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Targeting AXL can effectively inhibit c-Met-induced therapeutic resistance in renal cancer

ABSTRACT: The mechanism(s) for therapeutic resistance against c-Met/receptor tyrosine kinase (RTK) inhibitor(s) in renal cancer is totally unexplored. In renal cell carcinoma (RCC) cells, both AXL and c-Met are highly overexpressed and they form a complex. Interestingly, the prolonged treatment with c-Met/RTK inhibitor, Cabozantinib (Cabo), which is being used for the treatment of RCC patients, markedly increased the level of total c-Met and promoted renal cancer cell proliferation. This effect was confirmed not only in vitro but also in murine models and renal tumor tissues from Cabo-treated patients. Also, the lower concentrations of Cabo treatment could not inhibit HGF (c-Met ligand)-induced c-Met phosphorylation; rather they further increased the phosphorylation of the receptor and promoted downstream signaling events for tumor growth. In addition, our findings indicate that Cabo treatment induces AXL-c-Met association, and it interferes with the physiological degradation processes of c-Met within renal cancer cells. However, either the inhibition or the knockout of AXL could significantly overcome the therapeutic resistance against c-Met inhibitor(s); and it markedly induced apoptotic cell death through increased oxidative stress and inhibition of the transcription factor, Nrf2. We generated Cabo-resistant RCC cells, and we observed that the expression of both c-Met and AXL are markedly overexpressed in these cells; and the inhibition of AXL (through TP-0903) can resensitize the cancer cells to Cabo-mediated cell death. Moreover, we found significant differences in the epigenomic profile of the Cabo-resistant RCC cells compared with Cabo-sensitive cancer cells. Our in-depth studies suggest that AXL plays a major role in mediating therapeutic resistance against c-Met inhibitor(s). A combination therapy using c-Met inhibitor(s) in the presence of an AXL inhibitor can play a pivotal role to overcome acquired resistance against RTK inhibitors in renal cancer.

ORGANISM(S): Homo sapiens

PROVIDER: GSE296078 | GEO | 2025/09/10

REPOSITORIES: GEO

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Project description:Renal cell carcinoma (RCC) is one of the ten most common malignancies. Even though recent paradigm changes led to inclusion of immune checkpoint inhibitor combination therapy in treatment of naive metastatic RCC, insight in the biology and management of RCC would still favour the use of a combination of kinase inhibitors to target multiple pathways, presenting the possibility of enhanced efficacy and reduced development of resistance. We have used the streamlined-feedback system control (s-FSC) technique, a phenotypic approach, to identify optimized drug combinations (ODC) in 5 different human RCC lines. This approach requires no a priori mechanistic information on drug mechanism of action, and uses statistical modelling circumventing the need to experimentally screen large numbers of combinations. Different ODC with up to 90% effectivity were obtained for the 5 cell lines, importantly, by combining drug at doses that individually only inhibit 5-25% cell viability. Cell viability was reduced and apoptosis induced, accompanied by a general inhibition of downstream survival and growth promoting effector kinase RPS6. Global phosphoproteomics analysis of the cell lines revealed that in all cases where the ODC showed >50% efficacy, the most active kinases were targets of the selected drugs in the ODC. Interestingly, we observed considerable overlap in the top 20 most active kinases in all 5 cell lines, suggesting a universal ODC might be effective in all cells. Indeed, a combination of erlotinib and dasatinib, targeting EGFR and EPHA2/SRC signaling respectively, combined with AZD4547 or axitinib (targeting VEGFR and FGFR signaling), displayed excellent activity. The effect of the 786-O cell-line specific ODC was analysed in more detail using phosphoproteomics coupled to kinase activity analysis using the INKA pipeline.approaches. As expected, the activity of the main targets of erlotinib and dasatinib was reduced, but the activity of several untargeted kinases, including AXL, PTK2 and MET, remained high or increased, having potential implications for the development of resistance. Addition of crizotinib, targeting MET and PTK2, to the 3-drug ODC but not exchange with axitinib, further enhanced drug combination efficacy. In conclusion, we show that the phenotypic s-FSC method is highly effective in selecting optimized combinations of drugs, and that phosphoproteomics analysis can help further refine the selection of drugs included in the screen or final drug mixture.

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Targeting AXL can effectively inhibit c-Met-induced therapeutic resistance in renal cancer

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