Many side effects have been observed in common therapies such as chemotherapy, and radiotherapy which are the reasons for more interest toward research in the field of herbal medicine (
12-
14).
According to CANCER RESEARCH UK, herbal medicine is one of the most commonly used alternative therapies and conventional allopathic medicine (CAM) by those who suffer cancer. Some studies have shown that 60% of people use herbal remedies alongside other cancer treatments. Effective compounds in the treatment of cancer derives from plants, marine organisms or micro-organism. Emodin is an example of these compounds highly used in cancer studies. Previous studies have proved that emodin has anticancer activity and induces apoptosis (
5,
15,
16).
In the present study, the effects of emodin on growth and proliferation of SKBR3 cell line were examined. The results confirmed that emodin has anticancer effects with concentration of 25 µM as IC
50 in SKBR3 cells (
Figure 1). Besides, our results reveal that inhibitory effects of emodin on tumor cells is in a time- and dose-dependent manner.
Induction of apoptosis is among major processes through which cytotoxic drugs destroy tumor cells (
17). As a result, cancer therapies have focused on this strategy (
18). Apoptosis is a programmed cell death which can be induced by either intrinsic or extrinsic pathway. In this study, the mRNA expression levels of Capsase3, Caspase 8, Caspase 9, Bax and Bcl2 genes which are involved in apoptosis were investigated. All gene expressions were normalized to ABL (reference gene).
The results showed that the mRNA levels of Caspase 3, 8 and 9 were increased in SKBR3 Cells after treatment with emodin for 48 hours (
Figure 2). Caspases are key factors in apoptosis. Caspase 3 is an executive caspase in both intrinsic and extrinsic pathways. Caspase 8 is an initiator caspase in extrinsic and Caspase 9 is an initiator caspase in intrinsic pathway. Various studies have also come to the same results. In prostate cancer cell line, LNCaP, emodin induced apoptosis of LNCaP cells through the upregulation of caspase-3 and -9 (
19). In addition , the mRNA expression of Caspase-9, -8 and -3 increased significantly after treatment with emodin for 48 hours and the up-regulation exhibited an emodin dose-dependent pattern in human cervical cancer hela cells (
18). Furthermore, emodin promoted cell apoptosis of the gemcitabine-resistant SW1990 pancreatic cancer cell line through the increase of the expression levels of caspase-9 and -3 (
19). In our study, emodin up-regulated Caspase 3, 8 and 9 genes expression and could prevent the growth of SKBR3 cells through both intrinsic and extrinsic apoptosis pathways whereas it just stimulated the intrinsic apoptosis pathway in some cancer cell lines such as prostate cancer cell line, LNCaP, gemcitabine-resistant SW1990 pancreatic cancer cell line, human lung adenocarcinoma A549 cells.
Bcl-2 is an anti-apoptotic activator that inhibits the releasing of cytochrome c from the mitochondria in an intrinsic pathway. Bax is an apoptosis activator and triggers the release of cytochrome c and Smac-diablo (
20). Our results have indicated that emodin is able to, at the same time, increase bax (encoding the pro-apoptotic protein Bax) expression and down -regulate bcl-2 (encoding the anti-apoptotic protein Bcl-2) expression (
Figure 4). These results are in line with previous studies. Emodin induced apoptosis of LNCaP cells through the alterations in expression of Bax and Bcl2 genes which had the same result as ours (
21). In another study, the increased Bax concurrent with the decrease of Bcl-2 indicated that emodin induces apoptosis in human chronic myeloid leukemia K562 cell lines (
22). Furthermore, emodin induced a significant increase in the Bax expression level and a marked reduction of the Bcl 2 expression level in LOVO colorectal cancer cells (
23). In this study, the ratio of Bax/Bcl2 was increased (
Figure 4). According to previous studies, this ratio is considered as a predictive marker for response to cancer therapies and cancer prognosis (
24-
26). In the current study, induction of programmed cell death was also confirmed by flow cytometry (
Figure 2). The data of flow cytometry analysis was in complete agreement with the molecular research.
Based on our results, caspase 3 activity in SKBR3 cells was increased by emodin (
Figure 5). This result is consistent with our real time PCR result. This is also in line with previous studies. In one study, emodin caused rapid and transient induction of caspase 3 in HL-60 promyelocytic leukemia cell line. Moreover, emodin increased the activation of caspase-3 in human chronic myelocytic leukemia K562 cell lines. In another research, emodin-induced HK-2 cell apoptosis through the activation of caspase 3 in HK2 cells (
15,
22,
27).
5.1. Conclusion
In summary, emodin could induce apoptosis in SKBR3 cells through the modulation of expression of apoptosis-related genes Emodin treatment upregulated Caspase 3, 8, 9 and Bax gene expression but down-regulated the expression of Bcl2. According to our results, initially considered hypothesis is true. Both the intrinsic and the extrinsic apoptotic pathways might be involved in SKBR3 cells. However, further studies are necessary to understand the exact mechanisms of the activities of emodin.