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<article xml:lang="en" article-type="research-article" xmlns:xlink="http://www.w3.org/1999/xlink">
<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">IJMM</journal-id>
<journal-title-group>
<journal-title>International Journal of Molecular Medicine</journal-title></journal-title-group>
<issn pub-type="ppub">1107-3756</issn>
<issn pub-type="epub">1791-244X</issn>
<publisher>
<publisher-name>D.A. Spandidos</publisher-name></publisher></journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3892/ijmm.2014.1949</article-id>
<article-id pub-id-type="publisher-id">ijmm-34-06-1661</article-id>
<article-categories>
<subj-group>
<subject>Articles</subject></subj-group></article-categories>
<title-group>
<article-title>Tanshinone IIA inhibits human gastric carcinoma AGS cell growth by decreasing BiP, TCTP, Mcl-1 and Bcl-xL and increasing Bax and CHOP protein expression</article-title></title-group>
<contrib-group>
<contrib contrib-type="author">
<name><surname>SU</surname><given-names>CHIN-CHENG</given-names></name><xref ref-type="corresp" rid="c1-ijmm-34-06-1661"/></contrib>
<aff id="af1-ijmm-34-06-1661">Tumor Research Center of Integrative Medicine; Comprehensive Breast Cancer Center; Department of Surgery, Changhua Christian Hospital, Changhua 50006; School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan, R.O.C.</aff></contrib-group>
<author-notes>
<corresp id="c1-ijmm-34-06-1661">Correspondence to: Dr Chin-Cheng Su, Tumor Research Center of Integrative Medicine, Comprehensive Breast Cancer Center, Changhua Christian Hospital, 135 Nan-Hsiao Street, Changhua 50006, Taiwan, R.O.C., E-mail: <email>succ.maeva@msa.hinet.net</email></corresp></author-notes>
<pub-date pub-type="ppub">
<month>12</month>
<year>2014</year></pub-date>
<pub-date pub-type="epub">
<day>29</day>
<month>09</month>
<year>2014</year></pub-date>
<volume>34</volume>
<issue>6</issue>
<fpage>1661</fpage>
<lpage>1668</lpage>
<history>
<date date-type="received">
<day>01</day>
<month>04</month>
<year>2014</year></date>
<date date-type="accepted">
<day>22</day>
<month>09</month>
<year>2014</year></date></history>
<permissions>
<copyright-statement>Copyright &#x000A9; 2014, Spandidos Publications</copyright-statement>
<copyright-year>2014</copyright-year>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/3.0">
<license-p>This is an open-access article licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License. The article may be redistributed, reproduced, and reused for non-commercial purposes, provided the original source is properly cited.</license-p></license></permissions>
<abstract>
<p>Tanshinone IIA (Tan-IIA) is extracted from Danshen (<italic>Salviae Miltiorrhizae Radix</italic>) and is a natural anti-cancer agent, which possesses antitumor activity in a variety of human cancer cells. Tan-IIA can induce apoptosis and inhibit the proliferation of gastric cancer through different molecular mechanisms. However, the efficacy and molecular mechanism of Tan-IIA in gastric cancer have not been well studied. In the present study, the cytotoxicity of Tan-IIA in human gastric cancer AGS cells by 3-(4,5-dimethylthiazol-2-y1)-2,5-diphenyltetrazolium bromide assay was examined. The protein expression levels of B-cell lymphoma-extra large (Bcl-xL), Bcl-2-associated X protein (Bax), myeloid cell leukemia 1 protein (Mcl-1), translationally-controlled tumor protein (TCTP), binding immunoglobulin protein (BiP), calnexin, protein kinase-like endoplasmic reticulum kinase, eIF2&#x003B1;, activating transcription factor 4 (ATF4), inositol-requiring enzyme 1&#x003B1; (IRE1&#x003B1;), ATF6, caspase-12, caspase-9, caspase-3, C/EBP-homologous protein (CHOP) and &#x003B2;-actin in AGS cells were measured by western blot analysis. The results showed that Tan-IIA inhibited AGS cells in a time-and dose-dependent manner. AGS cells treated with Tan-IIA upregulated the protein expression of caspase-12, caspase-9, caspase-3, CHOP and Bax, but downregulated the protein expression of BiP, TCTP, Mcl-1 and Bcl-xL. These findings indicated that Tan-IIA inhibits the growth of human gastric cancer AGS cells. One of the molecular mechanisms may be through decreasing the protein expression of BiP to induce the activation of endoplasmic reticulum stress, followed by increasing the protein expression of caspase-12 to upregulate CHOP expression. The other may be through decreasing the protein expression of Mcl-1, Bcl-xL and TCTP, but increasing Bax, caspase-9 and caspase-3 to induce apoptosis. The chemotherapeutic potential of Tan-IIA for human gastric cancer warrants further study in the future.</p></abstract>
<kwd-group>
<kwd>tanshinone IIA</kwd>
<kwd>gastric carcinoma AGS cells</kwd>
<kwd>endoplasmic reticulum stress</kwd>
<kwd>translationally-controlled tumor protein</kwd>
<kwd>myeloid cell leukemia 1 protein</kwd></kwd-group></article-meta></front>
<body>
<sec sec-type="intro">
<title>Introduction</title>
<p>Tanshinone IIA (Tan-IIA; C<sub>19</sub>H<sub>18</sub>O<sub>3</sub>), a phenanthrenequinone derivative extracted from Danshen, <italic>Salviae Miltiorrhizae Radix</italic> (<xref ref-type="bibr" rid="b1-ijmm-34-06-1661">1</xref>,<xref ref-type="bibr" rid="b2-ijmm-34-06-1661">2</xref>), is a natural anti-cancer agent, which possesses antitumor activity in a variety of human cancer cells, such as lung (<xref ref-type="bibr" rid="b3-ijmm-34-06-1661">3</xref>), colon (<xref ref-type="bibr" rid="b4-ijmm-34-06-1661">4</xref>) and breast cancer (<xref ref-type="bibr" rid="b5-ijmm-34-06-1661">5</xref>). It has been well documented that Tan-IIA can induce apoptosis and reverse the malignant phenotype of SGC7901 gastric cancer cells. Tan-IIA also exerted powerful inhibitory effects in the gastric cancer cells, SGC7901, in a time- and dose-dependent manner, and arrested gastric cancer cells in the G<sub>0</sub>/G<sub>1</sub> phase (<xref ref-type="bibr" rid="b6-ijmm-34-06-1661">6</xref>,<xref ref-type="bibr" rid="b7-ijmm-34-06-1661">7</xref>). Tan-IIA induced growth inhibition and apoptosis in gastric cancer <italic>in vitro</italic> and <italic>in vivo</italic>. Tan-IIA not only arrested gastric cancer MKN-45 cells in G<sub>2</sub>/M phase, but also triggered the intrinsic apoptotic-signaling pathway, through upregulating expression of the p53 gene and downregulating the expression of the B-cell lymphoma (Bcl) 2 gene (<xref ref-type="bibr" rid="b8-ijmm-34-06-1661">8</xref>,<xref ref-type="bibr" rid="b9-ijmm-34-06-1661">9</xref>). These studies indicate that Tan-IIA may serve as an effective adjunctive reagent in the treatment of gastric cancer. However, the molecular mechanisms of Tan-IIA in gastric cancer cells remain unclear. In previous studies by my group, it was shown that Tan-IIA inhibited the growth of pancreatic cancer BxPC-3 cells by decreasing the protein expression of translationally-controlled tumor protein (TCTP), myeloid cell leukemia 1 protein (Mcl-1) and Bcl-extra large (Bcl-xL) (<xref ref-type="bibr" rid="b10-ijmm-34-06-1661">10</xref>). Tan-IIA inhibited the growth of breast cancer cells, BT-20, through increasing the protein expression of caspase-12, GADD153 and phospho-p38 (<xref ref-type="bibr" rid="b11-ijmm-34-06-1661">11</xref>). Tan-IIA also inhibited the growth of hepatocellular carcinoma Hep-J5 cells by increasing calreticulin, caspase-12 and GADD153 protein expression (<xref ref-type="bibr" rid="b12-ijmm-34-06-1661">12</xref>). However, the molecular mechanisms that cause Tan-IIA to induce apoptosis in human gastric cancer via interaction of endoplasmic reticulum stress (ER stress) and intrinsic apoptotic signaling pathway have not been clarified. In the present study, the effects of Tan-IIA in human gastric cancer AGS cells were investigated.</p></sec>
<sec sec-type="materials|methods">
<title>Materials and methods</title>
<sec sec-type="materials">
<title>Materials</title>
<p>The AGS human gastric adenocarcinoma cell line (BCRC no.: 60102) was obtained from the Food Industry Research and Development Institute (Hsinchu, Taiwan). Tan-IIA (CAS-no.: 568-72-9), 3-(4,5-dimethylthiazol-2-y1)-2,5-diphenyltetrazolium bromide (MTT), sodium deoxycholate, leupeptin, Triton X-100, Tris-HCl, ribonuclease-A, sodium pyruvate, 4-(2-hydroxethyl)-1-piperazineethanesulphonic acid, dimethylsulfoxide (DMSO) and Tween-20, mouse anti-&#x003B2;-actin were obtained from Sigma-Aldrich (St. Louis, MO, USA). Potassium phosphate and 0.2 mm polyvinylidene fluoride membranes were purchased from Merck KGaA (Darmstadt, Germany). F-12K medium, fetal bovine serum (FBS), penicillin-streptomycin and glutamine were obtained from Gibco-BRL (Carlsbad, CA, USA). BioMax film was obtained from Kodak. The Bcl-2-associated X protein (Bax) &#x0005B;no.: 2774; molecular weight (MW) 20 kDa&#x0005D;, Bcl-xL (no.: 2764; MW 30 kDa), Mcl-1 (no.: 5453; MW 40 kDa), TCTP (no.: 8441; MW 23 kDa), binding immunoglobulin protein (BiP) (no.: 3177; MW 78 kDa), calnexin (no.: 2679; MW 90 kDa), protein kinase-like endoplasmic reticulum kinase (PERK) (no.: 5683; MW 140 kDa), eIF2&#x003B1; (no.: 9722; MW 38 kDa), inositol-requiring enzyme 1&#x003B1; (IRE1&#x003B1;) (no.: 3294; MW 130 kDa), caspase-12 (no.: 2202; MW 42 kDa), caspase-9 (no.: 9502; MW 35 kDa), caspase-3 (no.: 9661; MW 17 kDa), ERK (no.: 4370; MW 44/42 kDa), and p38 (no.: 4511; MW 40 kDa) antibodies were all obtained from Cell Signaling Technology, Inc. (Beverly, MA, USA). C/EBP-homologous protein (CHOP) (NB600-1335; MW 29 kDa), p53 (NB100-92601; MW 43 kDa) and c-Jun N-terminal kinase (NB100-192, MW 42 kDa) antibodies were obtained from Novus Biologicals (Littleton, CO, USA). Activating transcription factor 4 (ATF4) (ab1371; MW 38 kDa) and ATF6 (ab11909; MW 75 kDa) antibodies were obtained from Abcam (Cambridge, MA, USA).</p></sec>
<sec>
<title>Cell culture</title>
<p>The human gastric adenocarcinoma AGS cells were obtained from the Food Industry Research and Development Institute. The AGS cells were placed into 75-cm<sup>2</sup> tissue culture flasks and maintained in F-12K with 10&#x00025; heat-inactivated FBS, 100 U/ml penicillin and 100 &#x003BC;g/ml streptomycin. Cells were grown at 37&#x000B0;C in a humidified atmosphere of 5&#x00025; CO<sub>2</sub>. All the data presented are from at least three independent experiments.</p></sec>
<sec>
<title>Cytotoxicity assay</title>
<p>The cytotoxicity of Tan-IIA for AGS cells was evaluated by the MTT assay in triplicate as previously described (<xref ref-type="bibr" rid="b13-ijmm-34-06-1661">13</xref>). Briefly, the AGS cells were plated in 96-well plates at a density of 2&#x000D7;10<sup>4</sup> cells/well for 16&#x02013;20 h. After this the cells were treated with various concentrations (0, 1, 3, 9, 15, 30 and 60 &#x003BC;g/ml) of Tan-IIA for 24, 48 and 72 h. Subsequently, the cells were incubated with 1 mg/ml of MTT in fresh complete F-12K medium for 1 h. The surviving cells converted MTT to formazan by forming a blue-purple color when dissolved in DMSO. The intensity of formazan was measured at 590 nm using a microplate reader. The relative percentage of cell viability was calculated by dividing the absorbance of treated cells by that of the control in each experiment, using the following formula: Proliferation rate (&#x00025;) = (OD test - OD blank) &#x000D7; 100, where OD test and OD blank are the optical density of the test substances and the blank control, respectively.</p></sec>
<sec>
<title>Western blot analysis</title>
<p>The western blot analysis procedures are as previously described (<xref ref-type="bibr" rid="b14-ijmm-34-06-1661">14</xref>,<xref ref-type="bibr" rid="b15-ijmm-34-06-1661">15</xref>). Briefly, AGS cells were treated with various concentrations of Tan-IIA for different durations, and the cells were lysed in the ice-cold whole cell extract buffer containing the protease inhibitors. The lysate was agitated for 30 min at 4&#x000B0;C and centrifuged at 12,281 &#x000D7; g for 10 min. Protein concentration was measured by the bicinchoninic acid protein assay kit (Pierce Biotechnology, Inc., Rockford, IL, USA). Equal amounts of proteins were subjected to electrophoresis using 12&#x00025; sodium dodecyl sulfate-polyacrylamide gels. To verify equal protein loading and transfer, proteins were transferred to polyvinylidene difluoride membranes and the membranes were blocked for 1 h at 4&#x000B0;C using blocking buffer (5&#x00025; skimmed dried milk in solution containing 50 mM Tris-HCl (pH 8.0), 2 mM CaCl<sub>2</sub>, 80 mM sodium chloride, 0.05&#x00025; Tween-20 and 0.02&#x00025; sodium azide). The membranes were subsequently incubated for 2 h at room temperature with the specific primary antibody followed by anti-rabbit or anti-mouse immunoglobulin G-horseradish peroxidase-conjugated secondary antibodies. The membranes were washed three times for 10 min with washing solution. Finally, the protein bands were visualized on the X-ray film using the enhanced chemiluminescence detection system (PerkinElmer Life and Analytical Sciences, Inc., Boston, MA, USA).</p></sec>
<sec>
<title>Statistical analysis</title>
<p>Values are presented as the means &#x000B1; standard deviation. The Student&#x02019;s t-test was used to analyze statistical significance. P&lt;0.05 was considered to indicate a statistically significant difference for all the tests.</p></sec></sec>
<sec sec-type="results">
<title>Results</title>
<sec>
<title>Effects of Tan-IIA in the viability of AGS cells</title>
<p>The results revealed that Tan-IIA inhibited the proliferation of AGS cells in a time- and dose-dependent manner. The half maximal inhibitory concentration (IC<sub>50</sub>) was 5.5, 3.7 and 3.5 &#x003BC;g/ml at 24, 48 and 72 h, respectively (<xref rid="f1-ijmm-34-06-1661" ref-type="fig">Fig. 1</xref>).</p></sec>
<sec>
<title>Effects of various concentrations of Tan-IIA on the protein expression of Bax, Bcl-xL, Mcl-1, TCTP and &#x003B2;-actin in AGS cells</title>
<p>The AGS cells were treated with various concentrations of Tan-IIA (0, 2.0, 3.7 and 5.5 &#x003BC;g/ml) for 24 or 48 h and the protein expression levels of Bax, Bcl-xL, Mcl-1, TCTP and &#x003B2;-actin were evaluated by western blot analysis. The results revealed that Tan-IIA increased the protein expression levels of Bax (<xref rid="f2-ijmm-34-06-1661" ref-type="fig">Fig. 2A</xref>), but significantly decreased Bcl-xL (<xref rid="f2-ijmm-34-06-1661" ref-type="fig">Fig. 2B</xref>), Mcl-1 (<xref rid="f2-ijmm-34-06-1661" ref-type="fig">Fig. 2C</xref>) and TCTP (<xref rid="f2-ijmm-34-06-1661" ref-type="fig">Fig. 2D</xref>) levels.</p></sec>
<sec>
<title>Effects of various concentrations of Tan-IIA on the protein expression of BiP, calnexin, PERK, eIF2&#x003B1;, ATF4, IRE1&#x003B1;, ATF6, caspase-12, caspase-9, caspase-3, CHOP and &#x003B2;-actin in AGS cells</title>
<p>The AGS cells were treated with various concentrations of Tan-IIA (0, 2.0, 3.7 and 5.5 &#x003BC;g/ml) for 24 or 48 h and the protein expression levels of BiP, calnexin, PERK, eIF2&#x003B1;, ATF4, IRE1&#x003B1;, ATF6, caspase-12, caspase-9, caspase-3, CHOP and &#x003B2;-actin were evaluated by western blot analysis. The results revealed that Tan-IIA can decrease the protein expression level of BiP (<xref rid="f3-ijmm-34-06-1661" ref-type="fig">Fig. 3A</xref>) but increased caspase-12 (<xref rid="f4-ijmm-34-06-1661" ref-type="fig">Fig. 4A</xref>), caspase-9 (<xref rid="f4-ijmm-34-06-1661" ref-type="fig">Fig. 4B</xref>), caspase-3 (<xref rid="f4-ijmm-34-06-1661" ref-type="fig">Fig. 4C</xref>), and CHOP (<xref rid="f4-ijmm-34-06-1661" ref-type="fig">Fig. 4D</xref>) levels significantly. The protein expression levels of calnexin, PERK, eIF2&#x003B1;, ATF4, IRE1&#x003B1; and ATF6 did not change significantly (data not shown).</p></sec>
<sec>
<title>Effects of one Tan-IIA concentration on the protein expression of Bax, Bcl-xL, Mcl-1, TCTP and &#x003B2;-actin in AGS cells</title>
<p>The AGS cells were treated with Tan-IIA (3.7 &#x003BC;g/ml) for different durations (0, 24 and 48 h) and subsequently the protein expression levels of Bax, Bcl-xL, Mcl-1, TCTP and &#x003B2;-actin were evaluated by western blot analysis. The results revealed that Tan-IIA increased the protein expression levels of Bax (<xref rid="f5-ijmm-34-06-1661" ref-type="fig">Fig. 5A</xref>) but decreased Bcl-xL (<xref rid="f5-ijmm-34-06-1661" ref-type="fig">Fig. 5B</xref>), Mcl-1 (<xref rid="f5-ijmm-34-06-1661" ref-type="fig">Fig. 5C</xref>) and TCTP (<xref rid="f5-ijmm-34-06-1661" ref-type="fig">Fig. 5D</xref>) levels significantly.</p></sec>
<sec>
<title>Effects of one Tan-IIA concentration on the protein expression of BiP, calnexin, PERK, eIF2&#x003B1;, ATF4, IRE1&#x003B1;, ATF6, caspase-12, caspase-9, caspase-3, CHOP and &#x003B2;-actin in AGS cells</title>
<p>The AGS cells were treated with Tan-IIA (3.7 &#x003BC;g/ml) for different durations (0, 24 and 48 h) and the protein expression levels of BiP, calnexin, PERK, eIF2&#x003B1;, ATF4, IRE1&#x003B1;, ATF6, caspase-12, caspase-9, caspase-3, CHOP and &#x003B2;-actin were evaluated by western blot analysis. The results revealed that Tan-IIA can decrease the protein expression level of BiP (<xref rid="f3-ijmm-34-06-1661" ref-type="fig">Fig. 3B</xref>) but increased caspase-12 (<xref rid="f6-ijmm-34-06-1661" ref-type="fig">Fig. 6A</xref>), caspase-9 (<xref rid="f6-ijmm-34-06-1661" ref-type="fig">Fig. 6B</xref>), caspase-3 (<xref rid="f6-ijmm-34-06-1661" ref-type="fig">Fig. 6C</xref>), and CHOP (<xref rid="f6-ijmm-34-06-1661" ref-type="fig">Fig. 6D</xref>) levels significantly.</p></sec></sec>
<sec sec-type="discussion">
<title>Discussion</title>
<p>The results of the present study revealed that Tan-IIA inhibited the proliferation of human gastric cancer AGS cells in a time- and dose-dependent manner. This is in accordance with previous studies (<xref ref-type="bibr" rid="b6-ijmm-34-06-1661">6</xref>&#x02013;<xref ref-type="bibr" rid="b9-ijmm-34-06-1661">9</xref>). TCTP was discovered in Ehrlich ascites tumor cells (<xref ref-type="bibr" rid="b16-ijmm-34-06-1661">16</xref>), is conserved in all eukaryotes and encodes for a hydrophilic protein of 18&#x02013;23 kDa (<xref ref-type="bibr" rid="b17-ijmm-34-06-1661">17</xref>). TCTP has been implicated in the protection of cells against apoptosis (<xref ref-type="bibr" rid="b18-ijmm-34-06-1661">18</xref>). Susini <italic>et al</italic> (<xref ref-type="bibr" rid="b19-ijmm-34-06-1661">19</xref>) showed that TCTP protects from apoptotic cell death by antagonizing Bax function. Liu <italic>et al</italic> (<xref ref-type="bibr" rid="b20-ijmm-34-06-1661">20</xref>) also documented that TCTP stabilized and enhanced the antiapoptotic activity of Mcl-1. These results indicate that TCTP binds to Mcl-1, antagonizing Bax, and thus inhibiting the induction of apoptosis. The present results demonstrated that the treatment of AGS cells with Tan-IIA decreased the protein expression levels of Mcl-1, Bcl-xL and TCTP, but increased Bax, caspase-9 and caspase-3 levels with a time- and dose-dependent manner. Therefore, one of the molecular mechanisms of Tan-IIA involved in the inhibition of human gastric cancer AGS cell proliferation may be through decreasing the protein expression of Mcl-1, Bcl-xL and TCTP, but increasing Bax, caspase-9 and caspase-3, thus inducing apoptosis. Following endoplasmic reticulum response over loading, ER stress is activated, and the upstream element, caspase-12, is activated to increase the target protein, CHOP (also known as GADD153) (<xref ref-type="bibr" rid="b21-ijmm-34-06-1661">21</xref>). Our previous study showed that Tan-IIA induced ER stress to inhibit human breast cancer BT-20 cells (<xref ref-type="bibr" rid="b11-ijmm-34-06-1661">11</xref>) and human hepatocellular cancer Hep-J5 cells (<xref ref-type="bibr" rid="b12-ijmm-34-06-1661">12</xref>). In the present study, the results showed that Tan-IIA increased the protein expression levels of caspase-12, caspase-9, caspase-3 and CHOP. These results indicate that Tan-IIA induced ER stress to inhibit the proliferation of AGS cells. The proposed model of the interactions between Bax, TCTP, Mcl-1, Bcl-xL and the ER stress pathway in AGS cells treated with Tan-IIA is shown in <xref rid="f7-ijmm-34-06-1661" ref-type="fig">Fig. 7</xref>.</p>
<p>To the best of our knowledge, this is the first study to demonstrate that Tan-IIA inhibited human gastric cancer AGS cells. One of the molecular mechanisms may be through decreasing the protein expression of BiP to induce the activation of ER stress, followed by increasing the protein expression of caspase-12 to upregulate CHOP expression. The other may be through decreasing the protein expression of Mcl-1, Bcl-xL and TCTP, but increasing Bax, caspase-9 and caspase-3.</p></sec></body>
<back>
<ack>
<title>Acknowledgements</title>
<p>The present study was supported by grant no. 102-CCH-IRP-066 from the Research Section of the Changhua Christian Hospital, Changhua, Taiwan, R.O.C.</p></ack>
<ref-list>
<title>References</title>
<ref id="b1-ijmm-34-06-1661"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Che</surname><given-names>AJ</given-names></name><name><surname>Zhang</surname><given-names>JY</given-names></name><name><surname>Li</surname><given-names>CH</given-names></name><name><surname>Chen</surname><given-names>XF</given-names></name><name><surname>Hu</surname><given-names>ZD</given-names></name><name><surname>Chen</surname><given-names>XG</given-names></name></person-group><article-title>Separation and determination of active components in <italic>Radix Salviae miltiorrhizae</italic> and its medicinal preparations by nonaqueous capillary electrophoresis</article-title><source>J Sep Sci</source><volume>27</volume><fpage>569</fpage><lpage>575</lpage><year>2004</year></element-citation></ref>
<ref id="b2-ijmm-34-06-1661"><label>2</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Zhou</surname><given-names>L</given-names></name><name><surname>Zuo</surname><given-names>Z</given-names></name><name><surname>Chow</surname><given-names>MS</given-names></name></person-group><article-title>Danshen: an overview of its chemistry, pharmacology, pharmacokinetics, and clinical use</article-title><source>J Clin Pharmacol</source><volume>45</volume><fpage>1345</fpage><lpage>1359</lpage><year>2005</year></element-citation></ref>
<ref id="b3-ijmm-34-06-1661"><label>3</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chiu</surname><given-names>TL</given-names></name><name><surname>Su</surname><given-names>CC</given-names></name></person-group><article-title>Tanshinone IIA induces apoptosis in human lung cancer A549 cells through the induction of reactive oxygen species and decreasing the mitochondrial membrane potential</article-title><source>Int J Mol Med</source><volume>25</volume><fpage>231</fpage><lpage>236</lpage><year>2010</year></element-citation></ref>
<ref id="b4-ijmm-34-06-1661"><label>4</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Su</surname><given-names>CC</given-names></name><name><surname>Chen</surname><given-names>GW</given-names></name><name><surname>Kang</surname><given-names>JC</given-names></name><name><surname>Chan</surname><given-names>MH</given-names></name></person-group><article-title>Growth inhibition and apoptosis induction by tanshinone IIA in human colon adenocarcinoma cells</article-title><source>Planta Med</source><volume>74</volume><fpage>1357</fpage><lpage>1362</lpage><year>2008</year></element-citation></ref>
<ref id="b5-ijmm-34-06-1661"><label>5</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Su</surname><given-names>CC</given-names></name><name><surname>Lin</surname><given-names>YH</given-names></name></person-group><article-title>Tanshinone IIA inhibits human breast cancer cells through increased Bax to Bcl-xL ratios</article-title><source>Int J Mol Med</source><volume>22</volume><fpage>357</fpage><lpage>361</lpage><year>2008</year></element-citation></ref>
<ref id="b6-ijmm-34-06-1661"><label>6</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hou</surname><given-names>J</given-names></name><name><surname>He</surname><given-names>J</given-names></name><name><surname>Jin</surname><given-names>X</given-names></name><name><surname>Hu</surname><given-names>T</given-names></name><name><surname>Zhang</surname><given-names>Y</given-names></name></person-group><article-title>Study on optimisation of extraction process of tanshinone IIA and its mechanism of induction of gastric cancer SGC7901 cell apoptosis</article-title><source>Afr J Tradit Complement Altern Med</source><volume>10</volume><fpage>456</fpage><lpage>458</lpage><year>2013</year></element-citation></ref>
<ref id="b7-ijmm-34-06-1661"><label>7</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Xu</surname><given-names>M</given-names></name><name><surname>Cao</surname><given-names>FL</given-names></name><name><surname>Li</surname><given-names>NY</given-names></name><name><surname>Liu</surname><given-names>YQ</given-names></name><name><surname>Li</surname><given-names>YP</given-names></name><name><surname>Lv</surname><given-names>CL</given-names></name></person-group><article-title>Tanshinone IIA reverses the malignant phenotype of SGC7901 gastric cancer cells</article-title><source>Asian Pac J Cancer Prev</source><volume>14</volume><fpage>173</fpage><lpage>177</lpage><year>2013</year></element-citation></ref>
<ref id="b8-ijmm-34-06-1661"><label>8</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chen</surname><given-names>J</given-names></name><name><surname>Shi</surname><given-names>DY</given-names></name><name><surname>Liu</surname><given-names>SL</given-names></name><name><surname>Zhong</surname><given-names>L</given-names></name></person-group><article-title>Tanshinone IIA induces growth inhibition and apoptosis in gastric cancer <italic>in vitro</italic> and <italic>in vivo</italic></article-title><source>Oncol Rep</source><volume>27</volume><fpage>523</fpage><lpage>528</lpage><year>2012</year></element-citation></ref>
<ref id="b9-ijmm-34-06-1661"><label>9</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Dong</surname><given-names>X</given-names></name><name><surname>Dong</surname><given-names>J</given-names></name><name><surname>Peng</surname><given-names>G</given-names></name></person-group><article-title>Growth-inhibiting and apoptosis-inducing effects of Tanshinone II A on human gastric carcinoma cells</article-title><source>J Huazhong Univ Sci Technolog Med Sci</source><volume>27</volume><fpage>706</fpage><lpage>709</lpage><year>2007</year></element-citation></ref>
<ref id="b10-ijmm-34-06-1661"><label>10</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Huang</surname><given-names>CY</given-names></name><name><surname>Chiu</surname><given-names>TL</given-names></name><name><surname>Kuo</surname><given-names>SJ</given-names></name><name><surname>Chien</surname><given-names>SY</given-names></name><name><surname>Chen</surname><given-names>DR</given-names></name><name><surname>Su</surname><given-names>CC</given-names></name></person-group><article-title>Tanshinone IIA inhibits the growth of pancreatic cancer BxPC-3 cells by decreasing protein expression of TCTP, MCL-1 and Bcl-xL</article-title><source>Mol Med Rep</source><volume>7</volume><fpage>1045</fpage><lpage>1049</lpage><year>2013</year></element-citation></ref>
<ref id="b11-ijmm-34-06-1661"><label>11</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Yan</surname><given-names>MY</given-names></name><name><surname>Chien</surname><given-names>SY</given-names></name><name><surname>Kuo</surname><given-names>SJ</given-names></name><name><surname>Chen</surname><given-names>DR</given-names></name><name><surname>Su</surname><given-names>CC</given-names></name></person-group><article-title>Tanshinone IIA inhibits BT-20 human breast cancer cell proliferation through increasing caspase 12, GADD153 and phospho-p38 protein expression</article-title><source>Int J Mol Med</source><volume>29</volume><fpage>855</fpage><lpage>863</lpage><year>2012</year></element-citation></ref>
<ref id="b12-ijmm-34-06-1661"><label>12</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Cheng</surname><given-names>CY</given-names></name><name><surname>Su</surname><given-names>CC</given-names></name></person-group><article-title>Tanshinone IIA inhibits Hep-J5 cells by increasing calreticulin, caspase 12 and GADD153 protein expression</article-title><source>Int J Mol Med</source><volume>26</volume><fpage>379</fpage><lpage>385</lpage><year>2010</year></element-citation></ref>
<ref id="b13-ijmm-34-06-1661"><label>13</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Mossman</surname><given-names>T</given-names></name></person-group><article-title>Rapid colorimetric assay for cellular growth and survival: application to proliferation and cytotoxicity assays</article-title><source>J Immunol Methods</source><volume>65</volume><fpage>55</fpage><lpage>63</lpage><year>1983</year></element-citation></ref>
<ref id="b14-ijmm-34-06-1661"><label>14</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Bradford</surname><given-names>MM</given-names></name></person-group><article-title>A rapid and sensitive method for the quantitation of microgram quantities of protein utilizing the principle of protein-dye binding</article-title><source>Anal Biochem</source><volume>72</volume><fpage>248</fpage><lpage>254</lpage><year>1976</year></element-citation></ref>
<ref id="b15-ijmm-34-06-1661"><label>15</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chen</surname><given-names>HC</given-names></name><name><surname>Hsieh</surname><given-names>WT</given-names></name><name><surname>Chang</surname><given-names>WC</given-names></name><name><surname>Chung</surname><given-names>JG</given-names></name></person-group><article-title>Aloe-emodin induced in vitro G2/M arrest of cell cycle in human promyelocytic leukemia HL-60 cells</article-title><source>Food Chem Toxicol</source><volume>42</volume><fpage>1251</fpage><lpage>1257</lpage><year>2004</year></element-citation></ref>
<ref id="b16-ijmm-34-06-1661"><label>16</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Yenofsky</surname><given-names>R</given-names></name><name><surname>Cereghini</surname><given-names>S</given-names></name><name><surname>Krowczynska</surname><given-names>A</given-names></name><name><surname>Brawerman</surname><given-names>G</given-names></name></person-group><article-title>Regulation of mRNA utilization in mouse erythroleukemia cells induced to differentiate by exposure to dimethyl sulfoxide</article-title><source>Mol Cell Biol</source><volume>3</volume><fpage>1197</fpage><lpage>1203</lpage><year>1983</year></element-citation></ref>
<ref id="b17-ijmm-34-06-1661"><label>17</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Bommer</surname><given-names>UA</given-names></name><name><surname>Lazaris-Karatzas</surname><given-names>A</given-names></name><name><surname>De Benedetti</surname><given-names>A</given-names></name><etal/></person-group><article-title>Translational regulation of the mammalian growth-related protein P23: involvement of eIF-4E</article-title><source>Cell Mol Biol Res</source><volume>40</volume><fpage>633</fpage><lpage>641</lpage><year>1994</year></element-citation></ref>
<ref id="b18-ijmm-34-06-1661"><label>18</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Bommer</surname><given-names>UA</given-names></name><name><surname>Thiele</surname><given-names>BJ</given-names></name></person-group><article-title>The translationally controlled tumour protein (TCTP)</article-title><source>Int J Biochem Cell Biol</source><volume>36</volume><fpage>379</fpage><lpage>385</lpage><year>2004</year></element-citation></ref>
<ref id="b19-ijmm-34-06-1661"><label>19</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Susini</surname><given-names>L</given-names></name><name><surname>Besse</surname><given-names>S</given-names></name><name><surname>Duflaut</surname><given-names>D</given-names></name><etal/></person-group><article-title>TCTP protects from apoptotic cell death by antagonizing bax function</article-title><source>Cell Death Differ</source><volume>15</volume><fpage>1211</fpage><lpage>1220</lpage><year>2008</year></element-citation></ref>
<ref id="b20-ijmm-34-06-1661"><label>20</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Liu</surname><given-names>H</given-names></name><name><surname>Peng</surname><given-names>HW</given-names></name><name><surname>Cheng</surname><given-names>YS</given-names></name><name><surname>Yuan</surname><given-names>HS</given-names></name><name><surname>Yang-Yen</surname><given-names>HF</given-names></name></person-group><article-title>Stabilization and enhancement of the antiapoptotic activity of mcl-1 by TCTP</article-title><source>Mol Cell Biol</source><volume>25</volume><fpage>3117</fpage><lpage>3126</lpage><year>2005</year></element-citation></ref>
<ref id="b21-ijmm-34-06-1661"><label>21</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ma</surname><given-names>Y</given-names></name><name><surname>Hendershot</surname><given-names>LM</given-names></name></person-group><article-title>The role of the unfolded protein response in tumour development: friend or foe?</article-title><source>Nat Rev Cancer</source><volume>4</volume><fpage>966</fpage><lpage>977</lpage><year>2004</year></element-citation></ref></ref-list></back>
<floats-group>
<fig id="f1-ijmm-34-06-1661" position="float">
<label>Figure 1</label>
<caption>
<p>Cytotoxic effects of tanshinone IIA (Tan-IIA) on AGS cells. The cytotoxic effects of Tan-IIA on AGS cells were determined by the 3-(4,5-dimethylthiazol-2-y1)-2,5-diphenyltetrazolium bromide (MTT) assay as described in &#x02018;Materials and methods&#x02019;. Each point is the mean &#x000B1; standard deviation of three experiments.</p></caption>
<graphic xlink:href="IJMM-34-06-1661-g00.gif"/></fig>
<fig id="f2-ijmm-34-06-1661" position="float">
<label>Figure 2</label>
<caption>
<p>Protein expressions of B-cell lymphoma (Bcl)-2 associated X protein (Bax), Bcl-extra large (xL), myeloid cell leukemia 1 protein (Mcl-1), translationally-controlled tumor protein (TCTP) and &#x003B2;-actin in AGS cells. The AGS cells were treated with various concentrations of tanshinone IIA (Tan-IIA) (0, 2.0, 3.7 and 5.5 &#x003BC;g/ml) for 24 or 48 h and the protein expression levels were evaluated by western blot analysis as described in &#x02018;Materials and methods&#x02019;. The results revealed that Tan-IIA increased the protein expression levels of (A) Bax but significantly decreased those of (B) Bcl-xL in a dose-dependent manner. Protein expression levels of (C) myeloid cell leukemia 1 protein (Mcl-1) and (D) translationally-controlled tumor protein (TCTP) were significantly decreased in a dose-dependent manner.</p></caption>
<graphic xlink:href="IJMM-34-06-1661-g01.gif"/>
<graphic xlink:href="IJMM-34-06-1661-g02.gif"/>
<graphic xlink:href="IJMM-34-06-1661-g03.gif"/>
<graphic xlink:href="IJMM-34-06-1661-g04.gif"/></fig>
<fig id="f3-ijmm-34-06-1661" position="float">
<label>Figure 3</label>
<caption>
<p>Protein expressions of binding immunoglobulin protein (BiP) and &#x003B2;-actin in AGS cells. (A) The AGS cells were treated with various concentrations of tanshinone IIA (Tan-IIA) (0, 2.0, 3.7 and 5.5 &#x003BC;g/ml) for 24 or 48 h and the protein expression levels were evaluated by western blot analysis as described in &#x02018;Materials and methods&#x02019;. The results revealed that Tan-IIA can decrease the protein expression level of BiP in a dose-dependent manner. (B) The AGS cells were treated with Tan-IIA (3.7 &#x003BC;g/ml) for different durations (0, 24 and 48 h) and the protein expression levels were evaluated by western blot analysis as described in &#x02018;Materials and methods&#x02019;. The results revealed that Tan-IIA decreased the protein expression level of BiP in a time-dependent manner.</p></caption>
<graphic xlink:href="IJMM-34-06-1661-g05.gif"/></fig>
<fig id="f4-ijmm-34-06-1661" position="float">
<label>Figure 4</label>
<caption>
<p>Protein expressions of binding immunoglobulin protein (BiP), calnexin, protein kinase-like endoplasmic reticulum kinase (PERK), eIF2&#x003B1;, activating transcription factor 4 (ATF4), inositol-requiring enzyme 1&#x003B1; (IRE1&#x003B1;), ATF6, caspase-12, caspase-9, caspase-3, C/EBP-homologous protein (CHOP) and &#x003B2;-actin in AGS cells. The AGS cells were treated with various concentrations of tanshinone IIA (Tan-IIA) (0, 2.0, 3.7 and 5.5 &#x003BC;g/ml) for 24 or 48 h and the protein expression levels were evaluated by western blot analysis as described in &#x02018;Materials and methods&#x02019;. The results revealed that Tan-IIA significantly increased (A) caspase-12, (B) caspase-9, (C) caspase-3 and (D) CHOP levels in a dose-dependent manner.</p></caption>
<graphic xlink:href="IJMM-34-06-1661-g06.gif"/>
<graphic xlink:href="IJMM-34-06-1661-g07.gif"/>
<graphic xlink:href="IJMM-34-06-1661-g08.gif"/>
<graphic xlink:href="IJMM-34-06-1661-g09.gif"/></fig>
<fig id="f5-ijmm-34-06-1661" position="float">
<label>Figure 5</label>
<caption>
<p>Protein expressions of B-cell lymphoma (Bcl)-2 associated X protein (Bax), myeloid cell leukemia 1 protein (Mcl-1), translationally-controlled tumor protein (TCTP), Bcl-extra large (xL) and &#x003B2;-actin in AGS cells. The AGS cells were treated with tanshinone IIA (Tan-IIA) (3.7 &#x003BC;g/ml) for different durations (0, 24 and 48 h) and the protein expression levels were evaluated by western blot analysis as described in &#x02018;Materials and methods&#x02019;. The results revealed that Tan-IIA increased the protein expression levels of (A) Bax but significantly decreased (B) Bcl-xL, (C) Mcl-1 and (D) TCTP levels in a time-dependent manner.</p></caption>
<graphic xlink:href="IJMM-34-06-1661-g10.gif"/></fig>
<fig id="f6-ijmm-34-06-1661" position="float">
<label>Figure 6</label>
<caption>
<p>Protein expressions of calnexin, protein kinase-like endoplasmic reticulum kinase (PERK), eIF2&#x003B1;, activating transcription factor 4 (ATF4), inositol-requiring enzyme 1&#x003B1; (IRE1&#x003B1;), ATF6, caspase-12, caspase-9, caspase-3, C/EBP-homologous protein (CHOP) and &#x003B2;-actin in AGS cells. The AGS cells were treated with tanshinone IIA (Tan-IIA) (3.7 &#x003BC;g/ml) for different durations (0, 24 and 48h) and the protein expression levels were evaluated by western blot analysis as described in &#x02018;Materials and methods&#x02019;. The results revealed that Tan-IIA significantly increased (A) caspase-12, (B) caspase-9, (C) caspase-3 and (D) CHOP levels in a time-dependent manner.</p></caption>
<graphic xlink:href="IJMM-34-06-1661-g11.gif"/></fig>
<fig id="f7-ijmm-34-06-1661" position="float">
<label>Figure 7</label>
<caption>
<p>Proposed signaling pathway through which tanshinone IIA (Tan-IIA) exerts its anti-proliferative effects on human gastric cancer AGS cells. Bax, B-cell lymphoma (Bcl)-2 associated X protein; TCTP, translationally-controlled tumor protein; Mcl-1, myeloid cell leukemia 1; Bcl-xL, Bcl-extra large; BiP, binding immunoglobulin protein; CHOP, C/EBP-homologous protein.</p></caption>
<graphic xlink:href="IJMM-34-06-1661-g12.gif"/></fig></floats-group></article>
