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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">IJO</journal-id>
<journal-title-group>
<journal-title>International Journal of Oncology</journal-title></journal-title-group>
<issn pub-type="ppub">1019-6439</issn>
<issn pub-type="epub">1791-2423</issn>
<publisher>
<publisher-name>D.A. Spandidos</publisher-name></publisher></journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3892/ijo.2014.2471</article-id>
<article-id pub-id-type="publisher-id">ijo-45-02-0683</article-id>
<article-categories>
<subj-group>
<subject>Articles</subject></subj-group></article-categories>
<title-group>
<article-title>Tanshinone IIA induces cytochrome <italic>c</italic>-mediated caspase cascade apoptosis in A549 human lung cancer cells via the JNK pathway</article-title></title-group>
<contrib-group>
<contrib contrib-type="author">
<name><surname>ZHANG</surname><given-names>JIAN</given-names></name><xref rid="af1-ijo-45-02-0683" ref-type="aff">1</xref></contrib>
<contrib contrib-type="author">
<name><surname>WANG</surname><given-names>JU</given-names></name><xref rid="af1-ijo-45-02-0683" ref-type="aff">1</xref></contrib>
<contrib contrib-type="author">
<name><surname>JIANG</surname><given-names>JIU-YANG</given-names></name><xref rid="af1-ijo-45-02-0683" ref-type="aff">1</xref></contrib>
<contrib contrib-type="author">
<name><surname>LIU</surname><given-names>SHANG-DIAN</given-names></name><xref rid="af2-ijo-45-02-0683" ref-type="aff">2</xref></contrib>
<contrib contrib-type="author">
<name><surname>FU</surname><given-names>KAI</given-names></name><xref rid="af1-ijo-45-02-0683" ref-type="aff">1</xref></contrib>
<contrib contrib-type="author">
<name><surname>LIU</surname><given-names>HONG-YU</given-names></name><xref rid="af2-ijo-45-02-0683" ref-type="aff">2</xref><xref ref-type="corresp" rid="c1-ijo-45-02-0683"/></contrib></contrib-group>
<aff id="af1-ijo-45-02-0683">
<label>1</label>Department of Thoracic Surgery, The First Affiliated Hospital, Harbin Medical University, Harbin 150001, P.R. China</aff>
<aff id="af2-ijo-45-02-0683">
<label>2</label>Department of Cardiovascular Surgery, The First Affiliated Hospital, Harbin Medical University, Harbin 150001, P.R. China</aff>
<author-notes>
<corresp id="c1-ijo-45-02-0683">Correspondence to: Professor Hong-Yu Liu, Department of Cardiovascular Surgery, The First Affiliated Hospital, Harbin Medical University, 199 Dazhi Street, Harbin 150001, P.R. China, E-mail: <email>hyliu.hmu@gmail.com</email></corresp></author-notes>
<pub-date pub-type="collection">
<month>8</month>
<year>2014</year></pub-date>
<pub-date pub-type="epub">
<day>28</day>
<month>05</month>
<year>2014</year></pub-date>
<volume>45</volume>
<issue>2</issue>
<fpage>683</fpage>
<lpage>690</lpage>
<history>
<date date-type="received">
<day>20</day>
<month>03</month>
<year>2014</year></date>
<date date-type="accepted">
<day>14</day>
<month>05</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 (TSIIA), a natural diterpene quinone in the traditional Chinese medicinal herb Dan-Shen (<italic>Salvia miltiorrhiza</italic>), has extensively exerted antitumor activity in cellular and animal models. However, the molecular mechanisms underlying the antitumor effects of TSIIA remain largely unknown. The <italic>in vitro</italic> effects of TSIIA on apoptosis were investigated in A549 non-small cell lung cancer (NSCLC) cells. The data showed that TSIIA significantly suppressed the proliferation of A549 cells in a dose-dependent manner, with IC<sub>50</sub> values of 16.0&#x000B1;3.7 and 14.5&#x000B1;3.3 &#x003BC;M at 48 h as determined by Cell Counting Kit-8 (CCK-8) assay and clone formation assay, respectively. The change of mitochondrial morphology and the loss of mitochondrial membrane potential (MMP) were observed during the induction. Furthermore, TSIIA induced A549 cell apoptosis as confirmed by typical morphological changes, with cytochrome <italic>c</italic> release from the mitochondria and Bax translocation to the mitochondria. Caspase activity data indicated that TSIIA activated caspase-9 and caspase-3 of mitochondria-mediated apoptosis, but not caspase-8 of receptor-mediated apoptosis, which could be largely rescued by SP600125 (JNK inhibitor). Taken together, these findings provide the first evidence that TSIIA inhibits growth of NSCLC A549 cells, induces activation of JNK signaling and triggers caspase cascade apoptosis mediated by the release of cytochrome <italic>c</italic>, which provides a better understanding of the molecular mechanisms of TSIIA on lung cancer.</p></abstract>
<kwd-group>
<kwd>tanshinone IIA</kwd>
<kwd>apoptosis</kwd>
<kwd>lung cancer</kwd>
<kwd>cytochrome <italic>c</italic></kwd>
<kwd>caspase</kwd>
<kwd>JNK</kwd></kwd-group></article-meta></front>
<body>
<sec sec-type="intro">
<title>Introduction</title>
<p>Tanshinone IIA (TSIIA, 1,6,6-trimethyl-6,7,8,9-tetrahydrophenanthro &#x0005B;1,2-b&#x0005D; furan-10,11-dione) is the most abundant diterpene quinine isolated from <italic>Salvia miltiorrhiza</italic>, known as &#x02018;Dan-Shen&#x02019;. This plant has been safely used for more than 2,000 years in traditional Chinese medicine for treating a large variety of cardiovascular diseases including atherosclerosis, coronary artery disease, angina pectoris, myocardial infarction and hypertension (<xref rid="b1-ijo-45-02-0683" ref-type="bibr">1</xref>). TSIIA and the other two tanshinones, cryptotanshinone (CTS) and tanshinone I (TSI), are the three major active ingredients, the potent antitumor properties of which have been extensively investigated both <italic>in vitro</italic> and <italic>in vivo</italic> in recent years (<xref rid="b2-ijo-45-02-0683" ref-type="bibr">2</xref>). Previous studies have suggested that CTS mainly inhibited angiogenesis (<xref rid="b3-ijo-45-02-0683" ref-type="bibr">3</xref>), while TSI mainly inhibited migration, invasion and metastasis (<xref rid="b4-ijo-45-02-0683" ref-type="bibr">4</xref>). Whereas, TSIIA significantly induced cell apoptosis on a panel of human tumor cell lines, such as breast cancer (<xref rid="b5-ijo-45-02-0683" ref-type="bibr">5</xref>&#x02013;<xref rid="b7-ijo-45-02-0683" ref-type="bibr">7</xref>), glioma (<xref rid="b8-ijo-45-02-0683" ref-type="bibr">8</xref>), lung cancer (<xref rid="b9-ijo-45-02-0683" ref-type="bibr">9</xref>,<xref rid="b10-ijo-45-02-0683" ref-type="bibr">10</xref>), ovarian cancer (<xref rid="b11-ijo-45-02-0683" ref-type="bibr">11</xref>), gastric cancer (<xref rid="b12-ijo-45-02-0683" ref-type="bibr">12</xref>), hepatoma (<xref rid="b13-ijo-45-02-0683" ref-type="bibr">13</xref>), leukemia (<xref rid="b14-ijo-45-02-0683" ref-type="bibr">14</xref>), prostate cancer (<xref rid="b15-ijo-45-02-0683" ref-type="bibr">15</xref>), renal cell carcinoma (<xref rid="b16-ijo-45-02-0683" ref-type="bibr">16</xref>), cervix carcinoma (<xref rid="b17-ijo-45-02-0683" ref-type="bibr">17</xref>) and colon cancer (<xref rid="b18-ijo-45-02-0683" ref-type="bibr">18</xref>). Therefore, TSIIA might have therapeutic potential in cancer therapy. However, the molecular mechanisms of TSIIA-induced apoptosis still remain elusive.</p>
<p>Lung cancer is the leading cause of cancer mortality in USA and worldwide (<xref rid="b19-ijo-45-02-0683" ref-type="bibr">19</xref>,<xref rid="b20-ijo-45-02-0683" ref-type="bibr">20</xref>). It is estimated that about 585,720 Americans will die from cancer in 2014, corresponding to about 1,600 deaths per day with more than one-quarter due to lung cancer. Approximately 87&#x00025; of lung cancer cases are non-small cell lung cancer (NSCLC) and the majority of patients presents with advanced stage disease at diagnosis (<xref rid="b20-ijo-45-02-0683" ref-type="bibr">20</xref>,<xref rid="b21-ijo-45-02-0683" ref-type="bibr">21</xref>). The available chemotherapeutics is often limited due to undesirable drug resistance and side-effects (<xref rid="b22-ijo-45-02-0683" ref-type="bibr">22</xref>). The cell line A549 was first derived from the patient with lung cancer in 1972 (<xref rid="b23-ijo-45-02-0683" ref-type="bibr">23</xref>). A549 cells are adenocarcinomic human alveolar basal epithelial cells, which were commonly employed as the <italic>in vitro</italic> model of NSCLC. In 2010, Chiu and Su showed that TSIIA induced apoptosis in A549 lung cancer cells <italic>in vitro</italic>, due to inducing the reactive oxygen species (ROS) release and upregulating the Bax/Bcl-2 ratio (<xref rid="b9-ijo-45-02-0683" ref-type="bibr">9</xref>). In 2012, Liu <italic>et al</italic> demonstrated that TSIIA significantly inhibited tumor growth of A549 xenografts <italic>in vivo</italic> mediated by inhibiting NQO1, an emerging and promising therapeutic target in cancer therapy (<xref rid="b24-ijo-45-02-0683" ref-type="bibr">24</xref>). As TSIIA exerted great antitumor activity in cellular and animal lung cancer models, it might be a promising new drug for the treatment of NSCLC.</p>
<p>Currently, three basic apoptotic signaling pathway have been established: mitochondria, endoplasmic reticulum, and death receptor, changes in which can provide rational targets for new anticancer drugs (<xref rid="b25-ijo-45-02-0683" ref-type="bibr">25</xref>). Mitochondria could be considered as a novel target for chemotherapies. A variety of key events in apoptosis focus on mitochondria, including the release of caspase activators (such as cytochrome <italic>c</italic>), changes in electron transport, loss of mitochondrial membrane potential, and participation of pro- and anti-apoptotic Bcl-2 family proteins (<xref rid="b26-ijo-45-02-0683" ref-type="bibr">26</xref>). Furthermore, evidence suggests that the c-jun N-terminal kinase (JNK) cascade participates in the mitochondria-mediated death pathway in response to various chemical and physical stresses (<xref rid="b27-ijo-45-02-0683" ref-type="bibr">27</xref>). The experiments related to some of these factors were carried out in this study. Our data demonstrate for the first time that TSIIA might induce the activation of JNK pathway, mediate the release of cytochrome <italic>c</italic>, and trigger the activation of caspase-9 and caspase-3 caspase cascade in the mitochondrial-induced apoptotic pathway.</p></sec>
<sec sec-type="materials|methods">
<title>Materials and methods</title>
<sec>
<title>Chemicals and reagents</title>
<p>TSIIA (<xref rid="f1-ijo-45-02-0683" ref-type="fig">Fig. 1A</xref>, &gt;97&#x00025; HPLC) was purchased from Sigma-Aldrich Chemical Co. (Shanghai, China). A stock solution of 40 mM TSIIA was prepared in sterilized DMSO and further diluted to appropriate concentrations with cell culture medium immediately before use. DMSO &#x0005B;0.1&#x00025; (v/v)&#x0005D; was used as a vehicle control throughout the study.</p>
<p>RPMI-1640 medium, heat-inactivated fetal bovine serum (FBS), penicillin and streptomycin were acquired from Gibco Co., USA. Cell Counting Kit-8 (CCK-8, #CK04) was obtained from Dojindo Laboratories (Kumamoto, Japan). Lactate dehydrogenase (LDH) assay kit (#A020) was purchased from Jiancheng Bioengineering Institute (Nanjing, China). JNK inhibitor SP600125 (#8177S) was purchased from Cell Signaling Technology (Danvers, MA). Hoechst Staining Kit (#C0003), Mito-Tracker Green (#C1048), Mitochondrial membrane potential assay kit with JC-1 (#C2006), Cell Mitochondria Isolation Kit (#C3601), Caspase-3 Activity Assay Kit (#C1115), Caspase-8 Activity Assay Kit (#C1151), Caspase-9 Activity Assay Kit (#C1157), BCA Protein Assay Kit (#P0012), BeyoECL Plus kit (#P0018), Alexa Fluor 555-labeled goat anti-mouse IgG (H+L) (#A0459), and all other antibodies for cytochrome <italic>c</italic>, Bax, &#x003B2;-actin, and goat anti-rabbit and anti-mouse secondary antibodies were purchased from Beyotime Institute of Biotechnology (Haimen, China). All other chemicals were of analytic grade and commercially available.</p></sec>
<sec>
<title>Cell culture</title>
<p>A549 human lung cancer cells were obtained from Cell Library of Committee on Type Culture Collection of Chinese Academy of Sciences. Cultures were maintained in 95&#x00025; air and 5&#x00025; CO<sub>2</sub> at 37&#x000B0;C in RPMI-1640 with 10&#x00025; FBS, 2 mM L-glutamine, 100 U/ml penicillin and 100 U/ml streptomycin. To determine the effects of JNK inhibitor (SP600125) on TSIIA-induced apoptosis in A549 cells, cell culture was pre-incubated for 2 h with SP600125 (10 &#x003BC;M) before the addition of TSIIA.</p></sec>
<sec>
<title>CCK-8 assay</title>
<p>A549 cells (1&#x000D7;10<sup>5</sup> cells/ml in 96-well culture plates) were treated with DMSO (0.1&#x00025;) or TSIIA (2.5, 5, 10, 20 and 40 &#x003BC;M) for 48 h. The medium (90 &#x003BC;l) was incubated with 10 &#x003BC;l of CCK-8 solution for 2 h at 37&#x000B0;C. Absorbance was read at 450 nm on a microplate reader (Bio-Rad Model 550, Bio-Rad Laboratories, Hercules, CA). Cell viability (&#x00025;) was calculated as (experimental absorbance - background absorbance)/(control absorbance - background absorbance) &#x000D7;100&#x00025; (<xref rid="b28-ijo-45-02-0683" ref-type="bibr">28</xref>). IC<sub>50</sub> value, the concentration of TSIIA inhibiting 50&#x00025; of the cell growth at 48 h, was calculated by the method of Reed and Muench (<xref rid="b29-ijo-45-02-0683" ref-type="bibr">29</xref>).</p></sec>
<sec>
<title>Clone formation assay</title>
<p>A549 cells seeded at 500 cells/well in 6-well culture plates were treated with DMSO (0.1&#x00025;) or TSIIA (2.5, 5, 10, 20 and 40 &#x003BC;M) for 48 h and then maintained in the routine medium. After 10 days incubation, cell colonies consisting of more than 50 cells stained with crystal violet were counted and pictures were taken by a digital camera (<xref rid="b30-ijo-45-02-0683" ref-type="bibr">30</xref>). The ratio of clone formation was calculated following the equation: rate of clone formation (&#x00025;) = (clone amount/500) &#x000D7;100&#x00025;. The IC<sub>50</sub> value was then calculated.</p></sec>
<sec>
<title>LDH measurement</title>
<p>After A549 cells were exposed to DMSO (0.1&#x00025;) or TSIIA (2.5, 5, 10, 20 and 40 &#x003BC;M) for 48 h, each culture medium was centrifuged at 250 &#x000D7; g for 10 min. Supernatant was transferred to a 96-well culture plate to determine the amount of LDH according to the manual of the LDH assay kit (<xref rid="b31-ijo-45-02-0683" ref-type="bibr">31</xref>). LDH activity is reported as percentage relative to control level. Absorbance of samples was measured at 450 nm.</p></sec>
<sec>
<title>Detection of mitochondrial fluorescent</title>
<p>After treated with DMSO (0.1&#x00025;) or TSIIA (20 &#x003BC;M) for 48 h, respectively, A549 cells were washed twice with pre-chilled PBS. The mitochondrial green fluorescent probe (Mito-Tracker Green) was added to a final concentration of 100 nm, and the cells were then cultured in the dark for 30 min (<xref rid="b32-ijo-45-02-0683" ref-type="bibr">32</xref>). After being washed three times with PBS, the cells were imaged by a reflected fluorescence microscope (Nikon MF30 LED, Japan) with excitation wavelength of 490 nm and emission wavelength of 516 nm.</p></sec>
<sec>
<title>Measurement of mitochondrial membrane potential (MMP)</title>
<p>After labeling cells using a Mito-Tracker Green, we measured the change in mitochondrial membrane potential of TSIIA-treated A549 cells. After treatment, cells were incubated with JC-1 (2.5 &#x003BC;g/ml) at 37&#x000B0;C in dark for 20 min. After washing twice with ice-cold dyeing working buffer, the samples were collected and placed on ice using a method previously described (<xref rid="b33-ijo-45-02-0683" ref-type="bibr">33</xref>). The MMP changes were evaluated by a FACSCalibur Flow Cytometer (Becton-Dickinson, San Jose, CA). High membrane potential was associated with emission at 590 nm (red), and low membrane potential at 530 nm (green) when excited at 488 nm. MMP was determined by a ratio of fluorescence intensity at 590 nm to that at 530 nm.</p></sec>
<sec>
<title>Immunofluorescent labeling</title>
<p>A549 cells were seeded on sterile cover glasses placed in the 6-well plates the day before treatment with DMSO (0.1&#x00025;) or TSIIA (20 &#x003BC;M) for 48 h. After fixation with 4&#x00025; formaldehyde, cells were permeabilized for 15 min in 1&#x00025; Triton X-100 in PBS. The cells were incubated with the mouse anti-cytochrome <italic>c</italic> antibody overnight at 4&#x000B0;C and then incubated with Alexa Fluor 555-labeled goat anti-mouse IgG (H+L) antibody for 2 h at room temperature. The nucleus was stained with Hoechst 33258 for 20 min in the dark (<xref rid="b34-ijo-45-02-0683" ref-type="bibr">34</xref>). Images were observed under a reflected fluorescence microscope (Nikon MF30 LED, Japan).</p></sec>
<sec>
<title>Mitochondrial and cytosolic fractionation</title>
<p>After treatment with DMSO (0.1&#x00025;) or TSIIA (20 &#x003BC;M) for 48 h, respectively, A549 cells were incubated in 100 &#x003BC;l ice-cold mitochondrial lyses buffer on ice for 10 min. Cell suspension was then taken into a glass homogenizer and homogenized for 30 strokes using a tight pestle on ice. The homogenate was centrifuged at 600 &#x000D7; g for 10 min at 4&#x000B0;C to remove nuclei and unbroken cells. Then the supernatant was collected and centrifuged again at 12,000 &#x000D7; g for 30 min at 4&#x000B0;C to obtain the cytosol (supernatant) and mitochondria (deposition) fraction (<xref rid="b35-ijo-45-02-0683" ref-type="bibr">35</xref>). Protein concentrations were determined using BCA Protein Assay Kit.</p></sec>
<sec>
<title>Western blot analysis</title>
<p>Release of cytochrome <italic>c</italic> from the mitochondria to cytosol and translocation of Bax from cytosol to mitochondria were measured by western blot analysis as previously described (<xref rid="b36-ijo-45-02-0683" ref-type="bibr">36</xref>). The signal was visualized using a BeyoECL Plus kit. The level of &#x003B2;-actin was used to normalize the amount of the protein of interest. The density of the band was expressed relative to the density in vehicle control cells.</p></sec>
<sec>
<title>Caspase activity measurement</title>
<p>Lysates of A549 cells were prepared after treatment with TSIIA (10 or 20 &#x003BC;M) for 48 h. In some cases, cells were pretreated for 2 h with SP600125 (10 mM) before TSIIA treatment. Caspase-3, -8, -9 activity assays were performed on 96-well microplates by incubating 10 &#x003BC;l cell lysate in 80 &#x003BC;l reaction buffer containing 10 &#x003BC;l caspase substrate (2 mM). Lysates were incubated at 37&#x000B0;C for 4 h. Samples were measured with a microplate reader at an absorbance of 405 nm. Caspase activity was expressed as the ratio of treated to vehicle control cells (<xref rid="b37-ijo-45-02-0683" ref-type="bibr">37</xref>).</p></sec>
<sec>
<title>Statistical analysis</title>
<p>All data were obtained from three independent assays (n=3). Values were expressed as mean &#x000B1; standard deviation (SD). Statistical analyses of the data between treated and control cells were performed by Student&#x02019;s t-test and one-way analysis of variance (ANOVA). A p-value &lt;0.05 was considered statistically significant.</p></sec></sec>
<sec sec-type="results">
<title>Results</title>
<sec>
<title>TSIIA inhibits the proliferation of A549 cells</title>
<p>The number of viable cells was assessed by CCK-8 assay. Treatment with TSIIA (2.5, 5, 10, 20 and 40 &#x003BC;M) resulted in a dose-dependent suppression of cell viability (<xref rid="f1-ijo-45-02-0683" ref-type="fig">Fig. 1B</xref>, p&lt;0.05). IC<sub>50</sub> value of TSIIA on A549 cells was 16.0&#x000B1;3.7 &#x003BC;M at 48 h.</p>
<p>Also, clone formation assay was done to determine a long-term effect of TSIIA on A549 cell growth. The results of colony images showed that the rate of clone formation was reduced in a dose-dependent manner (<xref rid="f1-ijo-45-02-0683" ref-type="fig">Fig. 1C</xref>, p&lt;0.05). IC<sub>50</sub> value was 14.5&#x000B1;3.3 &#x003BC;M with 10 days incubation after TSIIA treatment for 48 h.</p>
<p>Leakage of LDH to the cell culture medium indicates cell membrane damage. Our LDH assay detects the amount of LDH released by cells with damaged membranes as indicator of necrosis. Except 40 &#x003BC;M, treatment with TSIIA (2.5, 5, 10 and 20) did not affect the concentration of LDH in the supernatant of culture medium (<xref rid="f1-ijo-45-02-0683" ref-type="fig">Fig. 1D</xref>, p&gt;0.05). It suggested that the anti-proliferative effect of TSIIA on A549 cells was not due to cytotoxicity at the TSIIA dose of 10 and 20 &#x003BC;M, and these concentrations were used in further analysis.</p></sec>
<sec>
<title>TSIIA causes mitochondrial morphological changes and MMP loss</title>
<p>The change of mitochondrial morphology and decreasing of MMP are associated with mitochondrial damage linked to apoptosis (<xref rid="b38-ijo-45-02-0683" ref-type="bibr">38</xref>). Thus, we next evaluated the effect of TSIIA on mitochondria. Cell shrinkage and cytoplasm vacuolization were observed in TSIIA-treated A549 cells (<xref rid="f2-ijo-45-02-0683" ref-type="fig">Fig. 2A and B</xref>). As one of three results shown in <xref rid="f2-ijo-45-02-0683" ref-type="fig">Fig. 2D and F</xref>, after treatment with DMSO (0.1&#x00025;) or TSIIA (20 &#x003BC;M), the JC-1 red/green fuorescent ratio in A549 cells was 5.83&#x000B1;0.862 and 1.14&#x000B1;0.156, respectively, suggesting that TSIIA induces a marked decrease of MMP in A549 cells (p&lt;0.05). Compared to JC-1, the mitochondrial fluorescent probe Mito-Tracker Green, could track mitochondria independent of the MMP. It was observed that after TSIIA treatment, some mitochondria changed their filamentous staining pattern to aggregates, some lost the green fluorescence, which was different from the control group (<xref rid="f2-ijo-45-02-0683" ref-type="fig">Fig. 2C and D</xref>). As previous studies showed that TSIIA significantly induced cell apoptosis on a panel of human tumor cell lines, we thought that TSIIA could induce NSCLC A549 cell apoptosis through the mitochondria pathway.</p></sec>
<sec>
<title>TSIIA induces cytochrome c release into the cytosol and Bax translocation into mitochondria</title>
<p>The release of cytochrome <italic>c</italic> from mitochondria into the cytosol is one of the major apoptosis pathways (<xref rid="b39-ijo-45-02-0683" ref-type="bibr">39</xref>). To elucidate whether cytochrome <italic>c</italic> release in TSIIA-induced apoptosis, we determined the subcellular localization of cytochrome <italic>c</italic> by immunofluorescent labeling. As shown in <xref rid="f3-ijo-45-02-0683" ref-type="fig">Fig. 3</xref>, the staining pattern became diffuse in most cells treated with 20 &#x003BC;M TSIIA for 48 h, consistent with a translocation of cytochrome <italic>c</italic> into the cytosol, whereas, cytochrome <italic>c</italic> displayed a dotted pattern in untreated cells, consistent with its location within the mitochondria. The condensation and fragmentation of the chromatin of the nucleus was also observed by Hoechst 33258 in these cells with diffuse cytochrome <italic>c</italic> staining.</p>
<p>It has been well documented that during mitochondria-mediated apoptosis, Bax can translocate from cytosol to mitochondria, causing the release of cytochrome <italic>c</italic> (<xref rid="b40-ijo-45-02-0683" ref-type="bibr">40</xref>). By cell fractionation-based western blot assay, the results showed that Bax level reduced and cytochrome <italic>c</italic> level increased in the cytosol fraction, while Bax level increased and cytochrome <italic>c</italic> level decreased in the mitochondrial fraction in A549 cells treated with 20 &#x003BC;M TSIIA for 48 h (<xref rid="f5-ijo-45-02-0683" ref-type="fig">Fig. 5</xref>, p&lt;0.05).</p></sec>
<sec>
<title>TSIIA activates the caspase-9 and caspase-3 cascade</title>
<p>The caspase cascade is crucial for apoptotic signal transduction. Cytosolic cytochrome <italic>c</italic> induces caspase-9-dependent activation of caspase-3 (<xref rid="b41-ijo-45-02-0683" ref-type="bibr">41</xref>). The working principles of Caspase-3, -8 or -9 Activity Assay Kit are based on the cleavage of the following substrates: acetyl-Asp-Glu-Val-Asp p-nitroanilide (Ac-DEVD-pNA), acetyl-Ile-Glu-Thr-Asp p-nitroanilide (Ac-IETD-pNA) and acetyl-Leu-Glu-His-Asp p-nitroanilide (Ac-LEHD-pNA). Activity of caspase-9 and caspase-3 was shown to be dose-dependently increased with treatment of TSIIA for 48 h in A549 cells (p&lt;0.05), but activity of caspase-8 was not significantly induced (p&gt;0.05).</p>
<p>The JNK pathway plays a pivotal role in stress responses and induces apoptosis in response to various stimuli and the absence of JNK caused a defect in the mitochondrial death signaling pathway, including the failure to release cytochrome <italic>c</italic> (<xref rid="b42-ijo-45-02-0683" ref-type="bibr">42</xref>). To detect whether TSIIA-induced mitochondria apoptosis related to JNK pathway, effects of SP600125 (10 &#x003BC;M, JNK inhibitor) on TSIIA-induced caspase activation were also assessed. The results showed that inhibition of JNK signaling by adding SP600125 significantly blocked caspase-9 and caspase-3 activation in A549 cells with TSIIA treatment (<xref rid="f5-ijo-45-02-0683" ref-type="fig">Fig. 5</xref>, p&lt;0.05). This strongly suggested that JNK pathway performed a crucial function in TSIIA-induced apoptosis in A549 cells, accompanied by the activation of caspase-9 and caspase-3.</p></sec></sec>
<sec sec-type="discussion">
<title>Discussion</title>
<p>TSIIA was originally isolated and identified from the traditional Chinese medicinal herb Dan-Shen. More than 40 tanshinones and their analogs have been isolated since the 1930s, which exhibit various biological activities of anti-atherosclerosis, cardioprotection, neuroprotection and antitumor effects (<xref rid="b43-ijo-45-02-0683" ref-type="bibr">43</xref>). Studies in the past decade suggest that TSIIA hits the model of &#x02018;one-drug-multi-target-multi-disease&#x02019;, which is shared by traditional Chinese medicines (TCM), such as berberine (<xref rid="b44-ijo-45-02-0683" ref-type="bibr">44</xref>). TSIIA exhibited broad antitumor activity towards cancer cell lines of different origins, including H146 (<xref rid="b10-ijo-45-02-0683" ref-type="bibr">10</xref>), A549 (<xref rid="b9-ijo-45-02-0683" ref-type="bibr">9</xref>), COC1/DDP (<xref rid="b11-ijo-45-02-0683" ref-type="bibr">11</xref>), BEL-7402 (<xref rid="b13-ijo-45-02-0683" ref-type="bibr">13</xref>), U-937 (<xref rid="b14-ijo-45-02-0683" ref-type="bibr">14</xref>), MDA-MB-231 (<xref rid="b7-ijo-45-02-0683" ref-type="bibr">7</xref>), 786-O (<xref rid="b16-ijo-45-02-0683" ref-type="bibr">16</xref>), LNCaP (<xref rid="b15-ijo-45-02-0683" ref-type="bibr">15</xref>) and CaSki (<xref rid="b17-ijo-45-02-0683" ref-type="bibr">17</xref>). However, the precise mechanism of the antitumor activity of TSIIA has remained unclear. For new drug development to treat human lung cancer, we evaluated the mechanism of apoptosis of TSIIA on NSCLC A549 cells <italic>in vitro</italic>.</p>
<p>Consistent with previous studies, the proliferation of A549 cells was significantly inhibited by exposure to various concentrations (2.5, 5, 10, 20 and 40 &#x003BC;M) of TSIIA in a dose-dependent manner by both CCK-8 assay (<xref rid="f1-ijo-45-02-0683" ref-type="fig">Fig. 1B</xref>) (<xref rid="b9-ijo-45-02-0683" ref-type="bibr">9</xref>) and clone formation assay (<xref rid="f1-ijo-45-02-0683" ref-type="fig">Fig. 1C</xref>). The IC<sub>50</sub> value (14.5&#x000B1;3.3 &#x003BC;M) obtained by clone formation assay was lower than that of CCK-8 assay (16.0&#x000B1;3.7 &#x003BC;M). In contrast to CCK-8 assay, clone formation is a very convenient and highly sensitive assay. With this long-term cell clonogenic ability assay, we revealed that TSIIA-treated A549 cells might perform an irreversible loss of long-term growth ability. Also, the results of LDH assay (<xref rid="f1-ijo-45-02-0683" ref-type="fig">Fig. 1D</xref>), show that the concentrations of TSIIA with 10 and 20 &#x003BC;M were without any obvious necrosis.</p>
<p>Mitochondria, which generate 80&#x00025; of the energy required for cellular activities, are important sites of respiration and oxidative phosphorylation in the cell. To gain insight into the molecular mechanism involving TSIIA-induced apoptosis in A549 cells, some key factors in mitochondria-mediated apoptosis were assessed. MMP is an important parameter of mitochondrial function and has been used as an indicator of cell health. The loss of MMP is a hallmark for apoptosis (<xref rid="b26-ijo-45-02-0683" ref-type="bibr">26</xref>). In this study, after 48 h with TSIIA (20 &#x003BC;M), the mitochondria morphological damage of A549 cells was present and the MMP was decreased (<xref rid="f2-ijo-45-02-0683" ref-type="fig">Fig. 2</xref>).</p>
<p>Accumulating evidence indicates that mechanism by which TSIIA induced apoptosis associated with expression of the Bcl-2 family proteins (<xref rid="b9-ijo-45-02-0683" ref-type="bibr">9</xref>). We focused our efforts on one cardinal member of this family that are known to be pro-apoptotic Bax. In our study, Bax, localized in the outer mitochondrial membrane, was downregulated. This event might result in losing mitochondrial membrane potential and releasing cytochrome <italic>c</italic> from mitochondria into the cytosol, which can lead to irreversible commitment of A549 cells to apoptosis through the mitochondrial pathway (<xref rid="f3-ijo-45-02-0683" ref-type="fig">Figs. 3</xref> and <xref rid="f4-ijo-45-02-0683" ref-type="fig">4</xref>).</p>
<p>Furthermore, whether TSIIA could trigger apoptosis in the caspase cascade through the release of cytochrome <italic>c</italic>, activities of some important caspases were studied. Caspase-8 and caspase-9 are the key initiator caspases of the death receptor pathway and the mitochondrial pathway, respectively, that cleave and activate downstream effector caspases such as caspase-3 inducing apoptosis (<xref rid="b26-ijo-45-02-0683" ref-type="bibr">26</xref>). Our results showed that TSIIA dose-dependently triggered the activity of caspase-3 and caspase-9 without significantly inducing the activity of caspase-8, which led to apoptosis in A549 cells through the mitochondrial pathway (<xref rid="f5-ijo-45-02-0683" ref-type="fig">Fig. 5</xref>).</p>
<p>Finally, we assessed whether TSIIA can induce apoptosis in the JNK-dependent pathway or the JNK-independent pathway. Previous research showed that Bax was essential for apoptotic signal transduction by JNK (<xref rid="b45-ijo-45-02-0683" ref-type="bibr">45</xref>,<xref rid="b46-ijo-45-02-0683" ref-type="bibr">46</xref>) and the release of cytochrome <italic>c</italic> from mitochondria was involved in apoptosis induced by JNK activation (<xref rid="b42-ijo-45-02-0683" ref-type="bibr">42</xref>). We confirmed TSIIA induced apoptosis with cytochrome <italic>c</italic> release from mitochondria and Bax translocation to mitochondria. However, the relationship between TSIIA-induced apoptosis and JNK pathway has not been reported. In our study, SP600125, an inhibitor of JNK pathway, inhibited the TSIIA-induced activity of caspase-9 and caspase-3 (<xref rid="f5-ijo-45-02-0683" ref-type="fig">Fig. 5B and C</xref>). Although our present data did not confirm whether another pathway performed this function, our findings here indicated that in response to TSIIA, the JNK pathway might give rise to apoptosis of A549 cells.</p>
<p>Altogether these studies revealed for the first time a regulatory mechanism of TSIIA-induced apoptosis, which was associated, at least in part, with the activation of JNK signaling and caspase cascade mediated by the release of cytochrome <italic>c</italic> (<xref rid="f6-ijo-45-02-0683" ref-type="fig">Fig. 6</xref>). Given the fact that TSIIA has been safely used in the clinic (mostly in China) (<xref rid="b2-ijo-45-02-0683" ref-type="bibr">2</xref>,<xref rid="b47-ijo-45-02-0683" ref-type="bibr">47</xref>), TSIIA may be a novel therapeutic for treating NSCLC.</p></sec></body>
<back>
<ack>
<title>Acknowledgements</title>
<p>This study was supported by the research fund of Harbin Medical University, P.R. China.</p></ack>
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<floats-group>
<fig id="f1-ijo-45-02-0683" position="float">
<label>Figure 1</label>
<caption>
<p>Effects of TSIIA on the growth of A549 cells. (A) Chemical structure of tanshinone IIA (TSIIA). (B) Cell viability (&#x00025;) was determined by CCK-8 assay. Exponentially growing A549 cells were treated with the indicated concentration of TSIIA for 48 h. (C) Rate of clone formation (&#x00025;) was determined by clone formation assay. (D) Cytotoxity (&#x00025;) was determined by LDH measurement. Values are means &#x000B1; SD (n=3). <sup>*</sup>p&lt;0.05 vs. control.</p></caption>
<graphic xlink:href="IJO-45-02-0683-g00.gif"/></fig>
<fig id="f2-ijo-45-02-0683" position="float">
<label>Figure 2</label>
<caption>
<p>Mitochondrial morphological changes and MMP loss induced by TSIIA in A549 cells. Cells were treated with DMSO (0.1&#x00025;) or TSIIA (20 &#x003BC;M) for 48 h and then observed under fluorescence microscopy (A, B, C and D) (magnification, &#x000D7;400). Scale bar, 50 &#x003BC;M. Pictures were enhances using Adobe Photoshop for brightness, contrast, and sharpening for uniformity of appearance only. Graphs of mitochondrial membrane potential (MMP) were evaluated by a FACSCalibur Flow Cytometer (E and F). Results were representative of three independent experiments.</p></caption>
<graphic xlink:href="IJO-45-02-0683-g01.gif"/></fig>
<fig id="f3-ijo-45-02-0683" position="float">
<label>Figure 3</label>
<caption>
<p>Effects of TSIIA on cytochrome <italic>c</italic> by cell immunofluorescence. A549 cells were treated with DMSO (0.1&#x00025;) or TSIIA (20 &#x003BC;M) for 48 h and then images were taken with fluorescence microscopy (magnification, &#x000D7;200). Scale bar, 20 &#x003BC;M. (A and B) Nuclei (visualized with Hochest 33258, blue signal). (C and D) Localization of Alexa Fluor 555-Cyt <italic>c</italic> (Alexa Fluor 555 fluorescence, red signal). (E and F) Merge of the two images of (A and C) or (B and D), respectively. Results are representative of three independent experiments.</p></caption>
<graphic xlink:href="IJO-45-02-0683-g02.gif"/></fig>
<fig id="f4-ijo-45-02-0683" position="float">
<label>Figure 4</label>
<caption>
<p>Effects of TSIIA on distribution and expression of Bax and cytochrome <italic>c</italic> (Cyt <italic>c</italic>). A549 cells were treated with DMSO (0.1&#x00025;) or TSIIA (20 &#x003BC;M) for 48 h and protein expressions of Bax and Cyt <italic>c</italic> were tested by western blot analysis. Cyto, cytosole; Mito, mitochondria. &#x003B2;-actin was used as the internal control. Data are presented as means &#x000B1; SD of three independent experiments and analyzed by one-way ANOVA. <sup>*</sup>p&lt;0.05, Cyt <italic>c</italic> vs. control; <sup>#</sup>p&lt;0.05, Bax vs. control.</p></caption>
<graphic xlink:href="IJO-45-02-0683-g03.gif"/></fig>
<fig id="f5-ijo-45-02-0683" position="float">
<label>Figure 5</label>
<caption>
<p>Effects of TSIIA on caspase-3, -8, -9 activation in A549 cells. Graphs were drawn from the results using (A) caspase-8, (B) caspase-9 and (C) caspase-3 Activity Assay kit. After various treatments as described in Materials and methods, activities of caspases were measured with a microplate reader at an absorbance of 405 nm. Values are means &#x000B1; SD (n=3). <sup>*</sup>p&lt;0.05 vs. control; <sup>#</sup>p&lt;0.05 vs. 20 &#x003BC;M TSIIA-treated alone.</p></caption>
<graphic xlink:href="IJO-45-02-0683-g04.gif"/></fig>
<fig id="f6-ijo-45-02-0683" position="float">
<label>Figure 6</label>
<caption>
<p>A proposed mechanism of TSIIA-induced apoptosis in A549 cells.</p></caption>
<graphic xlink:href="IJO-45-02-0683-g05.gif"/></fig></floats-group></article>
