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Department of Advanced Therapeutics, British Columbia Cancer Research Centre, Vancouver, British Columbia, V5Z 1L3 Canada, and Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, V6T 1Z3 Canada

Alterations in metabolism of ceramide (Cer) to the noncytotoxic metabolite glucosylceramide have been implicated in the multidrug resistance (MDR) phenomenon. This observation has been made with tumor cells that also overexpress P-glycoprotein (Pgp), raising the possibility that Pgp plays a role in regulating Cer metabolism. We investigated the effect of the glucosylceramide synthase inhibitor 1-phenyl-2-decanoylamino-3-morpholino-1-propanol (PDMP) on the chemosensitivity of two wild-type and multidrug-resistant human breast tumor cell lines. Subtoxic concentrations of PDMP sensitized drug-selected MCF7/AdrR and Pgp-overexpressing MDA435/LCC6^MDR1 (MDR1 gene-transfected) cell lines to Taxol and vincristine but did not alter the chemosensitivity of the wild-type cells. Evaluation of Taxol uptake indicated that the effect of PDMP was not due to membrane permeability alterations because anticancer drug accumulation was unaffected by PDMP. Whereas both multidrug-resistant cell lines overexpress Pgp, only the MCF7/AdrR cell line overexpresses the glucosylceramide synthase enzyme. This difference enabled us to distinguish between sensitization effects associated with Cer metabolism versus Pgp-mediated transport. Interestingly, when Pgp function was blocked, the PDMP effect was reduced 3-fold in MCF7/AdrR cells and was no longer observed in the MDA435/LCC6^MDR1 cells. These observations imply that Cer metabolism and apoptosis effects are regulated not only by enzymes that convert Cer to nontoxic metabolites but also by Pgp-mediated transport. Given the intracellular distribution patterns of Pgp, we propose that this effect is related to glucosylceramide translocation across the Golgi bilayer. We have applied this model to the situation of Cer metabolism-based chemosensitization and demonstrate that MDR modulation strategies aimed primarily at altering drug transport mechanisms can influence other MDR mechanisms such as glycosphingolipid metabolism. This work highlights the relationship between drug transport and Cer metabolism in the context of chemosensitization and cautions against making oversimplified assumptions that these mechanisms act independently.

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