Flavonoids potentiate the efficacy of cytarabine through modulation of drug-induced apoptosis.

Recent studies have provided strong evidence for potential beneficial effects of flavonoids in chemoprevention or in combination with chemotherapeutics in tumor cells treatment. The aim of this work was to compare the antioxidant properties of four flavonoids with emphasis on association of these antioxidant properties with their effects on the therapeutic efficacy of cytarabine (AraC) using L1210 leukemia cells. The results of antiproliferative studies showed that antiproliferative potential of flavonoids tested decreased in the order: isorhamnetin > kaempferol > myricetin > rutin, while their antioxidant properties decreased in the order: rutin > myricetin > kaempferol > isorhamnetin. Combinational treatment of isorhamnetin, kaempferol and myricetin with AraC led to synergism in their antiproliferative activities (CIs < 1). Rutin exhibited antagonism with AraC (CIs > 1). Apoptotic DNA fragmentation and flow cytometry analyses revealed that synergism in antiproliferative activities of compounds tested might be due to potentiation of AraC-induced apoptosis. In conclusion, our results clearly indicate that isorhamnetin, kaempferol and myricetin despite their antioxidant properties might be used to increase the sensitivity of leukemia cells to AraC treatment.