Cigarette smoke-induced LKB1/AMPK pathway deficiency reduces EGFR TKI sensitivity in NSCLC

Oncogene. 2021 Feb;40(6):1162-1175. doi: 10.1038/s41388-020-01597-1. Epub 2020 Dec 17.

Abstract

Smoker patients with non-small cell lung cancer (NSCLC) have poorer prognosis and survival than those without smoking history. However, the mechanisms underlying the low response rate of those patients to EGFR tyrosine kinase inhibitors (TKIs) are not well understood. Here we report that exposure to cigarette smoke extract enhances glycolysis and attenuates AMP-activated protein kinase (AMPK)-dependent inhibition of mTOR; this in turn reduces the sensitivity of NSCLC cells with wild-type EGFR (EGFRWT) to EGFR TKI by repressing expression of liver kinase B1 (LKB1), a master kinase of the AMPK subfamily, via CpG island methylation. In addition, LKB1 expression is correlated positively with sensitivity to TKI in patients with NSCLC. Moreover, combined treatment of EGFR TKI with AMPK activators synergistically increases EGFR TKI sensitivity. Collectively, the current study suggests that LKB1 may serve as a marker to predict EGFR TKI sensitivity in smokers with NSCLC carrying EGFRWT and that the combination of EGFR TKI and AMPK activator may be a potentially effective therapeutic strategy against NSCLC with EGFRWT.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • AMP-Activated Protein Kinase Kinases
  • Animals
  • Carcinoma, Non-Small-Cell Lung / chemically induced
  • Carcinoma, Non-Small-Cell Lung / drug therapy*
  • Carcinoma, Non-Small-Cell Lung / genetics
  • Carcinoma, Non-Small-Cell Lung / pathology
  • Cell Line, Tumor
  • Cigarette Smoking / adverse effects
  • CpG Islands / drug effects
  • DNA Methylation / drug effects
  • Drug Resistance, Neoplasm / genetics
  • ErbB Receptors / genetics
  • Heterografts
  • Humans
  • Mice
  • Mutation / genetics
  • Protein Kinase Inhibitors / pharmacology
  • Protein Kinases / genetics
  • Protein Serine-Threonine Kinases / genetics*
  • Signal Transduction / drug effects
  • Smoking / adverse effects
  • TOR Serine-Threonine Kinases / genetics*

Substances

  • Protein Kinase Inhibitors
  • Protein Kinases
  • MTOR protein, human
  • EGFR protein, human
  • ErbB Receptors
  • Protein Serine-Threonine Kinases
  • STK11 protein, human
  • TOR Serine-Threonine Kinases
  • AMP-Activated Protein Kinase Kinases