Open Access Highly Accessed Research article

Enhanced cytotoxic effect of radiation and temozolomide in malignant glioma cells: targeting PI3K-AKT-mTOR signaling, HSP90 and histone deacetylases

Eun Jung Choi1, Bong Jun Cho1, David J Lee1, Yeo Hyeon Hwang1, Sun Ha Chun1, Hans H Kim1 and In Ah Kim12*

Author Affiliations

1 Department of Radiation Oncology, Seoul National University Bundang Hospital, 166 Gumiro, Bundanggu, Seongnamsi Kyeonggido, South Korea

2 Cancer Research Institute, Seoul National University 101 Daehak-ro, Jongno-gu, Seoul 110-779, South Korea

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BMC Cancer 2014, 14:17  doi:10.1186/1471-2407-14-17

Published: 13 January 2014



Despite aggressive treatment with radiation therapy and concurrent adjuvant temozolomide (TMZ), glioblastoma multiform (GBM) still has a dismal prognosis. We aimed to identify strategies to improve the therapeutic outcome of combined radiotherapy and TMZ in GBM by targeting pro-survival signaling from the epidermal growth factor receptor (EGFR).


Glioma cell lines U251, T98G were used. Colony formation, DNA damage repair, mode of cell death, invasion, migration and vasculogenic mimicry as well as protein expression were determined.


U251 cells showing a low level of methyl guanine transferase (MGMT) were highly responsive to the radiosensitizing effect of TMZ compared to T98G cells having a high level of MGMT. Treatment with a dual inhibitor of Class I PI3K/mTOR, PI103; a HSP90 inhibitor, 17-DMAG; or a HDAC inhibitor, LBH589, further increased the cytotoxic effect of radiation therapy plus TMZ in U251 cells than in T98G cells. However, treatment with a mTOR inhibitor, rapamycin, did not discernibly potentiate the radiosensitizing effect of TMZ in either cell line. The mechanism of enhanced radiosensitizing effects of TMZ was multifactorial, involving impaired DNA damage repair, induction of autophagy or apoptosis, and reversion of EMT (epithelial-mesenchymal transition).


Our results suggest possible strategies for counteracting the pro-survival signaling from EGFR to improve the therapeutic outcome of combined radiotherapy and TMZ for high-grade gliomas.

Glioblastoma; Radiosensitization; Temozolomide; Pro-survival signaling