Abstract 1916: Targeting Warburg effect to overcome lapatinib resistance in esophageal adenocarcinoma
Authors: Hassan Md Sazzad , Holmes Samantha , Makuru Victoria , Johnson Chloe , von Holzen Urs 
Published: September 2020

Abstract
Background: A major target for esophageal adenocarcinoma (EAC) therapies is the human epidermal growth factor receptor 2 (HER2). EAC overexpresses HER2 and lapatinib, a dual tyrosine kinase inhibitor blocking HER1 and HER2 pathways fails to improve patient survival. Molecular mechanisms of this lapatinib resistance are still unclear. We therefore explored the role of glycolytic enzyme pyruvate kinase M2 (PKM2), a key regulator of Warburg effect in lapatinib resistance mechanism of EAC cells.
Methods: First we established lapatinib-resistant OE19 (LPR-OE19) cells from OE19 EAC cells and characterized it. We then investigated the comparative cell growth inhibition, apoptotic and lactate production effects of HER2 inhibitor lapatinib and PKM2 inhibitor shikonin either alone or in combinations, both in OE19 and LPR-OE19 cells with and without knockdown of PKM2 and HSP40 by siRNAs. We then explored the antitumor efficacy following lapatinib and shikonin mono and combination therapies in murine subcutaneous xenograft model of human EAC.
Results: Lapatinib-resistant OE19 (LPR-OE19) cells were established from OE19 cells by intermittent exposure to increasing concentrations of lapatinib for a period of total six months. Lapatinib resistant LPR-OE19 cells showed downregulation of HSP40 both at protein and mRNA levels whereas showed upregulation of PKM2 only at protein level. LPR-OE19 cells showed significantly reduced sensitivity to lapatinib induced cell growth inhibition, apoptosis and decreased cell migration compared to parent OE19 cells. Interestingly, augmented cell growth inhibition, apoptosis and decreased cell migration were observed in LPR-OE19 cells compared to parent OE19 cells when lapatinib was combined with shikonin. More interestingly, knockdown of PKM2 in LPR-OE19 cells abolished the reduced sensitivity of lapatinib induced cell growth inhibition and also abolished augmented cell growth inhibition response when lapatinib and shikonin were combined. Contrary to that, knockdown of HSP40 in OE19 cells enhanced PKM2 expression leading to significantly reduced sensitivity to lapatinib induced growth inhibition with augmented growth inhibition when lapatinib and shikonin were combined. Moreover, LPR-OE19 cells showed enhanced lactate production compared to parent OE19. Interestingly, PKM2 and HSP40 co-localize with each other in the cell nucleus suggesting that PKM2 bound to molecular chaperone HSP40. In subcutaneous xenografts using LPR-OE19 cells, average net tumor growth after two weeks in different therapy groups was 494.72 mm3 in control, 403.11 mm3 after lapatinib (p=0.241), 339.48 mm3 after shikonin (p=0.0478), and 141.59 mm3 after shikonin plus lapatinib (p=0.0003).
Conclusions: In conclusion, these data suggest that combination therapy with lapatinib and glycolytic inhibitor shikonin should be tested as a potent option for lapatinib resistant HER2-positive EAC patients and could be a novel treatment strategy for specific EAC. In addition, it is suggested that targeting HSP40-PKM2 interaction as an innovative therapeutic approach to overcome lapatinib resistance in EAC.
Citation Format: Md Sazzad Hassan, Samantha Holmes, Victoria Makuru, Chloe Johnson, Urs von Holzen. Targeting Warburg effect to overcome lapatinib resistance in esophageal adenocarcinoma [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 1916.