Abstract
This study aims to determine whether usnic acid (UA) could induce the expression of apoptosis-related genes in apoptosis pathway. The current study has enabled us to better understand the target of UA in the treatment of breast cancer. Cell viability was determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. Based on the previous study and the results of this study, UA had the most antiproliferative effect on SK-BR-3 breast cancer cell line. We examined differential expression of 88 apoptosis-related genes by quantitative real-time polymerase chain reaction using the apoptosis primary library panel in SK-BR-3 breast cancer cell. We observed a difference in the significant differential expression of 74 apoptosis-related genes in breast cancer after SK-BR-3 cells applied to UA (7.21 µM) for 48 h. The expression level of 56 of these 74 differentiated apoptosis-related genes increased (
Introduction
Among noncommunicable diseases, cancer can be considered as unique and the most malignant disease that displays exponentially increasing incidence in recent years. 1 With the data from Globocan 2018, breast cancer is the most commonly diagnosed cancer for woman. 1 Breast cancer can be classified as Luminal A, Luminal B with HER-2 negative, Luminal B with HER-2 positive, HER-2 enriched, and basal-like (triple negative) according to the molecular structure. 2 Therapeutic approach should be designed regarding molecular structures of breast cancer subtypes. 3 Most of the developed and investigated therapeutic approach should not be considered as just one solution for breast cancer treatment. Therapeutic approaches are classified into radiation therapy, surgery, and systematic therapies, which consist of immunotherapy, chemotherapy, hormonal and target therapy. 3 Chemotherapy has been considered as the main solution of cancer treatment, but damage to healthy cells during treatment can cause many physical and psychological side effects on patients. For preventing drug resistance and increasing the side effect of the treatment, the cocktail of the chemotherapeutics has been used. 4 However, researchers have been investigating different methods and alternative drug molecules to reduce the side effects of chemotherapeutics.
Many alternative pharmaceuticals candidate molecules have also developed for cancer treatment in recent years. Hu et al. determined apoptosis and inhibitory effect of flaxseed (
The success of chemotherapy application for patients with late-stage metastatic breast cancer is dependent on cells being able to maintain their ability to undergo apoptosis. 17 However, tumor cells inherit the ability to avoid apoptosis, and this is an underlying molecular reason contributing to disease progression and chemotherapy resistance. 17 Development of therapeutic options that focus on apoptosis mechanisms is thus essential and crucial for cancer treatment. Since synthetic drugs have side effects on breast cancer treatment, natural compounds and apoptosis status have attracted much attention in recent years. Recent research studies were based on inhibiting the carcinogenesis through apoptosis of novel candidate molecules. 18
There are many studies that determine the apoptotic effect of UA. 10,11,15,16,19 –22 In these studies, the apoptotic effect of UA was generally determined by flow cytometry and Western blot methods, and in the literature there are no studies in which the apoptotic effect is defined on mRNA level of UA on breast cancer cells. We showed more reliable results by analyzing data based on gene expression modification after applied to UA on breast cancer by quantitative real-time polymerase chain reaction (qRT-PCR).
In this study, it was aimed to demonstrate the inhibitory proliferative activity of the UA on SK-BR-3 breast cancer and noncancerous breast epithelial cells (MCF-12A). Moreover, we also determined the gene expression level of 88 apoptosis-related genes on breast cancer cell line. This is the first article that fully screened the apoptosis pathway to determine the effect of UA on breast cancer cells. The results obtained from apoptosis primary library array are verified by Western blot analysis. By depending on the results, UA can be considered as a potential apoptosis-inducing agent and might be classified as a favorable drug candidate for breast cancer treatment.
Materials and methods
In previous study, the antiproliferative effect of UA was determined in BT-474, MCF-7, and MDA-MB-431 cells. 12 In this study, we evaluated the antiproliferative effect of UA on SK-BR-3 cancer cell and MCF-12A noncancerous breast epithelial cell. In order to develop a more detailed and effective treatment method based on UA on breast cancer, we determined the effect of UA on four different types of breast cancer subtypes.
Usnic acid
UA was obtained from Sigma (St. Louis, USA) and UA stock concentration (100 µM) was prepared in 0.1% dimethyl sulfoxide (DMSO) (v/v). Appropriate dilutions of stock solution (50, 25, 15, 12.5, 6.25, 3.125, and 1.562 μM) were made with DMSO.
Cell culture
Human SK-BR-3 breast cancer and MCF-12A noncancerous breast epithelial cell lines have been obtained from American Type Culture Collection (Manassas, Virginia, USA). The breast cancer cells were maintained in Dulbecco’s modified Eagle’s Medium (DMEM) (Sigma) supplemented with 10% fetal bovine serum (FBS) (Biological Industries, Israel) and 1% antibiotics (100 µg/mL penicillin and 100 µg/mL streptomycin) (Biowest, Nuaillé, France). MCF-12A noncancerous breast epithelial cells were cultured in DMEM Ham’s F12 (Sigma) with % 1 penicillin/streptomycin, 10 μg/ml insulin, 0.5 mg/ml hydrocortisone (PubChem, Washington, USA), 10% FBS, and 20 ng/ml epidermal growth factor (EGF, Goquick, Massachusetts, USA). Both cells were incubated at 37°C in a humidified atmosphere of 5% CO2.
Cell proliferation assay
The viability of cells was measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) method (Sigma). Cells (1 × 105) were seeded in 96-well plates and incubated for 24 h. Then different concentrations of UA (100, 50, 35, 25, 15, 12.5, 6.25, 3.125, and 1.562 µL) were added to each well for incubation at 37°C in 5% CO2 for 48 h. Nontreated cells were used as experimental controls. After 48 h, MTT solution was added to the plate (0.5 mg/mL final concentration), examined cells were incubated for 4 h. At the end of 4 h, 100 µL of DMSO has been added to each well. Absorbance level was measured as 570 nm by using microplate reader (PerkinElmer 1420 Multilabel Counter, Massachusetts, USA). The experiments were analyzed according to the mean ± standard deviation of the cell growth inhibition percentage and GraphPad Prism 7.01 program.
Total RNA extraction and cDNA synthesis
Cells (5 × 105 cells/well) were cultured in six-well plates and were treated with IC50 concentrations of UA for 48 h. SK-BR-3 breast cancer and MCF-12A noncancerous breast epithelial cells were harvested for total RNA extraction by using Genezol Reagent (Geneaid, Taiwan) following manufacturer’s protocol. RNA samples were measured using Nanodrop ND-1000 Spectrophotometer (Thermo Fisher Scientific, Illinois, USA) and RNA integrity was evaluated by 1% agarose gel electrophoresis. Reverse transcription process was performed by using NG dART Kit (EURx, Poland) following manufacturer’s protocol. The conditions for this step were determined as 10 min at 25°C initially, 30 min at 48°C for amplification step, and 5 min at 95°C for the final step.
qRT-PCR assay
cDNA samples have been used for further analysis of 88 human apoptosis library primers and were determined by RT-PCR system (Roche, OR, USA). PCR cycling conditions are determined as follows: 95°C for 10 min, for 40 cycles amplification 10 s at 95°C, 30 s at 60°C, and 8 s at 72°C. The expression levels of these 88 apoptosis-related genes were standardized to GAPDH housekeeping genes. ΔΔCt method was used for quantification.
23
All reactions were performed in triplicate. The data analyzed with analysis of variance test and value of
Western blot analysis
SK-BR-3 breast cancer cells were treated with IC50 concentrations of UA for 48 h. Cells were harvested and washed with cold phosphate-buffered saline. Proteins from cell pellets were isolated by applying lysis buffer, which contains 7 M urea, 2 M thiourea, 4% chaps, 1% DDT, 2% ampholyte, and supplemented with protease inhibitor. The percentages of the proteins were quantified by using BCATM Protein Assay Kit (Merck, Germany). By using 12% sodium dodecyl sulfate-polyacrylamide gel electrophoresis, equal amounts of protein obtained from each sample have been separated. Following the separation process, isolated proteins were transferred to nitrocellulose membrane (Thermo Fisher Scientific, Illinois, USA) and then blocked for 1 h using 5% nonfat milk. As control, membrane was incubated at 4°C including diluted anti-Bcl-2, Bax, Caspase-3 and Caspase-9 primary antibodies (Santa Cruz Biotechnology, Texas, USA) and GAPDH primary antibodies (Cell Signaling, Massachusetts, USA). Then, by using Tris-Buffered Saline Tween, membranes were washed for three times. After that step, membranes were incubated again at room temperature for 1.5 h with the application of horseradish peroxide conjugated secondary antibodies (Abcam, Cambridge, MA, USA). In the end of Western blot step, for visualization of the immunoreactive bands, chemiluminescence kit (Thermo Fisher Scientific, Illinois, USA) was used. The immunoreactive bands have been visualized and evaluated with ImageJ program version 1.41.
Results
Cell viability analysis
In order to determine the effect of UA, MTT assays were performed to four different breast cancer cell lines. We revealed the proliferative effect of UA on three breast cancer cells (BT-474, MCF-7, and MDA-MB-431) in our previous study.
12
Additionally, in this study, we included the SK-BR-3 breast cancer cell with different receptor status and noncancerous breast epithelial cell (MCF-12A). Thus, we determined the effect of UA with a detailed approach, using four breast cancer cells with different subtypes. In the result of the MTT assay, IC50 values have been determined as 13.11, 12.65, and 12.84 for MCF-7, BT-474, and MDA-MB-431, respectively, in the previous studies.
12
In order to determine and prove the effect of UA on SK-BR-3 breast cancer cell and MCF-12A noncancerous breast epithelial cells, MTT assay used for time- and concentration-dependent manner. It should be noted that the 6.25 and 12.5 μM concentrations of UA treatments after 48 h showed significant antiproliferative effects on the SK-BR-3 breast cancer cell line (

Effect of UA on the viability of the SK-BR-3 cancer cell line and MCF-12A noncancerous breast epithelial cell. Cells were treated with different concentrations of UA derivatives for 48 h. Each value is the mean (±SE) of three experiments performed in duplicate. Statistical significance was determined with ANOVA and is marked with *. After 48 h, three concentrations of UA (6.25, 12.5, and 25 μM) showed significant effect on SK-BR-3 breast cancer cell (*
Gene expression analysis
In the present study, we analyzed the expression of 88 genes (apoptosis primary library array) following treatment of SK-BR-3 breast cancer cell line with UA (Table A1 in the Online Supplemental Material). The seven genes in the apoptosis array primary library, BAG3, TRAF6, TNFSF7, TNFSF1, TNFSF15, ATM, and TP73L, showed no expression changes after application of UA.
As a result of this study, apoptosis-related genes were divided into six groups depending on the gene families. In Caspase family, seven upregulated (CASP1, CASP2, CASP3 (

UA induces apoptosis in SK-BR-3 breast cancer cells at mRNA level. The ratio of fold change has been determined by qRT-PCR assay. Relative fold change of (a) Caspase family consists 11 genes, 7 genes were upregulated and 4 genes were downregulated, (b) Kinase family, all of the 5 genes were upregulated, (c) Bcl-2 family, 7 genes were upregulated and 6 genes were downregulated, (d) TRAF family in which all of the genes were upregulated, (e) TNF family,18 genes were upregulated and 3 genes were downregulated, (f) different genes family, 15 genes were upregulated and 5 genes were downregulated. Results are statistically significant when *
BCL2 family consists of 13 genes, which are divided into two subgroups as 7 upregulated (BCL2L2, BCL10, BAK1, BAX, BOK, MCL1, and HRK) and 6 downregulated (BCL2, BCL2A1, BCL2L11, BAG1, BAG3, and BAG4) genes (Figure 2(c)). MCL1 mRNA level was significantly higher (fold change 13.91) in the SK-BR cell (
In the apoptosis array library, 21 genes belonging to the TNF family were determined after the expression of UA (TNF, TNFRSF11B, TNFRSF1A, TNFRSF21B, TNFSF6, TNFSF7, TNFRSF8, TNFSF8, TNFRSF9, TNFSF10, TNFRSF10A, TNFSF8, TNFRSF9, TNFSF10, TNFRSF10A, TNFSF10, TNFFFF TNFSF15, TNFSF4, CD40, FASLG, LTBR). In these genes, only the expression level of TNF, TNFSF7, and TNFRSF10D has been downregulated (Figure 2(e)). Among these genes, TNFSF8 gene showed significant upregulation with the fold change level of 21.44 (
For those which cannot be classified into a family, we grouped them as different genes. In different genes group, there are 20 genes, which consist of 15 upregulated (APAF1, ATM, BFAR, CARD4, BIK, CRADD, DFFA, DFFB, TP53, FADD, TP73L, GADD45A, RPA3, CIDEA, and CIDEB) and 5 downregulated genes (BRE, BIRC1, BIRC2, BIRC3, and BIRC5) (Figure 2(f)). After UA application on SK-BR-3 cells, GADD45A showed significantly highest up regulation (p < 0.05) (Figure 2(f)) among upregulated genes, while, BIRC2 was presented as most down regulated gene (p < 0.05) (Figure 2(f)) among all genes.
Western blot analysis
To determine the mechanisms underlying the apoptosis induced UA, we evaluated the expression of Bcl-2, Bax, Caspase-3, and Caspase-9 protein markers in SK-BR-3 (Figure 3(a)). As shown in Figure 3(b), treatment of UA on SK-BR-3 cell led to decreased Bcl-2 level. Bax was upregulated in SK-BR-3 cell treatment with UA (Figure 3(b)). Activation of apoptosis signaling by UA Caspase-3 and Caspase-9 protein levels was increased (Figure 3(b)).

Apoptosis-related proteins were analyzed by Western blot. (a) The expression levels of apoptosis-related proteins after application of UA on SK-BR-3 cells. (b) Relative protein change of Bcl-2, Bax, Caspase-3, and Caspase-9 in comparison to GADPH (control). *
Discussion
About 50% of natural products were approved by FDA and these natural products have been used in the drug market for human health. 24 However, candidate drug molecules could be limiting for treatment since they cannot be easily produced in their pharmacologically active form in higher quantities. 25,26 Researchers are increasingly searching for new effective candidate drug molecules from biological organisms instead of synthetic molecules. Lichens, which are the most efficient biological organisms, are the symbiotic organisms with mycobiant, algae or cyanobacterium. 27 In recent years, researchers have shown that lichen secondary metabolites have biological activity and their metabolites have advantages and become an important reason for preference for treatment against cancer disease. 24 One of the advantages, lichen secondary metabolite stems from never-ending potential biological source of chemical content with a variety of pharmacological activities of drug industries. Lichen secondary metabolites could play a significant role especially in cancer treatment because they are usually less toxic than traditional chemotherapy agents such as tamoxifen and paclitaxel, effective, inexpensive, and easily available. 27 Many studies indicated that UA has anticancer properties on different cancer cells. In this study, we evaluated antiproliferative effect of UA on SK-BR-3 breast cancer cell and noncancerous breast epithelial cell (MCF-12A). The results showed that UA exhibited moderate to high levels of anticancer activity on mainly SK-BR-3 breast cancer cell, without damaging MCF-12A noncancerous breast epithelial cell.
Carcinogenesis is related to an inequality between cell apoptosis and proliferation stage. In this study, we showed that UA induced apoptosis in breast cancer cell as confirmed by qRT-PCR and Western blot assay. Many studies have been reported to play an important role in apoptosis applied to UA. Previous studies have determined that UA inhibits high proliferation and induces apoptosis in various cancer cells, such as lung cancer cell (A549) 22 ; human melanoma (HTB-140) and human prostate cancer (DU-145, PC-3) cell lines 28 ; LUSC cells 16 ; human gastric cancer AGS and SNU-1 cells 19 ; breast (MCF-7), cervical (HeLa), and prostate cancer (PC-3) cell lines 10 ; K562/ADR cells 29 ; HEPG2 and SNU-449 hepatocarcinoma cells 30 ; HTB-140 (Hs 294T)-human melanoma derived from metastasis to lymph node; DU145 (HTB-81)-human carcinoma derived from brain metastasis and PC-3 (CRL-1435)-human adenocarcinoma derived from bone metastasis and two normal types of cells: human skin fibroblasts and normal human prostate epithelium (PNT2) 28 ; MCF-7 31 ; CaCo2, HepG2, Hep2C, Rd, Wehi 11 ; HCT116 and LS174 32 ; T47D and MCF-7 33 ; MCF-7, MDA-MB-231, BT-474 12 . This is the first study in which the anti proliferative effect of UA on SK-BR-3 breast cancer cell lines determined with the contribution of our previously studied results. Furthermore, previously mentioned studies explain the induced effect of UA on apoptosis pathway with flow cytometry analysis on cell culture-based and protein results by performing Western blot analysis. Despite increasing research on the apoptotic effect of UA to the different cancer cells, there is not available explored on full apoptotic pathway bu using qRT-PCR on breast cancer. Thus, we evaluated transcriptional modulations induced of breast cancer cell to UA treatments. We have also found crucial therapeutic strategies by depending on the effect of UA on apoptosis pathway.
It has been proved that the damaging effect of UA on breast cancer cell lines is more considerable rather than human noncancerous breast epithelial cell. Studzińska-Sroka et al. examined the effect of physodic acid on MCF-10A cell and Ebrahim et al. determined the effect of norstictic acid on MCF-10A. 34,35 These studies suggested that there is no significant cytotoxic effect on noncancerous MCF-10A cells when physodic acid and norstictic acid applied. In this study, the effect of UA on MCF-12A noncancerous breast epithelial cell was obtained for the first time in the literature and it was determined that UA did not harm noncancerous breast epithelial cell while showing antiproliferative effect on breast cancer.
Ebrahim et al. demonstrated that norstictic acid, which is ethanol extracted of
Through the regulation of gene expression, which are related to apoptosis such as Bcl-2 family products anti/pro-apoptotic proteins, p38, and p53,
8,11
lichens play crucial role as apoptosis activators in various cancer cell lines by depending on autonomous cell death.
8,36
Dinçsoy and Cansaran-Duman studied the antiproliferative effect of UA on nonmalignant cell lines (Vero, L929) and cancer cell lines (CaCo2, RD, Hep2C, HepG2, and Wehi).
11
After application of UA on Hep2C cell line, they observed threefold decrease in Bax gene while Bcl-2 antiapoptotic gene and p53 tumor suppressor gene decrease fivefold. In addition, in RD cell line, there was 8-fold and 2.5-fold decrease in Bcl-2 and p53 genes, while Bax gene increased in 2-fold. In Wehi cell line, it was 2.5-fold increase in
In the study by Geng et al., the expression levels of apoptosis-related proteins (activated caspase-3 and PARP, Bax, and Bcl2) and autophagy-associated proteins (LC3-II and p62) were verified through Western blot analysis. 38 Western blot analysis revealed that the protein expression levels of Bax, activated caspase-3, and PARP were increased, but the level of Bcl-2 in GC cells was decreased, which led to cell apoptosis. 38 Similarly with Geng et al. results, in our study we have observed increase in Bax and activated Caspases while reduction in Bcl-2 by Western blot analysis.
The results of our study suggest that UA could be a promising molecule for the treatment of breast cancer, because UA could significantly prevent growth by inducing apoptosis in breast cancer cells. The side effect and insufficient of drugs used in breast cancer treatment, UA as a natural agent has a strong possibility to be developed into an effective therapeutics for breast cancer. Further studies are still needed to determine the potential clinical application and clarify their beneficial effects in breast cancer.
Supplemental material
Supplemental_material_Table_1_25.03.2020 - The expression profiles of apoptosis-related genes induced usnic acid in SK-BR-3 breast cancer cell
Supplemental_material_Table_1_25.03.2020 for The expression profiles of apoptosis-related genes induced usnic acid in SK-BR-3 breast cancer cell by RŞ Özben and D Cansaran-Duman in Human & Experimental Toxicology
Footnotes
Acknowledgment
The authors thank Ankara University, Management of Scientific Research Projects, for the financial support.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was financially supported by Ankara University, Management of Scientific Research Projects (Project No. 16H0415002).
Supplemental material
Supplemental material for this article is available online.
References
Supplementary Material
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