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Enhanced Antitumor Effect of Combination Therapy With Gemcitabine and Guggulsterone in Pancreatic Cancer

Ahn, Dong-Won MD*†; Seo, Jeong Kyun MD, PhD*; Lee, Sang Hyub MD, PhD*‡; Hwang, Jin-Hyeok MD, PhD*‡; Lee, Jun Kyu MD, PhD§; Ryu, Ji Kon MD, PhD*; Kim, Yong-Tae MD, PhD*; Yoon, Yong Bum MD, PhD*

doi: 10.1097/MPA.0b013e318249d62e
Original Articles

Objectives Guggulsterone is a dietary plant sterone possessing therapeutic potential against cancers. However, the antitumor effect of this natural compound on pancreatic cancer has not been determined yet. This study was designed to investigate the therapeutic efficacy of guggulsterone in pancreatic cancer.

Methods In this study, we examined the effect of guggulsterone on cell proliferation and apoptosis in pancreatic cancer cell lines, and then, we investigated the mechanisms responsible for the effect of guggulsterone. Finally, we investigated whether the combination of guggulsterone and gemcitabine had an additional therapeutic effect compared to gemcitabine single regimen in pancreatic cancer cell lines (in vitro) and in a xenograft model using nude mice (in vivo).

Results In vitro, the combination treatment resulted in more growth inhibition and apoptosis through the down-regulation of nuclear factor κB activity with suppression of Akt and BcL-2 and through the activation of c-Jun NH2-terminal kinase and Bax in pancreatic cancer cell lines. In vivo, the combination therapy augmented tumor growth inhibition through the same mechanisms in tumor tissue.

Conclusions The combination of guggulsterone to gemcitabine enhanced antitumor efficacy through apoptosis induction by suppressing Akt and nuclear factor κB activity and by modulating apoptosis-related protein expression in pancreatic cancer.

From the *Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea; †Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea; ‡Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea; and §Department of Internal Medicine, Dongguk University Ilsan Hospital, Graduate School of Medicine, Dongguk University-Seoul, Seoul, Korea.

Received for publication March 9, 2011; accepted December 9, 2011.

Reprints: Sang Hyub Lee, MD, PhD, Department of Internal Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi-do, 463-707, Korea (e-mail:

Dong-Won Ahn and Jeong Kyun Seo contributed equally to this work.

This study was supported by grant no. 11-2008-021 of the Seoul National University Bundang Hospital Research Fund.

The authors declare no conflict of interest.

© 2012 Lippincott Williams & Wilkins, Inc.