Yang Kaibo, Zhang Xing, Yang Kun, Liu Sinan, Zhang Jingyao, Fu Yunong, Liu Tong, Wu Kunjin, Li Jing, Liu Chang, Huang Qichao, Qu Kai
Department of Hepatobiliary Surgery and Liver Transplantation, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China.
Key Laboratory of Surgical Critical Care and Life Support (Xi'an Jiaotong University), Ministry of Education, Xi'an, 710004, China.
Mol Med. 2025 May 27;31(1):209. doi: 10.1186/s10020-025-01263-w.
Resistance to tyrosine kinase inhibitors (TKIs) poses a significant challenge in the treatment of hepatocellular carcinoma (HCC). Although dysregulation of mitochondrial dynamics has been implicated in the aggressive behaviors of various tumors, the specific role and underlying mechanisms by which this dysregulation contributes to cabozantinib resistance in HCC cells remains insufficiently characterized. By investigating mitochondrial dynamics as central regulators of cabozantinib resistance, this work specifically aims to discover actionable targets for restoring drug sensitivity in treatment-refractory HCC cells. We employed transmission electron microscopy (TEM) and confocal microscopy to analyze mitochondrial morphology in HCC cells resistant to TKIs. Additionally, we utilized an oncogene hydrodynamic injection-induced primary liver cancer mouse model to assess the therapeutic efficacy of combining cabozantinib with other pharmacological agents. Our results demonstrated significant increases in mitochondrial fragmentation, p62 aggregation, and mitophagy in cabozantinib-resistant HCC cells, which correlated with overexpression of c-Myc. Notably, inhibiting mitochondrial fission, p62 aggregation, or autophagy effectively reversed the resistance of HCC cells to cabozantinib. Mechanistically, cabozantinib treatment was shown to induce c-Myc expression, which significantly enhanced mitochondrial fragmentation and p62 aggregation, thereby promoting mitophagy. This mitophagic process selectively eliminated damaged mitochondria, reducing cytochrome C-induced apoptosis in cabozantinib-resistant cells. Ultimately, combining cabozantinib with either the autophagy inhibitor chloroquine or the p62 aggregation inhibitor XRK3F2 resulted in improved anticancer efficacy. In conclusion, c-Myc overexpression facilitates p62 aggregation-mediated mitophagy, leading to cabozantinib resistance in HCC cells. Inhibition of autophagy effectively restores cabozantinib sensitivity in HCC.
对酪氨酸激酶抑制剂(TKIs)产生耐药性是肝细胞癌(HCC)治疗中的一项重大挑战。尽管线粒体动力学失调与多种肿瘤的侵袭性行为有关,但这种失调导致HCC细胞对卡博替尼耐药的具体作用及潜在机制仍未得到充分阐明。通过研究线粒体动力学作为卡博替尼耐药的核心调节因子,本研究旨在发现可恢复难治性HCC细胞药物敏感性的可操作靶点。我们采用透射电子显微镜(TEM)和共聚焦显微镜分析对TKIs耐药的HCC细胞中的线粒体形态。此外,我们利用癌基因流体动力学注射诱导的原发性肝癌小鼠模型评估卡博替尼与其他药物联合使用的治疗效果。我们的结果表明,卡博替尼耐药的HCC细胞中线粒体碎片化、p62聚集和线粒体自噬显著增加,这与c-Myc的过表达相关。值得注意的是,抑制线粒体分裂、p62聚集或自噬可有效逆转HCC细胞对卡博替尼的耐药性。机制上,卡博替尼治疗可诱导c-Myc表达,显著增强线粒体碎片化和p62聚集,从而促进线粒体自噬。这种线粒体自噬过程选择性地清除受损线粒体,减少细胞色素C诱导的卡博替尼耐药细胞凋亡。最终,将卡博替尼与自噬抑制剂氯喹或p62聚集抑制剂XRK3F2联合使用可提高抗癌疗效。总之,c-Myc过表达促进p62聚集介导的线粒体自噬,导致HCC细胞对卡博替尼耐药。抑制自噬可有效恢复HCC对卡博替尼的敏感性。