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. 2020 Oct 28;11(10):925.
doi: 10.1038/s41419-020-03126-0.

Metformin as a senostatic drug enhances the anticancer efficacy of CDK4/6 inhibitor in head and neck squamous cell carcinoma

Affiliations

Metformin as a senostatic drug enhances the anticancer efficacy of CDK4/6 inhibitor in head and neck squamous cell carcinoma

Qinchao Hu et al. Cell Death Dis. .

Abstract

CDK4/6 inhibitors show promising antitumor activity in a variety of solid tumors; however, their role in head and neck squamous cell carcinoma (HNSCC) requires further investigation. The senescence-associated secretory phenotype (SASP) induced by CDK4/6 inhibitors has dual effects on cancer treatment. The need to address the SASP is a serious challenge in the clinical application of CDK4/6 inhibitors. We investigated whether metformin can act as a senostatic drug to modulate the SASP and enhance the anticancer efficacy of CDK4/6 inhibitors in HNSCC. In this study, the efficacy of a combination of the CDK4/6 inhibitor LY2835219 and metformin in HNSCC was investigated in in vitro assays, an HSC6 xenograft model, and a patient-derived xenograft model. Senescence-associated β-galactosidase staining, antibody array, sphere-forming assay, and in vivo tumorigenesis assay were used to detect the impacts of metformin on the senescence and SASP induced by LY2835219. We found that LY2835219 combined with metformin synergistically inhibited HNSCC by inducing cell cycle arrest in vitro and in vivo. Metformin significantly modulated the profiles of the SASP elicited by LY2835219 by inhibiting the mTOR and stat3 pathways. The LY2835219-induced SASP resulted in upregulation of cancer stemness, while this phenomenon can be attenuated when combined with metformin. Furthermore, results showed that the stemness inhibition by metformin was associated with blockade of the IL6-stat3 axis. Survival analysis demonstrated that overexpression of IL6 and stemness markers was associated with poor survival in HNSCC patients, indicating that including metformin to target these proteins might improve patient prognosis. Collectively, our data suggest that metformin can act as a senostatic drug to enhance the anticancer efficacy of CDK4/6 inhibitors by reprogramming the profiles of the SASP.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1. Combining a CDK4/6 inhibitor and metformin synergistically inhibited HNSCC in vitro and in vivo.
A A CCK8 assay showed that the CDK4/6 inhibitor LY2835219 reduced the cell viability of the HNSCC cell lines HSC3, HSC6, and Cal27. B A CCK8 assay showed that metformin reduced the cell viability of HSC3, HSC6, and Cal27 cells. C Cells were treated with increasing concentrations of LY2835219 with or without metformin. According to the CI values calculated by Compusyn, the combination of LY2835219 and metformin exhibited a synergistic effect (CI < 1). D A clonogenic assay indicated that LY2835219 and metformin synergistically inhibited the colony-forming ability of HNSCC cell lines. EG LY2835219 (25 mg/kg/d, p.o., qd) and metformin (100 mg/kg/d, i.p., qd) synergistically inhibited tumor growth in an HSC6 xenograft model. HJ LY2835219 (40 mg/kg/d, p.o., qd) and metformin (200 mg/kg/d, i.p., qd) synergistically inhibited tumor growth in a PDX model. K Immunohistochemistry results (400×) showed that LY2835219 and metformin synergistically inhibited the expression of Ki67 and PCNA in HSC6 xenograft tumors. Bar: 100 μm. *P < 0.05 when compared with the control group; #P < 0.05 when compared with the combined group; ns indicates no significant difference; one-way ANOVA. CI: combination index; LY: LY2835219; Met: Metformin; PDX, Patient-derived xenograft.
Fig. 2
Fig. 2. CDK4/6 inhibitor combined with metformin promoted cell cycle arrest.
A, B Flow cytometry results showed that the combination of the CDK4/6 inhibitor LY2835219 (HSC3: 0.1 μM; HSC6: 0.3 μM; Cal27: 1.25 μM) with metformin (HSC3: 10 mM; HSC6: 1 mM; Cal27: 10 mM) induced cell cycle arrest in the G0/G1 phase. C Western blot results showed that LY2835219 upregulated the expression of p16 and p21 and downregulated the expression of pRb. D Western blot results showed that metformin upregulated the expression of p16 and p21 and downregulated the expression of pRb. E Compared with LY2835219 monotherapy, the combination treatment significantly upregulated p21 expression and suppressed p-Rb expression. F Immunohistochemistry results (400×) showed that LY2835219 and metformin synergistically upregulated p21 expression and downregulated pRb expression in HSC6 xenograft tumors. Bar: 100 μm. *P < 0.05 when compared with the control group; #P < 0.05 when compared with the combined group; one-way ANOVA. LY: LY2835219; Met: Metformin.
Fig. 3
Fig. 3. Metformin modulated the profiles of the SASP induced by a CDK4/6 inhibitor by inhibiting the mTOR and stat3 pathways.
A SA-β-gal staining (100×) showed that remarkable senescence in cells was elicited by the CDK4/6 inhibitor LY2835219 (Cal27: 1.25 μM; HSC6: 0.3 μM; HSC3: 0.1 μM) but not by metformin (Cal27: 10 mM; HSC6: 1 mM; HSC3: 10 mM). Compared with LY2835219 monotherapy, the combination including metformin had no significant impact on the proportion of senescent cells. Bar: 400 μm. B Antibody array results indicated that the levels of a series of tumor-promoting SASP factors (such as IL6, IL8, MCP1, and GRO) were upregulated by LY2835219, while the combination including metformin inhibited this upregulation. C qRT-PCR results confirmed the modulation of the SASP by metformin. D Western blot results showed that the mTOR and stat3 pathways were activated by LY2835219. E Metformin treatment inhibited the mTOR and stat3 pathways. F The combination treatment inhibited the stat3 and mTOR pathways, which were activated by LY2835219 monotherapy. G qRT-PCR results confirmed that both INK-128 (a selective mTOR inhibitor) and S3I-201 (a selective stat3 inhibitor) could suppress the upregulation of the expression of some of the SASP factors induced by LY2835219. *P < 0.05 when compared with the control group; #P < 0.05 when compared with the combined group; ns indicates no significant difference; one-way ANOVA. LY: LY2835219; Met: metformin.
Fig. 4
Fig. 4. Combination of LY2835219 with metformin blocked the stemness induced by the SASP.
A A sphere-forming assay showed that LY CM significantly enhanced the sphere-forming ability, while LY + Met CM attenuated this effect. Bar: 500 μm. Western blot (B), laser confocal microscopy (C), and flow cytometry (D) results showed that the expression of the cancer stem cell markers ALDH1A1, CD44, and Nanog was upregulated in cells stimulated with LY CM, but this upregulation was diminished when cells were treated with LY + Met CM. Bar: 50 μm. E Cells pre-stimulated with CM from different groups were then treated with LY2835219. A CCK8 assay revealed that the cells stimulated with LY CM had a significantly lower inhibition ratio than the control cells, while the cells stimulated with LY + Met CM had an inhibition ratio similar to that of the control cells. F, G An in vivo study demonstrated that the tumorigenic ability of Cal27 cells was upregulated by LY CM but not by LY + Met CM. Tissue immunofluorescence staining (400×) showed that ALDH1A1 and CD44 levels were upregulated in tumors in the LY CM group but not in those in the LY + Met CM group. Bar: 100 μm. H Immunohistochemistry results (400×) for the HSC6 xenograft model showed that ALDH1A1 and CD44 levels were upregulated in tumors in the LY group but not in those in the LY + Met group. Bar: 100 μm. *P < 0.05 when compared with the control group; #P < 0.05 when compared with the combined group; ns indicates no significant difference; one-way ANOVA. LY: LY2835219; Met: metformin; CM: conditioned medium.
Fig. 5
Fig. 5. Metformin inhibited SASP-induced stemness by blocking the IL6-stat3 axis.
A Western blot results showed that cells treated with IL6 had significantly increased expression of stemness markers. B ELISA results confirmed that the combined therapy decreased the IL6 secretion level, which was upregulated in the LY2835219 group. C Western blot results showed that an anti-IL6 neutralizing antibody effectively attenuated the increased expression of stemness markers induced by LY CM. D The anti-IL6 antibody abolished the SASP-enhanced sphere-forming ability (50×). Bar: 500 μm. E Immunohistochemistry results (400×) for the HSC6 xenograft model showed that IL6 expression was upregulated in tumors in the LY group but not in those in the LY + Met group. Bar: 100 μm. F Western blot results demonstrated that p-stat3 expression was upregulated by LY CM but not by LY + Met CM. G Cells stimulated with IL6 exhibited dramatic activation of the stat3 pathway. H The anti-IL6 antibody inhibited p-stat3, whose expression was upregulated by LY CM. I, J S3I-201 remarkably abrogated LY CM- or IL6-induced stat3 activation and stemness elevation. K A sphere-forming assay (50×) demonstrated that S3I-201 significantly abolished the LY CM-enhanced sphere-forming ability. Bar: 500 μm. *P < 0.05 when compared with the control group; #P < 0.05 when compared with the combined group; ns indicates no significant difference; one-way ANOVA. LY: LY2835219; Met: metformin; CM: conditioned medium.
Fig. 6
Fig. 6. IL6 and cancer stemness markers were associated with poor survival in HNSCC.
A survival analysis using the TCGA database showed that the overexpression of IL6 and the cancer stemness markers ALDH1A1 and CD44 was associated with poor overall survival in HNSCC. There was no significant association between Nanog and patient prognosis.
Fig. 7
Fig. 7. Schematic Diagram.
Schematic showing metformin blocking CDK4/6 inhibitor-induced stemness by modulating the SASP.

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