Doxorubicin is a conventional and effective
chemotherapy drug against
hepatocellular carcinoma (HCC). However, during long-term
doxorubicin monotherapy, HCC cells may eventually develop acquired-resistance to
doxorubicin which results in recurrence and a poor prognosis.
Salinomycin, an
ionophore antibiotic, was recently reported to selectively kill human cancer stem cells (CSCs) which were response for chemoresistance. In this study,
salinomycin was found to exert synergistic cytotoxicity with
doxorubicin in HCC cells and be capable of inhibiting
doxorubicin-induced epithelial-mesenchymal transition (EMT), an important cellular process involved in the acquired chemoresistance of
tumors. Further experiments revealed that FOXO3a, a multifunctional
transcription factor that can be activated by
salinomycin, was vital in mediating
doxorubicin-induced EMT. In addition, activated FOXO3a disturbed the interaction between β-
catenin and TCF and inhibited the expression of β-
catenin/TCF target genes (ZEB1, c-Myc and CyclinD1), which played important roles in
doxorubicin-induced EMT in HCC cells. Finally, the enhanced curative efficacy of combination treatment of
doxorubicin and
salinomycin for HCC was confirmed in established xenograft models. In summary, the present study identifies a new
doxorubicin-based
chemotherapy for advanced HCC and provides a potential anti-
cancer strategy targeting FOXO3a and related cell pathway molecules.