Hyperoside, also known as quercetin 3-O-beta-D-galactopyranoside, has recently received a lot of attention for its anticancer, anti-inflammatory, antioxidant and organ protective activities. In particular, hyperoside can inhibit cell growth by inducing cell apoptosis and cell cycle arrest in several cancer cells [14–19]. However, the exact mechanism of its antitumor effects remains unclear. Some studies attributed this effect to the PI3K/Akt signaling pathway, but others suggested that MAPKs, Fas or NF-κB were also involved in its antitumor activities [9, 10].
Unscheduled proliferation is a hallmark of cancer. Akt and MAPK signaling pathways regulate cell proliferation, survival and differentiation at different transition points, which have a profound impact on the development of various cancers. It is well established that hyperactivation of Akt kinases is a common event in many human cancers, including bladder cancer [20], leading to tumor cell survival and enhanced resistance to apoptosis through multiple mechanisms [21]. Overexpression of upstream activators, including epidermal growth factor receptor (EGFR; also known as ERBB1), ERBB2 and/or ERBB3, are associated with grade, stage and outcome in subsets of bladder cancer, and EGFR induces PI3K/Akt activation via RAS activation [22, 23]. In our study, hyperoside activated the EGFR-Ras signaling and induced the phosphorylation of Akt at Ser473 in T24 bladder cancer cells, thereby promoting cell proliferation and preventing cell apoptosis.
Unlike Akt, MAPKs have cell type- and context-dependent actions in different cancers, with ERK inhibiting apoptosis and increasing cell proliferation, while JNK and/or p38 are c-Jun/AP-1 and/or p53-mediated apoptotic regulators [24]. However, the role of MAPK signaling and its relationship to key mutations in bladder tumors remain unclear. Current data suggest that the majority of bladder cancers may be highly dependent on ERK [25], while both FGFR3 mutations and PIK3CA mutations commonly cooccur in NMIBC, suggesting synergistic activation of MAPK and PI3K pathways [26, 27]. Our data showed that all three MAPKs were phosphorylated by hyperoside induced upstream signals in T24 bladder cancer cells. Taken together, hyperphosphorylated Akt and ERK by the upregulation of EGFR-Ras expression might promote cell proliferation and resist apoptosis, but phosphorylation of JNK and p38 by the activation of Ras or Fas signaling could promote cell cycle arrest and apoptosis conversely.
Previous studies [9, 10] only focused on and verified the involvement of a single pathway in several cancer cell lines and have not systematically analyzed the role of hyperoside using quantitative proteomics and bioinformatics analysis. In fact, the addition of drug to cells can cause changes in a variety of cellular pathways, eventually resulting in a certain phenotype in a specific cellular and environmental context. In our study, hyperoside induced cell cycle arrest and only a small amount of apoptosis in bladder cancer cells, mainly as a result of the phosphorylation of JNK and p38. The inconspicuous cell apoptosis may be related to the antiapoptotic effects of the phosphorylation of Akt and ERK. Since the hyperactivation of Akt and ERK is already present in most bladder cancers [20, 25], the phosphorylation of Akt and ERK by hyperoside might not significantly enhance their activity further, which could explain why they do not dominatet in the story of hyperoside.
Although adjuvant therapy can improve treatment outcomes, especially with the great advances in the development of combined therapeutics such as immune checkpoint inhibitors PD-1/PD-L1 inhibitor combined chemotherapy or antibody-drug conjugates (ADCs) or CTLA-4 inhibitors [4, 28], advanced and metastatic bladder cancer can develop resistance to these drugs when treated for a period. Therefore, identification of novel targets and development of effective drugs are urgently needed for bladder cancer treatment. Natural products, especially flavonoids, are an abundant source for screening antitumor drugs due to their remarkable efficacy and low toxicity [6]. Our results indicated that hyperoside not only inhibited the proliferation of bladder cancer cells in vitro, but also suppressed the tumorigenesis of bladder cancer in vivo. Molecularly, well-known cell cycle arrest markers, including cyclins and phosphorylation of CDKs and Rb proteins, were significantly reduced by hyperoside treatment, suggesting that hyperoside might exert its antitumor effects by inducing cell cycle arrest. Moreover, caspase-3 activation plays a central role in apoptosis by cleaving intracellular proteins vital for cell survival and growth, such as PARP [30, 31], leading to the completion of apoptosis and reinforcing the anticancer abilities of hyperoside in bladder cancer cells.