Division of Oncology, Department of Internal Medicine, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA.
Department of Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO 63110, USA.
Sci Transl Med. 2021 Dec;13(622):eabb5445. doi: 10.1126/scitranslmed.abb5445. Epub 2021 Dec 1.
Combination chemotherapies remain the cornerstone treatment for pancreatic ductal adenocarcinoma (PDAC), but de novo and acquired resistance is common. In this study, we aimed to identify and characterize resistance mechanisms to a FIRINOX chemotherapy regimen (a combination of 5-fluorouracil, irinotecan, and oxaliplatin) because it is the most aggressive regimen currently used clinically for patients with PDAC. Using an unbiased reverse-phase protein array, we detected phospho-activation of heat shock protein 27 (Hsp27) as the most up-regulated event after FIRINOX treatment in PDAC cells. Silencing by RNA interference or by a small-molecule inhibitor enhanced apoptosis caused by FIRINOX in vitro. Mechanistically, FIRINOX up-regulated tumor necrosis factor–α (TNFα), causing autocrine phosphorylation and activation of transforming growth factor–β–activated kinase 1 (TAK1), MAPK activated protein kinase 2 (MAPKAPK2 or MK2), and, ultimately, Hsp27. Targeting MK2, the kinase that directly phosphorylates Hsp27, abrogated Hsp27 activation, sensitized PDAC cells to apoptosis, and suppressed SN-38–induced protective autophagy in vitro, in part by blocking phospho-activation of Beclin1. In an autochthonous PDAC mouse model, the MK2 inhibitor ATI-450 decreased PDAC development and progression. When combined with FIRINOX, ATI-450 eliminated most PDAC foci and marked prolonged mouse survival without causing additional toxicity. Last, we found that high phospho-MK2 expression in tumors was associated with poorer survival of patients with PDAC. Our study identified MK2 as a mediator of genotoxic stress–induced activation of prosurvival pathways and provides preclinical support for combining an MK2 inhibitor with FIRINOX-based chemotherapies to treat PDAC.
联合化疗仍然是胰腺导管腺癌(PDAC)的基石治疗方法,但新出现的和获得性耐药很常见。在这项研究中,我们旨在鉴定和表征对 FIRINOX 化疗方案(5-氟尿嘧啶、伊立替康和奥沙利铂的组合)的耐药机制,因为它是目前临床上用于 PDAC 患者的最具侵袭性的方案。使用无偏倚的反相蛋白阵列,我们在 PDAC 细胞中检测到 FIRINOX 处理后最上调的事件是热休克蛋白 27(Hsp27)的磷酸化激活。通过 RNA 干扰或小分子抑制剂沉默可增强 FIRINOX 在体外引起的细胞凋亡。从机制上讲,FIRINOX 上调肿瘤坏死因子-α(TNFα),导致自分泌磷酸化和转化生长因子-β激活激酶 1(TAK1)、丝裂原激活蛋白激酶激活蛋白激酶 2(MAPKAPK2 或 MK2)的激活,最终导致 Hsp27 的磷酸化激活。靶向 MK2(直接磷酸化 Hsp27 的激酶)可阻断 Hsp27 的激活,使 PDAC 细胞对细胞凋亡敏感,并抑制体外 SN-38 诱导的保护性自噬,部分原因是阻断 Beclin1 的磷酸化激活。在自发的 PDAC 小鼠模型中,MK2 抑制剂 ATI-450 可减少 PDAC 的发生和进展。当与 FIRINOX 联合使用时,ATI-450 消除了大多数 PDAC 病灶,并显著延长了小鼠的存活时间,而没有引起额外的毒性。最后,我们发现肿瘤中高磷酸化 MK2 的表达与 PDAC 患者的生存较差相关。我们的研究确定 MK2 是诱导生存途径的遗传毒性应激的介质,并为联合使用 MK2 抑制剂和基于 FIRINOX 的化疗治疗 PDAC 提供了临床前支持。