Reversal of the multidrug resistance by drug combination using multifunctional liposomes

One of the major obstacles to the success of cancer chemotherapy is the multi-drug resistance (MDR) that results due mainly to the over-expression of drug efflux transporter pumps such as P-glycoprotein (P-gp). Highly efficacious third generation P-gp inhibitors, like tariquidar, have shown promising results against MDR. However, P-gp is also expressed in normal tissues like the blood-brain barrier, gastrointestinal tract, liver and kidney. It is therefore important to limit the exposure of P-gp inhibitors to normal tissues and increase their co-localization with anticancer agents in tumor tissues to maximize the efficacy of a P-gp inhibitor. To minimize non-specific binding and increase its delivery to tumor tissues, liposomes, self-assembling phospholipid vesicles, were chosen as a drug delivery vehicle. The liposome has been identified as a system capable of carrying molecules with diverse physicochemical properties. It can also alter the pharmacokinetic profile of loaded molecules which is a concern with both tariquidar and paclitaxel. Liposomes can easily be surface-modified rendering them cell-specific as well as organelle-specific. The main objective of present study was to develop an efficient liposomal delivery system which would deliver therapeutic molecules of interest to tumor tissues and avoid interaction with normal tissues. In this study, the co-delivery of tariquidar and paclitaxel into tumor cells to reverse the MDR using long-circulating cationic liposomes was investigated. SKOV-3TR, the resistant variant of SKOV-3 and MCF-7/ADR, the resistant variant of MCF-7 were used as model cell lines. Uniform liposomal formulations were generated with high incorporation efficiency and no apparent decrease in tariquidar potency towards P-gp. Tariquidar- and paclitaxel- co-loaded long-circulating liposomes showed significant re-sensitization of SKOV-3TR and MCF-7/ADR for paclitaxel in vitro. Further modification of these liposomes with antitumor 2C5 resulted in increased cell association with these cancer cells. The 2C5-modified immunoliposomes, along with unmodified liposomes co-loaded with tariquidar and paclitaxel were tested for their antitumor effects in vivo. Significant tumor growth inhibition occurred with combination therapy in resistant as well as sensitive cell lines. However, immunoliposomes failed to increase antitumor effect in vivo as spontaneous accumulation of liposomes at added dose may have saturated tumor accumulation.;We were also interested in evaluating physiological factors responsible for the MDR. Spheroids grown in vitro provided platform to demonstrate many characteristics of tumor tissues such as cell-cell interaction, a hypoxic core, low pH environment at core and a relevant genetic profile. In this study, spheroids were utilized to evaluate paclitaxel cytotoxity and to evaluate effects of 2C5 modification on cellular uptake. Lack of cytotoxicity was observed in spheroids treated with paclitaxel alone as well as in combination with tariquidar. Likely explanations could be the presence of cells in diverse cell cycle stages and limited penetration. Also, increased uptake was observed in spheroids when treated with 2C5-modified Rh-labeled liposomes compared to UPC10-modified Rh-labeled liposomes. Such results have clearly demonstrated the importance of using this novel research model in cancer research.