Inhibition of mTOR in combination with doxorubicin in an experimental model of hepatocellular carcinoma

J Hepatol. 2008 Jul;49(1):78-87. doi: 10.1016/j.jhep.2008.03.024. Epub 2008 Apr 28.


Background/aims: Hepatocellular carcinoma (HCC) is resistant to chemotherapy. We reported that sirolimus, an mTOR inhibitor, has antiangiogenic properties in HCC. Since antiangiogenic therapy may enhance chemotherapy effects, we tested the antitumorigenic properties of sirolimus combined with doxorubicin in experimental HCC.

Methods: Morris Hepatoma (MH) cells were implanted into livers of syngeneic rats. Animals were assigned to sirolimus, pegylated liposomal doxorubicin, both combined or control groups. Tumoral growth was followed by MRI. Antiangiogenic effects were assessed by CD31 immunostaining and capillary tube formation assays. Cell proliferation was monitored in vitro by thymidine incorporation. Expression of p21 and phosphorylated MAPKAP kinase-2 was quantified by immunoblotting.

Results: Animals treated with the combination developed smaller tumors with decreased tumor microvessel density compared to animals that received monotherapies. In vitro, inhibition of mTOR further impaired capillary formation in the presence of doxorubicin. Doxorubicin reduced endothelial cell proliferation; inhibition of mTOR accentuated this effect. Doxorubicin stimulated p21 expression and the phosphorylation of MAPKAP kinase-2 in endothelial cells. Addition of mTOR inhibitor down-regulated p21, but did not decrease MAPKAP kinase-2 phosphorylation.

Conclusions: Sirolimus has additive antitumoral and antiangiogenic effects when administered with doxorubicin. These findings offer a rationale for combining mTOR inhibitors with chemotherapy in HCC treatment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Antibiotics, Antineoplastic / pharmacology*
  • Antineoplastic Combined Chemotherapy Protocols / pharmacology
  • Aorta / cytology
  • Apoptosis / drug effects
  • Carcinoma, Hepatocellular / drug therapy*
  • Carcinoma, Hepatocellular / pathology
  • Cells, Cultured
  • Disease Models, Animal
  • Doxorubicin / analogs & derivatives*
  • Doxorubicin / pharmacology
  • Endothelial Cells / cytology
  • Intracellular Signaling Peptides and Proteins / metabolism
  • Liver Neoplasms, Experimental / drug therapy*
  • Liver Neoplasms, Experimental / pathology
  • Male
  • Neoplasm Transplantation
  • Oncogene Protein p21(ras) / metabolism
  • Phosphorylation / drug effects
  • Polyethylene Glycols / pharmacology*
  • Protein-Serine-Threonine Kinases / metabolism
  • Rats
  • Rats, Inbred ACI
  • Sirolimus / analogs & derivatives*
  • Sirolimus / pharmacology
  • Transcription Factors / antagonists & inhibitors*


  • Antibiotics, Antineoplastic
  • Crtc1 protein, rat
  • Intracellular Signaling Peptides and Proteins
  • Transcription Factors
  • liposomal doxorubicin
  • Polyethylene Glycols
  • temsirolimus
  • Doxorubicin
  • MAP-kinase-activated kinase 2
  • Protein-Serine-Threonine Kinases
  • Oncogene Protein p21(ras)
  • Sirolimus