药性,可能与其调节多药耐药相关基因表达有关。     

Saikosaponin A,an active glycoside from Radix bupleuri,reverses P-glycoprotein-mediated multidrug resistance in MCF-7/ADR cells and HepG2/ADM cells

1.?The expression and function of P-glycoprotein (P-gp) is associated with the phenotype of multidrug resistance (MDR). Saikosaponin A (SSA) is a triterpenoid saponin isolated from Radix Bupleuri. This study was mainly designed to understand effects of SSA on MDR in MCF-7/ADR and HepG2/ADM cells.

2.?MDR reversal was examined as the alteration of cytotoxic drugs IC50 in resistant cells in the presence of SSA by MTT assay, and was compared with the non-resistant cells. Apoptosis and uptake of P-gp substrates in the tumor cells were detected by flow cytometry. Western blot was performed to assay the expression of P-gp.

3.?Our results demonstrate SSA could increase the chemosensitivity of P-gp overexpressing HepG2/ADM and MCF-7/ADR cells to doxorubicin (DOX), vincristine (VCR) and paclitaxel. SSA promoted apoptosis of MCF-7/ADR cells in the presence of DOX. Moreover, it could also increase the retention of P-gp substrates DOX and rhodamine 123 in MCF-7/ADR cells, and decrease digoxin efflux ratio in Caco-2 cell monolayer. Finally, a mechanistic study showed that SSA reduced P-gp expression without affecting hydrolytic activity of P-gp.

4.?In conclusion, our findings suggest that SSA could be further developed for sensitizing resistant cancer cells and used as an adjuvant therapy together with anticancer drugs to improve their therapeutic efficacies.     

Reversal of P-glycoprotein-mediated multidrug resistance by the novel tetrandrine derivative W6

Overexpression of ATP-dependent efflux pump P-glycoprotein (P-gp) is the main cause of multidrug resistance (MDR) and chemotherapy failure in cancer treatment. Inhibition of P-gp-mediated drug efflux is an effective way to overcome cancer drug resistance. The present study investigated the reversal effect of the novel tetrandrine derivative W6 on P-gp-mediated MDR. KBv200, MCF-7/adr and their parental sensitive cell lines KB, MCF-7 were used for reversal study. The intracellular accumulation with P-gp substrates of doxorubicin was determined by flow cytometry. The expression of P-gp and ERK1/2 was investigated by western blot and real-time-PCR (RT-PCR) analysis. ATPase activity of P-gp was performed by P-gp-Glo^TM assay systems. In comparison with P-gp-negative parental cells, W6 produced a favorable reversal effect in the MDR cells, as determined using the MTT assay. W6 significantly and dose-dependently increased intracellular accumulation of P-gp substrate doxorubicin (DOX) in P-gp overexpressing KBv200 cells, and also inhibited the ATPase activity of P-gp. W6 inhibited P-gp expression in KBv200 cells in a time-dependent manner, but it had no effect on MDR1 expression. In addition, W6 significantly decreased the ERK1/2 activation in KBv200 cells. Our results showed that W6 effectively reversed P-gp-mediated MDR by inhibiting the transport function and expression of P-gp, demonstrating the potential clinical utility of W6.     

三氧化二砷对人肺腺癌A549/R细胞多药耐药相关蛋白表达的影响

目的探讨三氧化二砷(As2O3)对人肺腺癌A549/R细胞耐药性的逆转作用及对多药耐药相关蛋白（MRP）表达的影响。方法以荧光分光光度计测定细胞内药物浓度的改变，采用半定量逆转录聚合酶联反应(RT PCR) 技术检测As2O3处理后A549/R MRP基因表达的变化。结果As2O3的非细胞毒性剂量可增加A549/R细胞内多柔比星(ADM)浓度，降低其IC50。A549/R细胞中MRP呈过表达状态，不同浓度的As2O3处理A549/R后MRP表达水平明显降低。结论As2O3可部分逆转A549/R细胞对ADM的耐药性，其逆转机制与改变MRP基因表达有关。     

Ritonavir induces P-glycoprotein expression, multidrug resistance-associated protein (MRP1) expression, and drug transporter-mediated activity in a human intestinal cell line.

The present study characterized the response of P-glycoprotein (P-gp) and multidrug resistance-associated protein (MRP1) to chronic ritonavir (RIT) exposure by assessing increases in P-gp and MRP1 protein expression and activity. LS-180V intestinal carcinoma cells were exposed for 3 days to 1-100 microM RIT concurrently with controls. P-gp and MRP1 protein was quantified by Western blot analysis. Cell accumulation assays, using the P-gp substrate rhodamine 123 (RH123), the P-gp/MRP1 substrate doxorubicin (DOX), and the MRP substrate carboxyfluorescein (CBF), were performed as a measure of transporter activity. RIT strongly induced P-gp and MRP1 expression (maximum 6-fold and 3-fold increases, respectively) in a concentration-dependent fashion. Following extended exposure to RIT (> 10 microM), cells accumulated < 50% of the RH123 and DOX compared with controls, whereas accumulation of CBF was decreased by 30% at 30 microM. Differences in cell accumulation of RH123 could be eliminated with verapamil (100 microM; a P-gp inhibitor), whereas decreased DOX cell accumulation was only partially reversed by verapamil. Indomethacin (100 microM; an MRP1 inhibitor) had no significant effect on RH123 or DOX accumulation, suggesting limited MRP1-mediated activity. Thus, RIT induced protein expression of P-gp and MRP1 and increased cellular drug exclusion of RH123, DOX, and CBF. Similar in vivo phenomena may occur during anti-HIV drug therapy, explaining potential decrements in therapeutic efficacy due to decreases in bioavailability or alterations in drug distribution.