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Research Articles

Liposome-enabled bufalin and doxorubicin combination therapy for trastuzumab-resistant breast cancer with a focus on cancer stem cells

ORCID Icon, ORCID Icon, ORCID Icon, ORCID Icon, ORCID Icon & ORCID Icon
Pages 489-506 | Received 15 Apr 2023, Accepted 10 Jan 2024, Published online: 25 Jan 2024

Figures & data

Table 1. The origins and mechanism of action for targeting BCSCs of all-trans retinoic acid (ATRA), salinomycin (Sal), and bufalin.

Figure 1. Schematic illustration of (A) transwell migration assay and (B) transwell invasion assay. BT-474 and BT-474R cells were seeded in the upper chamber in the serum-free DMEM and moved through the 8.0 µm pore membrane without or with Matrigel toward the lower chamber, containing DMEM with 10% FBS. Blue cell represents non-BCSCs and orange cells represent BCSCs.

Figure 1. Schematic illustration of (A) transwell migration assay and (B) transwell invasion assay. BT-474 and BT-474R cells were seeded in the upper chamber in the serum-free DMEM and moved through the 8.0 µm pore membrane without or with Matrigel toward the lower chamber, containing DMEM with 10% FBS. Blue cell represents non-BCSCs and orange cells represent BCSCs.

Figure 2. Confirmation of trastuzumab-resistance in BT-474R. (A) Morphology observed under a light microscope. BT-474R has a similar morphology as BT-474; (B) Cell viability in the presence of trastuzumab for 5 days (mean ± SD, three independent experiments, four wells per concentration each time); (C) Cell growth curves and (D) Doubling time in the presence or absence of 10 µg/ml trastuzumab. ****p < 0.0001. ns: no significant difference.

Figure 2. Confirmation of trastuzumab-resistance in BT-474R. (A) Morphology observed under a light microscope. BT-474R has a similar morphology as BT-474; (B) Cell viability in the presence of trastuzumab for 5 days (mean ± SD, three independent experiments, four wells per concentration each time); (C) Cell growth curves and (D) Doubling time in the presence or absence of 10 µg/ml trastuzumab. ****p < 0.0001. ns: no significant difference.

Figure 3. Characterization of BCSCs subpopulation in BT-474 and BT-474R by flow cytometry. CD44+/CD24 BCSCs had minimal expression and ALDH+ BCSCs were elevated in BT-474R. MDA-MB-231 and SKBR3 were used as positive controls for CD44+/CD24 and ALDH+ cells, respectively. (A) CD44+/CD24 cells (in Q3). (B) Expression of ALDH+BCSC population in BT-474, BT-474R. Both experiments were performed in triplicates, and a representative graph is shown.

Figure 3. Characterization of BCSCs subpopulation in BT-474 and BT-474R by flow cytometry. CD44+/CD24− BCSCs had minimal expression and ALDH+ BCSCs were elevated in BT-474R. MDA-MB-231 and SKBR3 were used as positive controls for CD44+/CD24− and ALDH+ cells, respectively. (A) CD44+/CD24− cells (in Q3). (B) Expression of ALDH+BCSC population in BT-474, BT-474R. Both experiments were performed in triplicates, and a representative graph is shown.

Figure 4. Representative images of mammospheres (A,B) and SEF (C,D) formed in BT-474 (A,C) and BT-474R (B,D) after treated with free ATRA (1 µM), Sal (1 µM), and Buf (0.02 µM) alone or in combination with Dox (0.1 µM) for 5 days. Data are mean ± SD from three independent experiments.

Figure 4. Representative images of mammospheres (A,B) and SEF (C,D) formed in BT-474 (A,C) and BT-474R (B,D) after treated with free ATRA (1 µM), Sal (1 µM), and Buf (0.02 µM) alone or in combination with Dox (0.1 µM) for 5 days. Data are mean ± SD from three independent experiments.

Figure 5. Physicochemical characteristics of liposome formulations. (A) Cryo-TEM images showing the morphology and structure of Buf-pSL and Buf-CDpSL. Scale bar: 100 nm (B) Dox and (C) Buf release in different mediums (pH 7.4 vs. pH 5.0). (D) Buf-CDpSL demonstrated better stability than Buf-pSL during the first 3 months.

Figure 5. Physicochemical characteristics of liposome formulations. (A) Cryo-TEM images showing the morphology and structure of Buf-pSL and Buf-CDpSL. Scale bar: 100 nm (B) Dox and (C) Buf release in different mediums (pH 7.4 vs. pH 5.0). (D) Buf-CDpSL demonstrated better stability than Buf-pSL during the first 3 months.

Table 2. Characterization parameters of freshly prepared liposomes (n = 3 experiments).

Figure 6. ALDH+ cell populations in BT-474 and Bt-474R measured by an AldeRed™ ALDH detection assay following 24 h exposure to bufalin (Buf; 100 nM) and doxorubicin (Dox; 1 µM) alone or in combination as free drug(s) or loaded in pSL, with untreated cells as controls. Data are mean ± SD (n = 3 independent experiments). ns: not statistically different by ANOVA; ****p < 0.0001.

Figure 6. ALDH+ cell populations in BT-474 and Bt-474R measured by an AldeRed™ ALDH detection assay following 24 h exposure to bufalin (Buf; 100 nM) and doxorubicin (Dox; 1 µM) alone or in combination as free drug(s) or loaded in pSL, with untreated cells as controls. Data are mean ± SD (n = 3 independent experiments). ns: not statistically different by ANOVA; ****p < 0.0001.

Figure 7. Buf And Dox inhibit sphere formation of BCSCs in BT-474 and BT-474R. (A) Morphologies of spheres formed in untreated BT-474 and BT-474R cells (control). (B,C) Morphologies of spheres in BT-474 (B) and BT-474R (C) after being treated with Buf (10 nM) and Dox (100 nM) mono-or combination either as free drug or liposomes for 5 days. Cells were seeded at 4000 cells per well in ultra-low adherent 24 well plate. (D) SFE of BT-474 and BT-474R with or without (control) Buf and Dox treatment (mean ± SD). *p < 0.05; **p < 0.01; ***p < 0.001; ****p < 0.0001. The experiments were repeated three times, with two wells for each treatment in each experiment, and images from one experiment are presented.

Figure 7. Buf And Dox inhibit sphere formation of BCSCs in BT-474 and BT-474R. (A) Morphologies of spheres formed in untreated BT-474 and BT-474R cells (control). (B,C) Morphologies of spheres in BT-474 (B) and BT-474R (C) after being treated with Buf (10 nM) and Dox (100 nM) mono-or combination either as free drug or liposomes for 5 days. Cells were seeded at 4000 cells per well in ultra-low adherent 24 well plate. (D) SFE of BT-474 and BT-474R with or without (control) Buf and Dox treatment (mean ± SD). *p < 0.05; **p < 0.01; ***p < 0.001; ****p < 0.0001. The experiments were repeated three times, with two wells for each treatment in each experiment, and images from one experiment are presented.

Figure 8. Buf And Dox inhibit self-renewal of BCSCs in BT-474 and BT-474R. (A) Morphology of secondary spheres formed in untreated BT-474 and BT-474R cells (control) were round. After treatments, the secondary mammospheres in (B) BT-474 and (C) BT-474R lost their integrity. (D) Secondary SFE of BT-474 and BT-474R (mean ± SD from three repeated experiments, with two wells for each treatment each time. *p < 0.05; **p < 0.01; ***p < 0.001.

Figure 8. Buf And Dox inhibit self-renewal of BCSCs in BT-474 and BT-474R. (A) Morphology of secondary spheres formed in untreated BT-474 and BT-474R cells (control) were round. After treatments, the secondary mammospheres in (B) BT-474 and (C) BT-474R lost their integrity. (D) Secondary SFE of BT-474 and BT-474R (mean ± SD from three repeated experiments, with two wells for each treatment each time. *p < 0.05; **p < 0.01; ***p < 0.001.

Figure 9. In vitro anti-proliferation effect of Buf and Dox alone or in combination (as free drug or in liposomes) to BT-474 and BT-474R cells. (A) Cell viability after treatment of 24 h (mean ± SD, n = 3 experiments, four wells for each concentration in each experiment). Concentrations of the combined therapy were expressed based on Buf. (B) CI showing synergism of Buf and Dox in BT-474 and BT-474R as both free drug and liposomal formulation.

Figure 9. In vitro anti-proliferation effect of Buf and Dox alone or in combination (as free drug or in liposomes) to BT-474 and BT-474R cells. (A) Cell viability after treatment of 24 h (mean ± SD, n = 3 experiments, four wells for each concentration in each experiment). Concentrations of the combined therapy were expressed based on Buf. (B) CI showing synergism of Buf and Dox in BT-474 and BT-474R as both free drug and liposomal formulation.
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