Increasing the dose of erlotinib does not significantly

Inhibition of mutant EGFR in lung cancer cells triggers SOX2-FOXO6-dependent survival pathways. Rothenberg SM, Concannon K, Cullen S, Boulay G, Turke AB, Faber AC, Lockerman EL, Rivera MN, Engelman JA, Maheswaran S, Haber DA - Elife (2015) Bottom Line: Treatment of EGFR-mutant lung cancer with erlotinib results in dramatic tumor regression but it is invariably followed by drug resistance.In characterizing early transcriptional changes following drug treatment of mutant EGFR-addicted cells, we identified the stem cell transcriptional regulator SOX2 as being rapidly and specifically induced, both in vitro and in vivo.Together, these observations point to a physiological feedback mechanism that attenuates oncogene addiction-mediated cell death associated with the withdrawal of growth factor signaling and may therefore contribute to the development of resistance. View Article: PubMed Central - PubMed Affiliation: Cancer Center, Massachusetts General Hospital, Harvard Medical School, Charlestown, United States. ABSTRACT Treatment of EGFR-mutant lung cancer with erlotinib results in dramatic tumor regression but it is invariably followed by drug resistance. In characterizing early transcriptional changes following drug treatment of mutant EGFR-addicted cells, we identified the stem cell transcriptional regulator SOX2 as being rapidly and specifically induced, both in vitro and in vivo. Suppression of SOX2 sensitizes cells to erlotinib-mediated apoptosis, ultimately decreasing the emergence of acquired resistance, whereas its ectopic expression reduces drug-induced cell death. We show that erlotinib relieves EGFR-dependent suppression of FOXO6, leading to its induction of SOX2, which in turn represses the pro-apoptotic BH3-only genes BIM and BMF. Together, these observations point to a physiological feedback mechanism that attenuates oncogene addiction-mediated cell death associated with the withdrawal of growth factor signaling and may therefore contribute to the development of resistance. Show MeSH Major Cell Survival/physiology* Forkhead Transcription Factors/physiology* Lung Neoplasms/metabolism* Receptor, Epidermal Growth Factor/antagonists & inhibitors/genetics SOXB1 Transcription Factors/physiology Minor Adaptor Proteins, Signal Transducing/physiology Apoptosis/drug effects Apoptosis Regulatory Proteins/physiology Cell Line, Tumor Erlotinib Hydrochloride/pharmacology Humans Membrane Proteins/physiology Proto-Oncogene Proteins/physiology Related in: MedlinePlus	$Increasing the dose of erlotinib does not significantly increase thefraction of SOX2+ cells.HCC827 (left) and PC9 (right) cells were treated for 24 hr with theindicated dose of erlotinib, followed by immunofluorescence microscopywith antibodies to SOX2 and DAPI. The distribution of SOX2+ cellsis shown. N = 607–1169 for HCC827 cells, 2746–6818for PC9, % SOX2+ is shown. Note: increased cell death at thehighest dose of erlotinib precludes accurate determination ofSOX2+ PC9 cells. Source data are included as Figure2—source data 4.DOI:http://dx.doi.org/10.7554/eLife.06132.015$ © Copyright Policy Related In: Results - Collection License Show All Figures getmorefigures.php?uid=PMC4384750&req=5 fig2s1: Increasing the dose of erlotinib does not significantly increase thefraction of SOX2+ cells.HCC827 (left) and PC9 (right) cells were treated for 24 hr with theindicated dose of erlotinib, followed by immunofluorescence microscopywith antibodies to SOX2 and DAPI. The distribution of SOX2+ cellsis shown. N = 607–1169 for HCC827 cells, 2746–6818for PC9, % SOX2+ is shown. Note: increased cell death at thehighest dose of erlotinib precludes accurate determination ofSOX2+ PC9 cells. Source data are included as Figure2—source data 4.DOI:http://dx.doi.org/10.7554/eLife.06132.015 Mentions: The level of SOX2 induction in cultured cells exposed to erlotinib showedconsiderable heterogeneity, with a subset of cells (∼20%, with someexperimental variability) expressing high levels (Figure 2A). The SOX2+ fraction was not increased by higher drugdosage, beyond that required for full inhibition of EGFR (Figure 2—figure supplement 1). Given the link betweenSOX2 expression and cellular reprogramming, we first asked whether cells with thehigh SOX2 expression represent a subset with stem cell markers. However, SOX2expression did not correlate with expression of the putative stem cell markers CD133,CD44, CD24, OCT-4, or KLF-4 (Figure 2—figuresupplement 2) nor did microarray-based expression profiling of highSOX2-sorted cells identify a stem-like signature (data not shown). Nonetheless,SOX2-expressing cells had a very low proliferative index, as measured by Ki67staining (0.5% of Ki67+/SOX2+ vs 51% Ki67+/SOX2− HCC827cells at baseline [p = 0.015]; and 0.15% Ki67+/SOX2+ vs 6.4%Ki67+/SOX2− cells following erlotinib [p < 0.0001]) (Figure 2C, Figure 2—figure supplement 3).10.7554/eLife.06132.008Figure 2.Induction of SOX2 in erlotinib-treated cells.

Inhibition of mutant EGFR in lung cancer cells triggers SOX2-FOXO6-dependent survival pathways.

Rothenberg SM, Concannon K, Cullen S, Boulay G, Turke AB, Faber AC, Lockerman EL, Rivera MN, Engelman JA, Maheswaran S, Haber DA - Elife (2015)

Bottom Line: Treatment of EGFR-mutant lung cancer with erlotinib results in dramatic tumor regression but it is invariably followed by drug resistance.In characterizing early transcriptional changes following drug treatment of mutant EGFR-addicted cells, we identified the stem cell transcriptional regulator SOX2 as being rapidly and specifically induced, both in vitro and in vivo.Together, these observations point to a physiological feedback mechanism that attenuates oncogene addiction-mediated cell death associated with the withdrawal of growth factor signaling and may therefore contribute to the development of resistance.

View Article: PubMed Central - PubMed

Affiliation: Cancer Center, Massachusetts General Hospital, Harvard Medical School, Charlestown, United States.

ABSTRACT

Treatment of EGFR-mutant lung cancer with erlotinib results in dramatic tumor regression but it is invariably followed by drug resistance. In characterizing early transcriptional changes following drug treatment of mutant EGFR-addicted cells, we identified the stem cell transcriptional regulator SOX2 as being rapidly and specifically induced, both in vitro and in vivo. Suppression of SOX2 sensitizes cells to erlotinib-mediated apoptosis, ultimately decreasing the emergence of acquired resistance, whereas its ectopic expression reduces drug-induced cell death. We show that erlotinib relieves EGFR-dependent suppression of FOXO6, leading to its induction of SOX2, which in turn represses the pro-apoptotic BH3-only genes BIM and BMF. Together, these observations point to a physiological feedback mechanism that attenuates oncogene addiction-mediated cell death associated with the withdrawal of growth factor signaling and may therefore contribute to the development of resistance.

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$Increasing the dose of erlotinib does not significantly increase thefraction of SOX2+ cells.HCC827 (left) and PC9 (right) cells were treated for 24 hr with theindicated dose of erlotinib, followed by immunofluorescence microscopywith antibodies to SOX2 and DAPI. The distribution of SOX2+ cellsis shown. N = 607–1169 for HCC827 cells, 2746–6818for PC9, % SOX2+ is shown. Note: increased cell death at thehighest dose of erlotinib precludes accurate determination ofSOX2+ PC9 cells. Source data are included as Figure2—source data 4.DOI:http://dx.doi.org/10.7554/eLife.06132.015$

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fig2s1: Increasing the dose of erlotinib does not significantly increase thefraction of SOX2+ cells.HCC827 (left) and PC9 (right) cells were treated for 24 hr with theindicated dose of erlotinib, followed by immunofluorescence microscopywith antibodies to SOX2 and DAPI. The distribution of SOX2+ cellsis shown. N = 607–1169 for HCC827 cells, 2746–6818for PC9, % SOX2+ is shown. Note: increased cell death at thehighest dose of erlotinib precludes accurate determination ofSOX2+ PC9 cells. Source data are included as Figure2—source data 4.DOI:http://dx.doi.org/10.7554/eLife.06132.015

Mentions: The level of SOX2 induction in cultured cells exposed to erlotinib showedconsiderable heterogeneity, with a subset of cells (∼20%, with someexperimental variability) expressing high levels (Figure 2A). The SOX2+ fraction was not increased by higher drugdosage, beyond that required for full inhibition of EGFR (Figure 2—figure supplement 1). Given the link betweenSOX2 expression and cellular reprogramming, we first asked whether cells with thehigh SOX2 expression represent a subset with stem cell markers. However, SOX2expression did not correlate with expression of the putative stem cell markers CD133,CD44, CD24, OCT-4, or KLF-4 (Figure 2—figuresupplement 2) nor did microarray-based expression profiling of highSOX2-sorted cells identify a stem-like signature (data not shown). Nonetheless,SOX2-expressing cells had a very low proliferative index, as measured by Ki67staining (0.5% of Ki67+/SOX2+ vs 51% Ki67+/SOX2− HCC827cells at baseline [p = 0.015]; and 0.15% Ki67+/SOX2+ vs 6.4%Ki67+/SOX2− cells following erlotinib [p < 0.0001]) (Figure 2C, Figure 2—figure supplement 3).10.7554/eLife.06132.008Figure 2.Induction of SOX2 in erlotinib-treated cells.