Ected two weeks post-treatment. Expression was normalized to b-actin control. Data represent the mean 6 S.E of at least three independent experiments (*p,0.05). (C) mtDNA was Thiazole Orange biological activity measured in CO2 treated or control tumor samples by PCR and the relative copy number was determined by normalizing to nDNA. Data represent the mean 6 S.E. of at least three independent experiments (*p,0.05). (D) Immunofluorescence staining of mitochondria in CO2 treated or control tumors after two weeks (Blue, get 58543-16-1 nuclear; Red, mitochondria). doi:10.1371/journal.pone.0049189.gin vivo. The results strongly support that the effect of our transcutaneous CO2 system on the induction of mitochondrial apoptosis through PGC-1a expression was caused by raising intracellular Ca2+ concentration. We here show that localized, transcutaneous application of CO2 to an in vivo model of human MFH led to mitochondria-mediated apoptosis and impaired tumor growth, with no observable effects on body weight, a side effect typically observed following chemotherapy. Although further studies are needed to elucidate the mechanisms of the effects of the treatment on tumor cell apoptosis, our data indicate that transcutaneous application of CO2 may be a useful therapeutic tool for human MFH.Aldrich) and 100 U/ml penicillin/streptomycin solution (SigmaAldrich). Cells were maintained at 37uC in a humidified 5 CO2 atmosphere.Animal ModelsMale athymic BALB/c nude mice, aged 5? weeks were obtained from CLEA Japan, Inc (Tokyo, Japan). Animals were maintained under pathogen-free conditions, in accordance with institutional principles. All animal experiments were performed according to the Guide for the Care and Use of Laboratory Animals at the host institution and were approved by the institutional animal committee (P-101203). Nara-H cells (4.06106 cells in 500 ml PBS) were injected into dorsal, subcutaneous area of mice as previously described [38].Materials and Methods Cell CultureThe human MFH cell line, Nara-H (ScienStuff Co., Nara, Japan) [37], was used in this study. Cells were grown in Dulbecco’s Modified Eagle’s Medium (Sigma-Aldrich Co., St Louis, MO, USA) supplemented with 10 (v/v) fetal bovine serum (SigmaTranscutaneous CO2 TreatmentTranscutaneous application of CO2 was performed as previously described [12]. Briefly, the area of skin around the implanted tumor was treated with CO2 hydrogel. This area wasCO2 Induces Mitochondrial Apoptosis in CancersFigure 3. Evaluation of mitochondrial induced apoptosis in CO2 or control treated tumors. (A) DNA fragmentation analysis of tumor samples from CO2 treated and control mice two weeks post-treatment by immunofluorescence. (Blue, nuclear; Green, apoptosis nuclear) (B) DNA fragmentation was assessed by flow cytometry in CO2 treated tumors (Blue dots) and control tumors (Red) two weeks post-treatment. (C) Immunoblot analyses determined that increased expression of the cleavage products of caspase 3 and 9, and PARP occurred in the CO2 treated tumors compared to the control tumors. Tubulin was used as an endogenous loading control. (D) Immunoblot analysis of cytochrome c and Bax in mitochondrial and cytoplasmic fractions of CO2 treated and control tumors. Tubulin was used as an endogenous loading control. (C, D) Positive bands in immunoblot analyses were semiquantified using densitometrical analyses using the Image J program (NIH, USA, http://rsb.info.nih.gov/ij/). doi:10.1371/journal.pone.0049189.gthen sealed with a polyethylene bag and 100 CO2 gas wa.Ected two weeks post-treatment. Expression was normalized to b-actin control. Data represent the mean 6 S.E of at least three independent experiments (*p,0.05). (C) mtDNA was measured in CO2 treated or control tumor samples by PCR and the relative copy number was determined by normalizing to nDNA. Data represent the mean 6 S.E. of at least three independent experiments (*p,0.05). (D) Immunofluorescence staining of mitochondria in CO2 treated or control tumors after two weeks (Blue, nuclear; Red, mitochondria). doi:10.1371/journal.pone.0049189.gin vivo. The results strongly support that the effect of our transcutaneous CO2 system on the induction of mitochondrial apoptosis through PGC-1a expression was caused by raising intracellular Ca2+ concentration. We here show that localized, transcutaneous application of CO2 to an in vivo model of human MFH led to mitochondria-mediated apoptosis and impaired tumor growth, with no observable effects on body weight, a side effect typically observed following chemotherapy. Although further studies are needed to elucidate the mechanisms of the effects of the treatment on tumor cell apoptosis, our data indicate that transcutaneous application of CO2 may be a useful therapeutic tool for human MFH.Aldrich) and 100 U/ml penicillin/streptomycin solution (SigmaAldrich). Cells were maintained at 37uC in a humidified 5 CO2 atmosphere.Animal ModelsMale athymic BALB/c nude mice, aged 5? weeks were obtained from CLEA Japan, Inc (Tokyo, Japan). Animals were maintained under pathogen-free conditions, in accordance with institutional principles. All animal experiments were performed according to the Guide for the Care and Use of Laboratory Animals at the host institution and were approved by the institutional animal committee (P-101203). Nara-H cells (4.06106 cells in 500 ml PBS) were injected into dorsal, subcutaneous area of mice as previously described [38].Materials and Methods Cell CultureThe human MFH cell line, Nara-H (ScienStuff Co., Nara, Japan) [37], was used in this study. Cells were grown in Dulbecco’s Modified Eagle’s Medium (Sigma-Aldrich Co., St Louis, MO, USA) supplemented with 10 (v/v) fetal bovine serum (SigmaTranscutaneous CO2 TreatmentTranscutaneous application of CO2 was performed as previously described [12]. Briefly, the area of skin around the implanted tumor was treated with CO2 hydrogel. This area wasCO2 Induces Mitochondrial Apoptosis in CancersFigure 3. Evaluation of mitochondrial induced apoptosis in CO2 or control treated tumors. (A) DNA fragmentation analysis of tumor samples from CO2 treated and control mice two weeks post-treatment by immunofluorescence. (Blue, nuclear; Green, apoptosis nuclear) (B) DNA fragmentation was assessed by flow cytometry in CO2 treated tumors (Blue dots) and control tumors (Red) two weeks post-treatment. (C) Immunoblot analyses determined that increased expression of the cleavage products of caspase 3 and 9, and PARP occurred in the CO2 treated tumors compared to the control tumors. Tubulin was used as an endogenous loading control. (D) Immunoblot analysis of cytochrome c and Bax in mitochondrial and cytoplasmic fractions of CO2 treated and control tumors. Tubulin was used as an endogenous loading control. (C, D) Positive bands in immunoblot analyses were semiquantified using densitometrical analyses using the Image J program (NIH, USA, http://rsb.info.nih.gov/ij/). doi:10.1371/journal.pone.0049189.gthen sealed with a polyethylene bag and 100 CO2 gas wa.