Induction of apoptosis by metformin in epithelial ovarian cancer: Involvement of the Bcl-2 family proteins

Objective. The aims of the study were to evaluate the ability of metformin to induce apoptosis in epithelial ovarian cancer cell lines and to identify the pathways involved in this effect. Methods. After treatment with metformin and/or cisplatin, OVCAR-3 and OVCAR-4 cellular apoptosis was assessed by flow cytometry and caspase 3/7 activity. Cell cycle analysis was also performed by flow cytometry as well. Modulation of protein expression of the Bcl-2 family after treatment with metformin and/or cisplatin was determined by Western blotting. Results. Metformin induced apoptosis in OVCAR-3 and OVCAR-4 cell lines in an AMPK-independent manner and provoked a cell cycle arrest in the S and G2/M phase. Moreover, we established that metformin can induce apoptosis in OVCAR-3 and OVCAR-4 cells by activating caspases 3/7, down-regulating Bcl-2 and Bcl-xL expression, and up-regulating Bax and Bad expression. The induction of apoptosis by metformin was also enhanced by cisplatin and combination of these drugs did not modulate the expression of Bcl-2 family proteins in OVCAR-3 cell line, whereas the effect was enhanced in OVCAR-4 cell line. Conclusion. Bcl-xL and Bcl-2 targeted strategies were suggested to constitute an effective therapeutic tool for the treatment of chemoresistant ovarian carcinoma, in conjunction with conventional chemotherapy. These data are relevant to ongoing translational research efforts and clinical trials exploring a possible protective effect of metformin against ovarian cancer, including BcI-2 inhibition. (C) 2011 Elsevier Inc. All rights reserved.