Phuchareon Janyaporn, McCormick Frank, Eisele David W, Tetsu Osamu
Head and Neck Cancer Research Laboratory, Department of Otolaryngology-Head and Neck Surgery, School of Medicine, University of California, San Francisco (UCSF), CA 94115; UCSF Helen Diller Family Comprehensive Cancer Center, School of Medicine, University of California, San Francisco, CA 94158.
UCSF Helen Diller Family Comprehensive Cancer Center, School of Medicine, University of California, San Francisco, CA 94158
Proc Natl Acad Sci U S A. 2015 Jul 21;112(29):E3855-63. doi: 10.1073/pnas.1510733112. Epub 2015 Jul 6.
Nonsmall cell lung cancer (NSCLC) is the leading cause of cancer death worldwide. About 14% of NSCLCs harbor mutations in epidermal growth factor receptor (EGFR). Despite remarkable progress in treatment with tyrosine kinase inhibitors (TKIs), only 5% of patients achieve tumor reduction >90%. The limited primary responses are attributed partly to drug resistance inherent in the tumor cells before therapy begins. Recent reports showed that activation of receptor tyrosine kinases (RTKs) is an important determinant of this innate drug resistance. In contrast, we demonstrate that EGFR inhibition promotes innate drug resistance despite blockade of RTK activity in NSCLC cells. EGFR TKIs decrease both the mitogen-activated protein kinase (MAPK) and Akt protein kinase pathways for a short time, after which the Ras/MAPK pathway becomes reactivated. Akt inhibition selectively blocks the transcriptional activation of Ets-1, which inhibits its target gene, dual specificity phosphatase 6 (DUSP6), a negative regulator specific for ERK1/2. As a result, ERK1/2 is activated. Furthermore, elevated c-Src stimulates Ras GTP-loading and activates Raf and MEK kinases. These observations suggest that not only ERK1/2 but also Akt activity is essential to maintain Ets-1 in an active state. Therefore, despite high levels of ERK1/2, Ets-1 target genes including DUSP6 and cyclins D1, D3, and E2 remain suppressed by Akt inhibition. Reduction of DUSP6 in combination with elevated c-Src renews activation of the Ras/MAPK pathway, which enhances cell survival by accelerating Bim protein turnover. Thus, EGFR TKIs evoke innate drug resistance by preventing Akt activity and inactivating Ets-1 function in NSCLC cells.
非小细胞肺癌(NSCLC)是全球癌症死亡的主要原因。约14%的NSCLC患者表皮生长因子受体(EGFR)存在突变。尽管酪氨酸激酶抑制剂(TKIs)治疗取得了显著进展,但只有5%的患者肿瘤缩小>90%。有限的初始反应部分归因于治疗开始前肿瘤细胞固有的耐药性。最近的报告显示,受体酪氨酸激酶(RTKs)的激活是这种先天性耐药的重要决定因素。相比之下,我们证明,尽管在NSCLC细胞中阻断了RTK活性,但EGFR抑制仍会促进先天性耐药。EGFR TKIs在短时间内会降低丝裂原活化蛋白激酶(MAPK)和Akt蛋白激酶途径,之后Ras/MAPK途径会重新激活。抑制Akt可选择性阻断Ets-1的转录激活,从而抑制其靶基因双特异性磷酸酶6(DUSP6),DUSP6是ERK1/2的特异性负调节因子。结果,ERK1/2被激活。此外,升高的c-Src刺激Ras的GTP负载并激活Raf和MEK激酶。这些观察结果表明,不仅ERK1/2,而且Akt活性对于维持Ets-1的活性状态也至关重要。因此,尽管ERK1/2水平较高,但包括DUSP6和细胞周期蛋白D1、D3和E2在内的Ets-1靶基因仍因Akt抑制而受到抑制。DUSP6的减少与c-Src的升高相结合,会使Ras/MAPK途径重新激活,通过加速Bim蛋白周转来增强细胞存活。因此,EGFR TKIs通过阻止Akt活性和使NSCLC细胞中的Ets-1功能失活来引发先天性耐药。