Most high-risk
neuroblastomas develop resistance to
cytostatics and therefore there is a need to develop new drugs. In previous studies, we found that
ellipticine induces apoptosis in human
neuroblastoma cells. We also investigated whether
ellipticine was able to induce resistance in the UKF-NB-4
neuroblastoma line and concluded that it may be possible after long-term treatment with increasing concentrations of
ellipticine. The aim of the present study was to investigate the mechanisms responsible for
ellipticine resistance. To elucidate the mechanisms involved, we used the
ellipticine-resistant subline UKF-NB-4(ELLI) and performed comparative genomic hybridization, multicolor and interphase FISH, expression microarray, real-time RT-PCR, flow cytometry and western blotting analysis of
proteins. On the basis of our results, it appears that
ellipticine resistance in
neuroblastoma is caused by a combination of overexpression of Bcl-2, efflux or degradation of the
drug and downregulation of topoisomerases. Other mechanisms, such as upregulation of
enzymes involved in oxidative phosphorylation, cellular respiration, V-
ATPases, aerobic respiration or
spermine synthetase, as well as reduced growth rate, may also be involved. Some changes are expressed at the
DNA level, including gains, amplifications or deletions. The present study demonstrates that resistance to
ellipticine is caused by a combination of mechanisms.