Background. Most non-small cell lung cancers (NSCLC) are chemoresistant. Id
entification and modulation of chemoresistance cell-signaling pathways may
sensitize NSCLC to chemotherapy and improve patient outcome. The purpose of
this study was to determine if chemotherapy induces nuclear factor-kappa B
(NF-kappa B) activation in NSCLC in vitro and whether inhibition of NF-kap
pa B would sensitize tumor cells to undergo chemotherapy-induced apoptosis.
Methods. Non-small cell lung cancer cells were treated with gemcitabine, ha
rvested, and nuclear extracts analyzed for NF-kappa B DNA binding by electr
ophoretic mobility shift assays. Additionally, NSCLC cells that stably expr
essed a plasmid encoding the superrepressor I kappa B alpha protein (H157I)
or a vector control (H157V) were generated. These cells were then treated
with gemcitabine and apoptosis determined by terminal deoxynucleotidyl tran
sferase mediated nick end labeling (TUNEL) assay.
Results. Chemotherapy induced NF-kappa B nuclear translocation and DNA bind
ing in all NSCLC cell lines. H157I cells had enhanced cell death compared w
ith H157V cells, suggesting that NF-kappa B is required for cell survival a
fter chemotherapy. The observed cell death following the loss of NF-kappa B
occurred by apoptosis.
Conclusions. Inhibition of chemotherapy-induced NF-kappa B activation sensi
tizes NSCLC to chemotherapy-induced apoptosis in vitro. Novel treatment str
ategies for patients with advanced NSCLC may involve chemotherapy combined
with inhibition of NF-kappa B-dependent cell-survival pathways. (Ann Thorac
Surg 2000;70:930-7) (C) 2000 by The Society of Thoracic Surgeons.