Choroidal melanoma is a serious metastatic malignant melanoma with poor prognosis. Common treatments for choroidal melanoma offer only temporary relief and are ineffective in inhibiting tumour metastasis or improving the survival rate[17]. Thus, exploring new treatment strategies is important for improving the prognosis of choroidal melanoma patients[7].
LiCl has been safely used in the clinic for the treatment of psychiatric disorders for several decades[18]. LiCl has also been reported to exhibit antitumour effects in various cancers[11]. As a GSK3β inhibitor, the most robust antineoplastic effect of lithium is related to GSK3β[19]. However, one study showed that LiCl exerts antitumour effects that are independent of GSK3β[12]. The present study investigated whether LiCl exhibited antitumour effects in choroidal melanoma cells and demonstrated the underlying molecular mechanism.
In this study, we evaluated the effect of LiCl on choroidal melanoma cell survival and colony formation and provided a potential mechanism. We analysed the cytotoxicity of LiCl against choroidal melanoma cells and found that LiCl displayed a concentration- and time-dependent inhibitory effect on the survival of choroidal melanoma cells. Furthermore, the number of colonies formed notably declined with increasing concentrations of LiCl. Flow cytometry analysis revealed that LiCl induced apoptosis in choroidal melanoma cells in a concentration-dependent manner. Subsequently, it was demonstrated that the levels of the cleaved forms of apoptosis-associated proteins were distinctly increased both in a dose- and time-dependent manner following LiCl treatment of OCM1 and M619 cells. These results revealed that LiCl exerts anticancer effects by decreasing cell viability, inhibiting colony formation, and inducing caspase-dependent apoptosis in choroidal melanoma cells.
Apoptosis, known as programmed cell death, suppresses carcinogenesis in normal cells due to various genes[20]. As an anti-apoptotic protein, Mcl-1 belongs to the BCL-2 family, which is closely connected to inhibitions of mitochondrial apoptosis[21]. Blocking Mcl-1 makes tumour cells more susceptible to anticancer agents[22]. NOXA, a BH3-only protein in the Bcl-2 family, has been reported to participate in chemotherapy-induced apoptosis in melanoma[23]. Interactions between Mcl-1 and NOXA regulate the mitochondrial apoptotic pathway[24]. In the present study, we found that after LiCl treatment, the level of Mcl-1 was obviously decreased, while the protein NOXA was upregulated in a concentration- and time-dependent manner. We found that Mcl-1 overexpression dramatically weakened LiCl-induced cleavage of apoptosis-associated proteins and impaired apoptosis after drug treatment. These results demonstrated that the NOXA/Mcl-1 axis may contribute to LiCl-induced intrinsic mitochondrial apoptosis in choroidal melanoma cells.
GSK3β plays multiple roles in different cancers, but its importance is still controversial[25]. Promotion of GSK3β inactivation by LiCl sensitizes both hepatoma and prostate cancer to TRAIL-induced apoptosis[26]. However, the study indicated that LiCl significantly enhanced cell apoptosis in non-small cell lung cancer by upregulating the death receptors DR4 and DR5, and LiCl sensitized cells to TRAIL-induced apoptosis independent of GSK3β[12]. Therefore, further studies are required to understand whether GSK3β participates in LiCl-induced ER stress and intrinsic apoptosis also needs further research.
To further investigate whether LiCl could affect tumorigenesis, we transplanted M619 cells into nude mice and found that xenograft tumour growth in the LiCl group was significantly slower than that in the control group. At 15 days after inoculation, tumour size and weight were dramatically decreased in the LiCl group. Ki-67, a nuclear protein, is widely used as a tumour proliferation marker. Our study showed that the number of Ki67-positive cells from the xenograft tumours also declined in the LiCl group. Furthermore, LiCl treatment significantly induced Mcl-1 expression and upregulated the NOXA level in M619 cell-based xenografts. In summary, LiCl prevents xenograft tumour growth in mice, and the NOXA/Mcl-1 axis is associated with this effect.
A previous study showed that cell apoptosis may be induced by ER stress and mitochondrial membrane permeability[27, 28]. CHOP, a key protein of ER stress-mediated cell death, also known as a bZIP-containing transcription factor, targets many apoptotic genes, including NOXA, modifying their expression and ultimately resulting in apoptosis[29]. Therefore, to evaluate whether the PERK/eIF2α/ATF4/CHOP signalling pathway was involved in LiCl-induced apoptosis, we examined p-eIF2α, eIF2α, ATF4 and CHOP levels, and the results showed that p-eIF2α, ATF4 and CHOP were upregulated in a concentration-dependent manner following treatment with LiCl. Additionally, we examined the expression of IRE1α and Bip, two other molecules involved in ER stress, and the results showed that both were upregulated by LiCl in a concentration-dependent manner. These data indicate that the anticancer effect of LiCl in choroidal melanoma cells was mediated by activation of the ER stress pathway, but further investigation is required to determine whether ER stress participates in LiCl-induced apoptosis and whether CHOP is involved in LiCl-induced NOXA upregulation.