Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore.
School of Biological Sciences, Nanyang Technological University Singapore, Singapore, Singapore.
Neuro Oncol. 2024 Jul 5;26(7):1247-1261. doi: 10.1093/neuonc/noae028.
BACKGROUND: Precision treatment of glioblastoma is increasingly focused on molecular subtyping, with the mesenchymal subtype particularly resistant to temozolomide. Here, we aim to develop a targeted therapy for temozolomide resensitization in the mesenchymal subtype. METHODS: We integrated kinomic profiles and kinase inhibitor screens from patient-derived proneural and mesenchymal glioma-propagating cells and public clinical datasets to identify key protein kinases implicated in temozolomide resistance. RNAseq, apoptosis assays, and comet assays were used to examine the role of p38MAPK signaling and adaptive chemoresistance in mesenchymal cells. The efficacy of dual p38MAPK and MEK/ERK inhibition using ralimetinib (selective orally active p38MAPK inhibitor; phase I/II for glioblastoma) and binimetinib (approved MEK1/2 inhibitor for melanoma; phase II for high-grade glioma) in primary and recurrent mesenchymal tumors was evaluated using an intracranial patient-derived tumor xenograft model, focusing on survival analysis. RESULTS: Our transcriptomic-kinomic integrative analysis revealed p38MAPK as the prime target whose gene signature enables patient stratification based on their molecular subtypes and provides prognostic value. Repurposed p38MAPK inhibitors synergize favorably with temozolomide to promote intracellular retention of temozolomide and exacerbate DNA damage. Mesenchymal cells exhibit adaptive chemoresistance to p38MAPK inhibition through a pH-/calcium-mediated MEK/ERK pathway. Dual p38MAPK and MEK inhibition effectively maintain temozolomide sensitivity in primary and recurrent intracranial mesenchymal glioblastoma xenografts. CONCLUSIONS: Temozolomide resistance in mesenchymal glioblastoma is associated with p38MAPK activation. Adaptive chemoresistance in p38MAPK-resistant cells is mediated by MEK/ERK signaling. Adjuvant therapy with dual p38MAPK and MEK inhibition prolongs temozolomide sensitivity, which can be developed into a precision therapy for the mesenchymal subtype.
背景:胶质母细胞瘤的精准治疗越来越注重分子亚型,其中间充质亚型对替莫唑胺特别耐药。在这里,我们旨在开发针对间充质亚型的替莫唑胺再敏化的靶向治疗方法。
方法:我们整合了来自患者来源的神经前体细胞和间充质神经胶质瘤增殖细胞的激酶组学图谱和激酶抑制剂筛选结果,以及公共临床数据集,以鉴定涉及替莫唑胺耐药的关键蛋白激酶。使用 RNAseq、凋亡测定和彗星测定来研究 p38MAPK 信号在间充质细胞中对适应性化学耐药的作用。使用雷利替尼(选择性口服活性 p38MAPK 抑制剂;用于胶质母细胞瘤的 I/II 期)和比美替尼(批准用于黑色素瘤的 MEK1/2 抑制剂;用于高级别神经胶质瘤的 II 期)对原发性和复发性间充质肿瘤进行双重 p38MAPK 和 MEK/ERK 抑制的疗效评估使用颅内患者来源的肿瘤异种移植模型,重点是生存分析。
结果:我们的转录组-激酶组学综合分析显示,p38MAPK 是主要靶点,其基因特征能够根据患者的分子亚型进行分层,并提供预后价值。重新利用的 p38MAPK 抑制剂与替莫唑胺协同作用,有利于促进替莫唑胺的细胞内保留并加剧 DNA 损伤。间充质细胞通过 pH-/钙介导的 MEK/ERK 途径表现出对 p38MAPK 抑制的适应性化学耐药性。双重 p38MAPK 和 MEK 抑制有效地维持原发性和复发性颅内间充质胶质母细胞瘤异种移植中的替莫唑胺敏感性。
结论:间充质胶质母细胞瘤的替莫唑胺耐药与 p38MAPK 的激活有关。p38MAPK 耐药细胞中的适应性化学耐药性是由 MEK/ERK 信号介导的。双重 p38MAPK 和 MEK 抑制的辅助治疗可延长替莫唑胺的敏感性,这可开发为间充质亚型的精准治疗方法。
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