Targeting Na + /K + ‐translocating adenosine triphosphatase in cancer treatment

Summary The Na + /K + ‐translocating adenosine triphosphatase ( ATP ase) transports sodium and potassium across the plasma membrane and represents a potential target in cancer chemotherapy. Na + /K + ‐ ATP ase belongs to the P‐type ATP ase family (also known as E1–E2 ATP ase), which is involved in transporting certain ions, metals, and lipids across the plasma membrane of mammalian cells. In humans, the Na + /K + ‐ ATP ase is a binary complex of an α ‐subunit that has four isoforms ( α 1 – α 4 ) and a β ‐subunit that has three isoforms ( β 1 – β 3 ). This review aims to update our knowledge on the role of Na + /K + ‐ ATP ase in cancer development and metastasis, as well as on how Na + /K + ‐ ATP ase inhibitors kill tumour cells. The Na + /K + ‐ ATP ase has been found to be associated with cancer initiation, growth, development, and metastasis. Cardiac glycosides have exhibited anticancer effects in cell‐based and mouse studies via inhibition of the Na + /K + ‐ ATP ase and other mechanisms. Na + /K + ‐ ATP ase inhibitors may kill cancer cells via induction of apoptosis and autophagy, radical oxygen species production, and cell cycle arrest. They also modulate multiple signalling pathways that regulate cancer cell survival and death, which contributes to their antiproliferative activities in cancer cells. The clinical evidence supporting the use of Na + /K + ‐ ATP ase inhibitors as anticancer drugs is weak. Several phase I and phase II clinical trials with digoxin, Anvirzel, and huachansu (an intravenous formulated extract of the venom of the wild toad), either alone or more often in combination with other anticancer agents, have shown acceptable safety profiles but limited efficacy in cancer patients. Well‐designed randomized clinical trials with reasonable sample sizes are certainly warranted to confirm the efficacy and safety of cardiac glycosides for the treatment of cancer.