Ethanol potentiates doxorubicin-induced inhibition of cell survival in cultured Chinese hamster ovary cells.

Doxorubicin is an antineoplastic drug which undergoes oxidation-reduction cycling and produces toxicity to some cancer cell lines. Since oxidation-reduction cycling requires reducing equivalents and because ethanol metabolism via alcohol dehydrogenase (ADH) increases NADH, the effect of ethanol on doxorubicin toxicity was examined in cultured cells. Since some cells exhibit resistance to anthracyclines such as doxorubicin, two different Chinese hamster ovary cell lines were used, one sensitive (AUX B1) and one resistant (CHRC5) to doxorubicin. Studies were designed to determine if ethanol could decrease resistance to doxorubicin. Cells were treated for 24 h with doxorubicin in the presence or absence of ethanol, and the number of live cells was estimated spectrophotometrically. Ethanol (60-150 mM) potentiated the doxorubicin-induced decrease in cell number in both cell lines. In AUX B1 cells the concentration of doxorubicin required for half-maximal inhibition of cell survival was reduced 20-fold by ethanol, and a completely nontoxic concentration of doxorubicin decreased the number of surviving cells to 30% in the presence of ethanol. Addition of ethanol to the medium also increased doxorubicin-induced inhibition of cell survival in CHRC5 cells, but the effect was less dramatic than in AUX B1 cells. The effect of ethanol on cell number was concentration related; the half-maximal response was observed with about 1 mM ethanol. The hypothesis that ethanol potentiates doxorubicin toxicity by generation of NADH during metabolism by ADH was strengthened by the observations that both cell lines possess ADH activity (30-400 units/10(12) cells) and that ethanol (0.1-0.5 mM) increased NADH fluorescence 15-80% over basal values in cultured cells. Further, the effect of doxorubicin on cell number was also potentiated by another substrate for ADH, 2-ethylhexanol. Desferrioxamine, an iron chelator, increased survival in cells treated with doxorubicin plus ethanol by up to 60% (half-maximal effect, 1 mM), and (+)-catechin, a radical scavenger, abolished the decrease in cell number due to doxorubicin plus ethanol at concentrations greater than 0.1 mM. Allopurinol, an inhibitor of xanthine oxidase with radical scavenging properties, diminished the effect of doxorubicin plus ethanol on cell number by 60% (P less than 0.05). Taken together, these data are consistent with the hypothesis that ethanol potentiates toxicity due to doxorubicin by providing reducing equivalents for oxidation-reduction cycling which produce toxic reduced oxygen species.