Int J Med Sci 2019; 16(11):1412-1423. doi:10.7150/ijms.34398

Research Paper

Synergistic apoptosis of human gastric cancer cells by bortezomib and TRAIL

Hang Thi Thuy Bui1,2†, Nhu Huynh Le1,2†, Qui Anh Le1,2, Sung Eun Kim3, Sooho Lee1, Dongchul Kang1,2✉

1. Ilsong Institute of Life Science, Hallym University, Anyang, Kyonggi-do, 14066, Republic of Korea.
2. Department of Biomedical Gerontology, Hallym University Graduate School, Chuncheon, Kangwon-do, 24252, Republic of Korea.
3. Department of Internal Medicine, Hallym University Sacred Heart Hospital, College of Medicine, Hallym University, Anyang, Kyonggi-do, 14068, Republic of Korea.
These authors contributed equally to this work.


Resistance against tumor necrosis factor-related apoptosis-inducing ligand (TRAIL)-induced cell death of cancer cells is a major obstacle in clinical application of TRAIL. Variable response to TRAIL of gastric cancer cells, synergy of TRAIL with bortezomib and potential mechanisms behind the phenomena were investigated in this study. The response to TRAIL varied among six gastric cancer cell lines, which correlated with the expression of apoptotic TRAIL receptors. Analysis of TCGA gene expression data showed that DR4 expression correlated with DR5 in gastric cancer. Although higher expression of DR4 was significantly associated with lower T, N and TNM stages, neither DR4 nor DR5 expression meaningfully influenced overall survival rate. Combined treatment of TRAIL with bortezomib resulted in strong synergistic response with enhanced activation of caspases-8, -9 and -3, and increased Annexin V-binding cell fractions in TRAIL-resistant SNU-216 cells. Bortezomib increased the expression of p21cip1/waf1, but p21cip1/waf1 silencing did not restore cell viability significantly. Bortezomib also increased DR5 expression and knockdown of DR5 expression significantly recovered cell viability reduced by the combination treatment. Bortezomib decreased phosphorylation of ERK1/2, but increased that of JNK. Treatment with either an ERK1/2 inhibitor U0126 or a JNK inhibitor SP600125 rescued SNU-216 from dying of bortezomib or combined treatment. However, upregulation of DR5 by bortezomib was knocked down only by inhibition of ERK1/2 activation significantly, but not by JNK activity inhibition. In summary, upregulation of DR5 by bortezomib is of critical significance in the synergy of bortezomib with TRAIL in apoptosis of TRAIL-resistant SNU-216 and that activity of ERK1/2 is required in the bortezomib-induced DR5 overexpression.

Keywords: Gastric cancer, TRAIL, Bortezomib, DR4, DR5, ERK, p21cip1/waf1

This is an open access article distributed under the terms of the Creative Commons Attribution License ( See for full terms and conditions.
How to cite this article:
Bui HTT, Le NH, Le QA, Kim SE, Lee S, Kang D. Synergistic apoptosis of human gastric cancer cells by bortezomib and TRAIL. Int J Med Sci 2019; 16(11):1412-1423. doi:10.7150/ijms.34398. Available from