Vorinostat and sorafenib increase ER stress, autophagy and apoptosis via ceramide-dependent CD95 and PERK activation

Margaret A. Park, Guo Zhang, Aditi Pandya Martin, Hossein Hamed, Clint Mitchell, Philip B. Hylemon, Martin Graf, Mohamed Rahmani, Kevin Ryan, Xiang Liu, Sarah Spiegel, James Norris, Paul B. Fisher, Steven Grant, Paul Dent

Research output: Contribution to journalArticlepeer-review

159 Scopus citations


We recently noted that low doses of sorafenib and vorinostat interact in a synergistic fashion to kill carcinoma cells by activating CD95, and this drug combination is entering phase I trials. The present studies mechanistically extended our initial observations. Low doses of sorafenib and vorinostat, but not the individual agents, caused an acidic sphingomyelinase and fumonisin B1-dependent increase in CD95 surface levels and CD95 association with caspase 8. Knock down of CD95 or FADD expression reduced sorafenib/vorinostat lethality. Signaling by CD95 caused PERK activation that was responsible for both promoting caspase 8 association with CD95 and for increased eIF2α phosphorylation; suppression of eIF2α function abolished drug combination lethality. Cell killing was paralleled by PERK- and eIF2α-dependent lowering of c-FLIP-s protein levels and overexpression of c-FLIP-s maintained cell viability. In a CD95-, FADD- and PERK-dependent fashion, sorafenib and vorinostat increased expression of ATG5 that was responsible for enhanced autophagy. Expression of PDGFRβ and FLT3 were essential for high dose single agent sorafenib treatment to promote autophagy. Suppression of PERK function reduced sorafenib and vorinostat lethality whereas suppression of ATG5 levels elevated sorafenib and vorinostat lethality. Overexpression of c-FLIP-s blocked apoptosis and enhanced drug-induced autophagy. Thus sorafenib and vorinostat promote ceramide-dependent CD95 activation followed by induction of multiple downstream survival regulatory signals: ceramide-CD95-PERK-FADD-pro- caspase 8 (death); ceramide-CD95-PERK-eIF2α-↓c-FLIP-s (death); ceramide-CD95-PERK-ATG5-autophagy (survival).

Original languageBritish English
Pages (from-to)1648-1662
Number of pages15
JournalCancer Biology and Therapy
Issue number10
StatePublished - Oct 2008


  • ASMase
  • Autophagy
  • c-FLIP-s
  • CD95
  • Cell death
  • Ceramide
  • FLT3
  • PDGFRβ
  • Sorafenib
  • Vorinostat


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