title: Ritonavir blocks AKT signaling, activates apoptosis and inhibits migration and invasion in ovarian cancer cells.
abstract: BACKGROUND
  Ovarian cancer is the leading cause of mortality from gynecological malignancies, often undetectable in early stages. The difficulty of detecting the disease in its early stages and the propensity of ovarian cancer cells to develop resistance to known chemotherapeutic treatments dramatically decreases the 5-year survival rate. Chemotherapy with paclitaxel after surgery increases median survival only by 2 to 3 years in stage IV disease highlights the need for more effective drugs. The human immunodeficiency virus (HIV) infection is characterized by increased risk of several solid tumors due to its inherent nature of weakening of immune system. Recent observations point to a lower incidence of some cancers in patients treated with protease inhibitor (PI) cocktail treatment known as HAART (Highly Active Anti-Retroviral Therapy).
  
  
  RESULTS
  Here we show that ritonavir, a HIV protease inhibitor effectively induced cell cycle arrest and apoptosis in ovarian cell lines MDH-2774 and SKOV-3 in a dose dependent manner. Over a 3 day period with 20 muM ritonavir resulted in the cell death of over 60% for MDAH-2774 compared with 55% in case of SKOV-3 cell line. Ritonavir caused G1 cell cycle arrest of the ovarian cancer cells, mediated by down modulating levels of RB phosphorylation and depleting the G1 cyclins, cyclin-dependent kinase and increasing their inhibitors as determined by gene profile analysis. Interestingly, the treatment of ritonavir decreased the amount of phosphorylated AKT in a dose-dependent manner. Furthermore, inhibition of AKT by specific siRNA synergistically increased the efficacy of the ritonavir-induced apoptosis. These results indicate that the addition of the AKT inhibitor may increase the therapeutic efficacy of ritonavir.
  
  
  CONCLUSIONS
  Our results demonstrate a potential use of ritonavir for ovarian cancer with additive effects in conjunction with conventional chemotherapeutic regimens. Since ritonavir is clinically approved for human use for HIV, drug repositioning for ovarian cancer could accelerate the process of traditional drug development. This would reduce risks, limit the costs and decrease the time needed to bring the drug from bench to bedside.
authors.affiliation: Laboratory of Surgical Oncology & Developmental Therapeutics, Department of Surgery, Wayne State University, Detroit, MI, USA. skumar@med.wayne.edu
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Kumar
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Bryant
authors.forename: Sreedhar
authors.initials: S
authors.lastname: Chamala
authors.forename: Aamer
authors.initials: A
authors.lastname: Qazi
authors.forename: Shelly
authors.initials: S
authors.lastname: Seward
authors.forename: Jagannath
authors.initials: J
authors.lastname: Pal
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Steffes
authors.forename: Donald W
authors.initials: DW
authors.lastname: Weaver
authors.forename: Robert
authors.initials: R
authors.lastname: Morris
authors.forename: John M
authors.initials: JM
authors.lastname: Malone
authors.forename: Masood A
authors.initials: MA
authors.lastname: Shammas
authors.forename: Madhu
authors.initials: M
authors.lastname: Prasad
authors.forename: Ramesh B
authors.initials: RB
authors.lastname: Batchu
mesh_terms: D017209:Apoptosis / Q000187:drug effects*; D014408:Biomarkers, Tumor / Q000378:metabolism; D015153:Blotting, Western; D053148:Caspase 3 / Q000378:metabolism; D002453:Cell Cycle / Q000187:drug effects*; D002465:Cell Movement / Q000187:drug effects*; D049109:Cell Proliferation / Q000187:drug effects; D018844:Cyclin-Dependent Kinases / Q000378:metabolism; D016213:Cyclins / Q000378:metabolism; D005260:Female; D020869:Gene Expression Profiling; D017320:HIV Protease Inhibitors / Q000494:pharmacology*; D006801:Humans; D009361:Neoplasm Invasiveness; D020411:Oligonucleotide Array Sequence Analysis; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000378:metabolism / Q000473:pathology*; D010766:Phosphorylation / Q000187:drug effects; D011065:Poly(ADP-ribose) Polymerases / Q000378:metabolism; D051057:Proto-Oncogene Proteins c-akt / Q000037:antagonists & inhibitors* / Q000235:genetics; D034741:RNA, Small Interfering / Q000494:pharmacology; D016160:Retinoblastoma Protein / Q000378:metabolism; D019438:Ritonavir / Q000494:pharmacology*; D015398:Signal Transduction / Q000187:drug effects; D014407:Tumor Cells, Cultured; D014945:Wound Healing / Q000187:drug effects
chemical_list: D014408:Biomarkers, Tumor; D016213:Cyclins; D017320:HIV Protease Inhibitors; D034741:RNA, Small Interfering; D016160:Retinoblastoma Protein; D011065:Poly(ADP-ribose) Polymerases; C494918:AKT1 protein, human; D051057:Proto-Oncogene Proteins c-akt; D018844:Cyclin-Dependent Kinases; C505407:CASP3 protein, human; D053148:Caspase 3; D019438:Ritonavir