title: Thrombin as a survival factor for cancer cells: thrombin activation in malignant effusions in vivo and inhibition of idarubicin-induced cell death in vitro.
abstract: OBJECTIVE
  The aim of the experiments shown here, is to demonstrate exemplarily that thrombin can be a survival factor for malignant cells.
  
  
  METHODS
  Activation of the coagulation system has been examined in patients with acute myeloid leukemia (AML) and non-Hodgkin lymphoma (NHL) before and after chemotherapy as well as in malignant effusions of heavily pretreated patients with solid tumors. Thrombin receptor expression (PAR-I) has been examined on HL-60 cells; the effect ofthrombin on the proliferation of the cells and inhibition of apoptosis induction by idarubicin has been shown.
  
  
  RESULTS
  Using fibrinopeptide A as an indirect parameter for thrombin activation, we found elevated levels in patients with AML and NHL before and a significant 2-fold increase after chemotherapy (p < 0.02 for the AML group; p < 0.0006 for the NHL group). Apparently, this does not only affect patients with hematological diseases, but also with solid tumors. In order to find out if the tumor cells directly activate thrombin, we examined malignant effusions of patients with different solid tumors. Comparing prothrombin fragment 1 + 2 in ascites and pleural effusions with the patients' serum levels, we found it significantly increased in all cases (mean of 1.96 +/- 0.5 nmol/l in the serum vs. 12.1 +/- 3.6 nmol/l in effusions; p < 0.001). The majority of patients presented elevated serum levels. Additionally, we incubated HL-60 cells (human promyelocytic leukemia) with thrombin prior to treatment with idarubicin. Expression of thrombin receptor (PAR-1) could be verified by FACS-analysis using a monoclonal antibody. HL-60 cells responded with increased proliferation to thrombin exposure with concentrations between 0.3 and 3 U/ml. This effect could be abolished by the addition of hirudin, demonstrating thrombin specificity. In these concentrations, thrombin was able to abrogate the induction of apoptosis by idarubicin completely (p < 0.005).
  
  
  CONCLUSIONS
  Here we give evidence for the role of thrombin as a resistance factor for tumor cells towards chemotherapy. In the light of the fact that thrombin is regularly activated in cancer patients, these findings indicate that thrombin is a clinically relevant cellular resistance factor. A number of pre-clinical and clinical studies imply that inhibition of the coagulation system, e.g. by low-molecular weight heparins or warfarin, increases the effect of chemotherapy.
authors.affiliation: Department of Internal Medicine, University of Kiel, Germany.
authors.forename: H
authors.initials: H
authors.lastname: Schiller
authors.forename: T
authors.initials: T
authors.lastname: Bartscht
authors.forename: A
authors.initials: A
authors.lastname: Arlt
authors.forename: M O
authors.initials: MO
authors.lastname: Zahn
authors.forename: A
authors.initials: A
authors.lastname: Seifert
authors.forename: T
authors.initials: T
authors.lastname: Bruhn
authors.forename: H D
authors.initials: HD
authors.lastname: Bruhn
authors.forename: F
authors.initials: F
authors.lastname: Gieseler
mesh_terms: D017209:Apoptosis / Q000187:drug effects*; D002455:Cell Division / Q000187:drug effects; D002470:Cell Survival / Q000187:drug effects; D005786:Gene Expression Regulation / Q000187:drug effects; D015972:Gene Expression Regulation, Neoplastic / Q000187:drug effects; D018922:HL-60 Cells; D006629:Hirudins / Q000378:metabolism / Q000494:pharmacology; D006801:Humans; D015255:Idarubicin / Q000037:antagonists & inhibitors* / Q000494:pharmacology / Q000627:therapeutic use; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy; D044463:Receptor, PAR-1 / Q000378:metabolism; D013917:Thrombin / Q000378:metabolism* / Q000494:pharmacology*; D013997:Time Factors
chemical_list: D006629:Hirudins; D044463:Receptor, PAR-1; D013917:Thrombin; D015255:Idarubicin