Aberrant activation of the
phosphatidylinositol 3-kinase (PI3K)/
mammalian target of rapamycin (mTOR) pathway has been reported for
rhabdomyosarcoma (RMS) and is implicated in survival of
tumor cells as well as therapeutic resistance. In the present study, we searched for combination
therapies with the dual PI3K/mTOR inhibitor
NVP-BEZ235 (
BEZ235) in RMS. Here, we identify a synthetic lethal interaction of
BEZ235 together with the lysosomotropic agent
chloroquine (CQ), which is effective against
embryonal rhabdomyosarcoma (ERMS).
BEZ235 and CQ at subtoxic concentrations synergize to induce apoptosis in ERMS cells, as confirmed by calculation of combination index (CI).
BEZ235 and CQ cooperate to activate
caspase-9, -3 and -8, which is crucial for apoptosis induction given that the broad-range
caspase inhibitor N-
benzyloxycarbonyl-Val-Ala-Asp-fluoromethylketone (
zVAD.fmk) blocks
BEZ235/CQ-induced apoptosis. Additionally, pharmacological inhibition of lysosomal
enzymes significantly reduces
BEZ235/CQ-induced apoptosis, indicating concomitant activation of the lysosomal compartment. Importantly,
BEZ235/CQ-induced apoptosis is significantly inhibited by
antioxidants, implying that increased oxidative stress contributes to
BEZ235/CQ-induced cell death. Importantly, our molecular studies reveal that
BEZ235/CQ-induced apoptosis is mediated by cooperative downregulation of the antiapoptotic BCL-2 family
protein MCL-1, since stabilization of MCL-1 by expression of a non-degradable MCL-1 phospho-defective mutant significantly decreases
BEZ235/CQ-induced apoptosis. Also, overexpression of antiapoptotic BCL-2 leads to a significant reduction of
BEZ235/CQ-induced apoptosis, emphasizing that an intact mitochondrial pathway of apoptosis is required for
BEZ235/CQ-induced cell death. This identification of a synthetic lethality of
BEZ235 and CQ has important implications for the development of
molecular targeted therapies for RMS.