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Midazolam regulated caspase pathway, endoplasmic reticulum stress, autophagy, and cell cycle to induce apoptosis in MA-10 mouse Leydig tumor cells

Authors So EC, Chen Y, Wang S, Wu C, Huang M, Lai M, Pan B, Kang F, Huang B

Received 1 December 2015

Accepted for publication 16 February 2016

Published 27 April 2016 Volume 2016:9 Pages 2519—2533

DOI https://doi.org/10.2147/OTT.S101671

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Dekuang Zhao

Peer reviewer comments 5

Editor who approved publication: Dr Faris Farassati


Edmund Cheung So,1,2 Yung-Chia Chen,3 Shu-Chun Wang,4 Chia-Ching Wu,4 Man-Chi Huang,4 Meng-Shao Lai,4 Bo-Syong Pan,4,5 Fu-Chi Kang,6 Bu-Miin Huang4

1Department of Anesthesia, An Nan Hospital, China Medical University, Tainan, Taiwan, Republic of China; 2Department of Anesthesia, School of Medicine, China Medical University, Taichung, Taiwan; Republic of China; 3Department of Anatomy, School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China; 4Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China; 5Department of Cancer Biology, Wake Forest University School of Medicine, Winston Salem, NC, USA; 6Department of Anesthesia, Chi Mei Medical Center, Chiali, Tainan, Taiwan, Republic of China

Purpose: Midazolam is widely used as a sedative and anesthetic induction agent by modulating the different GABA receptors in the central nervous system. Studies have also shown that midazolam has an anticancer effect on various tumors. In a previous study, we found that midazolam could induce MA-10 mouse Leydig tumor cell apoptosis by activating caspase cascade. However, the detailed mechanism related to the upstream and downstream pathways of the caspase cascade, such as endoplasmic reticulum (ER) stress, autophagy, and p53 pathways plus cell cycle regulation in MA-10 mouse Leydig tumor cells, remains elusive.
Methods: Flow cytometry assay and Western blot analyses were exploited.
Results: Midazolam significantly decreased cell viability but increased sub-G1 phase cell numbers in MA-10 cells (P<0.05). Annexin V/propidium iodide double staining further confirmed that midazolam induced apoptosis. In addition, expressions of Fas and Fas ligand could be detected in MA-10 cells with midazolam treatments, and Bax translocation and cytochrome c release were also involved in midazolam-induced MA-10 cell apoptosis. Moreover, the staining and expression of LC3-II proteins could be observed with midazolam treatment, implying midazolam could induce autophagy to control MA-10 cell apoptosis. Furthermore, the expressions of p-EIF2α, ATF4, ATF3, and CHOP could be induced by midazolam, indicating that midazolam could stimulate apoptosis through ER stress in MA-10 cells. Additionally, the expressions of cyclin A, cyclin B, and CDK1 could be inhibited by midazolam, and the phosphorylation of p53, P27, and P21 could be adjusted by midazolam, suggesting that midazolam could manage cell cycle through the regulation of p53 pathway to induce apoptosis in MA-10 cells.
Conclusion: Midazolam could induce cell apoptosis through the activation of ER stress and the regulation of cell cycle through p53 pathway with the involvement of autophagy in MA-10 mouse Leydig tumor cells.

Keywords: midazolam, apoptosis, ER stress, autophagy, cell cycle, MA-10 cells, caspase, tumor

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