icaritin and Carcinoma--Hepatocellular

The prenylated flavonoid icaritin (ICT) is currently undergoing phase 3 clinical trial for the treatment of advanced hepatocellular carcinoma (HCC), based on a solid array of preclinical and clinical data. The antitumor activity originates from the capacity of the drug to modulate several signaling effectors in cancer cells, mainly the estrogen receptor splice variant ERα36, the transcription factors STAT3 and NFκB, and the chemokine receptor CXCR4. Recent studies have implicated additional components, including different microRNAs, the generation of reactive oxygen species and the targeting of sphingosine kinase-1. ICT also engages the RAGE-HMGB1 signaling route and modulates the apoptosis/autophagy crosstalk to promote its anticancer activity. In addition, ICT exerts profound changes on the tumor microenvironment to favor an immune-response. Collectively, these multiple biochemical and cellular characteristics confer to ICT a robust activity profile which can be exploited to treat HCC, as well as other cancers, including glioblastoma and onco-hematological diseases such as chronic myeloid leukemia. This review provides an update of the pharmacological properties of ICT and its metabolic characteristics. It also addresses the design of derivatives, including both natural products and synthetic molecules, such as SNG1153 also in clinical trial. The prenylated flavonoid ICT deserves attention as a multifunctional natural product potentially useful to improve the treatment of advanced hepatocellular carcinoma.

Topics: Animals; Carcinoma, Hepatocellular; Drug Design; Flavonoids; Humans; Liver Neoplasms; Prenylation

With poor prognosis and limited treatment options for advanced hepatocellular carcinoma (HCC), development of novel therapeutic agents is urgently needed. This single-arm phase I study sought to assess the safety and preliminary efficacy of icaritin in human as a potential oral immunotherapy in addition to the immune-checkpoint inhibitors.. Eligible advanced HCC patients with Child-Pugh Class A or B were administered with a fixed oral dose of icaritin at either 600 or 800 mg b.i.d. The primary endpoint was safety, and the secondary endpoints included time-to-progression (TTP), overall survival (OS) and the clinical benefit rate (CBR). Icaritin treatment induced immune biomarkers and immune-modulating activities in myeloid cells were also explored.. No drug-related adverse events ≥ Grade 3 were observed in all 20 enrolled HCC patients. Among the 15 evaluable patients, 7 (46.7%) achieved clinical benefit, representing one partial response (PR, 6.7%) and 6 stable disease (SD, 40%). The median TTP was 141 days (range: 20-343 days), and the median OS was 192 days (range: 33-1036 days). Durable survival was observed in PR/SD patients with a median OS of 488 days (range: 72-773). TTP was significantly associated with the dynamic changes of peripheral neutrophils (p = 0.0067) and lymphocytes (p = 0.0337). Icaritin treatment induced changes in immune biomarkers-and immune-suppressive myeloid cells were observed.. Icaritin demonstrated safety profiles and preliminary durable survival benefits in advanced HCC patients, which were correlated with its immune-modulation activities and immune biomarkers. These results suggested the potential of icaritin as a novel oral immunotherapy for advanced HCC in addition to antibody-based PD-1/PD-L1 blockade therapies.. Clinicaltrial.gov identifier. NCT02496949 (retrospectively registered, July 14, 2015).

Topics: Administration, Oral; Adult; Aged; Biomarkers, Tumor; Carcinoma, Hepatocellular; Drug Administration Schedule; Female; Flavonoids; Humans; Liver Neoplasms; Lymphocytes; Male; Middle Aged; Neutrophils; Survival Analysis; Treatment Outcome

Icaritin, a small molecule currently being investigated in phase III clinical trials in China (NCT03236636 and NCT03236649) for treatment of advanced hepatocellular carcinoma (HCC), is a prenylflavonoid derivative obtained from the Epimedium genus. Previously, it was found that Icaritin decreased the expression of PD-L1, but its direct molecular targets and the underlying mechanisms have not been identified. In this study, we report the identification of IKK-α as the protein target of Icaritin by biotin-based affinity binding assay. The further mutagenesis assay has provided evidence that C46 and C178 in IKK-α were essential amino acids for Icaritin binding to IKK-α, revealing the binding sites of Icaritin to IKK-α for the first time. Functionally, Icaritin inhibited the NF-κB signalling pathway by blocking IKK complex formation, which led to decreased nuclear translocation of NF-κB p65, and subsequent downregulation of PD-L1 expression in a dose-dependent manner. More importantly, PD-L1-positive patients exhibited longer overall survival upon Icaritin therapy. Finally, Icaritin in combination with checkpoints antibodies, such as α-PD-1, has demonstrated much better efficacy than any single therapy in animal models. This is the first report that anticancer effects of Icaritin are mediated, at least in part, by impairing functions of IKK-α.

Topics: Animals; B7-H1 Antigen; Carcinoma, Hepatocellular; Cell Line, Tumor; Epimedium; Female; Flavonoids; Gene Expression Regulation, Neoplastic; HEK293 Cells; Humans; I-kappa B Kinase; Jurkat Cells; Liver Neoplasms; Male; Mice, Inbred C57BL; Molecular Structure; Neoplasms, Experimental; THP-1 Cells; Tumor Burden

Recent studies have demonstrated that splenic extramedullary hematopoiesis (EMH) is an important mechanism for the accumulation of myeloid-derived suppressor cells (MDSCs) in tumor tissues, and thus contributes to disease progression. Icaritin, a prenylflavonoid derivative from plants of the

Topics: Animals; Antineoplastic Agents, Phytogenic; Biomarkers; Carcinoma, Hepatocellular; Cell Line, Tumor; Disease Models, Animal; Fetal Blood; Flavonoids; Humans; Immunomodulation; Immunophenotyping; Kaplan-Meier Estimate; Liver Neoplasms; Lymphocytes, Tumor-Infiltrating; Mice; Myeloid-Derived Suppressor Cells; Tumor Burden; Xenograft Model Antitumor Assays

Icaritin, an active ingredient of the Chinese herb Epimedium, plays an anti-tumor role in liver cancer by inhibiting the proliferation of hepatocellular cells and promoting their apoptosis. In China, phase II and a large phase III clinical trial of icaritin reagent for the treatment of hepatocellular cancer is under-going, but the specific mechanism of icaritin action was unclear. Alpha-fetoprotein (AFP), an oncofetal protein, produced in the healthy fetal liver and yolk sac. Intracellular AFP promoted cellular proliferation and inhibited cellular apoptosis in hepatocellular carcinoma (HCC). The study was aimed to investigate the effect of icaritin on HCC through p53/AFP pathway.. Real-time RT PCR and western blot were used to detect p53 and AFP expression levels in HCC cells treated with icaritin. The mechanism of icaritin affecting p53 expression was verified by ubiquitination experiment, and the binding activity of icaritin on p53 in AFP promoter region was verified by luciferase experiment. EdU, MTT and flow cytometry were used to determine whether icaritin affected HCC cellular proliferation and apoptosis through p53/ AFP pathway. Expression levels of p53 and AFP in xenograft mouse model were determined by western blotting.. Our results showed icaritin inhibited AFP expression at mRNA and protein level. AFP was also identified as the target gene of the p53 transcription factor. Icaritin abrogated murine double minute (Mdm) 2-mediated p53 ubiquitination degradation to improve the stability of p53. Up-regulated p53 protein levels then transcriptionally inhibited the AFP promoter. Icaritin-mediated decrease of AFP through Mdm2/p53 pathways inhibited HCC cellular proliferation and promoted HCC cellular apoptosis.. Our findings revealed the mechanism of icaritin in promoting apoptosis and inhibiting proliferation in liver cancer cells. The regulatory mechanism of icaritin in AFP protein down-regulation provides a theoretical and experimental basis for further research into new drugs for the treatment of liver cancer.

Topics: alpha-Fetoproteins; Animals; Apoptosis; Carcinoma, Hepatocellular; Cell Proliferation; Down-Regulation; Flavonoids; Gene Expression Regulation, Neoplastic; Hep G2 Cells; Humans; Liver Neoplasms; Male; Mice; Signal Transduction; Tumor Suppressor Protein p53; Xenograft Model Antitumor Assays

Hepatocellular carcinoma (HCC) resistant to both chemotherapy and immunotherapy is among the deadliest malignancies. Doxorubicin widely used in transarterial chemotherapy in HCC can induce immunogenic cell death (ICD), but the resulting immunogenicity is still weak. We aim to seek a strategy for improving the efficacy of ICD in HCC based on an immunoregulatory drug called icaritin. Icaritin induced mitophagy and apoptosis to provoke ICD both in mouse Hepa1-6 and human Huh7 HCC cells. A combination of icaritin and doxorubicin with a molar ratio of 1:2 played a synergistic role in ICD induction. The poly lactic-

Topics: Animals; Carcinoma, Hepatocellular; Cell Line, Tumor; Doxorubicin; Flavonoids; Immunogenic Cell Death; Liver Neoplasms; Mice; Mitophagy; Tumor Microenvironment

Topics: Antineoplastic Agents, Phytogenic; beta-Galactosidase; Carcinoma, Hepatocellular; Cell Cycle Checkpoints; Cell Line, Tumor; Cell Survival; Cellular Senescence; DNA Damage; Dose-Response Relationship, Drug; Flavonoids; Gene Expression; Hep G2 Cells; Humans; Liver Neoplasms; Reactive Oxygen Species

Hepatocellular carcinoma (HCC) is a highly aggressive neoplasm. We aim to explore the anti-HCC activity by a natural prenylflavonoid icaritin. Icaritin was cytotoxic and pro-apoptotic when added to established (HepG2, KYN-2 and Huh-7 lines) and primary human HCC cells. At the signaling level, icaritin inhibited sphingosine kinase 1 (SphK1) activity in HCC cells, which led to pro-apoptotic ceramide production and JNK1 activation. SphK1 inhibition or silence (by shRNA/microRNA) mimicked icaritin-mediated cytotoxicity, and almost nullified icaritin's activity in HepG2 cells. Reversely, exogenous over-expression of SphK1 sensitized icaritin-induced HepG2 cell apoptosis. In vivo, oral administration of icaritin dramatically inhibited HepG2 xenograft growth in SCID mice. Further, SphK1 activity in icaritin-treated tumors was largely inhibited. In summary, icaritin exerts potent anti-HCC activity in vitro and in vivo. SphK1 inhibition could be the primary mechanism of its actions in HCC cells.

Topics: Animals; Apoptosis; Biomarkers, Tumor; Carcinoma, Hepatocellular; Cell Proliferation; Ceramides; Flavonoids; Gene Expression Regulation, Enzymologic; Humans; Liver Neoplasms; Male; Mice; Mice, SCID; Middle Aged; Phosphotransferases (Alcohol Group Acceptor); Signal Transduction; Tumor Cells, Cultured; Xenograft Model Antitumor Assays

Although it has showed that icaritin can apparently suppress growth of HCC by reducing the level of AFP, the intrinsic mechanism remains unclear. In this study, we explored the possible mechanism of miRNAs on post-transcriptional regulation of AFP gene, as well as the effects of HBV infection and icaritin in hepatoma cells. The results showed that miR-620, miR-1236 and miR-1270 could bind target sites in the range of 9-18 nt and 131-151 nt downstream of the stop codon in the AFP mRNA 3'-UTR to suppress the expression of AFP. Mutation of these target sites could reverse the effects of these miRNAs. Icaritin (10 μM) might reduce the stability and translational activity of AFP mRNA by increasing the expression levels of these mentioned miRNAs. HBV infection resulted in apparent decreases of these miRNAs and, consequently, increased AFP expression. The results indicated that miR-620, miR-1236 and miR-1270 are critical factors in the post-transcriptional regulation of AFP. Icaritin can counteract the effect of HBV. These findings will contribute to full understanding of the regulatory mechanism of AFP expression in hepatoma cells. And also it revealed a synergistic mechanism of HBV infection and elevation of AFP in the pathogenesis of HCC, as well as the potential clinical significance of icaritin on the therapy of HCC induced by HBV.

Topics: 3' Untranslated Regions; alpha-Fetoproteins; Antineoplastic Agents; Binding Sites; Carcinoma, Hepatocellular; Cell Proliferation; Dose-Response Relationship, Drug; Down-Regulation; Flavonoids; Gene Expression Regulation, Neoplastic; Hep G2 Cells; Hepatitis B virus; Humans; Liver Neoplasms; MicroRNAs; RNA Processing, Post-Transcriptional; RNA, Messenger; Time Factors

Icaritin is an active ingredient derived from the plant Herba epimedium, which exhibits various pharmacological and biological activities. However, the function, and the underlying mechanisms of icaritin on the growth of SMMC‑7721 human hepatoma cells have yet to be elucidated. The present study aimed to investigate the function and underlying mechanisms of icaritin in the growth of SMMC‑7721 cells. The cells were treated with varying concentrations of icaritin for 12, 24 and 48 h, respectively, prior to cytotoxic analysis. Apoptosis of SMMC‑7721 cells following treatment with icaritin was measured using flow cytometry. The gene expression of mitochondria‑ and Fas‑mediated caspase‑dependent pathways was detected by reverse transcription‑quantitative polymerase chain reaction and western blotting. Statistical analysis was performed by Student's t‑test and one‑way analysis or variance. The present study demonstrated that treatment with icaritin significantly inhibited growth, and induced apoptosis of SMMC‑7721 cells, in a time‑ and dose‑dependent manner. In addition, icaritin triggered the mitochondrial/caspase apoptotic pathway, by decreasing the Bcl‑2/Bax protein ratio and increasing activation of caspase‑3. Icaritin also activated the Fas‑mediated apoptosis pathway, as was evident by the increased expression levels of Fas and activation of caspase‑8. These data suggest that icaritin may be a potent growth inhibitor and induce apoptosis of SMMC‑7721 cells through the mitochondria‑ and Fas‑mediated caspase‑dependent pathways. The present study may provide experimental evidence for preclinical and clinical evaluations of icaritin for HCC therapy.

Topics: Antineoplastic Agents; Apoptosis; bcl-2-Associated X Protein; Carcinoma, Hepatocellular; Caspase 3; Caspases; Cell Line, Tumor; Cell Proliferation; Dose-Response Relationship, Drug; Flavonoids; Gene Expression Regulation, Neoplastic; Humans; Liver Neoplasms; Signal Transduction

Tumor-initiating cell (TIC) is a subpopulation of cells in tumors that are responsible for tumor initiation and progression. Recent studies indicate that hepatocellular carcinoma-initiating cells (HCICs) confer the high malignancy, recurrence and multi-drug resistance in hepatocellular carcinoma (HCC). In this study, we found that Icaritin, a prenylflavonoid derivative from Epimedium Genus, inhibited malignant growth of HCICs. Icaritin decreased the proportion of EpCAM-positive (a HCICs marker) cells, suppressed tumorsphere formation in vitro and tumor formation in vivo. We also found that Icaritin reduced expression of Interleukin-6 Receptors (IL-6Rs), attenuated both constitutive and IL-6-induced phosphorylation of Janus-activated kinases 2 (Jak2) and Signal transducer and activator of transcription 3 (Stat3), and inhibited Stat3 downstream genes, such as Bmi-1 and Oct4. The inhibitory activity of Icaritin in HCICs was augmented by siRNA-mediated silencing of Stat3 but attenuated by constitutive activation of Stat3.Taken together, our results indicate that Icaritin is able to inhibit malignant growth of HCICs and suggest that Icaritin may be developed into a novel therapeutic agent for effective treatment of HCC.

Topics: Animals; Antineoplastic Agents; Apoptosis; Blotting, Western; Carcinoma, Hepatocellular; Cell Proliferation; Female; Flavonoids; Humans; Immunoenzyme Techniques; Interleukin-6; Janus Kinase 2; Liver Neoplasms; Mice; Mice, Inbred NOD; Mice, SCID; Phosphorylation; Real-Time Polymerase Chain Reaction; Reverse Transcriptase Polymerase Chain Reaction; RNA, Messenger; Signal Transduction; STAT3 Transcription Factor; Tumor Cells, Cultured; Xenograft Model Antitumor Assays

Multidrug resistance (MDR) of tumor cells is a serious obstacle encountered in cancer treatment. In the current study a multiple drug‑resistant HepG2/adriamycin (HepG2/ADR) cell line was established and its MDR was characterized. Icaritin, an active ingredient isolated from the medical plant Herba Epimedium, was observed to reverse MDR in the present model. Icaritin significantly increased the intracellular accumulation of ADR and decreased the expression of the MDR1 gene in HepG2/ADR cells compared with drug‑sensitive HepG2 cells. In addition, the present results showed that icaritin may significantly downregulate the expression of P‑glycoprotein. These results indicate that icaritin is a novel and potent MDR reversal agent and may be a promising drug for tumor chemotherapy.

Topics: ATP Binding Cassette Transporter, Subfamily B; ATP Binding Cassette Transporter, Subfamily B, Member 1; Carcinoma, Hepatocellular; Cell Death; Cell Proliferation; Clone Cells; Down-Regulation; Doxorubicin; Drug Resistance, Multiple; Drug Resistance, Neoplasm; Flavonoids; Gene Expression Regulation, Neoplastic; Hep G2 Cells; Humans; Inhibitory Concentration 50; Intracellular Space; Liver Neoplasms; RNA, Messenger

Hepatic stellate cells (HSCs), a specialized stromal cytotype in the liver, have been demonstrated to actively contribute to hepatocellular carcinoma (HCC) development. However, the previous studies were performed using HSC cell lines, and the prognostic value of intratumoral HSCs (tHSCs) was unclear. Here we isolated tHSCs from fresh human HCC tissues, and analyzed the abilities of tHSCs to promote HCC progression by using in vitro assays for cell viability, migration and invasion as well as epithelial-mesenchymal transition (EMT) phenotype. 252 HCC patients who underwent hepatectomy were enrolled for analysis of tHSCs and E-cadherin expression in tumor tissues, and 55 HCC patients for analysis of tHSCs in tumor tissues and circulating tumor cells (CTCs) in blood. Prognostic factors were then identified. The results showed that coculture of tHSCs with HCC cells had a stronger effect on HCC cell viability, migration and invasion, accompanied with the acquisition of epithelial-mesenchymal transition (EMT) phenotype. In vivo cotransplantation of HCC cells with tHSCs into nude mice more efficiently promoted tumor formation and growth. Icaritin, a known apoptosis inducer of HSCs, was demonstrated to effectively inhibit tHSC proliferation in vitro and tHSC-induced HCC-promoting effects in vivo. Clinical evidence indicated that tHSCs were rich in 45% of the HCC specimens, tHSC-rich subtypes were negatively correlated either with E-cadherin expression in tumor tissues (r = -0.256, p < 0.001) or with preoperative CTCs in blood (r = -0.287, p = 0.033), and were significantly correlated with tumor size (p = 0.027), TNM staging (p = 0.018), and vascular invasion (p = 0.008). Overall and recurrence-free survival rates of tHSC-rich patients were significantly worse than those for tHSC-poor patients. Multivariate analysis revealed tHSC-rich as an independent factor for overall and recurrence-free survival. In conclusion, tHSCs provide a promising prognostic biomarker and a new treatment target for HCC.

Topics: Animals; Apoptosis; Biomarkers, Tumor; Carcinoma, Hepatocellular; Cell Proliferation; Cell Transplantation; Epithelial-Mesenchymal Transition; Flavonoids; Hepatic Stellate Cells; Heterografts; Humans; In Situ Nick-End Labeling; Liver Neoplasms; Mice; Mice, Nude; Prognosis

Chinese herbs have become a focus in cancer treatment. Icaritin, a prenylflavonoid derivative from Chinese herbs of the Epimedium genus, has selective estrogen receptor (ER) modulating activity. This study evaluates the effects of icaritin on the apoptosis of HepG2 hepatocellular carcinoma cells. Icaritin (at 5-50 µM) induced apoptosis of HepG2 cells. Few changes in icaritin-induced apoptosis were observed after pretreatment with ICI182780. Consistent with apoptosis induction, icaritin increased the Bax/Bcl-2 ratio and caspase-3 activation in HepG2 cells. Furthermore, icaritin was capable of stimulating the c-Jun N-terminal kinase 1 (JNK1), but not the JNK2, ERK1/2, and p38 subgroups of the mitogen-activated protein kinase (MAPK) family. Coincidently, icaritin-induced cell apoptosis was abolished by SP600125, a specific inhibitor for JNK. Collectively, our results suggest a novel pro-apoptotic activity of icaritin mediated via the JNK1 signaling pathway that is not associated with ER in HepG2 cells.

Topics: Anthracenes; Antineoplastic Agents, Phytogenic; Apoptosis; bcl-2-Associated X Protein; Carcinoma, Hepatocellular; Caspase 3; Drugs, Chinese Herbal; Epimedium; Flavonoids; Hep G2 Cells; Humans; JNK Mitogen-Activated Protein Kinases; Liver Neoplasms; Mitogen-Activated Protein Kinases; Phytotherapy; Proto-Oncogene Proteins c-bcl-2; Receptors, Estrogen; Signal Transduction