Abstract 4450: MYC upregulates MCT4 expression and promotes metabolic reprogramming and enhanced lactate utilization in LKB1-deficient NSCLC
Authors: Qian Yu , Molkentine David , Kong Yifan , Huang Qian , Yang Chendong , Poteete Alissa , Guimaraes Alvaro P. , Jiang Peixin , Skoulidis Ferdinandos , Reuben Alexandre , Minna John D. , DeBerardinis Ralph J. , Heymach John V. 
Published: March 2024

Abstract
STK11, which encodes the serine/threonine kinase LKB1, is the second most commonly altered tumor suppressor in non-small cell lung cancer (NSCLC). LKB1 loss is frequently co-mutated with KRAS and associated with primary resistance to immunotherapy, which is partially due to MCT4-dependent lactate secretion. However, the mechanisms driving MCT4 elevation and metabolic reprogramming remains unclear. We hypothesized that increased MYC expression, which is associated with LKB1 loss, plays a pivotal role in metabolic alterations, promoting lactate incorporation and maintaining redox homeostasis. To explore the impact of lactate on tumor cells with LKB1 loss, we performed metabolic profiling on KRAS mutant (K) murine lung cancer cells with or without LKB1 knockout (KL) treated with either glucose or lactate as the carbon source. PLS analysis indicated that there was no notable difference between K and KL cells after glucose treatment. However, we observed significant changes in metabolites between K and KL cells when treated with lactate. Differentially altered metabolites included TCA-related components such as acetyl-CoA and glutamate, indicating enhanced lactate utilization in KL tumor cells. We also noticed that KL cells showed increased oxidative phosphorylation (OXPHOS) with the addition of lactate, with increased GSH/GSSH and NADPH/NADP+ ratios, suggesting that, as compared to LKB1-intact cells, LKB1-deficient cells had an enhanced ability to utilize OXPHOS and maintain redox homeostasis with lower levels of ROS generation when utilizing lactate as an energy source. However, in KL cells, MYC knockout (KO) or MCT4 KO partially abolished the lactate-induced OXPHOS and increased ROS. Moreover, [U-13C]lactate tracing revealed that isotopologues were significantly enriched in TCA components in KL cells, and this was reversed by either MYC KO or MCT4 KO, suggesting that MYC and MCT4 were critical for lactate reutilization in KL tumor cells. We observed that MYC could directly bind to the promoter region and transcriptionally activate MCT4 expression, and restoring MCT4 in MYC KO cells enhanced lactate incorporation and decreased ROS levels. Finally, we injected KL murine tumor cells with or without MYC/MCT4 KO into mice and infused [U-13C]lactate to detect the isotopologues distribution in vivo. KL tumors showed significantly enhanced lactate incorporation as compared to K tumors, while MYC KO or MCT4 KO reversed these phenotypes. Collectively, our data indicates that in LKB1-deficient tumors, upregulation of MYC promotes MCT4 expression and increases lactate incorporation and utilization, and that can be inhibited by targeting MYC or MCT4. These findings provide insight into the mechanisms driving the metabolic reprogramming and aggressive phenotype of KRAS-mutant LKB1-deficient tumors and identify a novel therapeutic strategy for this recalcitrant subgroup.
Citation Format: Yu Qian, David Molkentine, Yifan Kong, Qian Huang, Chendong Yang, Alissa Poteete, Alvaro P. Guimaraes, Peixin Jiang, Ferdinandos Skoulidis, Alexandre Reuben, John D. Minna, Ralph J. DeBerardinis, John V. Heymach. MYC upregulates MCT4 expression and promotes metabolic reprogramming and enhanced lactate utilization in LKB1-deficient NSCLC [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4450.