EGFR‐TKIs Induced DPP4 Drives Metabolic Reprogramming of Persister Cells in Lung Cancer

Abstract Mutations in epidermal growth factor receptor (EGFR) are the key drivers of lung cancer initiation and recurrence. The cancer cells undergo transformation to a reversible drug‐tolerant persister (DTP) state prior to the development of resistance against EGFR‐tyrosine kinase inhibitors (TKIs...

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Main Authors: Yuanzhou Zhang, Xiaojun Zhang, Xupeng Yang, Xingshi Chen, Yuehong Wang, Jingying Hu, Rui Liu, Xiaoying Luo
Format: Article
Language:English
Published: Wiley 2025-08-01
Series:Advanced Science
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Online Access:https://doi.org/10.1002/advs.202506950
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author Yuanzhou Zhang
Xiaojun Zhang
Xupeng Yang
Xingshi Chen
Yuehong Wang
Jingying Hu
Rui Liu
Xiaoying Luo
author_facet Yuanzhou Zhang
Xiaojun Zhang
Xupeng Yang
Xingshi Chen
Yuehong Wang
Jingying Hu
Rui Liu
Xiaoying Luo
author_sort Yuanzhou Zhang
collection DOAJ
description Abstract Mutations in epidermal growth factor receptor (EGFR) are the key drivers of lung cancer initiation and recurrence. The cancer cells undergo transformation to a reversible drug‐tolerant persister (DTP) state prior to the development of resistance against EGFR‐tyrosine kinase inhibitors (TKIs). Two DTP lung cancer cells with different proliferative capacities are established and identified dipeptidyl peptidase 4 (DPP4) as a potential therapeutic target. The DTP cells primarily relied on oxidative phosphorylation, which is accompanied by the up‐regulation of fatty acid metabolism. Mechanistically, DPP4 facilitates the uptake of fatty acids via carnitine palmitoyl transferase 1a (CPT1A, and enhances fatty acid oxidation. In addition, the DPP4‐mitogen‐activated protein kinase kinase (MEK)‐Nuclear factor erythroid‐2‐related factor 2 (Nrf2) signaling pathway maintains mitochondrial function by activating the antioxidant pathway. The combination of osimertinib and sitagliptin, a DPP4 inhibitor, not only suppressed tumor progression but also reduced the number of residual tumor cells and minimal residual disease. Notably, this combination therapy significantly lowered recurrence rates and extended the survival of tumor‐bearing mice compared to the monotherapies. The study provides new insights into the metabolic adaptations of DTP lung cancer cells in response to EGFR‐TKIs, offering novel therapeutic strategies for targeting these persister cells.
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spelling doaj-art-0386556f4b834176a0160497f53d25b62025-08-23T14:13:41ZengWileyAdvanced Science2198-38442025-08-011231n/an/a10.1002/advs.202506950EGFR‐TKIs Induced DPP4 Drives Metabolic Reprogramming of Persister Cells in Lung CancerYuanzhou Zhang0Xiaojun Zhang1Xupeng Yang2Xingshi Chen3Yuehong Wang4Jingying Hu5Rui Liu6Xiaoying Luo7State Key Laboratory of Systems Medicine for Cancer Shanghai Cancer Institute Renji Hospital Shanghai Jiao Tong University School of Medicine Shanghai ChinaState Key Laboratory of Systems Medicine for Cancer Shanghai Cancer Institute Renji Hospital Shanghai Jiao Tong University School of Medicine Shanghai ChinaDepartment of Liver Surgery and Transplantation and Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education) Liver Cancer Institute Zhongshan Hospital Fudan University Shanghai ChinaDepartment of Thoracic Surgical Oncology Shanghai Lung Cancer Center Shanghai Chest Hospital Shanghai Jiao Tong University School of Medicine Shanghai ChinaState Key Laboratory of Systems Medicine for Cancer Shanghai Cancer Institute Renji Hospital Shanghai Jiao Tong University School of Medicine Shanghai ChinaState Key Laboratory of Systems Medicine for Cancer Shanghai Cancer Institute Renji Hospital Shanghai Jiao Tong University School of Medicine Shanghai ChinaState Key Laboratory of Systems Medicine for Cancer Shanghai Cancer Institute Renji Hospital Shanghai Jiao Tong University School of Medicine Shanghai ChinaState Key Laboratory of Systems Medicine for Cancer Shanghai Cancer Institute Renji Hospital Shanghai Jiao Tong University School of Medicine Shanghai ChinaAbstract Mutations in epidermal growth factor receptor (EGFR) are the key drivers of lung cancer initiation and recurrence. The cancer cells undergo transformation to a reversible drug‐tolerant persister (DTP) state prior to the development of resistance against EGFR‐tyrosine kinase inhibitors (TKIs). Two DTP lung cancer cells with different proliferative capacities are established and identified dipeptidyl peptidase 4 (DPP4) as a potential therapeutic target. The DTP cells primarily relied on oxidative phosphorylation, which is accompanied by the up‐regulation of fatty acid metabolism. Mechanistically, DPP4 facilitates the uptake of fatty acids via carnitine palmitoyl transferase 1a (CPT1A, and enhances fatty acid oxidation. In addition, the DPP4‐mitogen‐activated protein kinase kinase (MEK)‐Nuclear factor erythroid‐2‐related factor 2 (Nrf2) signaling pathway maintains mitochondrial function by activating the antioxidant pathway. The combination of osimertinib and sitagliptin, a DPP4 inhibitor, not only suppressed tumor progression but also reduced the number of residual tumor cells and minimal residual disease. Notably, this combination therapy significantly lowered recurrence rates and extended the survival of tumor‐bearing mice compared to the monotherapies. The study provides new insights into the metabolic adaptations of DTP lung cancer cells in response to EGFR‐TKIs, offering novel therapeutic strategies for targeting these persister cells.https://doi.org/10.1002/advs.202506950DTPDPP4EGFR‐Tkilung cancerOXPHOS
spellingShingle Yuanzhou Zhang
Xiaojun Zhang
Xupeng Yang
Xingshi Chen
Yuehong Wang
Jingying Hu
Rui Liu
Xiaoying Luo
EGFR‐TKIs Induced DPP4 Drives Metabolic Reprogramming of Persister Cells in Lung Cancer
Advanced Science
DTP
DPP4
EGFR‐Tki
lung cancer
OXPHOS
title EGFR‐TKIs Induced DPP4 Drives Metabolic Reprogramming of Persister Cells in Lung Cancer
title_full EGFR‐TKIs Induced DPP4 Drives Metabolic Reprogramming of Persister Cells in Lung Cancer
title_fullStr EGFR‐TKIs Induced DPP4 Drives Metabolic Reprogramming of Persister Cells in Lung Cancer
title_full_unstemmed EGFR‐TKIs Induced DPP4 Drives Metabolic Reprogramming of Persister Cells in Lung Cancer
title_short EGFR‐TKIs Induced DPP4 Drives Metabolic Reprogramming of Persister Cells in Lung Cancer
title_sort egfr tkis induced dpp4 drives metabolic reprogramming of persister cells in lung cancer
topic DTP
DPP4
EGFR‐Tki
lung cancer
OXPHOS
url https://doi.org/10.1002/advs.202506950
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