The antitumor effects and apoptotic mechanism of 20(S)-Protopanaxadiol in acute myeloid leukemia.

Background: Panax ginseng Meyer is a well-known herb in traditional Chinese medicine, with ginsenosides being its primary bioactive components. Among these, 20(S)-protopanaxadiol (20(S)-PPD) has demonstrated anti-tumor effects in various cancers. However, its role in acute myeloid leukemia (AML) remains unclear. Methods: MTT assays were conducted to assess the impact of 20(S)-PPD on AML cell proliferation, while flow cytometry was used to analyze its effects on apoptosis. Western blotting and network pharmacology analyses were employed to explore the signaling pathways and protein expression levels modulated by 20(S)-PPD in AML. c-Myc mRNA levels in AML cells were quantified using RT-PCR. Results: 20(S)-PPD effectively inhibits proliferation and induces apoptosis in AML cells, both in vitro and in patient samples. It achieves this by inhibiting the PI3K/AKT/mTOR pathway and activating the PERK/ATF4/CHOP pathway. Additionally, 20(S)-PPD reduces c-Myc protein and mRNA levels, primarily by decreasing c-Myc mRNA stability. Moreover, combining 20(S)-PPD with ABT-199 significantly enhances pro-apoptotic effects and markedly reduces c-Myc protein and mRNA levels in both AML and cytarabine-resistant (AraC-R) AML cells. This combination therapy holds promise for overcoming resistance and improving treatment outcomes in AML. Conclusion: This study demonstrates the potent antitumor activity of 20(S)-PPD in AML and elucidates its underlying mechanisms. Notably, 20(S)-PPD exhibits significant antitumor effects against AML cells, both as a single agent and in combination with ABT-199, where it displays pronounced synergy. These results suggest a promising new therapeutic strategy for AML treatment.