Anthelmintic drug albendazole arrests human gastric cancer cells at the mitotic phase and induces apoptosis.

As microtubules have a vital function in the cell cycle, oncologists have developed microtubule inhibitors capable of preventing uncontrolled cell division, as in the case of cancer. The anthelmintic drug albendazole (ABZ) has been demonstrated to inhibit hepatocellular, ovarian and prostate cancer cells via microtubule targeting. However, its activity against human gastric cancer (GC) cells has remained to be determined. In the present study, ABZ was used to treat GC cells (MKN-45, SGC-7901 and MKN-28). A a CCK-8 cell proliferation assay was performed to assess the effects of ABZ on cell viability and cell cycle changes were assessed using flow cytometry. SGC-7901 cells were selected for further study, and flow cytometry was employed to determine the apoptotic rate, immunofluorescence analysis was employed to show changes of the microtubule structure as well as the subcellular localization and expression levels of cyclin B1, and western blot analysis was used to identify the dynamics of microtubule assembly. The expression levels of relevant proteins, including cyclin B1 and Cdc2, the two subunits of mitosis-promoting factor as well as apoptosis-asociated proteins were also assessed by western blot analysis. The results showed that ABZ exerted its anti-cancer activity in GC cell lines by disrupting microtubule formation and function to cause mitotic arrest, which is also associated with the accumulation of cyclin B1, and consequently induces apoptosis.

Introduction

Microtubules, an integral part of the cytoskeleton, are composed of two major soluble proteins, α-tubulin and β-tubulin. Their unique polymerization dynamics are a critical molecular processes that regulate cellular functions such as intracellular transport, signal transduction, morphological maintenance and mitosis (1). Microtubule-binding agents are known to regulate chromosomal separation in mitosis by either polymerizing or depolymerizing the microtubules, and have been applied to the treatment of numerous malignancies (2). These agents are classified into two categories based on the type of molecular reaction they trigger, including microtubule-stabilizing agents that promote polymerization or the stabilization of microtubules, and microtubule-destabilizing agents that depolymerize or destabilize the polymer chain of microtubules (3). Both classes of agents suppress dynamics of microtubules, causing cell cycle arrest and eventually leading to cell death (4). Microtubule-binding agents easily damage malignant cells, since they undergo cell division more rapidly than normal cells.

Of note, although targeted therapies are currently more commonly used in cancer treatment facilities as a result of their higher specificity, microtubule-binding agents are continuously being used in research studies aiming to identify natural compounds that can also alter or regulate microtubule dynamics. It is required to fully elucidate the roles of microtubules in malignant cells, and it may be promising to utilise microtubule-binding agents used in other fields for cancer therapy.

Albendazole (ABZ) is an anthelmintic benzimidazole carbamate. Originally developed in 1975 as an anti-parasitic drug, ABZ is known for its efficiency and low toxicity in humans and farm animals (5,6). ABZ acts as an agonist that binds β-tubulin receptors and alters the protein's dynamics to inhibit polymerization in susceptible parasites (7). The mechanism underlying how ABZ disrupts microtubule polymerization prompted researchers to investigate the microtubule-binding agent and evaluate it as a potential anti-neoplastic drug. A previous study has identified the potential of several benzimidazole carbamates, including ABZ, in treating various cell lines, such as hepatocellular (8), prostate (9) and ovarian cancer cells (10–12). A synergistic anti-tumor effect has also been described with regard to the use of combinations of ABZ + 2-methoxyestradiol and ABZ + paclitaxel (9,13). Furthermore, preclinical studies have found that ABZ suppresses vascular endothelial growth factor secretion and prevents the formation of malignant ascites (10,11).

In the present study, it was found that ABZ inhibited the rapid proliferation of gastric cancer (GC) cells by disrupting microtubule formation and function, leading to mitotic arrest and, ultimately, to apoptosis and cell death. The study also examined the molecular mechanism of the anthelmintic drug's anti-tumor action on GC cells.

Materials and methods

Cell culture

The human GC cell lines MKN-45 (poorly differentiated), SGC-7901 (moderately differentiated) and MKN-28 (well differentiated) were obtained from the Type Culture Collection of the Chinese Academy of Sciences (Shanghai, China), grown in RPMI 1640 medium (Gibco; Thermo Fisher Scientific, Inc., Waltham, MA, USA) containing streptomycin (100 µg/ml), penicillin (100 U/ml) and 10% bovine serum (Gibco; Thermo Fisher Scientific, Inc.), and stored in an incubator at 37°C and 5% CO2.

Chemicals

ABZ (Sigma-Aldrich; Merck Millipore, Darmstadt, Germany) was dissolved in dimethyl sulfoxide (DMSO) to prepare a 1-mM stock solution, which was stored at −20°C.

Growth inhibition assay

Cellular proliferation was examined using a Cell Counting Kit-8 (CCK-8; Dojindo Molecular Technologies, Inc., Kumamoto, Japan). In brief, cells in the logarithmic growth phase were plated onto 96-well culture plates (3.5×103 cells/well in 100 µl) and incubated at 37°C and 5% CO2 for 24 h. After the cells were exposed to ABZ (0.01, 0.1, 0.25, 0.5, 1.0 or 1.5 µM) or 0.1% DMSO as a control for a further 24, 48, 72 or 96 h, the medium was removed and the cells were washed twice with 150 µl phosphate-buffered saline (PBS) solution. Subsequently, 100 µl culture medium containing 10 µl CCK-8 was added to each well and the cells were further incubated at 37°C in a humidified incubator with 5% CO2 for 2 h. Optical densities were measured using an EXL800 microplate reader (BioTek Instruments, Inc., Winooski, VT, USA) at 450 nm absorbance. Cellular growth inhibition was shown as a percentage of vehicle-treated cells, which were set as 100%.

Cell cycle analysis

Harvested cells were washed with phosphate-buffered saline (PBS) and fixed in 70% cold ethanol at 4°C overnight. Following removal of the ethanol by centrifugation (1,200 × g; 5 min), cells were washed with PBS, followed by another centrifugation step. Subsequently, 500 µl DNAStain comprehensive dye solution [50 mg/l RNase, 100 mg/l propidium iodide (PI) and 1 ml/l Triton X-100] (Keygen Biotech Co., Ltd, Nanjing, China) was added to and the resulting suspension was then incubated for 30 min in the dark at room temperature. The solution was then analyzed for cell cycle distribution using a FACScan (BD Biosciences, San Jose, CA, USA). The distribution of the treated cells in the different phases of the cell cycle was identified using ModFit software (version 3.2; Verity Software House, Topsham, ME, USA).

Apoptosis analysis by annexin V-fluorescein isothiocyanate (FITC)/PI double staining

In normal cells, phosphatidylserine is only found in the inner layer of the plasma membrane and only surface onto the outer layer once the cell is in the early stage of apoptosis. For apoptosis analysis, harvested cells were washed with cold PBS twice and then resuspended in 500 µl binding buffer. Approximately 5 µl annexin V-FITC and 5 µl PI were added to the solution, which was then vortexed at room temperature and incubated for 10 min. Cells present in the solution were sorted, identified and examined by flow cytometry.

Tubulin polymerization assay

A standard procedure was used to measure polymerized tubulin. SGC-7901 cells were first lysed using 50 µl hypotonic buffer (1 mM MgCl2, 2 mM EGTA, 0.5% Nonidet P40, 2 mM phenylmethylsulfonyl fluoride, 1 mM orthovanadate, 20 µl protease inhibitor mixture and 20 mM Tris-HCl, pH 6.8). The solution was then centrifuged at 12,000 × g for 10 min at 4°C. The supernatant, which contained soluble tubulin dimers, and the precipitate, which was composed of polymerized microtubules, were then separated. Equal amounts of the supernatant and the precipitate were analyzed using western blot analysis with mouse monoclonal anti-α-tubulin immunoglobulin (Ig)G (dilution, 1:2,000; cat. no. 3873; Cell Signaling Technology, Inc., Danvers, MA, USA) at 4°C overnight and secondary horse radish peroxidase (HRP)-conjugated anti-mouse antibody for 1 h at room temperature, as described later.

Immunofluorescence microscopy

SGC-7901 cells were cultured in 24-well plates containing glass cover slips at a density of 60,000 cells/ml. After reaching 50% confluence, cells were treated with 0.5 µM ABZ or 0.1% DMSO for 18 h prior to being fixed using 4% paraformaldehyde for 20 min. Subsequently, the cells were permeabilized by placing them in 0.5% Triton X-100 solution for 30 min. Cell growth was then blocked by incubation of the permeable cells in 5% goat serum albumin for 1 h. Cells were incubated with mouse monoclonal anti-α-tubulin IgG (as above) or rabbit polyclonal anti-cyclin B1 IgG (diluted 1:100; cat. no. 12231; Cell Signaling Technology, Inc.) overnight at 4°C. Anti-mouse (cat. no. VA1017) or anti-rabbit IgG (cat. no. VA1018) labeled with Texas red (dilution, 1:50; VICMED Co. Ltd. Xuzhou, China) was then added to the cells, and the solution was incubated for 1 h. The cells were subsequently washed in PBS three times and stained using DAPI diluted 1:1,000 in PBS for 5 min. The processed cells were then imaged by fluorescence microscopy (80i; Nikon Corporation, Tokyo, Japan).

Western blot analysis

Cells from each of the treated groups were homogenized in protein lysis buffer (Beyotime Institute of Biotechnology, Nanjing, China), followed by centrifugation at 15,000 × g at 4°C for 15 min. The concentrations of the protein present in the supernatant fluids were identified using a bicinchoninic acid assay (Pierce Biotechnology, Inc., Rockford, IL, USA). Samples were denatured, and 80 µg protein from each sample was separated by 10–12% SDS-PAGE and transferred onto nitrocellulose membranes (Amersham Pharmacia Biotech, Stockholm, Sweden) by a wet or semi-dry transfer. The antibodies used for western blot analysis were as follows: Rabbit anti-cyclin B1 (cat. no. as before), cyclin A2 (cat. no. 4656), B-cell lymphoma 2 (Bcl-2; cat. no. 4423), Bcl-2 extra large protein (Bcl-xL; cat. no. 2764), Bcl-2-associated death promoter (Bad; cat. no. 9239) and Bcl-2-associated × protein (Bax; cat. no. 5023) (diluted 1:1,000 in 5% skimmed milk; Cell Signaling Technology, Inc.), rabbit anti-cell division control protein 2 homolog (Cdc2; cat. no. C10288) or cleaved caspase-3 (cat. no. L0153) (diluted 1:1,000 in 5% skimmed milk; Anbo Biotechnology Inc., Sunnyvale, CA, USA) at 4°C overnight. The membranes were incubated with HRP-conjugated secondary IgG anti-mouse (cat. no. 7076) or anti-rabbit antibodies (cat. no. 7074) (dilution, 1:2,000; Cell Signaling Technology, Inc.) for 1 h at room temperature. Protein signals on the membranes were visualized using enhanced chemiluminescence western blotting detection reagents (Advansta, Menlo Park, CA, USA) These were visualized with an automatic chemiluminescence imaging analysis system (Tanon 5200 Multi; Tanon Science & Technology Co., Ltd., Shanghai, China), and ImageJ v. 1.4.3.67 was used for densitometric analysis (imagej.nih.gov/ij/).

Statistical analysis

SPSS statistical software (version 17.0; SPSS, Inc., Chicago, IL, USA) was utilized to analyze the data that were expressed as the mean ± standard deviation. One-way analysis of variance was performed to determine statistically significant differences of experimental data between the groups. P<0.05 was considered to indicate a statistically significant difference.

Results

ABZ exhibits anti-proliferative activity against various GC cell lines

Various concentrations of ABZ (0, 0.01, 0.1, 0.25, 0.5, 1.0 or 1.5 µM) were administered to human gastric cancer cell lines (MKN-45, SGC-7901 and MKN-28) for 24, 48, 72 and 96 h. The results of the CCK-8 assays indicated that ABZ markedly inhibited the proliferation of all of the tested GC cell lines in a time- and dose-dependent manner (Fig. 1). The IC50 values (Table I) at various time-points showed that the poorly and moderately differentiated GC cell lines, MKN-45 and SGC-7901, respectively, were more sensitive to ABZ, while the well-differentiated GC cells (MKN-28 cells) were less sensitive.

Figure 1.

ABZ inhibits the growth of human gastric cancer cells. Following the treatment of (A) MKN-45, (B) SGC-7901 and (C) MKN-28 cells for 24, 48, 72 and 96 h with various concentrations of ABZ (0.01, 0.1, 0.25, 0.5, 1.0 and 1.5 µM), a Cell Counting Kit-8 assay was used to determine growth inhibition. Results are presented as mean ± standard deviation of results from three independent experiments. ABZ, albendazole.

Table I.

IC50 values (µM) of albendazole in three gastric cancer cell lines.

Time (h)	MKN-45	SGC-7901	MKN-28
24	0.76±0.08	1.33±0.14	3.85±0.32
48	0.43±0.02	0.52±0.01	2.19±0.83
72	0.35±0.01	0.38±0.01	0.97±0.42
96	0.31±0.01	0.34±0.01	0.74±0.07

Values are expressed as the mean ± standard deviation.

ABZ triggers cell cycle arrest at the G2/M phase and apoptosis in human GC cells

Most microtubule-targeting agents are capable of inducing cell cycle arrest. In order to determine whether ABZ affects the cell cycle progression of human GC cells, the three cell lines were exposed to 0.1% DMSO or various ABZ doses for 24 h prior to analysis by flow cytometry (Fig. 2). The results showed that exposure to various concentrations of ABZ for 24 h caused an increased accumulation of cells in the G2/M phase and a corresponding decrease in the G0/G1 phase population. The number of cells blocked in G2/M phase was significantly increased following treatment with ABZ at 0.5 and 1.0 µM (P<0.05).

Figure 2.

ABZ arrested human gastric cancer cells at the G2/M phase. (A) MKN-45, (B) SGC-7901 and (C) MKN-28 cells were treated with various ABZ doses for 24 h and analyzed for DNA content by propidium iodide staining and flow cytometry. *P<0.05 vs. control group. ABZ, albendazole.

It has been established that microtubule-targeting agents induce cell cycle or mitotic arrest, which ultimately leads to cell death (4). The annexin V-PI double staining method was used to determine the apoptotic rate and to differentiate between apoptotic and necrotic cells. SGC-7901 cells were treated with various concentrations of ABZ for 24 and 48 h. Fig. 3 shows that treatment of SGC-7901 cells with ABZ increased the early and late apoptotic cell populations in a time- and dose-dependent manner. ABZ at 0.5 and 1.0 µM significantly increased the early apoptotic rate (P<0.05) and the population of apoptotic cells (especially early apoptotic cells) increased to a greater extent when they were treated for 48 h.

Figure 3.

Cell apoptosis was detected in SGC-7901 cells. Cells were incubated with ABZ (0, 0.1, 0.25, 0.5 and 1.0 µM) for (A) 24 h and (B) 48 h, and apoptosis was analyzed by staining with propidium iodide (Y-axis) as well as for phosphatidylserine translocation with FITC-annexin V (x-axis). The apoptotic rate of SGC-7901 is displayed in bar graphs. Values are presented as the mean ± standard deviation (n=3). *P<0.05 vs. control group. ABZ, albendazole; FITC, fluorescein isothiocyanate.

ABZ disrupts tubulin polymerization and increases the proportion of mitotic cells

The effect of ABZ on the dynamics of the GC cells' tubulin heterodimers were most obvious in SGC-7901 cells. As presented in Fig. 4A, the western blot analysis results showed that cells treated with various concentrations of ABZ for 24 h had a decreased microtubule polymer mass. In addition, abnormal morphological formation was detected when the microtubule polymer mass was examined indirectly using immunofluorescence. While the control SGC-7901 cells showed an organized distribution of microtubules (Fig. 4Ba), treated cells that were exposed to 0.5 µM ABZ for 18 h displayed irregular microtubule formation. In interphase cells, microtubules were less well dispersed with a fuzzy network structure, and appeared thicker and depolymerized (Fig. 4Bb). Mitotic cells were notably increased in size and primarily featured multipolar spindles and uncompressed chromosomes (Fig. 4Bc). These changes explain for the appearance of several multinucleated cells after treatment with ABZ (Fig. 4Bd).

Figure 4.

ABZ inhibits microtubule polymerization. (A) Polymerized tubulin (insoluble fraction) and unpolymerized tubulin (soluble fraction) were extracted from SGC-7901 cells treated with the indicated concentrations of ABZ for 24 h. Dimethyl sulfoxide (0.1%) was used to treat the control. (B) Effect of ABZ on cellular microtubule network organization in (a) untreated cells showing organized microtubules as well as in (b-c) cells treated with 0.5 µM ABZ, revealing (b) thicker, depolymerized and less organized microtubules in interphase cells, (c) multipolar spindles and uncompressed chromosomes in mitotic cells and (d) multinucleated cells. Immunofluorescent staining was used in SGC-7901 cells treated with ABZ for 18 h. Cells were fixed, permeabilized and stained with fluorescent-labeled anti-α-tubulin monoclonal antibody. DAPI was used for nuclear staining. Representative images were captured under a fluorescence microscope (magnification, ×1,000). ABZ, albendazole.

ABZ alters the expression of cell cycle regulatory proteins

Previous studies have found that the activation of M-phase promoting factor (MPF), a complex of Cdc2/cyclin B, triggered the normal progression of cells in the G2 phase to M phase (14–16). The mechanism of MPF is primarily regulated by the phosphorylation/dephosphorylation of Cdc2 (the catalytic subunit of MPF) and the synthesis, subcellular localization and degradation of cyclin B1 (the regulatory subunit of MPF). To determine whether the expression of cyclin B1 was associated with conspicuous alterations in ABZ-treated cells, the level and subcellular localization of the protein in control and ABZ-treated SGC-7901 cells were directly observed through immunofluorescence microscopy (Fig. 5A). While the level of cyclin B1 was obviously low and predominantly distributed in the cytoplasm of untreated control cells (Fig. 5Aa), the level was markedly increased, particularly in the nuclei of ABZ-treated cells (Fig. 5Ab and c). This phenomenon is consistent with the characteristic morphological changes observed in cells blocked in M-phase.

Figure 5.

ABZ alters the expression levels of cell cycle regulatory proteins. (A) Cells were treated with ABZ for 18 h and analyzed using immunofluorescence staining for cyclin B1. (a) control cells showing low levels of cyclin B1 and (b and c) treated cells showing markedly elevated cyclin B1. DAPI was used for nuclear staining. Representative images were captured under a fluorescence microscope (magnification, ×1,000). (B) Western blot analysis of cell cycle regulatory proteins. (C) Histogram demonstrating Cdc2, cyclin A2 and cyclin B1 protein expression levels. *P<0.05 vs. control group. ABZ, albendazole; Cdc2, cell division control protein 2 homolog.

The changes in expression levels of cell cycle-associated proteins in SGC-7901 cells were identified using immunoblot analysis. The results showed that the expression levels of cyclin B1 were dose-dependently elevated by ABZ at concentrations of 0.25–1.0 µM (24 h). By contrast, the Cdc2 and cyclin A2 levels were not significantly affected (Fig. 5B and C).

ABZ altered the expression levels of apoptosis-associated proteins

As presented in Fig. 6, the expression levels of the apoptotic proteins cleaved caspase-3 and Bax were dose-dependently increased by incubation with ABZ for 48 h, while Bad expression was low and not significantly affected. By contrast, the expression levels of the apoptosis-inhibiting proteins Bcl-2 and Bcl-xL were dose-dependently decreased by ABZ (Fig. 6A and B). Calculation of the Bcl-2/Bax ratios revealed that it was decreased by ABZ in a dose-dependant manner (Fig. 6C). These results partially explain the molecular mechanism the apoptotic effects of ABZ in the SGC-7901 human GC cell line in vitro.

Figure 6.

ABZ alters the expression levels of the apoptosis-associated proteins. Cells were treated with various ABZ doses for 48 h. (A) Western blot analysis of cleaved caspase-3, Bcl-2, Bcl-xL, Bad and Bax protein expression levels. (B) Histogram demonstrating cleaved caspase-3, Bcl-2, Bcl-xL, Bad and Bax protein expression levels. *P<0.05 vs. control group. (C) The Bcl-2/Bax ratios of protein levels in gastric cancer cells treated with ABZ. *P<0.05 vs. control group. ABZ, albendazole; Bcl-2, B-cell lymphoma 2; Bcl-Xl, Bcl-2 extra large protein; Bax, Bcl-2-associated × protein; Bad, Bcl-2-associated death promoter.

Discussion

Gastric cancer, or stomach cancer, is considered to be a leading cause of cancer-associated mortality globally, particularly in Eastern Asia, including China (17). Despite improved clinical therapies and decreasing incidence, the average 5-year survival rate for gastric cancer is only 10–15%, and it remains a major public health threat (18). An increasing number of novel anti-tumor agents are under investigation in academic and industrial research laboratories globally. Previous studies have found potential anti-tumor activity of established drugs used for the treatment of other diseases. For instance, celecoxib, a cyclooxygenase-2-selective nonsteroidal anti-inflammatory drug has been determined to reduce the risk of gastric cancer (19), colon cancer (20) and breast cancer (21).

Previous studies have demonstrated that the anthelmintic drug ABZ has potential use against cancer types other than GC (8–12). In the present study, the CCK-8 assay clearly demonstrated that cellular proliferation in all three human GC cell lines was profoundly inhibited by ABZ. To confirm that ABZ induces the depolymerization of microtubules, western blot analysis and immunofluorescence techniques were employed. It was observed that depolymerization prevented normal spindle fibers from forming and caused multipolar of chromatid separation. These results suggested that ABZ may lead to errors in sister chromatid separation through influencing the function of the centrosome, which is predominantly formed by microtubules. Furthermore, the ability of ABZ to induce cell cycle arrest and ultimately trigger apoptosis in treated GC cells was demonstrated, suggesting that ABZ has anti-cancer activity against GC cells.

The G2/M phase, accompanied by a variety of complex and active changes at the molecular level, is a critical stage of the cell cycle. The fact that cells in G2/M phase are vulnerable to external environmental conditions is of significance with respect to the growth of cancer cells (22). In the present study, ABZ-treated cells were subjected to tubulin analysis through immunofluorescence techniques and cell cycle analysis by flow cytometry, and it was identified that the majority of the G2/M cells were in fact arrested in the M phase rather than in the G2 phase.

It is now evident that substances involved in mitosis include microtubules and microtubule-associated proteins, as well as the major regulatory molecules, such as cyclins and cyclin-dependent kinases (CDKs). During a normal cell cycle, the progression of G2 cells to M phase is triggered by the activation of MPF, whose activity is predominantly regulated by the phosphorylation/dephosphorylation of Cdc2, as well as the synthesis, degradation and subcellular localization of cyclin B1. Activated MPF is important for the disintegration of the nuclear envelope, separation of the centrosome, assembly of the spindle, condensation of the chromosome and fragmentation of the Golgi apparatus. Furthermore, MPF contributes to the regulation of the anaphase-promoting complex/cyclosome, the core of the ubiquitin-dependent proteolytic pathway that controls the timely degradation of mitotic regulators, including the inhibitors of anaphase onset (securins) and cyclins (23). Thus, cells with activated MPF progress to the M phase, while cells with inactivated MPF are arrested during the G2 phase, preventing them from entering mitosis (24,25). The primary signal for the inactivation of MPF is the destruction of cyclin B (26,27). Previous studies have found that the M/G1 transition requires the degradation of cyclin B1 (28,29). Therefore, high levels of cyclin B trigger cell cycle arrest during the M phase; however, they also prevent cell division (25,30). In the present study, it was found that SGC-7901 cells treated with 0.5 µM ABZ for 18 h showed an increase in the nuclear accumulation of cyclin B1. Furthermore, treatment of SGC-7901 cells with various concentrations of ABZ (0.25–1.0 µM) for 24 h dose-dependently led to increased expression of cyclin B1, which may be a plausible reason for the M-phase arrest observed. However, no significant change in the expression of Cdc2 was be observed under the same conditions. Further study is therefore warranted to explain this phenomenon.

Microtubule inhibitors have been found to be strongly associated with apoptosis due to the arrest of abnormal cells in the normal cell cycle (31). The findings of the present study suggested that, in addition to blocking the cell cycle in GC cells, ABZ also induced apoptosis, as indicated by the positive annexin V-PI staining of cells. The caspase cascade, which has a central role in cell apoptosis, is controlled by certain molecules, including the Bcl-2 family of proteins, which is divided into two: i) The inhibiting proteins Bcl-2 and Bcl-xL and ii) the stimulating proteins Bax and Bad (32). Variation in the Bcl-2/Bax ratio in cells is reflective of the apoptotic status, with an anti-apoptotic state being associated with a high ratio, whereas a pro-apoptotic state is favored when this ratio is decreased (33–35). Therefore, the present study monitored the changes in expression levels of cleaved caspase-3 and members of the Bcl-2 family at 48 h after incubation with ABZ. The protein expression levels of Bax increased in a dose-dependent manner, while levels of the Bcl-2 and Bcl-xL proteins decreased. Furthermore, the ratio of Bcl-2/Bax proteins also decreased in a dose-dependent manner. However, Bad expression remained low and not significantly affected.

In conclusion, the findings of the present study indicated that the anthelmintic drug ABZ has the capacity to inhibit the proliferation of certain GC cell lines through the disruption of microtubule formation and normal activity, leading to the arrest of the cells during the M phase. Mitotic arrest was associated with the marked accumulation of cyclin B1 and the consequent triggering of apoptosis at the G2/M phase of the cell cycle. Furthermore, apoptosis was found to be regulated by proteins of the Bcl-2 family. Therefore, the present study demonstrated in vitro that ABZ has potential for the treatment of GC cells, which, however, remains to be verified in vivo. Finally, since a number of chemotherapies are limited by multi-drug resistance (36), future studies by our group will explore the full-scale anti-tumor mechanism of ABZ, its effects in vivo and its effect on multi-drug resistance protein.