KEAP1-NRF2 Pathway as a Novel Therapeutic Target for EGFR-Mutant Non-small Cell Lung Cancer

Background Kelch-like ECH-associated protein 1 (KEAP1)–nuclear factor erythroid-2-related factor 2 (NRF2) pathway is a major regulator protecting cells from oxidative and metabolic stress. Studies have revealed that this pathway is involved in mediating resistance to cytotoxic chemotherapy and immun...

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Main Authors: Jae-Sun Choi, Hye-Min Kang, Kiyong Na, Jiwon Kim, Tae-Woo Kim, Junyang Jung, Heejin Lim, Hyewon Seo, Seung Hyeun Lee
Format: Article
Language:English
Published: The Korean Academy of Tuberculosis and Respiratory Diseases 2025-01-01
Series:Tuberculosis and Respiratory Diseases
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Online Access:http://e-trd.org/upload/pdf/trd-2024-0087.pdf
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author Jae-Sun Choi
Hye-Min Kang
Kiyong Na
Jiwon Kim
Tae-Woo Kim
Junyang Jung
Heejin Lim
Hyewon Seo
Seung Hyeun Lee
author_facet Jae-Sun Choi
Hye-Min Kang
Kiyong Na
Jiwon Kim
Tae-Woo Kim
Junyang Jung
Heejin Lim
Hyewon Seo
Seung Hyeun Lee
author_sort Jae-Sun Choi
collection DOAJ
description Background Kelch-like ECH-associated protein 1 (KEAP1)–nuclear factor erythroid-2-related factor 2 (NRF2) pathway is a major regulator protecting cells from oxidative and metabolic stress. Studies have revealed that this pathway is involved in mediating resistance to cytotoxic chemotherapy and immunotherapy; however, its implications in oncogene-addicted tumors are largely unknown. This study aimed to elucidate whether this pathway could be a potential therapeutic target for epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer. Methods We measured the baseline expression of NRF2 using EGFR-mutant parental cells and acquired gefitinib resistant cells. We investigated whether NRF2 inhibition affected cell death in vitro and tumor growth in vivo using a xenograft mouse model, and compared the transcriptional changes before and after NRF2 inhibition. Results Baseline NRF2 expression was enhanced in PC9 and PC9 with gefitinib resistance (PC9/GR) cells than in other cell lines, with a more prominent expression in PC9/GR. The NRF2 inhibitor induced NRF2 downregulation and cell death in a dose-dependent manner. Cotreatment with an NRF2 inhibitor enhanced osimertinib-induced cell death in vitro, and potentiated tumor growth inhibition in a PC9/GR xenograft model. Finally, RNA sequencing revealed that NRF2 inhibition resulted in the altered expression of multiple genes involved in various signaling pathways. Conclusion We identified that NRF2 inhibition enhanced cell death and inhibited tumor growth in tyrosine kinase inhibitor (TKI)-resistant lung cancer with EGFR-mutation. Thus, NRF2 modulation may be a novel therapeutic strategy to overcome the resistance to EGFR-TKIs.
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language English
publishDate 2025-01-01
publisher The Korean Academy of Tuberculosis and Respiratory Diseases
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spelling doaj-art-78bbf3ef16ce4c508ec9b4bc73ec61ec2025-08-20T02:25:44ZengThe Korean Academy of Tuberculosis and Respiratory DiseasesTuberculosis and Respiratory Diseases1738-35362005-61842025-01-0188113814910.4046/trd.2024.00874896KEAP1-NRF2 Pathway as a Novel Therapeutic Target for EGFR-Mutant Non-small Cell Lung CancerJae-Sun Choi0Hye-Min Kang1Kiyong Na2Jiwon Kim3Tae-Woo Kim4Junyang Jung5Heejin Lim6Hyewon Seo7Seung Hyeun Lee8 Clinical Research Institute, Kyung Hee University Medical Center, Seoul, Republic of Korea Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea Department of Pathology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Republic of Korea Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Republic of Korea Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Republic of Korea Department of Anatomy and Neurobiology, College of Medicine, Kyung Hee University, Seoul, Republic of Korea Center for Scientific Instrumentation, Korea Basic Science Institute, Cheongju, Republic of Korea New Drug Development Center, Daegu-Gyeongbuk Medical Innovation Foundation, Daegu, Republic of Korea Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Republic of KoreaBackground Kelch-like ECH-associated protein 1 (KEAP1)–nuclear factor erythroid-2-related factor 2 (NRF2) pathway is a major regulator protecting cells from oxidative and metabolic stress. Studies have revealed that this pathway is involved in mediating resistance to cytotoxic chemotherapy and immunotherapy; however, its implications in oncogene-addicted tumors are largely unknown. This study aimed to elucidate whether this pathway could be a potential therapeutic target for epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer. Methods We measured the baseline expression of NRF2 using EGFR-mutant parental cells and acquired gefitinib resistant cells. We investigated whether NRF2 inhibition affected cell death in vitro and tumor growth in vivo using a xenograft mouse model, and compared the transcriptional changes before and after NRF2 inhibition. Results Baseline NRF2 expression was enhanced in PC9 and PC9 with gefitinib resistance (PC9/GR) cells than in other cell lines, with a more prominent expression in PC9/GR. The NRF2 inhibitor induced NRF2 downregulation and cell death in a dose-dependent manner. Cotreatment with an NRF2 inhibitor enhanced osimertinib-induced cell death in vitro, and potentiated tumor growth inhibition in a PC9/GR xenograft model. Finally, RNA sequencing revealed that NRF2 inhibition resulted in the altered expression of multiple genes involved in various signaling pathways. Conclusion We identified that NRF2 inhibition enhanced cell death and inhibited tumor growth in tyrosine kinase inhibitor (TKI)-resistant lung cancer with EGFR-mutation. Thus, NRF2 modulation may be a novel therapeutic strategy to overcome the resistance to EGFR-TKIs.http://e-trd.org/upload/pdf/trd-2024-0087.pdfkeap1-nrf2 pathwayepidermal growth factor receptortyrosine kinase inhibitorresistancebrusatol
spellingShingle Jae-Sun Choi
Hye-Min Kang
Kiyong Na
Jiwon Kim
Tae-Woo Kim
Junyang Jung
Heejin Lim
Hyewon Seo
Seung Hyeun Lee
KEAP1-NRF2 Pathway as a Novel Therapeutic Target for EGFR-Mutant Non-small Cell Lung Cancer
Tuberculosis and Respiratory Diseases
keap1-nrf2 pathway
epidermal growth factor receptor
tyrosine kinase inhibitor
resistance
brusatol
title KEAP1-NRF2 Pathway as a Novel Therapeutic Target for EGFR-Mutant Non-small Cell Lung Cancer
title_full KEAP1-NRF2 Pathway as a Novel Therapeutic Target for EGFR-Mutant Non-small Cell Lung Cancer
title_fullStr KEAP1-NRF2 Pathway as a Novel Therapeutic Target for EGFR-Mutant Non-small Cell Lung Cancer
title_full_unstemmed KEAP1-NRF2 Pathway as a Novel Therapeutic Target for EGFR-Mutant Non-small Cell Lung Cancer
title_short KEAP1-NRF2 Pathway as a Novel Therapeutic Target for EGFR-Mutant Non-small Cell Lung Cancer
title_sort keap1 nrf2 pathway as a novel therapeutic target for egfr mutant non small cell lung cancer
topic keap1-nrf2 pathway
epidermal growth factor receptor
tyrosine kinase inhibitor
resistance
brusatol
url http://e-trd.org/upload/pdf/trd-2024-0087.pdf
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