Cited by 1,454Melanoma and MAPK PathwaysProtein Kinase Regulation and GTPase SignalingProtein Tyrosine Phosphatases

RAF inhibitor resistance is mediated by dimerization of aberrantly spliced BRAF(V600E)

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Poulikakos, Poulikos I., Persaud, Yogindra, Janakiraman, Manickam, Kong, Xiangju, Ng, Charles, Moriceau, Gatien, Shi, Hubing, Atefi, Mohammad +16 more·2011·Nature

Abstract

Activated RAS promotes dimerization of members of the RAF kinase family. ATP-competitive RAF inhibitors activate ERK signalling by transactivating RAF dimers. In melanomas with mutant BRAF(V600E), levels of RAS activation are low and these drugs bind to BRAF(V600E) monomers and inhibit their activity. This tumour-specific inhibition of ERK signalling results in a broad therapeutic index and RAF inhibitors have remarkable clinical activity in patients with melanomas that harbour mutant BRAF(V600E). However, resistance invariably develops. Here, we identify a new resistance mechanism. We find that a subset of cells resistant to vemurafenib (PLX4032, RG7204) express a 61-kDa variant form of BRAF(V600E), p61BRAF(V600E), which lacks exons 4-8, a region that encompasses the RAS-binding domain. p61BRAF(V600E) shows enhanced dimerization in cells with low levels of RAS activation, as compared to full-length BRAF(V600E). In cells in which p61BRAF(V600E) is expressed endogenously or ectopically, ERK signalling is resistant to the RAF inhibitor. Moreover, a mutation that abolishes the dimerization of p61BRAF(V600E) restores its sensitivity to vemurafenib. Finally, we identified BRAF(V600E) splicing variants lacking the RAS-binding domain in the tumours of six of nineteen patients with acquired resistance to vemurafenib. These data support the model that inhibition of ERK signalling by RAF inhibitors is dependent on levels of RAS-GTP too low to support RAF dimerization and identify a novel mechanism of acquired resistance in patients: expression of splicing isoforms of BRAF(V600E) that dimerize in a RAS-independent manner.

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  • BRAF inhibitors have proven ineffective as single agents due to adaptive feedback re-activation of the MAPK and other signaling pathways.

    “BRAF inhibitors have proven ineffective as single agents due to adaptive feedback re-activation of the MAPK and other signaling pathways [5–13, 38].”

    From Co-targeting SRC overcomes resistance to BRAF inhibitors in colorectal cancer (2025) · cites this paper as [12]

    The Abstract (page not provided) reports that resistance to vemurafenib develops and that resistant cells can retain ERK signaling. But it describes RAF inhibitors as having remarkable clinical activity in BRAF(V600E) melanoma, not as ineffective single agents; its identified resistance mechanism is aberrant BRAF splicing and dimerization, not adaptive feedback reactivation of MAPK and other pathways. (LLM, conf=0.86)

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Authors
Poulikakos, P. I., Persaud, Y., Janakiraman, M., Kong, X., Ng, C., Moriceau, G., Shi, H., Atefi, M., Titz, B., Gabay, M. T., Salton, M., Dahlman, K. B., Tadi, M., Wargo, J. A., Flaherty, K. T., Kelley, M. C., Misteli, T., Chapman, P. B., Sosman, J. A., Graeber, T. G., Ribas, A., Lo, R. S., Rosen, N., & Solit, D. B.
Affiliations
  • Memorial Sloan Kettering Cancer Center (US)
  • University of California, Los Angeles (US)
  • National Institutes of Health (US)
  • Vanderbilt University (US)
  • Massachusetts General Hospital (US)
Corresponding author
Solit, David B.
Venue
Nature
Published
2011-11-23
Volume
480
Issue
7377
Pages
387-390
ISSN
  • 0028-0836 (ISSN-L)
  • 1476-4687
OpenAlex
W2043058822
Cited by
1,454
References
22
Citations by year
2026: 35 · 2025: 41 · 2024: 60 · 2023: 60 · 2022: 65 · 2021: 72 · 2020: 96 · 2019: 108 · 2018: 100 · 2017: 122 · 2016: 97 · 2015: 142 · 2014: 166 · 2013: 167 · 2012: 118
FWCI
59.40
Type
journal article
Language
en
Open access
Locations
  • Nature (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • National Institutes of Health
  • U.S. Public Health Service (T32 CACA062948-15)
  • National Cancer Institute (K22CA151638, R01CA127240, T32CA062948, P30CA008748)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Melanoma and MAPK Pathways
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Protein Kinase Regulation and GTPase Signaling
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Protein Tyrosine Phosphatases
Keywords
RAF inhibitors, BRAF V600E mutation, melanoma, vemurafenib, Raf kinase inhibitor, alternative splicing, protein dimerization, Ras-binding domain, ERK signaling, acquired drug resistance, kinase inhibitor resistance, BRAF-mutant melanoma, Ras activation
MeSH terms
Vemurafenib, Animals, Exons, Humans, Indoles, Melanoma, Sulfonamides, Alternative Splicing, Drug Resistance, Neoplasm, Protein Isoforms, MAP Kinase Signaling System, Cell Line, Tumor, Protein Kinase Inhibitors, Extracellular Signal-Regulated MAP Kinases, Proto-Oncogene Proteins B-raf, Mutant Proteins, Mice, Protein Multimerization

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