Enhanced Sensitivity of Nonsmall Cell Lung Cancer with Acquired Resistance to Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitors to Phenformin: The Roles of a Metabolic Shift to Oxidative Phosphorylation and Redox Balance

• Published in: Oxidative medicine and cellular longevity Vol. 2021; no. 1; p. 5428364
• Main Authors: Kim, Suntae, Im, Ji Hye, Kim, Wan Kyu, Choi, Young Jae, Lee, Ji-Yoon, Kim, Sang Kyum, Kim, Sun Jo, Kwon, Sung Won, Kang, Keon Wook
• Format: Journal Article
• Language: English
• Published: United States Hindawi 2021; Hindawi Limited
• Subjects: Animals; Antibodies; Apoptosis; Cancer therapies; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - metabolism; Carcinoma, Non-Small-Cell Lung - pathology; Cell culture; Cell growth; Cell Proliferation; Dehydrogenases; Drug Resistance, Neoplasm - drug effects; Epidermal growth factor; ErbB Receptors - antagonists & inhibitors; ErbB Receptors - genetics; Gefitinib - pharmacology; Gene Expression Regulation, Neoplastic - drug effects; Glucose; Humans; Hypoglycemic Agents - pharmacology; Kinases; Lung cancer; Lung Neoplasms - drug therapy; Lung Neoplasms - metabolism; Lung Neoplasms - pathology; Male; Membranes; Metabolism; Mice; Mice, Inbred BALB C; Mice, Nude; Mutation; Oxidation-Reduction; Oxidative Phosphorylation; Phenformin - pharmacology; Protein Kinase Inhibitors - pharmacology; Sodium; Tumor Cells, Cultured; Xenograft Model Antitumor Assays; South Korea; Ann Arbor Michigan; United States > US; Japan
• ISSN: 1942-0900; 1942-0994
• DOI: 10.1155/2021/5428364

Background. Although the efficacy of epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR- TKI) therapy has been proven in non-small cell lung cancer (NSCLC) patients, acquired resistance to EGFR-TKIs presents a serious clinical problem. Hence, the identification of new therapeutic strategy is needed to treat EGFR-TKI-resistant NSCLC. Methods. Acquired EGFR-TKI-resistant lung cancer cell lines (HCC827, H1993, and H292 cells with acquired resistance to gefitinib or erlotinib) were used for cell-based studies. IncuCyte live cell analysis system and XFp analyzer were used for the determination of cell proliferation and energy metabolism, respectively. In vivo anticancer effect of phenformin was assessed in xenografts implanting HCC827 and gefitinib-resistant HCC827 (HCC827 GR) cells. Results. HCC827 GR and erlotinib-resistant H1993 (H1993 ER) cells exhibited different metabolic properties compared with their respective parental cells, HCC827, and H1993. In EGFR-TKI-resistant NSCLC cells, glycolysis markers including the glucose consumption rate, intracellular lactate level, and extracellular acidification rate were decreased; however, mitochondrial oxidative phosphorylation (OXPHOS) markers including mitochondria-driven ATP production, mitochondrial membrane potential, and maximal OXPHOS capacity were increased. Cell proliferation and tumor growth were strongly inhibited by biguanide phenformin via targeting of mitochondrial OXPHOS complex 1 in EGFR-TKI-resistant NSCLC cells. Inhibition of OXPHOS resulted in a reduced NAD+/NADH ratio and intracellular aspartate levels. Recovery of glycolysis by hexokinase 2 overexpression in erlotinib-resistant H292 (H292 ER) cells significantly reduced the anticancer effects of phenformin. Conclusion. Long-term treatment with EGFR-TKIs causes reactivation of mitochondrial metabolism, resulting in vulnerability to OXPHOS inhibitor such as phenformin. We propose a new therapeutic option for NSCLC with acquired EGFR-TKI resistance that focuses on cancer metabolism.