Growth inhibition and apoptosis induction of MM cells by ambroxol (Abx). (A) Growth inhibition of myeloma cells by Abx. Eight myeloma cell lines and 4 CD138+ bone marrow samples were treated with various concentrations of Abx for 72 hours. The viability was evaluated by a trypan blue exclusion test for cell lines and by a WST-1 assay for the patient samples. All experiments were done in triplicate. ∗P < .05 vs 0 μM. (B) Cell surface Annexin V expression in myeloma cells treated with Abx. Cell surface expressions of Annexin V in KMS34 cells before and after 200 μM Abx treatment were evaluated by flow cytometry. (C) Caspase activation by Abx. KMS34 cells were treated with 200 μM Abx, and the time course changes of the cleavage of caspase-3 and caspase-9 were evaluated by western blot analysis. FITC, Fluorescein isothiocyanate; PI, Propidium Iodide.