ATP-Binding Cassette (ABC) Transporter Proteins, Multidrug Resistance and Novel Flavonoid Dimers as Potent, Nontoxic and Selective Inhibitors
Multidrug resistance (MDR) is often a major impediment to successful chemotherapy in the treatment of cancer. A common mechanism for MDR is the overexpression of an active ATP-binding cassette (ABC) transporter protein: either the P-glycoprotein (P-gp/ABCB1, also known as MDR1), the multidrug resistance protein 1 (MRP1/ABCC1) or the breast cancer resistant protein (BCRP/ABCG2), on the plasma membrane of cancer cells. These transporters can pump many structurally diverse anticancer drugs out of the cancer cells and render these drugs ineffective at a therapeutic dosage, i.e., multidrug resistance. Coadministration of a potent inhibitor of ABC transporter with an anticancer drug has been evaluated in several clinical trials to overcome MDR but led to a disappointing outcome. By taking advantage of the pseudo-dimeric structure (Figure 1) of ABC transporters, we demonstrated that some flavonoid dimers, using polyvalent interactions, can be potent inhibitors of the ABC transporters. Selective inhibition of the three different transporters with the flavonoid dimers can be achieved by placing the two flavonoid moieties at an optimal distance apart specific for each of the transporters. In addition to being potent and selective inhibitors of the transporters, the flavonoid dimers are found to be nontoxic to normal cells at their corresponding effective concentrations. The in vivo efficacy of the flavonoid dimers has been demonstrated. Further investigation of these flavonoid dimers as clinical candidates to overcome multidrug resistance in cancer chemotherapy is warranted.