Xu Zihan, Wang Li, Tu Li, Liu Tao, Zhang Yong, He Yingying, Xiao Guixiu, Ouyang Ganlu, Ma Xuelei, Luo Feng
Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China, 610041.
Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China, 610041.
Int J Biol Sci. 2025 Jan 1;21(1):382-399. doi: 10.7150/ijbs.99954. eCollection 2025.
The EGFR-TKIs (epidermal growth factor receptor-tyrosine kinases inhibitors) offer significant benefits to lung cancer patients with sensitive EGFR mutations; however, the development of acquired resistance poses a significant challenge and leads to poor prognosis. Thus, exploring novel therapeutic strategies to overcome EGFR-TKI resistance is urgently needed. This study introduces an innovative approach utilizing folic acid-modified milk exosomes loaded with c-kit siRNA (FA-mExo-siRNA-c-kit) to target EGFR-TKI resistance in lung cancer. Initially, gefitinib-resistant lung cancer cells exhibited stemness characteristics, including an epithelial-to-mesenchymal transition phenotype and elevated ABCG2 expression, which were closely regulated by c-kit. Subsequent treatment with FA-mExo-siRNA-c-kit demonstrated effective suppression of c-kit expression and attenuation of stemness traits , reducing gefitinib resistance. In xenograft and liver metastasis models, sequential administration of FA-mExo-siRNA-c-kit and gefitinib resulted in decreased tumor growth and prolonged survival. Mechanistically, c-kit was found to regulate the AKT/mTOR/4EBP1/eIF4E axis, promoting stemness and gefitinib resistance in lung cancer cells. This study unveils a novel mechanism of EGFR-TKI resistance involving the c-kit/mTOR pathway and proposes a promising therapeutic strategy for EGFR-TKI-resistant lung cancer, particularly with liver metastasis, using FA-mExo-siRNA-c-kit, suggesting potential for improved patient outcomes and warranting further investigation.
表皮生长因子受体-酪氨酸激酶抑制剂(EGFR-TKIs)为具有敏感EGFR突变的肺癌患者带来显著益处;然而,获得性耐药的出现构成了重大挑战,并导致预后不良。因此,迫切需要探索新的治疗策略来克服EGFR-TKI耐药性。本研究引入了一种创新方法,利用负载c-kit小干扰RNA的叶酸修饰牛奶外泌体(FA-mExo-siRNA-c-kit)来靶向肺癌中的EGFR-TKI耐药性。最初,吉非替尼耐药的肺癌细胞表现出干性特征,包括上皮-间质转化表型和ABCG2表达升高,这些均受c-kit密切调控。随后用FA-mExo-siRNA-c-kit处理可有效抑制c-kit表达并减弱干性特征,降低吉非替尼耐药性。在异种移植和肝转移模型中,序贯给予FA-mExo-siRNA-c-kit和吉非替尼可导致肿瘤生长减缓并延长生存期。从机制上讲,发现c-kit可调节AKT/mTOR/4EBP1/eIF4E轴,促进肺癌细胞的干性和吉非替尼耐药性。本研究揭示了一种涉及c-kit/mTOR途径的EGFR-TKI耐药新机制,并提出了一种有前景的治疗策略,即使用FA-mExo-siRNA-c-kit治疗EGFR-TKI耐药的肺癌,尤其是伴有肝转移的肺癌,这表明有望改善患者预后,值得进一步研究。
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