Division of Anti-Tumor Pharmacology, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China.
University of Chinese Academy of Sciences, No.19A Yuquan Road, Beijing, 100049, China.
Acta Pharmacol Sin. 2023 Oct;44(10):2113-2124. doi: 10.1038/s41401-023-01097-4. Epub 2023 May 25.
EZH2 has been regarded as an efficient target for diffuse large B-cell lymphoma (DLBCL), but the clinical benefits of EZH2 inhibitors (EZH2i) are limited. To date, only EPZ-6438 has been approved by FDA for the treatment of follicular lymphoma and epithelioid sarcoma. We have discovered a novel EZH1/2 inhibitor HH2853 with a better antitumor effect than EPZ-6438 in preclinical studies. In this study we explored the molecular mechanism underlying the primary resistance to EZH2 inhibitors and sought for combination therapy strategy to overcome it. By analyzing EPZ-6438 and HH2853 response profiling, we found that EZH2 inhibition increased intracellular iron through upregulation of transferrin receptor 1 (TfR-1), ultimately triggered resistance to EZH2i in DLBCL cells. We demonstrated that H3K27ac gain by EZH2i enhanced c-Myc transcription, which contributed to TfR-1 overexpression in insensitive U-2932 and WILL-2 cells. On the other hand, EZH2i impaired the occurrence of ferroptosis by upregulating the heat shock protein family A (Hsp70) member 5 (HSPA5) and stabilizing glutathione peroxidase 4 (GPX4), a ferroptosis suppressor; co-treatment with ferroptosis inducer erastin effectively overrode the resistance of DLBCL to EZH2i in vitro and in vivo. Altogether, this study reveals iron-dependent resistance evoked by EZH2i in DLBCL cells, and suggests that combination with ferroptosis inducer may be a promising therapeutic strategy.
EZH2 已被视为弥漫性大 B 细胞淋巴瘤 (DLBCL) 的有效靶点,但 EZH2 抑制剂 (EZH2i) 的临床获益有限。迄今为止,只有 EPZ-6438 被 FDA 批准用于治疗滤泡性淋巴瘤和上皮样肉瘤。我们在临床前研究中发现了一种新型 EZH1/2 抑制剂 HH2853,其抗肿瘤效果优于 EPZ-6438。在本研究中,我们探讨了对 EZH2 抑制剂产生原发性耐药的分子机制,并寻求联合治疗策略来克服这种耐药性。通过分析 EPZ-6438 和 HH2853 的反应谱,我们发现 EZH2 抑制通过上调转铁蛋白受体 1 (TfR-1) 增加细胞内铁,最终导致 DLBCL 细胞对 EZH2i 产生耐药性。我们证明了 EZH2i 引起的 H3K27ac 获得增强了 c-Myc 转录,这导致了 U-2932 和 WILL-2 细胞中 TfR-1 的过表达。另一方面,EZH2i 通过上调热休克蛋白家族 A (Hsp70) 成员 5 (HSPA5) 和稳定谷胱甘肽过氧化物酶 4 (GPX4) 来抑制铁死亡,从而抑制铁死亡的发生,铁死亡抑制剂 erastin 的联合治疗有效地克服了 DLBCL 对 EZH2i 的耐药性。总之,本研究揭示了 EZH2i 在 DLBCL 细胞中引起的铁依赖性耐药性,并表明与铁死亡诱导剂联合可能是一种有前途的治疗策略。
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