PROJECT SUMMARY
Despite recent advances in cancer therapies, platinum-based drugs are still widely used for the
treatment of solid tumors. A primary example is cisplatin, which is frequently used to treat lung,
bladder, testicular, and cervical cancers. However, limitations of this therapy include the development
of drug resistance in cancer cells as well as severe side effects, such as nephrotoxicity and
neurotoxicity. One major type of peripheral sensory neurotoxicity is ototoxicity, or drug-induced
damage to the inner ear, and cisplatin is the most ototoxic compound that can cause bilateral and
irreversible hearing loss. While DNA damage by cisplatin is the major cytotoxic mechanism in cancer
cells, cisplatin-induced ototoxicity appears to result from toxic levels of reactive oxygen species and
other signaling dysregulation within various cellular compartments. A variety of agents have been
tested against cisplatin-induced ototoxicity, mainly based on their antioxidant properties. However,
many of them show limited efficacies, and also interfere with the therapeutic effect of cisplatin. In our
preliminary studies, we have found that tetrandrine (TET), a compound isolated from the herb
Stephanai tetrandra, can protect against noise-induced hearing loss. Previous studies have also
revealed that TET can act synergistically with other cancer treatments in several important aspects:
increasing tumor cell cytotoxicity, enhancing radiosensitization, reducing multidrug resistance, and
inhibiting angiogenesis. At the molecular level, TET can block calcium channels, downregulate
multiple drug-resistant proteins, and modulate signaling pathways important for the inflammatory
response. Based on these findings, we propose a proof-of-concept project to test whether TET can
synergistically work with cisplatin to induce cancer cell death and, at the same time, prevent cisplatin-
induced ototoxicity. Because lung cancer is the leading cause of cancer-related death globally, and
because cisplatin is widely used to treat this disease, we will be focusing on lung cancer cell lines for
this study. We will first study the cytotoxic effects of TET and cisplatin in three lung cancer cell lines
and one cochlear cell line, and determine whether TET and cisplatin have synergistic effects when
used in combination against these cancer cells while TET has no ototoxic effects on the cochlear cell
line (Aim 1). We will then determine whether the TET can prevent cisplatin-induced ototoxicity in vivo
while preserving or enhancing anti-tumor efficacy (Aim 2). Our project goal is to develop a new
product to combine with cisplatin against lung cancer. This project will generate data important for
developing new approaches to reduce cisplatin-induced ototoxicity.