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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.2014.2689</article-id>
<article-id pub-id-type="publisher-id">ijo-45-06-2393</article-id>
<article-categories>
<subj-group>
<subject>Articles</subject></subj-group></article-categories>
<title-group>
<article-title>Cantharidin induces G2/M phase arrest by inhibition of Cdc25c and Cyclin A and triggers apoptosis through reactive oxygen species and the mitochondria-dependent pathways of A375.S2 human melanoma cells</article-title></title-group>
<contrib-group>
<contrib contrib-type="author">
<name><surname>HSIAO</surname><given-names>YU-PING</given-names></name><xref rid="af1-ijo-45-06-2393" ref-type="aff">1</xref><xref rid="af2-ijo-45-06-2393" ref-type="aff">2</xref></contrib>
<contrib contrib-type="author">
<name><surname>TSAI</surname><given-names>CHUNG-HUNG</given-names></name><xref rid="af1-ijo-45-06-2393" ref-type="aff">1</xref><xref rid="af3-ijo-45-06-2393" ref-type="aff">3</xref></contrib>
<contrib contrib-type="author">
<name><surname>WU</surname><given-names>PING-PING</given-names></name><xref rid="af4-ijo-45-06-2393" ref-type="aff">4</xref></contrib>
<contrib contrib-type="author">
<name><surname>HSU</surname><given-names>SHU-CHUN</given-names></name><xref rid="af5-ijo-45-06-2393" ref-type="aff">5</xref></contrib>
<contrib contrib-type="author">
<name><surname>LIU</surname><given-names>HSIN-CHUNG</given-names></name><xref rid="af5-ijo-45-06-2393" ref-type="aff">5</xref></contrib>
<contrib contrib-type="author">
<name><surname>HUANG</surname><given-names>YI-PING</given-names></name><xref rid="af6-ijo-45-06-2393" ref-type="aff">6</xref></contrib>
<contrib contrib-type="author">
<name><surname>YANG</surname><given-names>JEN-HUNG</given-names></name><xref rid="af7-ijo-45-06-2393" ref-type="aff">7</xref><xref rid="af8-ijo-45-06-2393" ref-type="aff">8</xref><xref rid="fn1-ijo-45-06-2393" ref-type="author-notes">*</xref><xref ref-type="corresp" rid="c1-ijo-45-06-2393"/></contrib>
<contrib contrib-type="author">
<name><surname>CHUNG</surname><given-names>JING-GUNG</given-names></name><xref rid="af5-ijo-45-06-2393" ref-type="aff">5</xref><xref rid="af9-ijo-45-06-2393" ref-type="aff">9</xref><xref rid="fn1-ijo-45-06-2393" ref-type="author-notes">*</xref><xref ref-type="corresp" rid="c1-ijo-45-06-2393"/></contrib></contrib-group>
<aff id="af1-ijo-45-06-2393">
<label>1</label>Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, R.O.C.</aff>
<aff id="af2-ijo-45-06-2393">
<label>2</label>Department of Dermatology, Chung Shan Medical University Hospital, Taichung, Taiwan, R.O.C.</aff>
<aff id="af3-ijo-45-06-2393">
<label>3</label>Department of Pathology, Chung Shan Medical University Hospital, Taichung, Taiwan, R.O.C.</aff>
<aff id="af4-ijo-45-06-2393">
<label>4</label>School of Pharmacy, China Medical University, Taichung, Taiwan, R.O.C.</aff>
<aff id="af5-ijo-45-06-2393">
<label>5</label>Department of Biological Science and Technology, China Medical University, Taichung, Taiwan, R.O.C.</aff>
<aff id="af6-ijo-45-06-2393">
<label>6</label>Department of Physiology, China Medical University, Taichung, Taiwan, R.O.C.</aff>
<aff id="af7-ijo-45-06-2393">
<label>7</label>School of Medicine, Tzu Chi University, Hualien, Taiwan, R.O.C.</aff>
<aff id="af8-ijo-45-06-2393">
<label>8</label>Department of Dermatology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan, R.O.C.</aff>
<aff id="af9-ijo-45-06-2393">
<label>9</label>Department of Biotechnology, Asia University, Taichung, Taiwan, R.O.C.</aff>
<author-notes>
<corresp id="c1-ijo-45-06-2393">Correspondence to: Professor Jing-Gung Chung, Department of Biological Science and Technology, China Medical University, no. 91, Hsueh-Shih Road, Taichung 404, Taiwan, R.O.C., E-mail: <email>jgchung@mail.cmu.edu.tw</email>. Professor Jen-Hung Yang, Department of Dermatology, Buddhist Tzu Chi General Hospital, no. 707, Sec. 3, Chung Yang Road, Hualien 970, Taiwan, R.O.C., E-mail: <email>jh.med.edu@hotmail.com</email></corresp><fn id="fn1-ijo-45-06-2393">
<label>*</label>
<p>Contributed equally</p></fn></author-notes>
<pub-date pub-type="collection">
<month>12</month>
<year>2014</year></pub-date>
<pub-date pub-type="epub">
<day>30</day>
<month>09</month>
<year>2014</year></pub-date>
<volume>45</volume>
<issue>6</issue>
<fpage>2393</fpage>
<lpage>2402</lpage>
<history>
<date date-type="received">
<day>22</day>
<month>07</month>
<year>2014</year></date>
<date date-type="accepted">
<day>05</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>Cantharidin (CTD), a component of natural mylabris (<italic>Mylabris phalerata</italic> Pallas) was reported to have high cytotoxicity in many human cancer cell lines. However, it was not reported to affect human melanoma A375.S2 cells. In the present study, we found that CTD induced cell morphological changes and decreased the percentage of viable cells and induced G2/M phase arrest and induction of apoptosis in A375. S2 cells. Results also showed that CTD induced the generation of reactive oxygen species (ROS) and Ca<sup>2+</sup> and decreased mitochondria membrane potential and lead to the release of cytochrome <italic>c</italic>, AIF and Endo G. Further investigation revealed that CTD induced A375.S2 cells with an increase of caspase activation and caspase-dependent apoptotic proteins to trigger correlated pathway mechanisms according to western blotting results. Western blotting was used for examining the changes of G2/M phase arrest and apoptosis-associated protein expression and confocal laser microscopy was used to examine the translocation apoptosis-associated protein. Results showed that CTD increased the protein expression of caspase-3, -8 and -9, cytochrome <italic>c</italic>, Bax, Bid, Endo G and AIF but inhibited the levels of Bcl-2 and Bcl-x. CTD induced ER stress-associated protein expression such as GRP78, IRE1&#x003B2;, ATF6&#x003B1; and caspase-12. Based on those observations, we suggest that CTD may have potential as a novel anti-cancer agent for the treatment of skin cancer.</p></abstract>
<kwd-group>
<kwd>cantharidin</kwd>
<kwd>mitochondria-dependent pathways</kwd>
<kwd>G2/M phase</kwd>
<kwd>sub-G1 phase</kwd>
<kwd>apoptosis</kwd>
<kwd>A375.S2 cells</kwd></kwd-group></article-meta></front>
<body>
<sec sec-type="intro">
<title>Introduction</title>
<p>Human melanoma, an aggressive skin cancer, accounts for 10&#x00025; of all skin cancers, but was estimated to be involved in &gt;80&#x00025; of deaths from skin cancers (<xref rid="b1-ijo-45-06-2393" ref-type="bibr">1</xref>). In Western countries, skin cancer melanoma is becoming more common and resulting in increased mortality (<xref rid="b2-ijo-45-06-2393" ref-type="bibr">2</xref>). In the USA, the incidence of melanoma has increased by 15-fold in the last 40 years (<xref rid="b1-ijo-45-06-2393" ref-type="bibr">1</xref>,<xref rid="b3-ijo-45-06-2393" ref-type="bibr">3</xref>). In individuals of European origin, the incidence of melanoma is still rising (<xref rid="b4-ijo-45-06-2393" ref-type="bibr">4</xref>). Survival ratio for metastatic melanoma is low and the 10-year survival rate for patients with metastatic melanoma is &lt;10&#x00025; (<xref rid="b5-ijo-45-06-2393" ref-type="bibr">5</xref>,<xref rid="b6-ijo-45-06-2393" ref-type="bibr">6</xref>). It was reported that human melanoma is highly resistant to conventional chemotherapy (<xref rid="b7-ijo-45-06-2393" ref-type="bibr">7</xref>). Currently, the effective treatment of human melanoma such as surgery, radiation, chemotherapy or a combination of radiotherapy with chemotherapy is not satisfactory. Thus, numerous studies had focused on finding novel potent drugs from natural products to combat this disease.</p>
<p>In nature, insects produce different defensive molecules against predators, and these molecules may be clinically used as medicinal drugs for therapeutic purposes (<xref rid="b8-ijo-45-06-2393" ref-type="bibr">8</xref>). The dried body of mylabris (<italic>Mylabris phalerata</italic> Pallas) has been used in Chinese traditional medicine for the treatment of cancer (<xref rid="b9-ijo-45-06-2393" ref-type="bibr">9</xref>). Cantharidin (CTD), a terpenoid, was isolated from mylabris (blister beetles) and other insects and was shown to induce cancer cell apoptosis in leukemia (<xref rid="b10-ijo-45-06-2393" ref-type="bibr">10</xref>), myeloma (<xref rid="b11-ijo-45-06-2393" ref-type="bibr">11</xref>), bladder (<xref rid="b12-ijo-45-06-2393" ref-type="bibr">12</xref>), breast (<xref rid="b13-ijo-45-06-2393" ref-type="bibr">13</xref>), colon (<xref rid="b14-ijo-45-06-2393" ref-type="bibr">14</xref>), liver (<xref rid="b15-ijo-45-06-2393" ref-type="bibr">15</xref>), pancreatic (<xref rid="b16-ijo-45-06-2393" ref-type="bibr">16</xref>) and lung (<xref rid="b17-ijo-45-06-2393" ref-type="bibr">17</xref>). It was reported that CTD inhibits migration and invasion of A549 human lung cancer cells via the inhibition of matrix metalloproteinase 2 (<xref rid="b18-ijo-45-06-2393" ref-type="bibr">18</xref>). Recently, we also found that CTD induces cell apoptosis through mitochondria-dependent pathways (<xref rid="b18-ijo-45-06-2393" ref-type="bibr">18</xref>) and induced DNA damage and inhibits DNA repair-associated protein levels in NCI-H460 human lung cancer cells (<xref rid="b19-ijo-45-06-2393" ref-type="bibr">19</xref>).</p>
<p>Numerous studies have shown that CTD induced cytotoxic effects in many human cancer cell lines through the induction of apoptosis, however, there is no available information to show CTD-induced apoptosis in human skin cancer cells. Therefore, in the present study, A375.S2 human melanoma cells were selected for use as a cell model to investigate the anti-melanoma potential of CTD <italic>in vitro</italic>. The results indicated that CTD induced G2/M phase arrest and cell apoptosis in A375.S2 cells via the caspase- and mitochondrial-dependent signaling pathways.</p></sec>
<sec sec-type="materials|methods">
<title>Materials and methods</title>
<sec>
<title>Chemicals and reagents</title>
<p>CTD, propidium iodide (PI), Trypsin-EDTA, dimethyl sulfoxide (DMSO) and DAPI were purchased from Sigma Chemical Co. (St. Louis, MO, USA). CTD was dissolved in DMSO to make a stock solution. Minimum essential medium (MEM), fetal bovine serum (FBS), L-glutamine and penicillin-streptomycin were purchased from Gibco<sup>&#x000AE;</sup>/Invitrogen Life Technologies (Carlsbad, CA, USA). Primary antibody such as WEE1, Cdc25c, Cyclin A, CDK1, p21, Fas, Fas-L, AIF, Endo G, cytochrome <italic>c</italic>, caspase-3, -8 and -9, Bax, Bid, Bcl-2, Bcl-x, XBP-1, GADD153, GRP78, caspase-12, IRE1&#x003B2;, ATF6&#x003B1; and Calpain 1 and peroxidase conjugated secondary antibodies were purchased from Cell Signaling Technology, Inc. (Beverly, MA, USA). The enhanced chemiluminescence (ECL) detection system was obtained from Amersham Life Science, Inc. (Arlington Heights, IL, USA).</p></sec>
<sec>
<title>Cell culture</title>
<p>The A375.S2 human malignant melanoma cancer cells were obtained from the Food Industry Research and Development Institute (Hsinchu, Taiwan). The cells were cultured in MEM supplemented with 10&#x00025; FBS, 1&#x00025; antibiotics (100 U/ml penicillin and 100 &#x003BC;g/ml streptomycin) and 2 mM L-glutamine (Gibco<sup>&#x000AE;</sup>/Invitrogen Life Technologies, Grand Island, NY, USA) and maintained at 37&#x000B0;C with 5&#x00025; CO<sub>2</sub> in a humidified atmosphere. The medium was changed every 2 days (<xref rid="b20-ijo-45-06-2393" ref-type="bibr">20</xref>&#x02013;<xref rid="b22-ijo-45-06-2393" ref-type="bibr">22</xref>).</p></sec>
<sec>
<title>Observation of morphological changes and measurement of viable cells</title>
<p>A375.S2 cells (2&#x000D7;10<sup>5</sup> cells/well) were seeded into 12-well plates for 24 h. CTD diluted in DMSO was then individually added to a final concentration of 0, 1, 2, 3, 4 and 5 &#x003BC;M, and an equal amount of DMSO was added to the well as the control group for 48 h. The cellular morphology was observed and photographed by using a phase contrast microscope at magnification of &#x000D7;200. Cells from each well were harvested for the measurement of percentage of viability using a flow cytometric method (BD Bioscience FACSCalibur flow cytometer; Becton-Dickinson, San Jose, CA, USA) as described previously (<xref rid="b20-ijo-45-06-2393" ref-type="bibr">20</xref>).</p></sec>
<sec>
<title>Measurement of cell cycle distribution by flow cytometry</title>
<p>A375.S2 cells (2&#x000D7;10<sup>5</sup> cells/well) were seeded into 12-well culture plates for 24 h and then were incubated with 0, 1, 2, 3, 4 and 5 &#x003BC;M of CTD, or only with vehicle (DMSO, 1&#x00025; in culture media) for 24 and 48 h. Cells were harvested by centrifugation and washed with phosphate-buffered saline (PBS). Then cells were fixed with 70&#x00025; ethanol overnight at least for 24 h at 4&#x000B0;C and were washed twice with PBS and stained with 1 ml PI working solution (100 &#x003BC;g/ml RNase A, 40 &#x003BC;g/ml PI and 0.1&#x00025; Triton X-100) for cellular staining at room temperature for 30 min in the dark. Analysis of cell cycle distribution was performed by a flow cytometer and analyzed by Cell Quest software package (BD Bioscience FACSCalibur flow cytometer; Becton-Dickinson) as described previously (<xref rid="b20-ijo-45-06-2393" ref-type="bibr">20</xref>). Each experiment was repeated three times.</p></sec>
<sec>
<title>Reactive oxygen species (ROS), intracellular Ca<sup>2+</sup> and mitochondrial membrane potential (&#x00394;&#x003A8;m) assays</title>
<p>Flow cytometry was used for measuring the levels of ROS, Ca<sup>2+</sup> and &#x00394;&#x003C8;m in A375.S2 cells. Briefly, A375.S2 cells (2&#x000D7;10<sup>5</sup> cells/well) placed in 12-well plates for 24 h were then treated with 4 &#x003BC;M of CTD for various time periods. The cells were collected from each timer point and then re-suspended in 500 &#x003BC;l of DCFH-DA (10 &#x003BC;M) for 30 min for ROS (H<sub>2</sub>O<sub>2</sub>) measurement, re-suspended in 500 &#x003BC;l of DiOC<sub>6</sub> (4 &#x003BC;M) for 30 min for the levels of &#x00394;&#x003C8;m measurement and re-suspended in 500 &#x003BC;l of Fluo-3/AM (2.5 &#x003BC;g/ml) for 30 min for intracellular Ca<sup>2+</sup> measurement and all samples were analyzed by flow cytometry as described previously.</p></sec>
<sec>
<title>Caspase-3, -8 and -9 activity assay</title>
<p>A375.S2 cells (2&#x000D7;10<sup>5</sup> cells/well) were seeded onto 12-well plates for 24 h and then were pre-treated with Z-VAD-FMK, Z-IETD-FMK, Z-LEHD-FMK and Z-DEVD-FMK (inhibitors of caspase-pan, -8, -9 and -3, respectively) and then treated with 4 &#x003BC;M of CTD for 0, 6, 24 and 48 h. Then cells were harvested and washed with PBS, and were re-suspended in 50 &#x003BC;l of 10 &#x003BC;M substrate solution of caspase-8, -9 and -3 substrates (CaspaLux8-L1D2, CaspaLux9-M1D2 and PhiPhiLux-G1D2, respectively) (OncoImmunin, Inc., Gaithersburg, MD, USA) for 30 min in the dark. Cells were measured for the activities of caspase-8, -9 and -3 by using flow cytometric assay as described previously (<xref rid="b20-ijo-45-06-2393" ref-type="bibr">20</xref>).</p></sec>
<sec>
<title>Western blotting</title>
<p>A375.S2 cells (1&#x000D7;10<sup>6</sup> cells/dish) were placed in 10 cm dish for 24 h and then were incubated with or without 4 &#x003BC;M CTD for 0, 6, 12, 24 and 48 h then lysed in an ice-cold lysis buffer &#x0005B;10 mM Tris-HCl (pH 7.4), 150 mM NaCl, 1 mM EGTA, 0.3 mM PMSF, 0.2 mM sodium orthovanadate, 0.1&#x00025; SDS, 1 mM EDTA, 1&#x00025; NP-40, 10 mg/ml leupeptin, and 10 mg/ml aprotinin&#x0005D;, followed by denaturation. Then centrifuged at 13,000 rpm for 20 min at 4&#x000B0;C, before getting the supernatant to measure protein concentration by using a Bio-Rad protein assay kit (Bio-Rad, Hercules, CA, USA). Protein (30 &#x003BC;g) was electrophoresed in 12&#x00025; SDS-PAGE gel at 4&#x000B0;C, steady flow (10 mA in composition gel, 15 mA in separation gel) followed by transfer onto nitrocellulose membranes. The membranes were blocked with 5&#x00025; skim milk in TBST (20 mmol/l Tris-HCl at pH 8.0, 150 mmol/l NaCl, and 0.05&#x00025; Tween-20) for 1 h at room temperature, and then probed with relevant primary antibodies (anti-WEE1, Cdc25c, Cyclin A, CDK1, p21, Fas, Fas-L, AIF, Endo G, cytochrome <italic>c</italic>, caspase-3, -8 and -9, Bax, Bid, Bcl-2, Bcl-x, XBP-1, GADD153, GRP78, caspase-12, IRE1&#x003B2;, ATF6&#x003B1; and Calpain 1) overnight at 4&#x000B0;C followed by peroxidase-conjugated secondary antibody for 1 h at 25&#x000B0;C. Proteins on the membrane were visualized by ECL detection (Amersham Biosciences ECL&#x02122;) and exposed to X-ray film and bands obtained were quantified using NIH Image analyzer (NIH, Bethesda, MD, USA). &#x003B2;-actin staining served as the internal standard for the membranes. All of the western blots were performed at least three times (<xref rid="b21-ijo-45-06-2393" ref-type="bibr">21</xref>,<xref rid="b22-ijo-45-06-2393" ref-type="bibr">22</xref>).</p></sec>
<sec>
<title>Confocal laser scanning microscopy assay</title>
<p>A375.S2 cells (5&#x000D7;10<sup>4</sup> cells/well) were placed on 4-well chamber slides and incubated with or without 4 &#x003BC;M CTD for 48 h and then fixed in 4&#x00025; formaldehyde in PBS for 15 min, and they were permeablized using 0.3&#x00025; Triton X-100 in PBS for 1 h, followed using 2&#x00025; BSA for blocking non-specific binding sites. Cells were stained by primary antibodies such as anti-Endo G, anti-cytochrome <italic>c</italic> and anti-AIF (all in green fluorescence) overnight and then washed with PBS. Cells were incubated with fluorescein isothiocyanate-conjugated second antibody (Santa Cruz Biotechnology, Santa Cruz, CA, USA) followed by mitotracker (red fluorescence) staining for nuclein examination. The stained cells were analyzed with Leica TCS SP2 Confocal Spectral Microscope as described previously (<xref rid="b23-ijo-45-06-2393" ref-type="bibr">23</xref>,<xref rid="b24-ijo-45-06-2393" ref-type="bibr">24</xref>).</p></sec>
<sec>
<title>Statistical analysis</title>
<p>All data were expressed as mean &#x000B1; SD from triplicate experiments. Statistically significant of differences between the CTD-treated and -untreated (control) groups were assessed by Student&#x02019;s t-test with SPSS 11.0 statistic software. P&lt;0.05 was considered statistically significant.</p></sec></sec>
<sec sec-type="results">
<title>Results</title>
<sec>
<title>CTD induced cell morphological changes and decreased the cell viability of A375.S2 cells</title>
<p>A375.S2 cells were pre-incubated with 0, 1, 2, 3, 4 and 5 &#x003BC;M of CTD for 48 h then cells were photographed by phase contrast microscopy and were harvested for the total percentage of viable cells and the results are shown in <xref rid="f1-ijo-45-06-2393" ref-type="fig">Fig. 1A and B</xref>. <xref rid="f1-ijo-45-06-2393" ref-type="fig">Fig. 1A</xref> shows that CTD induced cell morphological changes. <xref rid="f1-ijo-45-06-2393" ref-type="fig">Fig. 1B</xref> shows a significant dose-dependent reduction of living cells with CTD treatment when compared to the control groups in A375.S2 cells and these effects are dose-dependent.</p></sec>
<sec>
<title>CTD induces G2/M phase arrest and sub-G1 phase (apoptosis) of A375.S2 cells</title>
<p>A375.S2 cells were treated with various doses of CTD for 24 and 48 h before the cells were examined for sub-G1 phase in cell cycle assay by flow cytometry and the results are shown in <xref rid="f2-ijo-45-06-2393" ref-type="fig">Fig. 2A&#x02013;C</xref>. <xref rid="f2-ijo-45-06-2393" ref-type="fig">Fig. 2A</xref> shows representative profiles from flow cytometry assay indicating that CTD induced sub-G1 phase and G2/M phase arrest in A375.S2 cells. Data in <xref rid="f2-ijo-45-06-2393" ref-type="fig">Fig. 2B and C</xref> indicate that CTD induced G2/M phase arrest and induced sub-G1 phase development, respectively, and these effects are dose-dependent. At the 48-h treatment of CTD, a higher percentage of G2/M phase arrest and sub-G1 phase (apoptosis) was recorded than that of control groups.</p></sec>
<sec>
<title>CTD induces ROS and Ca<sup>2+</sup> production and decreases the levels of &#x00394;&#x003C8;m in A375.S2 cells</title>
<p>In order to confirm whether CTD induced apoptotic cell death in A375.S2 cells via the production of ROS and Ca<sup>2+</sup> or dysfunction of mitochondria, cells were treated with CTD then analyzed by flow cytometry and the results are shown in <xref rid="f3-ijo-45-06-2393" ref-type="fig">Fig. 3A&#x02013;C</xref>. <xref rid="f3-ijo-45-06-2393" ref-type="fig">Fig. 3A</xref> shows that CTD increased ROS production at 2&#x02013;6 h of treatment. Furthermore, CTD induced Ca<sup>2+</sup> production (<xref rid="f3-ijo-45-06-2393" ref-type="fig">Fig. 3C</xref>) from 1&#x02013;9 h of treatment in A375.S2 cells and these effects are time-dependent. However, <xref rid="f3-ijo-45-06-2393" ref-type="fig">Fig. 3B</xref> indicates that CTD decreased the levels of &#x00394;&#x003C8;m at 24-h of treatment and shows that CTD-induced apoptosis of A375.S2 cells is associated with dysfunction of mitochondria.</p></sec>
<sec>
<title>CTD affects the activities of caspase-8, -9 and -3 in A375. S2 cells</title>
<p>To confirm whether CTD induced apoptosis through the activation of caspase-8, -9 and -3 in A375. S2 cells, cells were pre-treated with or without the inhibitors (Z-VAD-FMK, Z-IETD-FMK, Z-LEHD-FMK and Z-DEVD-FMK: caspase-pan, -8, -9 and -3, respectively) and then were treated with 4 &#x003BC;M of CTD and were harvested and assessed by flow cytometric assay and the results are shown in <xref rid="f4-ijo-45-06-2393" ref-type="fig">Fig. 4A&#x02013;D</xref>. Results from <xref rid="f4-ijo-45-06-2393" ref-type="fig">Fig. 4A&#x02013;C</xref> indicate that CTD increased the activities of caspase-8, -9 and -3 and these effects are time-dependent. Cells were pre-treated with the inhibitors of caspase-pan, -8, -9 and -3 and then were treated with CTD and the total percentage of viable cells were measured and the results (<xref rid="f4-ijo-45-06-2393" ref-type="fig">Fig. 4D</xref>) show increased percentage of viable cells when compared to the treatment without the inhibitor. These results showed that CTD induced apoptosis via the caspase-dependent pathway.</p></sec>
<sec>
<title>CTD affects G2/M phase arrest and apoptosis-associated protein expression in A375.S2 cells</title>
<p>To further investigate whether CTD induced G2/M phase arrest and apoptosis in A375.S2 cells through the presented alterations of G2/M phase and apoptosis-associated protein, cells were treated with 4 &#x003BC;M of CTD for 0, 6, 12, 24 and 48 h and then the associated protein alterations were examined by western blotting and the results are shown in <xref rid="f5-ijo-45-06-2393" ref-type="fig">Fig. 5A&#x02013;D</xref>. <xref rid="f5-ijo-45-06-2393" ref-type="fig">Fig. 5A</xref> indicates that CTD inhibited Cdc25c, Cyclin A and CDK1 but increased p21 and WEE1 proteins in A375.S2 cells. These cellular proteins were known to respond to G2/M phase in cell cycle progression. We inferred that CTD could bring about the proteolytic activations of various G2/M phase proteins to obstruct the cell cycle progression of A375.S2 cells. Results in <xref rid="f5-ijo-45-06-2393" ref-type="fig">Fig. 5C</xref> show that CTD significantly increased the expression of Fas, Fas-L, and caspase-8 that is associated with the extrinsic pathway. Furthermore, results show that CTD increased cytochrome <italic>c</italic>, AIF, Endo G, caspase-9 and -3 (<xref rid="f5-ijo-45-06-2393" ref-type="fig">Fig. 5C</xref>), increased Bid, Bax, but decreased the levels of Bcl-2, Bcl-x and XBP-1 (<xref rid="f5-ijo-45-06-2393" ref-type="fig">Fig. 5B</xref>) that are all associated with the intrinsic apoptotic pathway. Additionally, <xref rid="f5-ijo-45-06-2393" ref-type="fig">Fig. 5D</xref> indicates that CTD increased ER stress-associated protein expression such as GADD153, GRP78, IRE1&#x003B2;, Calpain 1, ATF6&#x003B1; and caspase-12. These results indicate that CTD induced G2/M phase arrest via inhibited cell cycle progression-associated protein and induced apoptosis through the extrinsic, intrinsic and ER stress pathways in A375.S2 cells.</p></sec>
<sec>
<title>CTD affected the translocation of apoptotic associated proteins in A375.S2 cells</title>
<p>To further confirm that CTD affects the translocation of cytochrome <italic>c</italic>, AIF, and Endo G involved in apoptosis in A375.S2 cells, cells were treated with 4 &#x003BC;M of CTD for 48 h and then stained by anti-cytochrome <italic>c</italic>, AIF and Endo G to examine and photograph by confocal laser microscopic systems. Results show that CTD promoted Endo G (<xref rid="f6-ijo-45-06-2393" ref-type="fig">Fig. 6B</xref>), cytochrome <italic>c</italic> (<xref rid="f6-ijo-45-06-2393" ref-type="fig">Fig. 6A</xref>), AIF (<xref rid="f6-ijo-45-06-2393" ref-type="fig">Fig. 6C</xref>) releases from mitochondria in A375.S2 cells when compared to untreated (control) groups that indicated CTD induced apoptosis via the mitochondria-dependent pathway.</p></sec></sec>
<sec sec-type="discussion">
<title>Discussion</title>
<p>It was reported that &gt;50&#x00025; of anti-cancer drugs used in patients are directly or indirectly derived from natural plants (<xref rid="b24-ijo-45-06-2393" ref-type="bibr">24</xref>). CTD, a natural active compound isolated from various insects, was found to have <italic>in vitro</italic> antitumor activity against many human cancer cell lines (<xref rid="b10-ijo-45-06-2393" ref-type="bibr">10</xref>&#x02013;<xref rid="b17-ijo-45-06-2393" ref-type="bibr">17</xref>). In this study, for the first time, we demonstrated that CTD induced G2/M phase arrest via the inhibition of Cdc25c and cyclin A and induced apoptosis was through death receptor (extrinsic), intrinsic (mitochondria) and ER stress pathways in A375. S2 cells. Furthermore, results indicated that CTD induced cell morphological changes (<xref rid="f1-ijo-45-06-2393" ref-type="fig">Fig. 1A</xref>) and decreased the percentage of viable cells (<xref rid="f1-ijo-45-06-2393" ref-type="fig">Fig. 1B</xref>) via the induction of G2/M phase arrest, sub-G1 phase (apoptosis) (<xref rid="f2-ijo-45-06-2393" ref-type="fig">Fig. 2</xref>).</p>
<p>It is well known that cells undergo cell cycle from G0/G1, S, and G2/M phase that are controlled by checkpoint-associated proteins (<xref rid="b23-ijo-45-06-2393" ref-type="bibr">23</xref>,<xref rid="b25-ijo-45-06-2393" ref-type="bibr">25</xref>) and agents including anticancer drugs can affect checkpoint proteins distributing the progression of cell cycle then leading the cells to undergo apoptosis (<xref rid="b26-ijo-45-06-2393" ref-type="bibr">26</xref>,<xref rid="b27-ijo-45-06-2393" ref-type="bibr">27</xref>). Herein, we found CTD induced G2/M phase arrest in A375.S2 cells, it also inhibited the protein expression of Cdc25c, Cyclin A and CDK1 (<xref rid="f6-ijo-45-06-2393" ref-type="fig">Fig. 6A</xref>) that are associated with G2/M arrest.</p>
<p>It is well documented that the induction of apoptosis triggered by anticancer drugs has been recognized as the best strategy for anticancer therapy (<xref rid="b28-ijo-45-06-2393" ref-type="bibr">28</xref>,<xref rid="b29-ijo-45-06-2393" ref-type="bibr">29</xref>). It was reported that intracellular ROS generation plays an important role in physiological and pathological processes. Furthermore, higher ROS is involved in apoptotic cell death (<xref rid="b30-ijo-45-06-2393" ref-type="bibr">30</xref>). Mitochondria plays a critical role in cell apoptosis (<xref rid="b31-ijo-45-06-2393" ref-type="bibr">31</xref>,<xref rid="b32-ijo-45-06-2393" ref-type="bibr">32</xref>) and has been suggested to act as the central executioner in apoptotic signaling pathways (<xref rid="b33-ijo-45-06-2393" ref-type="bibr">33</xref>). We found that CTD increased the production of ROS (<xref rid="f3-ijo-45-06-2393" ref-type="fig">Fig. 3A</xref>) time-dependently and decreased the levels of &#x00394;&#x003C8;m (<xref rid="f3-ijo-45-06-2393" ref-type="fig">Fig. 3B</xref>) in A375.S2 cells. It was reported that the mitochondria-derived ROS is caused by the dysfunction of mitochondrial electron transport chain (<xref rid="b34-ijo-45-06-2393" ref-type="bibr">34</xref>). These observations indicated the mitochondrial dysfunction occurred during CTD-induced A375.S2 cell apoptosis. At 48-h of CTD treatment, it led to mitochondria dysfunction and results from western blotting also showed that CTD increased the release of cytochrome <italic>c</italic>, AIF and Endo G (<xref rid="f5-ijo-45-06-2393" ref-type="fig">Fig. 5C</xref>) release. Furthermore, it increased Bid and Bax but decreased Bcl-2 and Bcl-x (<xref rid="f5-ijo-45-06-2393" ref-type="fig">Fig. 5B</xref>) in A375. S2 cells. Bcl-2 gene family is divided mainly into the Bax, Bcl-2, and Bid proteins. Bax is an apoptosis-promoting protein, while Bcl-2 is an anti-apoptotic protein that plays a critical role in regulating cell apoptosis (<xref rid="b35-ijo-45-06-2393" ref-type="bibr">35</xref>,<xref rid="b36-ijo-45-06-2393" ref-type="bibr">36</xref>). By western blotting we found that the expression of Bax was increased and that of Bcl-2 was reduced in A375.S2 cells when treated with CTD, therefore increasing the Bax/Bcl-2 ratio significantly.</p>
<p>Other studies have shown that oxidative stress stimulates translocation of Bax from cytosol to mitochondria causing cytochrome <italic>c</italic> release inside the cytoplasm during liver apoptosis (<xref rid="b37-ijo-45-06-2393" ref-type="bibr">37</xref>). CTD-induced ROS generation, and we suggest that CTD-induced apoptosis might be modulated by the ROS-mediated pathways in A375.S2 cells.</p>
<p>It was well known that cysteine-containing aspartate-specific proteases (caspases) are involved in cell apoptosis (<xref rid="b38-ijo-45-06-2393" ref-type="bibr">38</xref>,<xref rid="b39-ijo-45-06-2393" ref-type="bibr">39</xref>). Caspase-8 is related to extrinsic pathway and caspase-9 is involved in the intrinsic pathway, however, caspase-3 is related to the common pathway of cell apoptosis and it is a key executor of cell apoptosis. In our study, the results in <xref rid="f5-ijo-45-06-2393" ref-type="fig">Fig. 5</xref> show that increased activation of caspase-8, -9 and -3 (<xref rid="f4-ijo-45-06-2393" ref-type="fig">Fig. 4</xref>), and expression of protein (<xref rid="f6-ijo-45-06-2393" ref-type="fig">Fig. 6B</xref>) are associated with cell apoptosis. Furthermore, cells were pre-treated with the inhibitors of caspase-8, -9 and -3 and then treated with CTD leading to increase in the percentage of viable cells when compared to CTD only treated cells.</p>
<p>In conclusion, caspase-pathway activation, mitochondria dysfunction and oxidative stress (ROS generation) induced by CTD contribute to the activation of the apoptotic pathway in CTD-treated A375.S2 cells. Furthermore, the modulating expression and translocation of apoptotic proteins induced the mitochondrial pathways in A375.S2 cells as shown in <xref rid="f7-ijo-45-06-2393" ref-type="fig">Fig. 7</xref>. Based on these observations, CTD inhibits human skin cancer A375.S2 cellular growth and our studies provide a better understanding of the molecular mechanism of CTD function.</p></sec></body>
<back>
<ack>
<title>Acknowledgements</title>
<p>This study was supported in part by a research grant from China Medical University &#x0005B;CMU102-ASIA-20&#x0005D;. Experiments and data analysis were performed in part through the use of the Medical Research Core Facilities Center, Office of Research and Development at China medical University, Taichung, Taiwan, R.O.C.</p></ack>
<ref-list>
<title>References</title>
<ref id="b1-ijo-45-06-2393"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Postovit</surname><given-names>LM</given-names></name><name><surname>Margaryan</surname><given-names>NV</given-names></name><name><surname>Seftor</surname><given-names>EA</given-names></name><name><surname>Hendrix</surname><given-names>MJ</given-names></name></person-group><article-title>Role of nodal signaling and the microenvironment underlying melanoma plasticity</article-title><source>Pigment Cell Melanoma Res</source><volume>21</volume><fpage>348</fpage><lpage>357</lpage><year>2008</year></element-citation></ref>
<ref id="b2-ijo-45-06-2393"><label>2</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Bergomi</surname><given-names>M</given-names></name><name><surname>Pellacani</surname><given-names>G</given-names></name><name><surname>Vinceti</surname><given-names>M</given-names></name><etal/></person-group><article-title>Trace elements and melanoma</article-title><source>J Trace Elem Med Biol</source><volume>19</volume><fpage>69</fpage><lpage>73</lpage><year>2005</year></element-citation></ref>
<ref id="b3-ijo-45-06-2393"><label>3</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chudnovsky</surname><given-names>Y</given-names></name><name><surname>Khavari</surname><given-names>PA</given-names></name><name><surname>Adams</surname><given-names>AE</given-names></name></person-group><article-title>Melanoma genetics and the development of rational therapeutics</article-title><source>J Clin Invest</source><volume>115</volume><fpage>813</fpage><lpage>824</lpage><year>2005</year></element-citation></ref>
<ref id="b4-ijo-45-06-2393"><label>4</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Thompson</surname><given-names>JF</given-names></name><name><surname>Scolyer</surname><given-names>RA</given-names></name><name><surname>Kefford</surname><given-names>RF</given-names></name></person-group><article-title>Cutaneous melanoma in the era of molecular profiling</article-title><source>Lancet</source><volume>374</volume><fpage>362</fpage><lpage>365</lpage><year>2009</year></element-citation></ref>
<ref id="b5-ijo-45-06-2393"><label>5</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Miller</surname><given-names>AJ</given-names></name><name><surname>Mihm</surname><given-names>MC</given-names><suffix>Jr</suffix></name></person-group><article-title>Melanoma</article-title><source>N Engl J Med</source><volume>355</volume><fpage>51</fpage><lpage>65</lpage><year>2006</year></element-citation></ref>
<ref id="b6-ijo-45-06-2393"><label>6</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Bhatia</surname><given-names>S</given-names></name><name><surname>Tykodi</surname><given-names>SS</given-names></name><name><surname>Thompson</surname><given-names>JA</given-names></name></person-group><article-title>Treatment of metastatic melanoma: an overview</article-title><source>Oncology (Williston Park)</source><volume>23</volume><fpage>488</fpage><lpage>496</lpage><year>2009</year></element-citation></ref>
<ref id="b7-ijo-45-06-2393"><label>7</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Gava</surname><given-names>B</given-names></name><name><surname>Zorzet</surname><given-names>S</given-names></name><name><surname>Spessotto</surname><given-names>P</given-names></name><name><surname>Cocchietto</surname><given-names>M</given-names></name><name><surname>Sava</surname><given-names>G</given-names></name></person-group><article-title>Inhibition of B16 melanoma metastases with the ruthenium complex imidazolium trans-imidazoledimethylsulfoxide-tetra-chlororuthenate and down-regulation of tumor cell invasion</article-title><source>J Pharmacol Exp Ther</source><volume>317</volume><fpage>284</fpage><lpage>291</lpage><year>2006</year></element-citation></ref>
<ref id="b8-ijo-45-06-2393"><label>8</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Newman</surname><given-names>DJ</given-names></name><name><surname>Cragg</surname><given-names>GM</given-names></name><name><surname>Snader</surname><given-names>KM</given-names></name></person-group><article-title>The influence of natural products upon drug discovery</article-title><source>Nat Prod Rep</source><volume>17</volume><fpage>215</fpage><lpage>234</lpage><year>2000</year></element-citation></ref>
<ref id="b9-ijo-45-06-2393"><label>9</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wang</surname><given-names>GS</given-names></name></person-group><article-title>Medical uses of mylabris in ancient China and recent studies</article-title><source>J Ethnopharmacol</source><volume>26</volume><fpage>147</fpage><lpage>162</lpage><year>1989</year></element-citation></ref>
<ref id="b10-ijo-45-06-2393"><label>10</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Xu</surname><given-names>B</given-names></name></person-group><article-title>The inf luence of several anticancer agents on cell proliferation, differentiation and the cell cycle of murine erythroleukemia cells</article-title><source>Am J Chin Med</source><volume>9</volume><fpage>268</fpage><lpage>276</lpage><year>1981</year></element-citation></ref>
<ref id="b11-ijo-45-06-2393"><label>11</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Sagawa</surname><given-names>M</given-names></name><name><surname>Nakazato</surname><given-names>T</given-names></name><name><surname>Uchida</surname><given-names>H</given-names></name><name><surname>Ikeda</surname><given-names>Y</given-names></name><name><surname>Kizaki</surname><given-names>M</given-names></name></person-group><article-title>Cantharidin induces apoptosis of human multiple myeloma cells via inhibition of the JAK/STAT pathway</article-title><source>Cancer Sci</source><volume>99</volume><fpage>1820</fpage><lpage>1826</lpage><year>2008</year></element-citation></ref>
<ref id="b12-ijo-45-06-2393"><label>12</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kuo</surname><given-names>JH</given-names></name><name><surname>Chu</surname><given-names>YL</given-names></name><name><surname>Yang</surname><given-names>JS</given-names></name><etal/></person-group><article-title>Cantharidin induces apoptosis in human bladder cancer TSGH 8301 cells through mitochondria-dependent signal pathways</article-title><source>Int J Oncol</source><volume>37</volume><fpage>1243</fpage><lpage>1250</lpage><year>2010</year></element-citation></ref>
<ref id="b13-ijo-45-06-2393"><label>13</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Williams</surname><given-names>LA</given-names></name><name><surname>M&#x000F6;ller</surname><given-names>W</given-names></name><name><surname>Merisor</surname><given-names>E</given-names></name><name><surname>Kraus</surname><given-names>W</given-names></name><name><surname>R&#x000F6;sner</surname><given-names>H</given-names></name></person-group><article-title>In vitro anti-proliferation/cytotoxic activity of cantharidin (Spanish Fly) and related derivatives</article-title><source>West Indian Med J</source><volume>52</volume><fpage>10</fpage><lpage>13</lpage><year>2003</year></element-citation></ref>
<ref id="b14-ijo-45-06-2393"><label>14</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Huang</surname><given-names>WW</given-names></name><name><surname>Ko</surname><given-names>SW</given-names></name><name><surname>Tsai</surname><given-names>HY</given-names></name><etal/></person-group><article-title>Cantharidin induces G2/M phase arrest and apoptosis in human colorectal cancer colo 205 cells through inhibition of CDK1 activity and caspase-dependent signaling pathways</article-title><source>Int J Oncol</source><volume>38</volume><fpage>1067</fpage><lpage>1073</lpage><year>2011</year></element-citation></ref>
<ref id="b15-ijo-45-06-2393"><label>15</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wang</surname><given-names>CC</given-names></name><name><surname>Wu</surname><given-names>CH</given-names></name><name><surname>Hsieh</surname><given-names>KJ</given-names></name><name><surname>Yen</surname><given-names>KY</given-names></name><name><surname>Yang</surname><given-names>LL</given-names></name></person-group><article-title>Cytotoxic effects of cantharidin on the growth of normal and carcinoma cells</article-title><source>Toxicology</source><volume>147</volume><fpage>77</fpage><lpage>87</lpage><year>2000</year></element-citation></ref>
<ref id="b16-ijo-45-06-2393"><label>16</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Li</surname><given-names>W</given-names></name><name><surname>Chen</surname><given-names>Z</given-names></name><name><surname>Zong</surname><given-names>Y</given-names></name><etal/></person-group><article-title>PP2A inhibitors induce apoptosis in pancreatic cancer cell line PANC-1 through persistent phosphorylation of IKK&#x003B1; and sustained activation of the NF-&#x003BA;B pathway</article-title><source>Cancer Lett</source><volume>304</volume><fpage>117</fpage><lpage>127</lpage><year>2011</year></element-citation></ref>
<ref id="b17-ijo-45-06-2393"><label>17</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hsia</surname><given-names>TC</given-names></name><name><surname>Yu</surname><given-names>CC</given-names></name><name><surname>Hsu</surname><given-names>SC</given-names></name><etal/></person-group><article-title>Cantharidin induces apoptosis of H460 human lung cancer cells through mitochondria-dependent pathways</article-title><source>Int J Oncol</source><volume>45</volume><fpage>245</fpage><lpage>254</lpage><year>2014</year></element-citation></ref>
<ref id="b18-ijo-45-06-2393"><label>18</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kim</surname><given-names>YM</given-names></name><name><surname>Ku</surname><given-names>MJ</given-names></name><name><surname>Son</surname><given-names>YJ</given-names></name><name><surname>Yun</surname><given-names>JM</given-names></name><name><surname>Kim</surname><given-names>SH</given-names></name><name><surname>Lee</surname><given-names>SY</given-names></name></person-group><article-title>Anti-metastatic effect of cantharidin in A549 human lung cancer cells</article-title><source>Arch Pharm Res</source><volume>36</volume><fpage>479</fpage><lpage>484</lpage><year>2013</year></element-citation></ref>
<ref id="b19-ijo-45-06-2393"><label>19</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hsia</surname><given-names>TC</given-names></name><name><surname>Lin</surname><given-names>JH</given-names></name><name><surname>Hsu</surname><given-names>SC</given-names></name><etal/></person-group><article-title>Cantharidin induces DNA damage and inhibits DNA repair-associated protein levels in NCI-H460 human lung cancer cells</article-title><source>Environ Toxicol</source><month>Mar</month><day>17</day><year>2014</year><comment>(Epub ahead of print)</comment></element-citation></ref>
<ref id="b20-ijo-45-06-2393"><label>20</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Huang</surname><given-names>SH</given-names></name><name><surname>Hsu</surname><given-names>MH</given-names></name><name><surname>Hsu</surname><given-names>SC</given-names></name><etal/></person-group><article-title>Phenethyl isothiocyanate triggers apoptosis in human malignant melanoma A375. S2 cells through reactive oxygen species and the mitochondria-dependent pathways</article-title><source>Hum Exp Toxicol</source><volume>33</volume><fpage>270</fpage><lpage>283</lpage><year>2014</year></element-citation></ref>
<ref id="b21-ijo-45-06-2393"><label>21</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chang</surname><given-names>Y-M</given-names></name><name><surname>Velmurugan</surname><given-names>BK</given-names></name><name><surname>Kuo</surname><given-names>W-W</given-names></name><etal/></person-group><article-title>Inhibitory effect of alpinate Oxyphyllae fructus extracts on Ang II-induced cardiac pathological remodeling-related pathways in H9c2 cardiomyoblast cells</article-title><source>BioMedicine</source><volume>3</volume><fpage>148</fpage><lpage>152</lpage><year>2013</year></element-citation></ref>
<ref id="b22-ijo-45-06-2393"><label>22</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Lin</surname><given-names>M-C</given-names></name><name><surname>Tsai</surname><given-names>S-Y</given-names></name><name><surname>Wang</surname><given-names>F-Y</given-names></name><name><surname>Liu</surname><given-names>F-H</given-names></name><name><surname>Syu</surname><given-names>J-N</given-names></name><name><surname>Tang</surname><given-names>F-Y</given-names></name></person-group><article-title>Leptin induces cell invasion and the upregulation of matrilysin in human colon cancer cells</article-title><source>BioMedicine</source><volume>3</volume><fpage>174</fpage><lpage>180</lpage><year>2013</year></element-citation></ref>
<ref id="b23-ijo-45-06-2393"><label>23</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Das</surname><given-names>KC</given-names></name><name><surname>Ravi</surname><given-names>D</given-names></name></person-group><article-title>Altered expression of cyclins and cdks in premature infant baboon model of bronchopulmonary dysplasia</article-title><source>Antioxid Redox Signal</source><volume>6</volume><fpage>117</fpage><lpage>127</lpage><year>2004</year></element-citation></ref>
<ref id="b24-ijo-45-06-2393"><label>24</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Lee</surname><given-names>KH</given-names></name></person-group><article-title>Anticancer drug design based on plant-derived natural products</article-title><source>J Biomed Sci</source><volume>6</volume><fpage>236</fpage><lpage>250</lpage><year>1999</year></element-citation></ref>
<ref id="b25-ijo-45-06-2393"><label>25</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Das</surname><given-names>KC</given-names></name><name><surname>Wasnick</surname><given-names>JD</given-names></name></person-group><article-title>Biphasic response of checkpoint control proteins in hyperoxia: exposure to lower levels of oxygen induces genome maintenance genes in experimental baboon BPD</article-title><source>Mol Cell Biochem</source><volume>395</volume><fpage>187</fpage><lpage>198</lpage><year>2014</year></element-citation></ref>
<ref id="b26-ijo-45-06-2393"><label>26</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Salameh</surname><given-names>A</given-names></name><name><surname>Galvagni</surname><given-names>F</given-names></name><name><surname>Anselmi</surname><given-names>F</given-names></name><name><surname>De Clemente</surname><given-names>C</given-names></name><name><surname>Orlandini</surname><given-names>M</given-names></name><name><surname>Oliviero</surname><given-names>S</given-names></name></person-group><article-title>Growth factor stimulation induces cell survival by c-Jun. ATF2-dependent activation of Bcl-XL</article-title><source>J Biol Chem</source><volume>285</volume><fpage>23096</fpage><lpage>23104</lpage><year>2010</year></element-citation></ref>
<ref id="b27-ijo-45-06-2393"><label>27</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Shirali</surname><given-names>S</given-names></name><name><surname>Aghaei</surname><given-names>M</given-names></name><name><surname>Shabani</surname><given-names>M</given-names></name><name><surname>Fathi</surname><given-names>M</given-names></name><name><surname>Sohrabi</surname><given-names>M</given-names></name><name><surname>Moeinifard</surname><given-names>M</given-names></name></person-group><article-title>Adenosine induces cell cycle arrest and apoptosis via cyclinD1/Cdk4 and Bcl-2/Bax pathways in human ovarian cancer cell line OVCAR-3</article-title><source>Tumour Biol</source><volume>34</volume><fpage>1085</fpage><lpage>1095</lpage><year>2013</year></element-citation></ref>
<ref id="b28-ijo-45-06-2393"><label>28</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kelly</surname><given-names>PN</given-names></name><name><surname>Strasser</surname><given-names>A</given-names></name></person-group><article-title>The role of Bcl-2 and its pro-survival relatives in tumourigenesis and cancer therapy</article-title><source>Cell Death Differ</source><volume>18</volume><fpage>1414</fpage><lpage>1424</lpage><year>2011</year></element-citation></ref>
<ref id="b29-ijo-45-06-2393"><label>29</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Strasser</surname><given-names>A</given-names></name><name><surname>Cory</surname><given-names>S</given-names></name><name><surname>Adams</surname><given-names>JM</given-names></name></person-group><article-title>Deciphering the rules of programmed cell death to improve therapy of cancer and other diseases</article-title><source>EMBO J</source><volume>30</volume><fpage>3667</fpage><lpage>3683</lpage><year>2011</year></element-citation></ref>
<ref id="b30-ijo-45-06-2393"><label>30</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Laurent</surname><given-names>A</given-names></name><name><surname>Nicco</surname><given-names>C</given-names></name><name><surname>Ch&#x000E9;reau</surname><given-names>C</given-names></name><etal/></person-group><article-title>Controlling tumor growth by modulating endogenous production of reactive oxygen species</article-title><source>Cancer Res</source><volume>65</volume><fpage>948</fpage><lpage>956</lpage><year>2005</year></element-citation></ref>
<ref id="b31-ijo-45-06-2393"><label>31</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Gillies</surname><given-names>LA</given-names></name><name><surname>Kuwana</surname><given-names>T</given-names></name></person-group><article-title>Apoptosis regulation at the mitochondrial outer membrane</article-title><source>J Cell Biochem</source><volume>115</volume><fpage>632</fpage><lpage>640</lpage><year>2014</year></element-citation></ref>
<ref id="b32-ijo-45-06-2393"><label>32</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wang</surname><given-names>Z</given-names></name><name><surname>Cai</surname><given-names>F</given-names></name><name><surname>Chen</surname><given-names>X</given-names></name><name><surname>Luo</surname><given-names>M</given-names></name><name><surname>Hu</surname><given-names>L</given-names></name><name><surname>Lu</surname><given-names>Y</given-names></name></person-group><article-title>The role of mitochondria-derived reactive oxygen species in hyperthermia-induced platelet apoptosis</article-title><source>PLoS One</source><volume>8</volume><fpage>e75044</fpage><year>2013</year></element-citation></ref>
<ref id="b33-ijo-45-06-2393"><label>33</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Crompton</surname><given-names>M</given-names></name></person-group><article-title>The mitochondrial permeability transition pore and its role in cell death</article-title><source>Biochem J</source><volume>341</volume><fpage>233</fpage><lpage>249</lpage><year>1999</year></element-citation></ref>
<ref id="b34-ijo-45-06-2393"><label>34</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Murphy</surname><given-names>MP</given-names></name></person-group><article-title>How mitochondria produce reactive oxygen species</article-title><source>Biochem J</source><volume>417</volume><fpage>1</fpage><lpage>13</lpage><year>2009</year></element-citation></ref>
<ref id="b35-ijo-45-06-2393"><label>35</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Korsmeyer</surname><given-names>SJ</given-names></name><name><surname>Shutter</surname><given-names>JR</given-names></name><name><surname>Veis</surname><given-names>DJ</given-names></name><name><surname>Merry</surname><given-names>DE</given-names></name><name><surname>Oltvai</surname><given-names>ZN</given-names></name></person-group><article-title>Bcl-2/Bax: a rheostat that regulates an anti-oxidant pathway and cell death</article-title><source>Semin Cancer Biol</source><volume>4</volume><fpage>327</fpage><lpage>332</lpage><year>1993</year></element-citation></ref>
<ref id="b36-ijo-45-06-2393"><label>36</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Lindsay</surname><given-names>J</given-names></name><name><surname>Esposti</surname><given-names>MD</given-names></name><name><surname>Gilmore</surname><given-names>AP</given-names></name></person-group><article-title>Bcl-2 proteins and mitochondria - specificity in membrane targeting for death</article-title><source>Biochim Biophys Acta</source><volume>1813</volume><fpage>532</fpage><lpage>539</lpage><year>2011</year></element-citation></ref>
<ref id="b37-ijo-45-06-2393"><label>37</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Guha</surname><given-names>M</given-names></name><name><surname>Kumar</surname><given-names>S</given-names></name><name><surname>Choubey</surname><given-names>V</given-names></name><name><surname>Maity</surname><given-names>P</given-names></name><name><surname>Bandyopadhyay</surname><given-names>U</given-names></name></person-group><article-title>Apoptosis in liver during malaria: role of oxidative stress and implication of mitochondrial pathway</article-title><source>FASEB J</source><volume>20</volume><fpage>1224</fpage><lpage>1226</lpage><year>2006</year></element-citation></ref>
<ref id="b38-ijo-45-06-2393"><label>38</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Galluzzi</surname><given-names>L</given-names></name><name><surname>Vitale</surname><given-names>I</given-names></name><name><surname>Abrams</surname><given-names>JM</given-names></name><etal/></person-group><article-title>Molecular definitions of cell death subroutines: recommendations of the Nomenclature Committee on Cell Death 2012</article-title><source>Cell Death Differ</source><volume>19</volume><fpage>107</fpage><lpage>120</lpage><year>2012</year></element-citation></ref>
<ref id="b39-ijo-45-06-2393"><label>39</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kroemer</surname><given-names>G</given-names></name><name><surname>Galluzzi</surname><given-names>L</given-names></name><name><surname>Brenner</surname><given-names>C</given-names></name></person-group><article-title>Mitochondrial membrane permeabilization in cell death</article-title><source>Physiol Rev</source><volume>87</volume><fpage>99</fpage><lpage>163</lpage><year>2007</year></element-citation></ref></ref-list></back>
<floats-group>
<fig id="f1-ijo-45-06-2393" position="float">
<label>Figure 1</label>
<caption>
<p>Cantharidin (CTD) induced cell morphological changes and decreased the percentage of viable A375.S2 cells. A375.S2 cells (2&#x000D7;10<sup>5</sup> cells/well) were treated with 0, 1, 2, 3, 4 and 5 &#x003BC;M of CTD for 48 h before (A) the cells were photographed for examining the cell morphological changes and (B) were harvested for the percentage of viable cell measurements and analyzed by flow cytometry as described in Materials and methods. <sup>*</sup>P&lt;0.05, significant difference between CTD-treated groups and the control as analyzed by Student&#x02019;s t-test.</p></caption>
<graphic xlink:href="IJO-45-06-2393-g00.gif"/></fig>
<fig id="f2-ijo-45-06-2393" position="float">
<label>Figure 2</label>
<caption>
<p>Cantharidin (CTD) induced sub-G1 phase and G2/M phase arrest of A375.S2 cells. A375.S2 cells were treated with 0, 1, 2, 3, 4 and 5 &#x003BC;M of CTD for 24 and 48 h before the cells were examined for cell cycle distribution and sub-G1 phase of cell cycle &#x0005B;(A) 48 h profiles; (B) percentage of G2/M phase; (C) percentage of sub-G1 phase&#x0005D; and analyzed by flow cytometry as described in Materials and methods. <sup>*</sup>P&lt;0.05, significant difference between CTD-treated groups and the control as analyzed by Student&#x02019;s t-test.</p></caption>
<graphic xlink:href="IJO-45-06-2393-g01.gif"/></fig>
<fig id="f3-ijo-45-06-2393" position="float">
<label>Figure 3</label>
<caption>
<p>Cantharidin (CTD) induces reactive oxygen species (ROS) and Ca<sup>2+</sup> production and decreased the levels of mitochondrial membrane potential (&#x00394;&#x003C8;m) in A375.S2 cells. A375.S2 cells (2&#x000D7;10<sup>5</sup> cells/well) were treated with 4 &#x003BC;M of CTD for various time periods. (A) Cells were isolated and suspended in 500 &#x003BC;l of DCFH-DA (10 &#x003BC;M) for ROS (H<sub>2</sub>O<sub>2</sub>), (B) re-suspended in 500 &#x003BC;l of DiOC<sub>6</sub> (4 &#x003BC;mol/l) for the levels of &#x00394;&#x003C8;m measurement and (C) re-suspended in 500 &#x003BC;l of Fluo-3/AM (2.5 &#x003BC;g/ml) for intracellular Ca<sup>2+</sup> concentrations as described in Materials and methods. The results are shown as a mean &#x000B1; SD (n=3); <sup>*</sup>P&lt;0.05, significant difference between CTD-treated groups and the control as analyzed by Student&#x02019;s t-test.</p></caption>
<graphic xlink:href="IJO-45-06-2393-g02.gif"/></fig>
<fig id="f4-ijo-45-06-2393" position="float">
<label>Figure 4</label>
<caption>
<p>Cantharidin (CTD) affects caspase-3, -8 and -9 activities in A375.S2 cells. A375.S2 cells (2&#x000D7;10<sup>5</sup> cells/well) were pre-treated with or without Z-VAD-FMK, Z-IETD-FMK, Z-LEHD-FMK and Z-DEVD-FMK (inhibitors of caspase-pan, -8, -9 and -3, respectively) then were incubated 4 &#x003BC;M CTD for different time periods. After harvesting and washing, the cells were re-suspended in 50 &#x003BC;l of 10 &#x003BC;M substrate solution of caspase-8, -9 and -3 substrates (CaspaLux8-L1D2, CaspaLux9-M1D2 and PhiPhiLux-G1D2), respectively, then the activities of (A) caspase-3, (B) caspase-8, (C) caspase-9 and (D) percentage of viable cells were measured by using flow cytometry as described in Materials and methods. The results are shown as a mean &#x000B1; SD (n=3); <sup>*</sup>P&lt;0.05, significant difference between CTD-treated groups and the control as analyzed by Student&#x02019;s t-test.</p></caption>
<graphic xlink:href="IJO-45-06-2393-g03.gif"/>
<graphic xlink:href="IJO-45-06-2393-g04.gif"/></fig>
<fig id="f5-ijo-45-06-2393" position="float">
<label>Figure 5</label>
<caption>
<p>Cantharidin (CTD) affects G2/M phase and apoptosis-associated protein expression in A375.S2 cells. A375.S2 cells were treated with 4 &#x003BC;M of CTD for 0, 6, 12, 24 and 48 h and then total proteins were quantitated and apoptosis-associated proteins were examined by western blotting as described in Materials and methods. (A) WEE1, Cdc25c, Cyclin A, CDK1 and p21; (B) Bcl-2, Bcl-x, Bid, Bax and XBP-1; (C) Fas, Fas-L, caspase-8, AIF, Endo G, cytochrome <italic>c</italic>, caspase-3 and -9; (D) GADD153, GRP78, caspase-12, calpain 1, IRE1&#x003B2; and ATF6&#x003B1;. &#x003B2;-actin, control.</p></caption>
<graphic xlink:href="IJO-45-06-2393-g05.gif"/></fig>
<fig id="f6-ijo-45-06-2393" position="float">
<label>Figure 6</label>
<caption>
<p>Cantharidin (CTD) affects the translocation of apoptosis-associated proteins in A375.S2 cells. A375.S2 cells were treated with 4 &#x003BC;M of CTD for 48 h and cells were stained with (A) anti-cytochrome <italic>c</italic>, (B) Endo G and (C) AIF then stained with secondary antibody (FITC-conjugated goat anti-mouse IgG, green fluorescence) and were examined and photographed by a Leica TCS SP2 confocal laser microscopic systems as described in Materials and methods.</p></caption>
<graphic xlink:href="IJO-45-06-2393-g06.gif"/></fig>
<fig id="f7-ijo-45-06-2393" position="float">
<label>Figure 7</label>
<caption>
<p>The proposed signaling pathways for cantharidin-induced G2/M phase arrest and apoptosis in A375.S2 human skin cancer cells.</p></caption>
<graphic xlink:href="IJO-45-06-2393-g07.gif"/></fig></floats-group></article>
