Role of p53 in irinotecan-induced intestinal cell death and mucosal damage

Anticancer Drugs. 2007 Feb;18(2):197-210. doi: 10.1097/CAD.0b013e328010ef29.


Irinotecan treatment of colorectal cancers results in high-grade intestinal mucositis in a large proportion of patients. The mechanisms behind irinotecan-induced mucosal injury, however, have yet to be fully explained. The aim of this study was to investigate the role of the p53 protein in the onset of intestinal damage following irinotecan treatment in two different settings. IEC-6 and FHs 74 intestinal cell lines were treated with irinotecan with and without a temporary p53 inhibitor, pifithrin-alpha, and examined for changes in proliferation and survival along with expression of p53 and related proteins. Forty tumour-bearing rats also underwent irinotecan treatment with and without pifithrin-alpha, and the effects on intestinal morphology, gene expression, apoptosis and other toxicities were assessed. Irinotecan caused a dose-dependent reduction in cell viability that was not prevented by pifithrin-alpha in either cell line. Rats responded to irinotecan with diarrhoea, weight loss, histopathological changes to the small and large intestine, increased crypt apoptosis, and a mild inflammatory response. Pifithrin-alpha reduced severity and duration of intestinal apoptosis; however, it did not significantly affect other parameters including p53 expression. Temporary inhibition of p53 activation does not markedly prevent intestinal cell death or mucositis following irinotecan treatment. Irinotecan may act through upregulation of proapoptotic proteins Bax and Bak to induce cell death.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Antineoplastic Agents, Phytogenic / pharmacology*
  • Apoptosis / drug effects
  • Benzothiazoles / pharmacology
  • Blotting, Western
  • Camptothecin / analogs & derivatives*
  • Camptothecin / pharmacology
  • Cell Adhesion / drug effects
  • Cell Count
  • Cell Death / drug effects
  • Cell Line
  • Cell Line, Tumor
  • Cell Survival / drug effects
  • Colon / pathology
  • Cyclin-Dependent Kinase Inhibitor p21 / metabolism
  • Epithelial Cells / drug effects
  • Female
  • Gene Expression Regulation, Neoplastic / drug effects
  • Genes, bcl-2 / drug effects
  • Immunohistochemistry
  • Intestinal Mucosa / cytology*
  • Intestinal Mucosa / drug effects
  • Intestinal Mucosa / pathology
  • Irinotecan
  • Proliferating Cell Nuclear Antigen / metabolism
  • Rats
  • Toluene / analogs & derivatives
  • Toluene / pharmacology
  • Tumor Suppressor Protein p53 / physiology*


  • Antineoplastic Agents, Phytogenic
  • Benzothiazoles
  • Cyclin-Dependent Kinase Inhibitor p21
  • Proliferating Cell Nuclear Antigen
  • Tumor Suppressor Protein p53
  • Toluene
  • Irinotecan
  • pifithrin
  • Camptothecin