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Updated: May 4, 2026

Zebrafish Model of Neuroblastoma Metastasis
Published on: March 14, 2021
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.
Abstract:
High-risk neuroblastoma (NB) is characterized by the development of chemoresistance, and bortezomib (BTZ), a selective inhibitor of proteasome, has been proposed in order to overcome drug resistance. Considering the involvement of the nuclear factor-erythroid-derived 2-like 2 (Nrf2) and heme oxygenase-1 (HO-1) in the antioxidant and detoxifying ability of cancer cells, in this study we have investigated their role in differently aggressive NB cell lines treated with BTZ, focusing on the modulation of HO-1 to improve sensitivity to therapy. We have shown that MYCN amplified HTLA-230 cells were slightly sensitive to BTZ treatment, due to the activation of Nrf2 that led to an impressive up-regulation of HO-1. BTZ-treated HTLA-230 cells down-regulated p53 and up-regulated p21, favoring cell survival. The inhibition of HO-1 activity obtained by Zinc (II) protoprophyrin IX (ZnPPIX) was able to significantly increase the pro-apoptotic effect of BTZ in a p53- and p21-independent way. However, MYCN non-amplified SH-SY5Y cells showed a greater sensitivity to BTZ in relation to their inability to up-regulate HO-1. Therefore, we have shown that HO-1 inhibition improves the sensitivity of aggressive NB to proteasome inhibition-based therapy, suggesting that HO-1 up-regulation can be used as a marker of chemoresistance in NB. These results open up a new scenario in developing a combined therapy to overcome chemoresistance in high-risk neuroblastoma.
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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