A Model of Chemotherapy-Induced Tumor Dormancy: Doxorubicin Retention and Degradation Defines Resumed Growth in Vivo
Abstract Background. Cancer recurrence after adjuvant chemotherapy with long periods of remission is common. After cessation of the therapy, the dormant cells may repopulate, but the signals that control the tumor to exit dormancy are not completely understood. We hypothesized that tissue bound cytotoxic drug indwelling in a body for years might somehow contribute to dormancy or recurrence of a tumor. The purpose of this study was to design a model demonstrating that viable cells implanted in mice can repopulate or be suppressed, depending on the cytotoxic preload conditions.Methods. A two-step dormancy/recurrence (TSDR) murine model was designed, which mimics the extrusion of taken up drug from tumor cells. The viable cells preloaded with drug were implanted into mice. The survival rates of these mice were then used as criteria to demonstrate the relationship between resumed growth and drug cellular efflux/viability. The drug internalization patterns following their exposure to doxorubicin (dox) or degraded dox (dox-dgr) were investigated by exploring flow cytometry, spectral analysis, high performance liquid chromatography and confocal microscopy. Antiproliferative and myelotoxic capacity was evaluated by hematological nadir induced by the iv injected drug. Results. The viable SL2 lymphoma cells exposed to 10 µg/ml of dox for 30 min and injected into syngeneic DBA/2 mice were made unable to recure. Exposure of cells to lower dox concentrations (0.01 – 1.0 µg/ml) resulted in tumor recurrence, similar to that which was observed during implantation of an untreated tumor. Dox-dgr kept at 37 °C for 365 days lost its tumoricidal and antiproliferative capacity and displayed a loss of selectivity of nuclear fluorescence.Conclusions. Our TSDR model is a rapid convenient tool to study in vivo behavior of cells preloaded with cytotoxic drug. This approach focuses on mechanisms of tumor cells exiting dormancy, in relation to cytotoxic drug efflux. Multiple modifications of our TSDR model are possible, including nude mice models. As an example, we used one-year body temperature exposed dox to demonstrate its inability to retain sufficient cytotoxic capacity.