Dichloroacetate and PX-478 exhibit strong synergistic effects in a various number of cancer cell lines

BMC Cancer. 2021 Apr 30;21(1):481. doi: 10.1186/s12885-021-08186-9.


Background: One key approach for anticancer therapy is drug combination. Drug combinations can help reduce doses and thereby decrease side effects. Furthermore, the likelihood of drug resistance is reduced. Distinct alterations in tumor metabolism have been described in past decades, but metabolism has yet to be targeted in clinical cancer therapy. Recently, we found evidence for synergism between dichloroacetate (DCA), a pyruvate dehydrogenase kinase inhibitor, and the HIF-1α inhibitor PX-478. In this study, we aimed to analyse this synergism in cell lines of different cancer types and to identify the underlying biochemical mechanisms.

Methods: The dose-dependent antiproliferative effects of the single drugs and their combination were assessed using SRB assays. FACS, Western blot and HPLC analyses were performed to investigate changes in reactive oxygen species levels, apoptosis and the cell cycle. Additionally, real-time metabolic analyses (Seahorse) were performed with DCA-treated MCF-7 cells.

Results: The combination of DCA and PX-478 produced synergistic effects in all eight cancer cell lines tested, including colorectal, lung, breast, cervical, liver and brain cancer. Reactive oxygen species generation and apoptosis played important roles in this synergism. Furthermore, cell proliferation was inhibited by the combination treatment.

Conclusions: Here, we found that these tumor metabolism-targeting compounds exhibited a potent synergism across all tested cancer cell lines. Thus, we highly recommend the combination of these two compounds for progression to in vivo translational and clinical trials.

Keywords: Cancer cell lines; Cancer therapy; Dichloroacetate; Drug combination; HIF-1α inhibition; Metabolism; PX-478; Synergism.

MeSH terms

  • A549 Cells
  • Antineoplastic Combined Chemotherapy Protocols / pharmacology*
  • Apoptosis / drug effects
  • Cell Cycle Checkpoints / drug effects
  • Cell Line, Tumor / drug effects*
  • Cell Proliferation / drug effects
  • Cell Survival / drug effects
  • Dichloroacetic Acid / pharmacology*
  • Dose-Response Relationship, Drug
  • Drug Screening Assays, Antitumor / methods
  • Drug Synergism
  • HT29 Cells
  • HeLa Cells
  • Humans
  • MCF-7 Cells
  • Mustard Compounds / pharmacology*
  • Phenylpropionates / pharmacology*
  • Reactive Oxygen Species / metabolism


  • 2-amino-3-(4'-N,N-bis(2-chloroethyl)amino)phenylpropionic acid N-oxide
  • Mustard Compounds
  • Phenylpropionates
  • Reactive Oxygen Species
  • Dichloroacetic Acid