HO-1 up-regulation: a key point in high-risk neuroblastoma resistance to bortezomib

Anna Lisa Furfaro1, Sabrina Piras1, Mario Passalacqua1

  • 1Department of Experimental Medicine, University of Genoa, 2, L.B. Alberti Street, I-16132 Genoa, Italy.

Insights

Inhibition of heme oxygenase-1 (HO-1) enhances bortezomib (BTZ) therapy effectiveness in high-risk neuroblastoma (NB) by overcoming chemoresistance. HO-1 upregulation serves as a marker for chemoresistance in NB.

Area of Science:

  • Oncology
  • Molecular Biology
  • Cancer Therapeutics

Background:

  • High-risk neuroblastoma (NB) exhibits chemoresistance, often linked to the Nrf2/HO-1 pathway.
  • Bortezomib (BTZ), a proteasome inhibitor, is explored to overcome drug resistance in NB.
  • The nuclear factor-erythroid-derived 2-like 2 (Nrf2) and heme oxygenase-1 (HO-1) pathway influences cancer cell antioxidant and detoxification capabilities.

Purpose of the Study:

  • Investigate the role of Nrf2 and HO-1 in NB cell lines with varying aggressiveness when treated with BTZ.
  • Focus on modulating HO-1 to enhance sensitivity to BTZ therapy in high-risk neuroblastoma.
  • Determine if HO-1 inhibition can improve the efficacy of proteasome inhibitor-based therapy.

Main Methods:

  • Treatment of MYCN-amplified (HTLA-230) and MYCN non-amplified (SH-SY5Y) neuroblastoma cell lines with bortezomib (BTZ).
  • Assessment of Nrf2 activation and HO-1 expression levels in response to BTZ.
  • Inhibition of HO-1 activity using Zinc (II) protoporphyrin IX (ZnPPIX) to evaluate its impact on BTZ efficacy.
  • Analysis of p53 and p21 modulation in BTZ-treated cells.

Main Results:

  • MYCN-amplified HTLA-230 cells showed limited sensitivity to BTZ due to Nrf2 activation and subsequent HO-1 upregulation.
  • BTZ treatment in HTLA-230 cells led to p53 downregulation and p21 upregulation, promoting cell survival.
  • Inhibition of HO-1 with ZnPPIX significantly enhanced BTZ's pro-apoptotic effect independently of p53 and p21.
  • MYCN non-amplified SH-SY5Y cells were more sensitive to BTZ, correlating with their inability to upregulate HO-1.

Conclusions:

  • HO-1 inhibition improves the sensitivity of aggressive neuroblastoma to proteasome inhibitor therapy.
  • HO-1 upregulation can serve as a predictive marker for chemoresistance in neuroblastoma.
  • Targeting the HO-1 pathway offers a potential strategy for combined therapy to overcome chemoresistance in high-risk NB.

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