Inhibition of X‑linked inhibitor of apoptosis protein enhances anti‑tumor potency of pure total flavonoids on the growth of leukemic cells

Flavonoids, a vast group of polyphenols widely distributed in plants, are known to possess a range of biological activities and potential anti‑tumor effects. X‑linked inhibitor of apoptosis protein (XIAP) promotes the progression of leukemia by preventing tumor cells undergoing apoptosis. The present study investigated the potential effects and underlying mechanisms of pure total flavonoids from Citrus paradisi Macfad (PTFC) on human U937 cells, and explored the effects of short hairpin (sh)RNA‑mediated XIAP knockdown on the anti‑cancer effects of PTFC. Western blotting was used to determine level of apoptosis‑associated effectors following PTFC treatment. A lentiviral vector of RNA interference of XIAP gene was constructed to downregulate XIAP expression. MTT assay and flow cytometry were used to determine the effects of PTFC separately or combined with XIAP‑shRNA on inhibition and apoptosis of U937 cells, respectively. Treatment with PTFC effectively inhibited leukemic cell proliferation in a dose‑ and time‑dependent manner. PTFC induced apoptosis of U937 cells in a dose‑dependent manner, at a particular concentration range, by decreasing XIAP expression levels and activating caspases‑3, ‑7 and ‑9. PTFC treatment combined with XIAP‑shRNA additionally demonstrated a marked increase in cell apoptosis, compared with PTFC or XIAP‑shRNA alone (P<0.05). Therefore, these findings suggest that PTFC inhibits growth and induces apoptosis in U937 cells in vitro. Furthermore, suppression of XIAP expression enhances these effects.