Thiazolides promote apoptosis in colorectal tumor cells via MAP kinase-induced Bim and Puma activation

While many anticancer therapies aim to target the death of tumor cells, sophisticated resistance mechanisms in the tumor cells prevent cell death induction. In particular enzymes of the glutathion-S-transferase (GST) family represent a well-known detoxification mechanism, which limit the effect of chemotherapeutic drugs in tumor cells. Specifically, GST of the class P1 (GSTP1-1) is overexpressed in colorectal tumor cells and renders them resistant to various drugs. Thus, GSTP1-1 has become an important therapeutic target. We have recently shown that thiazolides, a novel class of anti-infectious drugs, induce apoptosis in colorectal tumor cells in a GSTP1-1-dependent manner, thereby bypassing this GSTP1-1-mediated drug resistance. In this study we investigated in detail the underlying mechanism of thiazolide-induced apoptosis induction in colorectal tumor cells. Thiazolides induce the activation of p38 and Jun kinase, which is required for thiazolide-induced cell death. Activation of these MAP kinases results in increased expression of the pro-apoptotic Bcl-2 homologs Bim and Puma, which inducibly bind and sequester Mcl-1 and Bcl-x_L leading to the induction of the mitochondrial apoptosis pathway. Of interest, while an increase in intracellular glutathione levels resulted in increased resistance to cisplatin, it sensitized colorectal tumor cells to thiazolide-induced apoptosis by promoting increased Jun kinase activation and Bim induction. Thus, thiazolides may represent an interesting novel class of anti-tumor agents by specifically targeting tumor resistance mechanisms, such as GSTP1-1.Glutathione-S-transferases (GSTs) represent a superfamily of cellular phase II detoxification enzyme. Specifically, GSTs catalyze the conjugation of electrophilic substances to the tripeptid glutathione (GSH, γ-L-glutamyl-L-cysteinylglycine). Thereby, hazardous metabolic products, xenobiotics and oxidative stress products become rapidly neutralized by GSTs, protecting cells from potentially damaging substances and carcinogens. Consequently, GSTs have a critical role in the detoxification of cells and inactivation of drugs.^{1, 2} At the present, seven classes of mammalian cytosolic GSTs are known, whose expression is regulated in a tissue-specific manner^{3, 4, 5} pointing toward a defined role of individual GSTs in the biotransformation of drugs and reactive compounds in diverse tissues.^{6, 7}GSTs have a critical role in tumor therapy, as numerous tumors overexpress various GSTs, which contribute to the development of resistance to chemotherapeutic treatments.^{8, 9} In particular, high expression levels of GST class pi (GSTP1-1) have been reported in a wide range of solid tumors, such as colon, breast, kidney, pancreas, lung, and ovarian cancer cells, and lymphoma.^{10, 11, 12} The sensitivity of these tumors toward chemotherapeutic drugs, such as cisplatin, doxorubicin, and etoposide, is negatively affected by high expression levels of GSTP1-1.^{13, 14, 15, 16, 17} Thus, overexpression of GSTP1-1 in solid tumors limits the therapeutic effects of different chemotherapeutic drugs via their GSTP1-1-mediated inactivation.This observation identifies GSTs in general and GSTP1-1 in particular as important therapeutic targets in the treatment of solid tumors. Consequently, small molecular inhibitors of GSTs have been developed in the past to modulate GST activities and drug resistance of tumor cells, thereby sensitizing tumor cells to anticancer drugs. The therapeutic effect of the competitive inhibitors ethacrynic acid (EA) was proven in a clinical trial;¹⁸ however, long-term utility of EA was limited by its strong diuretic properties.¹⁹ A somewhat different approach includes the GST-activated pro-drugs and the GSH analog TLK199. TLK199 is metabolized and subsequently inhibits GST activities, making it a more selective GST inhibitor.²⁰ However, thus far experimental and clinical data on solid tumors are missing.Thiazolides are a novel class of anti-infectious drugs used for the treatment of intestinal infection, and show a broad activity against intestinal pathogens.^{21, 22, 23, 24} The parent compound nitazoxanide (NTZ; 2-(acetolyloxy)-N-(5-nitro-2-thiazolyl)benzamide) is successfully used for the treatment of Giardia lamblia and Cryptosporidium parvum infections.^{25, 26, 27, 28} Though thiazolides generally have minimal side effects on host tissue cells during therapeutic treatments,²⁹ it was recently noticed that they promote apoptosis induction in colorectal tumor cells, however, sparing non-transformed cells.³⁰ Of interest, while the bromo-thiazolide RM4819 (N-(5-bromothiazol-2-yl)2-hydroxy-3-methylbenzamide) shows only reduced anti-microbial activity, both NTZ and RM4819 promote cell death in colorectal tumor cells. This indicates that the therapeutic targets of thiazolides are substantially different in intestinal parasites and colorectal tumor cells. Subsequent studies identified GSTP1-1 as a major RM4819-binding partner in colorectal tumor cells.³⁰ While it was initially thought that thiazolides are inhibitors of GSTP1-1, it is presently accepted that GSTP1-1 is required for thiazolide-induced cell death induction. Interestingly, an N-acetyl-L-cysteine (NAC)-induced increase in cellular GSH levels enhanced thiazolide-induced cell death, whereas it lowered the sensitivity toward chemotherapeutic drugs by promoting their GSTP1-1-mediated inactivation.³¹ Thus, thiazolides appear to represent a novel class of GSTP1-1-activated pro-drugs, activated likely by conjugation to GSH, rather than GSTP1-1 inhibitors. This makes thiazolides an interesting novel class of anti-tumor drugs specifically targeting tumors with elevated levels of GSTs, and GSTP1-1 an Achilles'' heel for the potential therapeutic action of thiazolides. While thiazolides alone are relatively slow and weak inducers of apoptosis in colorectal tumor cells, they profoundly synergize with inducers of the intrinsic apoptosis pathway, such as chemotherapeutic drugs, as well triggers of the extrinsic pathway, such as TRAIL (TNF-related apoptosis-inducing ligand).³¹The mechanism of thiazolide-induced apoptosis and sensitization of tumor cells to other apoptosis triggers is presently incompletely understood, although GSTP1-1, the activation of the MAP kinases, and the Bcl-2-regulated mitochondrial apoptosis pathways appear to have a critical role in this process.³¹ In this study we investigated in more detail the underlying molecular signaling pathways leading to thiazolide-induced cell death in colorectal tumor cells. We find that activity of both the MAP kinases p38 and Jun kinase (JNK) is critical for mediating thiazolide-induced apoptosis, as their combined inhibition blocks cell death induction. In particular JNK was found to be important for the induction and activation of the downstream effectors of the Bcl-2 family, that is, the BH3-only proteins Bim and Puma. Bim and Puma appear to activate the mitochondrial pathway by interacting with and neutralizing the anti-apoptotic Bcl-2 homolog Bcl-x_L, and inhibition of JNK prevented Bim and Puma induction, interaction with Bcl-x_L, and induction of apoptosis. Furthermore, thiazolides induced interaction of Bim with Mcl-1 and promote the degradation of Mcl-1. While an increase in cellular GSH levels inhibited chemotherapy-induced apoptosis, it resulted in a more robust activation of JNK, Bim induction, Mcl-1 degradation, and associated thiazolide-induced cell death.In summary, we here show that thiazolides are a novel group of GSTP1-1-activated pro-drugs, which activate the mitochondrial apoptosis pathway at different levels. Given that GSTs are highly overexpressed in numerous tumors and that GSTs contribute to therapy resistance of these tumors, thiazolides may become an interesting therapeutic option for the treatment of chemoresistant tumor cells.