Synergistic Anticancer Effects of Gemcitabine and Resveratrol on A549 Non-Small Cell Lung Cancer Cell Line
DOI:
https://doi.org/10.54133/ajms.v10i1.2651Keywords:
Gemcitabine , Non-small cell lung cancer , Resveratrol , Drug synergismAbstract
Background: Non-small cell lung cancer (NSCLC) remains the leading cause of cancer-related mortality worldwide. Gemcitabine is an established effective agent in the treatment of NSCLC. However, resistance and dose-dependent toxicity limit the clinical efficacy of gemcitabine. Resveratrol, a polyphenolic compound, has been proposed as a chemosensitizing agent capable of modulating multiple survival pathways. Objective: To assess whether resveratrol enhances the anticancer activity of gemcitabine in A549 NSCLC cells. Methods: The viability of A549 cells was assessed using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) method. The synergistic interaction was analyzed using a constant molar ratio of 1:75 (gemcitabine: resveratrol). The combination index (CI) and dose reduction index (DRI) values were calculated across multiple effect levels. To see how the combination changed the ability of cells to divide and migrate, we used the clonogenic and wound-healing assays, respectively. Results: The data showed that combining gemcitabine and resveratrol increased cytotoxicity compared to using either drug alone. This was shown by CI values that were consistently below 1.0 for all effect levels that were tested. The DRI values for both drugs were greater than 1.0 at all the effect levels, suggesting dose-sparing potential. In addition, the combination significantly decreased the colony formation and cell migration compared with individual drug treatments. Conclusion: Resveratrol potentiated the anticancer effects of gemcitabine in A549 cells via synergistic cytotoxicity and enhanced suppression of the clonogenic survival and migratory potential.
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Mahdi MF, Raauf AM. Molecular modelling, Synthesis and antiproliferative avaluation of new phenyldiazenyl)-pyrazol Schiff base derivatives. Al Mustansiriyah J Pharm Sci. 2024;24(1):25-37. doi: 10.32947/ajps.v24i1.999.
Hasan HA, Ali KF, Mehdi WA. Synthesis, characterization, docking study and biological activates of new 3-aminorhodanine derivatives. Al Mustansiriyah Journal of Pharmaceutical Sciences. 2024;24(3):299-310. doi: 10.32947/ajps.v24i3.1072.
Chen CP, Hung TH, Hsu PC, Yeh CN, Huang WK, Pan YR, Hsiao YT, Lo CH, Wu CE. Synergistic effects of MK-1775 and gemcitabine on cytotoxicity in non-small cell lung cancer. Heliyon. 2024;10(22):e40299. doi: 10.1016/j.heliyon.2024.e40299.
Formisano L, Jansen VM, Marciano R, Bianco R. From Biology to therapy: Improvements of therapeutic options in lung cancer. Anticancer Agents Med Chem. 2018;18(9):1235-1240. doi: 10.2174/1871520617666170912123416.
Guarín-González YA, Cabello-Guzmán G, Von-Plessing C, Segura-del Río R, Barraza LF, Martin-Martín A, et al. Synthesis of nano-in-microcapsule delivery systems of nanomagnetite, microzeolite and gemcitabine in a chitosan matrix, with activity against lung cancer cells. Materials Today. 2024. doi: 10.2139/ssrn.4680352.
Larson AC, Knoche SM, Brumfield GL, Doty KR, Gephart BD, Moore-Saufley PR, et al. Gemcitabine modulates HLA-I regulation to improve tumor antigen presentation by pancreatic cancer cells. Int J Mol Sci. 2024;25(6):3211. doi: 10.3390/ijms25063211.
Himura R, Kawano S, Nagata Y, Kawai M, Ota A, Kudo Y, et al. Inhibition of aldo-keto reductase 1C3 overcomes gemcitabine/cisplatin resistance in bladder cancer. Chemico-Biol Interact. 2024;388:110840. doi: 10.1016/j.cbi.2023.110840.
Larson AC, Doty KR, Solheim JC. The double life of a chemotherapy drug: Immunomodulatory functions of gemcitabine in cancer. Cancer Med. 2024;13(10):e7287. doi: 10.1002/cam4.7287.
Yalçın S, Erkan M, Ünsoy G, Parsian M, Kleeff J, Gündüz U. Effect of gemcitabine and retinoic acid loaded PAMAM dendrimer-coated magnetic nanoparticles on pancreatic cancer and stellate cell lines. Biomed Pharmacother. 2014;68(6):737-743. doi: 10.1016/j.biopha.2014.07.003.
Swarnakar NK, Thanki K, Jain S. Enhanced antitumor efficacy and counterfeited cardiotoxicity of combinatorial oral therapy using doxorubicin- and coenzyme Q10-liquid crystalline nanoparticles in comparison with intravenous adriamycin. Nanomed Nanotechnol Biol Med. 2014;10(6):1231-41. doi: 10.1016/j.nano.2014.03.003.
Rudzińska A, Juchaniuk P, Oberda J, Wiśniewska J, Wojdan W, Szklener K, et al. Phytochemicals in cancer treatment and cancer prevention—review on epidemiological data and clinical trials. Nutrients. 2023;15(8):1896. doi: 10.3390/nu15081896.
Aluyen JK, Ton QN, Tran T, Yang AE, Gottlieb HB, Bellanger RA. Resveratrol: potential as anticancer agent. J Diet Suppl. 2012;9(1):45-56. doi: 10.3109/19390211.2011.650842.
Borriello A, Bencivenga D, Caldarelli I, Tramontano A, Borgia A, Virginia Adriana Pirozzi A, et al. Resveratrol and cancer treatment: is hormesis a yet unsolved matter? Curr Pharm Design. 2013;19(30):5384-5393. doi: 10.2174/1381612811319300007.
Moar K, Brahma M, Kakde GS, Pant A, Maruthi M, Maurya PK. Protective effect of resveratrol against non-small cell lung cancer: In-vitro and in-silico studies. Polycyclic Aromatic Compounds. 2025;45(4):681-696. doi: 10.1080/10406638.2024.2416068.
Sichetti M, Giuseffi M, Giglio E, Marino G, Mecca M. Effect of natural polyphenols on breast cancer chemoprevention and treatment. Mol Nutr Food Res. 2025:e70055. doi: 10.1002/mnfr.70055.
Maleki M, Tabnak P, Golchin A, Yousefi B, Nazari A. Resveratrol inhibited colorectal cancer progression by reducing oxidative DNA damage by targeting the JNK signaling pathway. Heliyon. 2024;10(21). doi: 10.1016/j.heliyon.2024.e38631.
Sukocheva OA. Resveratrol and pancreatic cancers: Questions and future perspectives. World Journal of Gastrointestinal Oncology. 2025;17(3):100342. doi: 10.4251/wjgo.v17.i3.100342.
Wan Z, Hallajzadeh J. The beneficial effects of resveratrol on hepatocellular carcinoma and nonalcoholic fatty liver disease: Modulation of apoptosis, autophagy, inflammation, and oxidative stress. Food Sci Nutr. 2025;13(7):e70555. doi: 10.1002/fsn3.70555.
Hummadi YMKAM, Al-Khfajy WSD, Jasem MA. Cinnamic acid enhances vinorelbine-induced cytotoxicity in MDA-MB-231 cells through modulation of PTEN and ATG5 expression. J Pharmacol Exp Ther. 2025;392(8):103654. doi: 10.1016/j.jpet.2025.103654.
Chou TC, Talalay P. Quantitative analysis of dose-effect relationships: the combined effects of multiple drugs or enzyme inhibitors. Adv Enzyme Regul. 1984;22:27-55. doi: 10.1016/0065-2571(84)90007-4.
Chou TC. Theoretical basis, experimental design, and computerized simulation of synergism and antagonism in drug combination studies. Pharmacol Rev. 2006;58(3):621-681. doi: 10.1124/pr.58.3.10.
Guzman C, Bagga M, Kaur A, Westermarck J, Abankwa D. ColonyArea: an ImageJ plugin to automatically quantify colony formation in clonogenic assays. PloS One. 2014;9(3):e92444. doi: 10.1371/journal.pone.0092444.
Salim W, Arif IS, Al-Sudani BT. Role of fasting mimicking diet in farnesoid x receptor for suppressing epithelial-to-mesenchymal transition, cell cycle progression, and viability of prostate cancer cells. Iraqi J Pharm Sci. 2023;32(1):115-124. doi: 10.31351/vol32iss1pp115-124.
Kadhim ME, Rajab NA. Cytotoxicity of sericin nanoparticles loaded with paclitaxel as a pulmonary drug delivery system: in vitro and in vivo studies. Al-Rafidain J Med Sci. 2024;7(1):144-152. doi: 10.54133/ajms.v7i1.1153.
Hatami E, Nagesh PK, Jaggi M, Chauhan SC, Yallapu MM. Gambogic acid potentiates gemcitabine induced anticancer activity in non-small cell lung cancer. Eur J Pharmacol. 2020;888:173486. doi: 10.1016/j.ejphar.2020.173486.
Su SH, Sundhar N, Kuo WW, Lai SC, Kuo CH, Ho TJ, et al. Artemisia argyi extract induces apoptosis in human gemcitabine-resistant lung cancer cells via the PI3K/MAPK signaling pathway. J Ethnopharmacol. 2022;299:115658. doi: 10.1016/j.jep.2022.115658.
Tang Y, Wang Y, Teng X. Sequence‑dependent effect of gemcitabine and cisplatin on A549 non‑small‑cell lung cancer cells. Mol Med Rep. 2013;8(1):221-226. doi: 10.3892/mmr.2013.1495.
Wang S, Su ZF, Yuan Y, Li J. Synergistic effects of sorafenib in combination with gemcitabine or pemetrexed in lung cancer cell lines with K-ras mutations. Contemp Oncol. 2016;20(1):33-38. doi: 10.5114/wo.2016.58499.
Fan Y, Li J, Yang Y, Zhao X, Liu Y, Jiang Y, et al. Resveratrol modulates the apoptosis and autophagic death of human lung adenocarcinoma A549 cells via a p53-dependent pathway: Integrated bioinformatics analysis and experimental validation. Int J Oncol. 2020;57(4):929-938. doi: 10.3892/ijo.2020.5107.
Li X, Li F, Wang F, Li J, Lin C, Du J. Resveratrol inhibits the proliferation of A549 cells by inhibiting the expression of COX-2. OncoTarget Ther. 2018:2981-2989. doi: 10.2147/OTT.S157613.
Cocetta V, Quagliariello V, Fiorica F, Berretta M, Montopoli M. Resveratrol as chemosensitizer agent: state of art and future perspectives. Int J Mol Sci. 2021;22(4):2049. doi: 10.3390/ijms22042049.
Mirzapur P, Khazaei MR, Moradi MT, Khazaei M. Apoptosis induction in human breast cancer cell lines by synergic effect of raloxifene and resveratrol through increasing proapoptotic genes. Life Sci. 2018;205:45-53. doi: 10.1016/j.lfs.2018.04.035.
Dun J, Chen X, Gao H, Zhang Y, Zhang H, Zhang Y. Resveratrol synergistically augments anti-tumor effect of 5-FU in vitro and in vivo by increasing S-phase arrest and tumor apoptosis. Exp Biol Med. 2015;240(12):1672-1681. doi: 10.1177/1535370215573396.
Arribas J, Bech-Serra JJ, Santiago-Josefat B. ADAMs, cell migration and cancer. Cancer Metastasis Rev. 2006;25(1):57-68. doi: 10.1007/s10555-006-7889-6.
Harikumar KB, Kunnumakkara AB, Sethi G, Diagaradjane P, Anand P, Pandey MK, et al. Resveratrol, a multitargeted agent, can enhance antitumor activity of gemcitabine in vitro and in orthotopic mouse model of human pancreatic cancer. Int J Cancer. 2010;127(2):257-268. doi: 10.1002/ijc.25041.
Jiang Z, Chen X, Chen K, Sun L, Gao L, Zhou C, et al. YAP inhibition by resveratrol via activation of AMPK enhances the sensitivity of pancreatic cancer cells to gemcitabine. Nutrients. 2016;8(10):546. doi: 10.3390/nu8100546.
Wu S, Ren J, Qian W, Gong M, Li J, Qin T, et al. Synergistic effects of resveratrol with gemcitabine in pancreatic cancer chemotherapy by inhibiting the c-Met/PARP1 axis. J Pancreatol. 2024;7(04):267-278. DOI: 10.1097/JP9.0000000000000160.
Qin SH, Lau AT, Liang ZL, Tan HW, Ji YC, Zhong QH, et al. Resveratrol promotes tumor microvessel growth via endoglin and extracellular signal-regulated kinase signaling pathway and enhances the anticancer efficacy of gemcitabine against lung cancer. Cancers. 2020;12(4):974. doi: 10.3390/cancers12040974.
Hu S, Li X, Xu R, Ye L, Kong H, Zeng X, et al. The synergistic effect of resveratrol in combination with cisplatin on apoptosis via modulating autophagy in A549 cells. Acta Biochim Biophys Sinica. 2016;48(6):528-535. doi: 10.1093/abbs/gmw026.
Kong F, Zhang R, Zhao X, Zheng G, Wang Z, Wang P. Resveratrol raises in vitro anticancer effects of paclitaxel in NSCLC cell line A549 through COX-2 expression. Korean J Physiol Pharmacol. 2017;21(5):465. doi: 10.4196/kjpp.2017.21.5.465.
Gu S, Chen C, Jiang X, Zhang Z. Resveratrol synergistically triggers apoptotic cell death with arsenic trioxide via oxidative stress in human lung adenocarcinoma A549 cells. Biol Trace Elem Res. 2015;163(1):112-123. doi: 10.1007/s12011-014-0186-2.
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