Artesunate promotes sensitivity to sorafenib in hepatocellular carcinoma

Enhancing sensitivity of carcinoma to sorafenib (Sor) is critical to overcome the limits of high frequency resistance and moderate efficiency during chemotherapy for advanced hepatocellular carcinoma (HCC). Here, we promote sensitivity of HCC to Sor by combination with Artesunate (Art), a derivative of artemisinin extracted from Chinese medical herb. The positive synergy of Art on inhibiting HCC growth contributes 48% dosage of Sor to reduce tumor cell viability in vitro and tumor size in vivo. Mechanically, in spite of effective suppression of RAF/MEK/ERK pathway, Sor is not able to eliminate chemoresistance of HCC driven by PI3K/AKT/mTOR pathway, while Art inhibits phosphorylation of AKT and mTOR significantly. Furthermore, combination with Art and Sor further improves apoptosis of HCC by dual inhibition of both pathways. Our study reveals a function of Art that induces HCC apoptosis via PI3K/AKT/mTOR pathway inhibition and suggests a potential therapeutic regimen of combination with Art and SOR against advanced HCC.