Aminophenoxazinones are degradation products resulting from the metabolism of different plant species, which comprise a family of natural products well known for their pharmacological activities. Aminophenoxazinones are tricyclic structures with double bonds in aromatic systems containing oxygen and nitrogen atom, which facilitates the development of synthetic derivatives to enhance the properties of these molecules. Aminophenoxazinones possess a number of promising properties like anticarcinogenic, antifungal, antiparasitic, antibacterial or antimicrobial activities.
First of all, we should highlight the study that Che et al. (2011) carried out to evaluate the cytotoxicity of Phx-3 on different types of cancer cells, such as MCF-7, A431, KCP-4, A549, KLM-1, MIA PaCa-2, ACHN, LoVo-1, U251MG and Y-79 lines [57]. In the case of ACHN (renal carcinoma), Liu et al. (2008) had already reported modest cytotoxic activity generated by Phx-3, as well as for a methylated and acetate derivative of this aminophenoxazinone [76]. Attending at IC50 values, the sensitivity of the mentioned cancer cell lines after 72 h of treatment with Phx-3 showed how almost all of them were vulnerable to Phx-3 at 10 µM (IC50 lower than 8 µM). KLM-1, Lovo-1 and Y79 lines were the exceptions (IC50 close to 20 µM). The normal cell lines HEL (embryonic pulmonary fibroblast) and HUVEC (umbilical cord) were also tested, being obtained high IC50 values (over 50 µM and 16 µM, respectively), which indicates that these cells are less sensitive to Phx-3 than cancer cells.
Regarding the pHi decrease, significant results were obtained for all cancer cell lines (reduction of 0.22-1.00 units at 20 µM, and 0.64-1.20 units at 100 µM), being comparable to those of the normal lines. The decrease was proved dose-dependent for MCF-7 (breast cancer) and A431 (skin cancer) cell lines for 30 min and ranging between 0 and 100 µM. Therefore, it can be concluded that the use of Phx-3 causes drastic acidification of cancer cells, which in turn induces their apoptosis [77]. Phx-3 would be a suitable drug for the treatment of cancer, as it causes drastic decreases in pHi (by more than 0.6), and induces apoptosis and cytotoxic effects on cancer cells without significant adverse effects.
MCF-7 and A431 lines were further evaluated to provide conclusions of the mechanism of action of Phx-3, attending at the reduction of the mitochondrial membrane potential (first and irreversible step towards apoptosis). The population of both MCF-7 and A431 lines, determined as their decrease in mitochondrial potential, increased as a direct function of both time and concentration of Phx-3. According to these data, and considering the reduction of the pHi value in both cell lines, it can be concluded that the apoptosis of MCF-7 and A431 cells could be preceded by the early acidification caused by Phx-3.
In other study, the cytotoxic and pro-apoptotic effects of Phx-3 on hepatocellular carcinoma dRLh-84 (rat) and HepG2 (human) cell lines, and the normal hepatocellular RLN-10 (rat) cell line have been studied [61]. Phx-3 reduced the number of viable cells in the three lines by a dose-dependent degree, being 2 µM enough to induce apoptosis by nuclear condensation and cell shrinkage. Moreover, Phx-3 combined with 2-deoxyglucose significantly enhanced apoptosis, but, on the other hand, some adverse effects were observed on normal liver cells. More recently, the combined treatment of Phx-3 with sorafenib was demonstrated to suppress the formation of hepatocellular carcinoma on in vivo studies. Phx-3 was reported as suppressor of the expression of GRP78, target protein directly related with different cancer cell lines, in HepG2 cells [78]. It must be noted that Phx-3 is named as questiomycin A in this last article.
The list of cancer lines with cell whose growth can be inhibited by Phx-3 may be completed with HeLa (cervical cancer, IC50 = 12.09 ± 3.29 µM) [35], U266 (myeloma), HL-60 (acute myeloid leukemia) and A549 (lung adenocarcinoma) lines[71]. The study of Moriya et al. (2011) was also focused on the pro-apoptotic transcription factor CHOP, being suggested that the regulation of its expression could represent a major target for treatments. So, in the case of U266, the activity of Phx-3 was enhanced by its combined application together with an inhibitor of NF-κB, a transcription factor related to the inhibition of CHOP.
Phx-1 (Figure 3) is an aminophenoxazinone with anticancer activity, obtained from the reaction of 2-amino-5-methylphenol with bovine hemoglobin [79]. The in vitro studies that have been conducted on this compound are similar to those previously described for Phx-3 [57].
Regarding the pHi reduction in MCF-7 and A431 cancer cell lines, similar or rather close results as those from Phx-3 were observed at the lowest concentrations (5-10 µM) were applied. However, Phx-1 proved to be significantly less active than Phx-3 at 50 µM, and concentration had to be increased up to 100 µM for any major differences to appear in the A431 line.
The study of Phx-1 on diverse cell lines (the same previously mentioned in the first paragraph of section 3.1), revealed that this compound achieves significant pHi reductions, but not as high as those attained by Phx-3. Thus, Phx-1 reached 0.01-0.16 at 20 µM and 0.11-0.59 at 100 µM, whereas Phx-3 achieved 0.22-1.00 at 20 µM and 0.64-1.20 at 100 µM. In both cases, the normal cell lines tested (HEL and HUVEC) suffered an equally significant decrease in pHi, comparable to that suffered by cancer cells.
The data obtained in relation to the cytotoxic effects of Phx-1, compared with those of Phx-3, revealed that the cytotoxicity generated by Phx-1 on all the tested cell lines was much lower (the most sensitive cancer line was MCF-7). These results are in agreement with the pHi changes undergone by the cells treated either Phx-1 or Phx-3 that have been summarized in the previous paragraph. This could represent a certain advantage regarding cancer treatment, since healthy cells would suffer a lesser damage.
Although the IC50 value of Phx-1 for Y-79 cells (retinoblastoma, eye cancer) is the highest, previous studies[80] showed in vivo antitumor effects in cells transplanted into mice whose strain suffers from a genetic mutation that causes the deterioration or lack of the thymus (organ where T cells mature). Phx-1 induced in vivo apoptosis to Y-79 in mice without any type of adverse effect even at high doses. These favorable signs make of Phx-1 a suitable candidate for the development of drugs for the treatment of retinoblastoma. In general, although Phx-1 is not highly effective, it could facilitate the induction of apoptosis and exert a cytotoxic effect on cancer cells.
It is worth highlighting that Phx-1 inhibited the proliferation and induced the apoptosis of diverse human leukemia cell lines (K562, HL-60 and HAL-01) in a dose-dependent manner. This study also proved that Phx-1 reduced in vivo the tumor growth rate in mice, whereas just few adverse effects were found on weight loss and white blood cell [81].
Once confirmed the ability of Phx-1 and Phx-3 to induce the apoptosis of diverse cancer cell lines, Tabuchi et al. (2011) studied the effects of these compounds to induce apoptotic cell death in human neutrophils, as this kind of cells are related with the mitochondrial depolarization and reduction of pHi. Both aminophenoxazines caused apoptosis or the loss of the morphology of neutrophils, while lymphocytes and monocytes did not undergo this process. These results would suggest that Phx-1 and Phx-3 are specific drugs to induce apoptotic cell death of neutrophils, being potential preventive anti-inflammatory drugs[58].
The antitumoral activity of Phx-1 and Phx-3 on NB-1 (neuroblastoma cell line) was demonstrated by another study. It was thereby confirmed that both aminophenoxazinones induced apoptosis and necrosis, being the IC50 value of Phx-3 much lower (0.5 µM vs. 20 µM)[82].
From the structural point of view, the differences in the bioactivity exhibited by Phx-1 and Phx-3 would be associated to the methyl group in Phx-1, even this premise is still to be confirmed. Molecular dynamics simulations could cast some light on the solubility of these compounds in cell membranes, which would allow to determine how much their structural differences affect cross-membrane processes and, thereby, explain the differences in their activity levels. In this line, certain recent studies have proven that the replacement of hydroxyl groups by fluorinated esters (in the eudesmanolide structure), improves the cytotoxicity of these compounds to cancer cells (HeLa, cervical cancer)[83].
Recent studies have tested the activity by different derivatives with an indole group on different cancer cell lines. Indole groups are heterocyclic compounds formed by a benzene atom linked to a pyrrole compound, that have a pair of free electrons in the nitrogen atom of their aromatic ring. It is a fairly common component in perfumes, drug candidates and hormones (like melatonin)[84]. Some natural indole alkaloids, such as vincristine (Figure 5), has been accepted in USA by the Food and Drug Administration (FDA) as antitumor drugs[85].
Figure 5. Structures of indole, the anticancer drug vincristine and the most active indole derivatives.
Taking into account the potential pharmacological effects of indoles, as well as those already recognized of phenoxazines and the synergistic effects exhibited by some pharmacophoric hybrids[86], Nunewar et al. (2020)[87] suggested that certain hybrids formed by two of these groups would possess some proliferative effect by operating as DNA exchangers. The general proposed mechanism consists of a first transfer of the molecule to the hydrophobic space between two adjacent DNA base pairs. As consequence, DNA would undergo conformational changes, in order for the molecule to accommodate itself between the base pairs. The resulting complex prevents DNA replication, which would lead to the death of the cell, being these results especially useful for the treatment of rapidly growing cancer cells.
Therefore, the cytotoxicity of certain indol derivatives was tested by Nunewar et al. (2020) on A549 (lung), MG-63 (bone), BT-474 (breast), Hep G2 (liver) and HCT116 (colon) human cancer cell lines, along with a normal line of lung epithelial tissue (L-132). All the derivatives tested showed remarkable IC50 values. The most inhibited cell line was A549, by the derivative 2 (IC50 = 3.71 ± 0.57 µM), characterized by two isopropyl substituents (Figure 5), and followed by compound 3 (IC50 = 4.43 ± 0.64 µM). In addition, 2 was the only derivative with the previously explained DNA intercalation capacity. These results confirm that hybrid compounds are a promising alternative for the search of new anticancer drugs.
Also in 2020 a number of studies were conducted on a series of pyridophenoxazinones (which possess intercalating capacity, and for generating free radicals that induce cell death by oxidative-stress) conjugated with the amino acid L-lysine, which were designed and synthesized with the aim of developing novel drug compounds with anticancer potential. Similarly to those describe in the previous section, these studies focused on the ability of the compounds to intercalate between the base pairs of nucleic acids. Thus, synthetized derivatives contained a basic side chain of L-lysine in the positions 9 or 10, and the N-terminal group of L-lysine was linked to the chromophore through an amide bond (Figure 6).
Figure 6. Structure of the pyridophenoxazinone derivatives conjugated to L-lysine.
Products 4-7 and 4’-7’ were tested on cancer cell lines of leukemia (CCRF-CEM, CCRF-SB and MT-4), colon (HT-29), breast cancer (MCF-7), cervical cancer (HeLa), papillary renal cell carcinoma (ACHN), and melanoma (SKMEL-28 and G-361). All the products inhibited the proliferation of a panel of human liquid and solid neoplastic cell lines, the latter being more sensitive to antiproliferative effects (only compound 7 showed similar activity in both states). The IC50 values of the derivatives with the L-lysine side chain attached to C-10 were higher than their corresponding derivative functionalized at C-9. The IC50 values of 4-7 were comparable to that of AMD and even lower than those of Doxo and VP-16 (commercial drugs). It is worth highlighting the lowest values of IC50, all in the range of 0.001-0.007 µM, achieved by 4 and 7 for HT-29, SKMEL-28, MCF-7 and G-361 lines. Authors proved that both compounds are strong DNA intercalators, and possess the capacity to selectively target the topoisomerase Topo IIα.
The difference in activity between the two series of derivatives was related to structure-activity correlations. Thus, the position of the nitrogen atom in D-ring would play an important role in the antiproliferative activity, whereas the position of the L-lysine side chain and the type of amine groups affect the cytotoxic activity both between the two series and within each series.
All the mentioned properties indicate that this new series of pyridophenoxazinones conjugated to L-lysine have a great antitumor therapeutic potential. Products 4 and 7 in particular, provide really interesting opportunities for the development of new DNA-targeting anticancer drugs.