Combined effect of baicalein and thermal-cycling stimulation on suppressing non-small cell lung cancer A549 cells under CoCl2-induced hypoxia

Lung cancer continues to be the leading cause of cancer-related mortality globally, with non-small cell lung cancer (NSCLC) representing the most prevalent subtype. Tumor hypoxia is a characteristic feature of the neoplastic microenvironment in NSCLC, facilitating tumor progression and conferring resistance to oxidative stress through the stabilization of hypoxia-inducible factor-1 alpha (HIF-1). In this study, we investigated the combined anticancer effects of baicalein (Bai), a natural flavonoid, and thermal-cycling stimulation (TCS), a physical treatment that minimizes damage to normal cells, under cobalt (II) chloride (CoCl2)-induced hypoxic conditions in NSCLC. In A549 NSCLC cells, the combination of Bai and TCS significantly decreased cell viability and induced apoptosis, while exhibiting minimal cytotoxicity on IMR-90 normal human lung fibroblast cells. On a mechanistic level, this combined treatment suppressed the expression of HIF-1 and superoxide dismutase 2 (SOD2) proteins, elevated intracellular reactive oxygen species (ROS) levels, and impaired DNA repair capability by downregulating MutT homolog 1 (MTH1) protein expression. Additionally, disruption of mitochondrial membrane potential and increased poly (ADP-ribose) polymerase (PARP) cleavage further confirmed the induction of apoptosis. These findings indicate that combining Bai with TCS offers a promising synergistic approach to treating NSCLC under hypoxic conditions.