靶向AXL克服肺腺癌EGFR-TKIs获得性耐药

目的:探索AXL在肺腺癌细胞(Lung adenocarcinoma cell, LAC)EGFR-TKIs获得性耐药中的作用,为肺癌临床治疗和新型药物的研发提供实验依据。方法:构建EGFR-TKIs获得性耐药的肺腺癌模型并通过CCK-8法检测耐药株对肺腺癌靶向治疗药物吉非替尼(Gefitinib)、厄洛替尼(Erlotinib)和奥希替尼(Osimertinib)的敏感性。基于基因组学分析筛选出潜在的克服耐药的靶点AXL,通过Western blot和qRT-PCR技术检测AXL的表达情况,并同时检测上皮-间质转化(Epithelial-mesenchymal transition,EMT)分子标志物。R428是AXL的小分子抑制剂,通过CCK-8法、Transwell以及划痕实验等探究靶向AXL对肺腺癌亲本及耐药株增殖和迁移能力的影响。结果:AXL在构建的耐药株中显著高表达,其蛋白表达水平上调15-20倍(P0.001),m RNA水平上调2-5倍(P0.01);EGFR-TKIs耐药株发生上皮间质转化(EMT);靶向AXL选择性抑制耐药株的增殖能力并且恢复了耐药株对EGFR-TKIs的敏感性(P0.001);靶向AXL显著抑制耐药株增强的迁移能力,与亲本株相比最高抑制率可达80%左右(P0.001)。结论:用遗传学和药理学手段靶向AXL可以显著逆转肺腺癌对EGFR-TKIs耐药,逆转耐药株所增强的迁移等肿瘤生物学特征,对克服EGFR-TKIs获得性耐药有着重要的临床治疗价值以及转化医学前景。     

FGFR1通过调控PI3K/AKT/mTOR信号通路介导非小细胞肺癌对吉非替尼的耐药

目的:探讨成纤维细胞生长因子受体1(FGFR1)诱导非小细胞肺癌(NSCLC)吉非替尼获得性耐药的机制。方法:用吉非替尼诱导PC9细胞构建耐药细胞株PC9/GR,用CCK-8、平板克隆形成、transwell技术检测细胞的增殖和迁移能力,用流式细胞术检测细胞的凋亡状况,qRT-PCR、免疫荧光和蛋白免疫印迹技术检测基因表达水平。进一步采用FGFR1抑制剂PD173074或si RNA-FGFR1处理PC9/GR细胞,检测细胞的增殖、迁移、克隆形成能力的变化及Akt、p-Akt、m TOR和p-mTOR表达的变化。结果:PC9/GR细胞的增殖、迁移及对吉非替尼的耐受能力显著增强;FGFR1在PC9/GR细胞中的表达水平显著升高;用PD173074处理PC9细胞后,其增殖、迁移能力及对吉非替尼的耐受能力显著下降;敲低FGFR1后Akt和m TOR的磷酸化水平显著下降。结论:FGFR1通过PI3K/AKT/mTOR信号通路介导非小细胞肺癌对吉非替尼的耐药。     

MiR-186-5p通过靶向调控PTTG1抑制肺腺癌细胞的上皮-间质转化

先前研究表明,miR-186-5p在人类许多恶性肿瘤中扮演抑癌基因的作用,但其在肺腺癌上皮-间质转化（epithelial-mesenchymal transition,EMT）中的作用并不明确。本研究旨在证明,miR-186-5p可通过靶向调控PTTG1抑制肺腺癌细胞的上皮-间质转化。我们首先分析了miR-186-5p在人肺癌细胞中的表达。荧光定量PCR（QRT-PCR）结果显示,与人正常肺上皮细胞BEAS-2B相比,肺腺癌细胞SPC-A1、A549中的miR-186-5p表达量明显降低。为研究miR-186-5p在肺腺癌细胞中的功能,利用GV369-miR-186-5p表达载体,实现了在A549细胞中的过表达。基因转染结合Transwell侵袭结果显示,与对照质粒转染的A549细胞相比,过表达miR-186-5p的A549细胞的体外侵袭能力明显下降。Western印迹检测细胞中EMT相关标志物揭示,GV369-miR-186-5p转染的A549细胞中的上皮-钙黏着蛋白（E-cadherin）表达明显上调,而神经-钙黏着蛋白（N-cadherin）和波形蛋白（vimentin）表达明显下调。同时,GV369-miR-186-5p转染引起其靶基因--垂体肿瘤转化基因1（pituitary tumor-transforming gene 1,PTTG1）编码蛋白在A549细胞中明显降低。重要的是,过表达miR-186-5p与敲减PTTG1均可导致上皮-钙黏着蛋白表达上调,而神经-钙黏着蛋白和波形蛋白下调|而miR-186-5p和PTTG1表达载体共转染后,3种EMT相关标志物在A549的表达与对照细胞的表达无明显差异,提示过表达PTTG1可抵消miR-186-5p对EMT相关标志物表达的影响。综上所述,miR-186-5p可通过靶向调控PTTG1抑制EMT的发生,进而抑制肺腺癌细胞的侵袭转移。     

bFGF 诱导肺腺癌细胞系A549 上皮间质转化

目的:探讨上皮间质转化(epithelial-mesenchymal transition,EMT)过程在肺癌侵袭转移中的作用。方法:体外培养A549细胞,以bFGF(10ng/ml)进行干预后,倒置相差显微镜观察细胞形态学变化;间接免疫荧光观察上皮细胞标志物E-cadherin和间质细胞标志物vimentin蛋白表达的变化;采用细胞划痕试验检测bFGF对A549细胞迁移能力的影响;采用transwell小室试验检测bFGF对A549细胞侵袭能力的影响。结果:bFGF(10ng/ml)干预后,在倒置相差显微镜下观察,A549细胞形态变成了梭形,形态如同成纤维细胞。间接免疫荧光显示A549细胞E-cadherin表达随时间延长逐渐减弱,而vimentin表达逐渐增强。细胞划痕试验显示,bFGF干预后细胞迁移能力提高。Transwell小室试验显示,bFGF干预后细胞侵袭能力提高。结论:bFGF在体外诱导肺腺癌细胞系A549细胞发生上皮间质转化,上皮间质转化是肺癌侵袭转移的重要机制之一。     

厄洛替尼联合多烯紫杉醇-卡铂治疗晚期非小细胞肺癌的临床研究

目的:探讨厄洛替尼联合多烯紫杉醇和卡铂对晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)的临床疗效及毒副反应。方法:选择2010年1月-2012年1月我院收治的Ⅲb或Ⅳ期非鳞状非小细胞肺癌患者共92例。所有病例均给予多烯紫杉醇(100mg/m3)+卡铂(AUC 5.5,浓度-时间曲线下面积5.5)治疗2个周期,完成2个周期治疗后,将病人随机分为对照治疗组(多烯紫杉醇+卡铂治疗)和厄洛替尼治疗组(厄洛替尼联合多烯紫杉醇+卡铂治疗),每组各46例,厄洛替尼组给予口服厄洛替尼150mg/dl/天剂量治疗。两组均继续治疗2个周期,观察厄洛替尼联合多烯紫杉醇-卡铂治疗对晚期非小细胞肺癌患者的疗效、患者中位生存期及毒副反应。结果:两组患者治疗客观有效率对照治疗组为26.1%,厄洛替尼治疗组为45.6%,差异具有统计学意义(P0.05)。厄洛替尼治疗组患者中位生存期为6.9个月。与对照治疗组相比,厄洛替尼治疗组中患者3/4级中性粒细胞降低的发生率显著降低,差异具有统计学意义(P0.05)。结论:厄洛替尼能增强多烯紫杉醇+卡铂治疗方案对晚期非小细胞肺癌的疗效,减轻化疗的毒副反应。     

ROR1激活AKT/FOXO1信号介导非小细胞肺癌吉非替尼耐药

EGFR-TKI靶向治疗在非小细胞肺癌（non-small cell lung cancer, NSCLC）综合治疗中显示出重要作用;然而,耐药性却极大限制其临床治疗效果。受体酪氨酸激酶样孤儿受体（receptor tyrosine kinase-like orphan receptor 1, ROR1）是I型受体酪氨酸激酶家族中的成员,在肿瘤发生发展中发挥重要作用。本研究拟探讨ROR1介导非小细胞肺癌吉非替尼耐药的作用及机制。采用吉非替尼反复诱导非小细胞肺癌HCC827细胞,建立吉非替尼耐药细胞株HCC827/GR。应用荧光定量PCR和Western 印迹检测HCC827/GR内ROR1的表达。采用shRNA的方法体外检测ROR1敲除前后HCC827/GR对吉非替尼耐药的变化,采用体外检测ROR1过表达前后HCC827对吉非替尼耐药的变化。体内检测ROR1敲除前后HCC827/GR对吉非替尼耐药的变化。Western 印迹检测HCC827/GR内ROR1下游信号分子的活化。实时荧光定量PCR及Western 印迹结果显示,HCC827/GR耐药细胞中的ROR1 mRNA和蛋白质表达水平显著高于HCC827敏感细胞。体外干扰ROR1表达,可明显增强HCC827/GR耐药细胞对吉非替尼的敏感性 (IC50 15.3±3.69 vs. 4.2±1.38),增加吉非替尼诱导的细胞凋亡 (20.5±2.52 vs. 41.8±3.74)。体外过表达ROR1显著增强HCC827敏感细胞对吉非替尼的耐药性(IC50 0.8±0.52 vs. 2.2±0.87)。体内裸鼠移植瘤实验同样发现,干扰ROR1能增强HCC827/GR移植瘤对吉非替尼的敏感性。进一步研究发现,AKT/FOXO1信号在HCC827/GR耐药细胞中异常活化,而干扰ROR1能够抑制AKT的磷酸化,并上调FOXO1的表达。上述结果表明,ROR1参与非小细胞肺癌吉非替尼耐药,抑制ROR1能够逆转吉非替尼耐药,其机制与ROR1调控AKT/FOXO1信号有关。     

厄洛替尼单药与替莫唑胺联合放疗对肺腺癌伴脑转移的临床疗效分析

目的:探讨厄洛替尼单药与替莫唑胺联合放疗治疗肺腺癌脑转移的有效性和安全性。方法:选择2009年1月~2011年12月我院收治的54例肺癌脑转移患者为研究对象,随机分为厄洛替尼组和替莫唑胺联合放疗组。厄洛替尼组(34例)给予口服厄洛替尼150 mg/d服药直到病情进展或不能耐受副作用,替莫唑胺联合放疗组(20例)给予全脑放疗(40Gy/20次,4周)并同期给予替莫唑胺75 mg·m-2·d-1,d1-5 po,放疗后序贯替莫唑胺150mg·m-2·d-1,d1-5 po,q28d,共6周期。治疗结束后,分析和比较两组的无进展生存期(PFS)、中位生存期(OS)、总有效率(RR)和疾病控制率(DCR)以及不良反应的发生情况。结果:厄洛替尼组的RR和DCR分别为76.5%和88.2%;替莫唑胺联合放疗组分别为80%和95%,两组比较差异均无统计学意义(P0.05)。两组的PFS分别为10.1和7.1个月,差异无统计学意义(P0.05),厄洛替尼组的OS为20.1个月,较替莫唑胺联合放疗组(10.8个月)明显延长,差异有统计学意义(P0.05)。两组常见的不良反应为皮疹、骨髓抑制、消化道反应、肝功能损伤等,其中厄洛替尼组和替莫唑胺联合放疗组皮疹的发生率两分别为76.5%和5%,两组比较有统计学差异(P0.05),两组其它不良反应的发生率比较差异均无统计学意义(P0.05)。结论:厄洛替尼治疗肺腺癌脑转移的近期疗效与替莫唑胺联合放疗相当,但其可显著延长患者的中位生存期,不良反应轻微。     

Mcl-1参与非小细胞肺癌对吉非替尼耐药的实验研究

目的:探究人髓细胞白血病基因-1(myeloid cell leukemia-1,Mcl-1)是否参与非小细胞肺癌对吉非替尼的耐药。方法:应用Western blot检测Mcl-1在吉非替尼敏感细胞PC-9和耐药细胞H1975表达差异;梯度浓度的吉非替尼作用于PC-9细胞后,Western blot实验检测B淋巴细胞瘤-2基因(B-cell lymphoma-2,Bcl-2)家族中抗凋亡蛋白的表达变化;应用Western blot实验检测Mcl-1在PC-9和H1975细胞内降解速度差异。结果:Mcl-1在PC-9细胞内的表达明显低于H1975细胞,差异有统计学意义(P0.05),并且随着吉非替尼作用浓度的升高,Mcl-1表达逐渐降低,而Bcl-2和Bcl-x L表达基本不变,并且PC-9细胞内Mcl-1降解更迅速,半衰期明显缩短。结论:非小细胞肺癌对吉非替尼耐药可能与Mcl-1的表达量上调,降解速度减慢,半衰期延长有关。     

埃兹蛋白的表达与非小细胞肺癌转移的关系研究

目的:探究埃兹蛋白(Ezrin)的表达与非小细胞肺癌转移的关系。方法:通过免疫组化检测Ezrin在有无转移的非小细胞肺癌组织中的表达差异,通过细胞免疫组化、western-blot、RT-PCR检测Ezrin在不同转移潜能肺癌细胞系中的表达差异,通过transwell考察Ezrin对不同转移潜能癌细胞侵袭和迁移能力的影响。结果:Ezrin蛋白在有转移的非小细胞肺癌组织中的表达水平明显高于无转移的肺癌组织,在高转移潜能肺癌细胞系中的表达高于低转移潜能细胞系,受抑制时会削弱高转移潜能肺癌细胞的迁移和侵袭能力,过表达时会增强低转移潜能肺癌细胞的侵袭和迁移能力。结论:Ezrin可能在非小细胞肺癌及其转移中发挥重要作用。     

除痰解毒方联合吉非替尼对肺腺癌H1975荷瘤小鼠Twist、Fibronectin表达的影响

本文研究除痰解毒方(Chutan Jiedu Decoction,CJD)联合吉非替尼对肺腺癌H1975荷瘤小鼠移植瘤twist、fibronectin表达的影响,从上皮间质转化(Epithelial-mesenchymal transition,EMT)角度探讨其抗肿瘤作用机制。建立人肺腺癌H1975耐药细胞荷瘤裸鼠模型,随机分为模型组,吉非替尼组,除痰解毒方低、中、高剂量组,除痰解毒方中剂量联合吉非替尼组,每组10只,各组予以相应的药物灌胃2周。检测瘤体积和瘤质量,计算抑瘤率,采用免疫组织化学法、Western blot法、荧光定量PCR法检测各组肿瘤组织twist、fibronectin蛋白及基因的表达。结果显示,联合用药组抑瘤率为61.92%,明显高于模型组、吉非替尼组,除痰解毒方低、中、高剂量组(P0.01)。免疫组织化学法、Western blot法及荧光定量PCR法结果均显示除痰解毒方中剂量、高剂量及联合用药组均能下调twist和fibronectin的表达,且联合用药组下调作用高于单独用药组(P0.01)。研究结果表明除痰解毒方联合吉非替尼对肺腺癌H1975荷瘤小鼠移植瘤生长及twist、fibronectin表达的抑制作用优于除痰解毒方单药及吉非替尼组,其协同增效作用可能与逆转EMT增强吉非替尼的敏感性有关。     

miR‐1‐3p and miR‐206 sensitizes HGF‐induced gefitinib‐resistant human lung cancer cells through inhibition of c‐Met signalling and EMT

Hepatocyte growth factor (HGF) overexpression is an important mechanism in acquired epidermal growth factor receptor (EGFR) kinase inhibitor gefitinib resistance in lung cancers with EGFR activating mutations. MiR‐1‐3p and miR‐206 act as suppressors in lung cancer proliferation and metastasis. However, whether miR‐1‐3p and miR‐206 can overcome HGF‐induced gefitinib resistance in EGFR mutant lung cancer is not clear. In this study, we showed that miR‐1‐3p and miR‐206 restored the sensitivities of lung cancer cells PC‐9 and HCC‐827 to gefitinib in present of HGF. For the mechanisms, we demonstrated that both miR‐1‐3p and miR‐206 directly target HGF receptor c‐Met in lung cancer. Knockdown of c‐Met mimicked the effects of miR‐1‐3p and miR‐206 transfections Meanwhile, c‐Met overexpression attenuated the effects of miR‐1‐3p and miR‐206 in HGF‐induced gefitinib resistance of lung cancers. Furthermore, we showed that miR‐1‐3p and miR‐206 inhibited c‐Met downstream Akt and Erk pathway and blocked HGF‐induced epithelial‐mesenchymal transition (EMT). Finally, we demonstrated that miR‐1‐3p and miR‐206 can increase gefitinib sensitivity in xenograft mouse models in vivo. Our study for the first time indicated the new function of miR‐1‐3p and miR‐206 in overcoming HGF‐induced gefitinib resistance in EGFR mutant lung cancer cell.     

Cancer-associated fibroblasts promote epithelial-mesenchymal transition and EGFR-TKI resistance of non-small cell lung cancers via HGF/IGF-1/ANXA2 signaling

The involvement of the tumor stromal cells in acquired resistance of non-small cell lung cancers (NSCLCs) to tyrosine kinase inhibitors (TKIs) has previously been reported, but the precise mechanism remains unclear. In the present study, we investigated the role and mechanism underlying Cancer-associated fibroblasts (CAFs) in TKI resistance of NSCLCs. In vitro and in vivo experiments showed that HCC827 and PC9 cells, non-small cell lung cancer cells with EGFR-activating mutations, became resistant to the EGFR-TKI gefitinib when cultured with CAFs isolated from NSCLC tissues. Moreover, we showed that CAFs could induce epithelial-mesenchymal transition (EMT) phenotype of HCC827 and PC9 cells, with an associated change in the expression of epithelial to mesenchymal transition markers. Using proteomics-based method, we identified that CAFs significantly increased the expression of the Annexin A2 (ANXA2). More importantly, knockdown of ANXA2 completely reversed EMT phenotype and gefitinib resistance induced by CAFs. Furthermore, we found that CAFs increased the expression and phosphorylation of ANXA2 by secretion of growth factors HGF and IGF-1 and by activation of the corresponding receptors c-met and IGF-1R. Dual inhibition of HGF/c-met and IGF-1/IGF-1R pathways could significantly suppress ANXA2, and markedly reduced CAFs-induced EMT and gefitinib resistance. Taken together, these findings indicate that CAFs promote EGFR-TKIs resistance through HGF/IGF-1/ANXA2/EMT signaling and may be an ideal therapeutic target in NSCLCs with EGFR-activating mutations.     

Fibulin-3 negatively regulates ALDH1 via c-MET suppression and increases γ-radiation-induced sensitivity in some pancreatic cancer cell lines

Fibulin-3 (FBLN-3) has been postulated to be either a tumor suppressor or promoter depending on the cell type, and hypermethylation of the FBLN-3 promoter is often associated with human disease, especially cancer. We report that the promoter region of the FBLN-3 was significantly methylated (>95%) in some pancreatic cancer cell lines and thus FBLN-3 was poorly expressed in pancreatic cancer cell lines such as AsPC-1 and MiaPaCa-2. FBLN-3 overexpression significantly down-regulated the cellular level of c-MET and inhibited hepatocyte growth factor-induced c-MET activation, which were closely associated with γ-radiation resistance of cancer cells. Moreover, we also showed that c-MET suppression or inactivation decreased the cellular level of ALDH1 isozymes (ALDH1A1 or ALDH1A3), which serve as cancer stem cell markers, and subsequently induced inhibition of cell growth in pancreatic cancer cells. Therefore, forced overexpression of FBLN-3 sensitized cells to cytotoxic agents such as γ-radiation and strongly inhibited the stemness and epithelial to mesenchymal transition (EMT) property of pancreatic cancer cells. On the other hand, if FBLN3 was suppressed in FBLN-3-expressing BxPC3 cells, the results were opposite. This study provides the first demonstration that the FBLN-3/c-MET/ALDH1 axis in pancreatic cancer cells partially modulates stemness and EMT as well as sensitization of cells to the detrimental effects of γ-radiation.     

Erlotinib inhibits colon cancer metastasis through inactivation of TrkB-dependent ERK signaling pathway

The distal metastasis is the main cause of death in patients with colon cancer. Tyrosine receptor kinase B (TrkB) and ERK signals may be the potential targets for the treatment of colon cancer metastasis. This study aims to investigate whether erlotinib inhibits distant metastasis of colon cancer by regulating TrkB and ERK signaling pathway. Human colon adenocarcinoma cell lines (SW480 and Caco-2) pretreated with exogenous C-X-C motif chemokine ligand 8 (CXCL8) were used to assess the suppressive effect of erlotinib on tumor metastasis, including anoikis, epithelial-mesenchymal transformation (EMT), migration, and invasion. Through TrkB overexpression, Akt suppression, and ERK suppression, the roles of TrkB, Akt, and ERK in erlotinib-induced metastasis inhibition of colon cancer cells were explored. The results showed that erlotinib alleviated CXCL8-induced metastasis of the colon cancer cells. Overexpression of TrkB in colon cancer cells eliminated the effect of erlotinib on anoikis, inhibition of EMT, migration, and invasion, and downregulation of p-ERK and p-Akt. Furthermore, the inhibition of ERK activation instead of Akt activation was found to participate in erlotinib-mediated metastasis resistance, including anoikis, inhibition of EMT, migration, and invasion. In conclusion, erlotinib inhibits colon cancer cell anoikis resistance, EMT, migration, and invasion by inactivating TrkB-dependent ERK signaling pathway.     

AUY922 Effectively Overcomes MET- and AXL-Mediated Resistance to EGFR-TKI in Lung Cancer Cells

The activation of bypass signals, such as MET and AXL, has been identified as a possible mechanism of EGFR-TKI resistance. Because various oncoproteins depend on HSP90 for maturation and stability, we investigated the effects of AUY922, a newly developed non-geldanamycin class HSP90 inhibitor, in lung cancer cells with MET- and AXL-mediated resistance. We established resistant cell lines with HCC827 cells harboring an exon 19-deletion mutation in of the EGFR gene via long-term exposure to increasing concentrations of gefitinib and erlotinib (HCC827/GR and HCC827/ER, respectively). HCC827/GR resistance was mediated by MET activation, whereas AXL activation caused resistance in HCC827/ER cells. AUY922 treatment effectively suppressed proliferation and induced cell death in both resistant cell lines. Accordingly, the downregulation of EGFR, MET, and AXL led to decreased Akt activation. The inhibitory effects of AUY922 on each receptor were confirmed in gene-transfected LK2 cells. AUY922 also effectively controlled tumor growth in xenograft mouse models containing HCC827/GR and HCC827/ER cells. In addition, AUY922 reduced invasion and migration by both types of resistant cells. Our study findings thus show that AUY922 is a promising therapeutic option for MET- and AXL-mediated resistance to EGFR-TKI in lung cancer.     

Long non‐coding RNA H19 is responsible for the progression of lung adenocarcinoma by mediating methylation‐dependent repression of CDH1 promoter

Lung adenocarcinoma is a common histologic type of lung cancer with a high death rate globally. Increasing evidence shows that long non‐coding RNA H19 (lncRNA H19) and CDH1 methylation are involved in multiple tumours. Here, we tried to investigate whether lncRNA H19 or CDH1 methylation could affect the development of lung adenocarcinoma. First, lung adenocarcinoma tissues were collected to detect CDH1 methylation. Then, the regulatory mechanisms of lncRNA H19 were detected mainly in concert with the treatment of overexpression of lncRNA H19, siRNA against lncRNA H19, overexpression of CDH1 and demethylating agent A‐5az in lung adenocarcinoma A549 cell. The expression of lncRNA H19 and epithelial‐mesenchymal transition (EMT)‐related factors as well as cell proliferation, sphere‐forming ability, apoptosis, migration and invasion were detected. Finally, we observed xenograft tumour in nude mice so as to ascertain tumorigenicity of lung adenocarcinoma cells. LncRNA H19 and methylation of CDH1 were highly expressed in lung adenocarcinoma tissues. A549 cells with silencing of lncRNA H19, overexpression of CDH1 or reduced CDH1 methylation by demethylating agent 5‐Az had suppressed cell proliferation, sphere‐forming ability, apoptosis, migration and invasion, in addition to inhibited EMT process. Silencing lncRNA H19 could reduce methylation level of CDH1. In vivo, A549 cells with silencing lncRNA H19, overexpression of CDH1 or reduced CDH1 methylation exhibited low tumorigenicity, reflected by the smaller tumour size and lighter tumour weight. Taken together, this study demonstrates that silencing of lncRNA H19 inhibits EMT and proliferation while promoting apoptosis of lung adenocarcinoma cells by inhibiting methylation of CDH1 promoter.     

Effect of aerobic exercise on acquired gefitinib resistance in lung adenocarcinoma

Lung adenocarcinoma patients with epidermal growth factor receptor (EGFR)-activating mutations respond well to tyrosine kinase inhibitors but typically develop resistance. Current therapies mainly target differentiated cells, not cancer stem cells (CSCs), but CSCs affect the occurrence, invasion, metastasis and treatment sensitivity of malignant tumours. Recently, aerobic exercise has emerged as adjuvant therapy for cancer. Aerobic exercise can accelerate blood circulation, improve tissue oxygen supply, reduce the stress level of patients, improve the antioxidant capacity of the body, and facilitate the degradation of hypoxia-inducible factor-1 (HIF-1) in tumour tissues, thus weakening its maintenance effect on CSCs. In this study, we successfully established lung adenocarcinoma cell lines with gefitinib resistance. Long-term gefitinib induction could increase the level of oxidative stress in lung adenocarcinoma cells and reduce the antioxidant capacity, resulting in the high expression of HIF-1 and ALDH1 and leading to the enrichment of CSCs, and a decreased response to gefitinib. This may be one of the important reasons for gefitinib-acquired resistance in lung adenocarcinoma. In the case of drug resistance, effective aerobic exercise could reduce ROS, activate SOD, inhibit HIF-1 and ALDH1, and cause a reduction in CSCs to sensitise cells to gefitinib again and ultimately inhibit the malignant proliferation of tumours. Therefore, in the treatment of lung adenocarcinoma, the inhibitory effect of aerobic exercise on oxidative stress can enhance the response of drug-resistant cells to gefitinib and can be used as an effective adjunct measure in the treatment of lung adenocarcinoma.     

Hypoxia Increases Gefitinib-Resistant Lung Cancer Stem Cells through the Activation of Insulin-Like Growth Factor 1 Receptor

Accumulating evidence indicates that a small population of cancer stem cells (CSCs) is involved in intrinsic resistance to cancer treatment. The hypoxic microenvironment is an important stem cell niche that promotes the persistence of CSCs in tumors. Our aim here was to elucidate the role of hypoxia and CSCs in the resistance to gefitinib in non-small cell lung cancer (NSCLC) with activating epidermal growth factor receptor (EGFR) mutation. NSCLC cell lines, PC9 and HCC827, which express the EGFR exon 19 deletion mutations, were exposed to high concentration of gefitinib under normoxic or hypoxic conditions. Seven days after gefitinib exposure, a small fraction of viable cells were detected, and these were referred to as “gefitinib-resistant persisters” (GRPs). CD133, Oct4, Sox2, Nanog, CXCR4, and ALDH1A1–all genes involved in stemness–were highly expressed in GRPs in PC9 and HCC827 cells, and PC9 GRPs exhibited a high potential for tumorigenicity in vivo. The expression of insulin-like growth factor 1 (IGF1) was also upregulated and IGF1 receptor (IGF1R) was activated on GRPs. Importantly, hypoxic exposure significantly increased sphere formation, reflecting the self-renewal capability, and the population of CD133- and Oct4-positive GRPs. Additionally, hypoxia upregulated IGF1 expression through hypoxia-inducible factor 1α (HIF1α), and markedly promoted the activation of IGF1R on GRPs. Knockdown of IGF1 expression significantly reduced phosphorylated IGF1R-expressing GRPs under hypoxic conditions. Finally, inhibition of HIF1α or IGF1R by specific inhibitors significantly decreased the population of CD133- and Oct4-positive GRPs, which were increased by hypoxia in PC9 and HCC827 cells. Collectively, these findings suggest that hypoxia increased the population of lung CSCs resistant to gefitinib in EGFR mutation-positive NSCLC by activating IGF1R. Targeting the IGF1R pathway may be a promising strategy for overcoming gefitinib resistance in EGFR mutation-positive NSCLC induced by lung CSCs and microenvironment factors such as tumor hypoxia.