Cited by 692Autophagy in Disease and TherapyPancreatic and Hepatic Oncology ResearchProtein Kinase Regulation and GTPase Signaling

Combination of ERK and autophagy inhibition as a treatment approach for pancreatic cancer

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Bryant, Kirsten L., Stalnecker, Clint A., Zeitouni, Daniel, Klomp, Jennifer E., Peng, Sen, Tikunov, Andrey P., Gunda, Venugopal, Pierobon, Mariaelena +23 more·2019·Nature Medicine

Abstract

Pancreatic ductal adenocarcinoma (PDAC) is characterized by KRAS- and autophagy-dependent tumorigenic growth, but the role of KRAS in supporting autophagy has not been established. We show that, to our surprise, suppression of KRAS increased autophagic flux, as did pharmacological inhibition of its effector ERK MAPK. Furthermore, we demonstrate that either KRAS suppression or ERK inhibition decreased both glycolytic and mitochondrial functions. We speculated that ERK inhibition might thus enhance PDAC dependence on autophagy, in part by impairing other KRAS- or ERK-driven metabolic processes. Accordingly, we found that the autophagy inhibitor chloroquine and genetic or pharmacologic inhibition of specific autophagy regulators synergistically enhanced the ability of ERK inhibitors to mediate antitumor activity in KRAS-driven PDAC. We conclude that combinations of pharmacologic inhibitors that concurrently block both ERK MAPK and autophagic processes that are upregulated in response to ERK inhibition may be effective treatments for PDAC.

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Crossref · 10.1038/s41591-019-0368-8

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  • In KRAS-mutant pancreatic cancer cells, blocking the MAPK pathway reduces glucose uptake.

    “In KRAS mutant pancreatic cancer cells, inhibition of the MAPK pathway downregulates glucose uptake and forces the cell to become more dependent on autophagy for survival (95, 96).”

    From KRAS mutation in pancreatic cancer (2021) · cites this paper as [96]

  • In KRAS-mutant pancreatic cancer cells, MAPK pathway inhibition makes the cells more reliant on autophagy to survive.

    “In KRAS mutant pancreatic cancer cells, inhibition of the MAPK pathway downregulates glucose uptake and forces the cell to become more dependent on autophagy for survival (95, 96).”

    From KRAS mutation in pancreatic cancer (2021) · cites this paper as [96]

  • In KRAS-mutant pancreatic cancer cells, the autophagy pathway acts as a collateral dependency alongside MAPK pathway inhibition.

    “Recently, through combinatorial RNAi screens and hypothesis-driven approaches, we and others have identified the autophagy pathway as a collateral dependency partner with MAPK pathway inhibitors in pancreatic cancer cells with KRAS mutation (30, 95, 96).”

    From KRAS mutation in pancreatic cancer (2021) · cites this paper as [96]

  • Blocking autophagy by concomitant inhibition of autophagy and MEK or ERK kinases is likely to be therapeutically beneficial in patients with KRAS-mutant pancreatic ductal adenocarcinoma, NRAS-mutant melanoma, and BRAF-mutant colorectal cancer.

    “blocking this protective mechanism by concomitant inhibition of autophagy and MEK or ERK kinases is likely to be therapeutically beneficial in patients with KRAS-mutant pancreatic ductal adenocarcinoma, NRAS-mutant melanoma, and BRAF-mutant colorectal cancer (66, 67).”

    From New Horizons in KRAS-Mutant Lung Cancer: Dawn After Darkness (2019) · cites this paper as [66]

  • Three simultaneously published studies indicated that upon inhibition of the MAPK pathway, KRAS-mutant tumors depend on autophagy for survival.

    “These studies indicated that upon the inhibition of the MAPK pathway, KRAS-mutant tumors depend on autophagy for survival”

    From New Horizons in KRAS-Mutant Lung Cancer: Dawn After Darkness (2019) · cites this paper as [66]

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Authors
Bryant, K. L., Stalnecker, C. A., Zeitouni, D., Klomp, J. E., Peng, S., Tikunov, A. P., Gunda, V., Pierobon, M., Waters, A. M., George, S. D., Tomar, G., Papke, B., Hobbs, G. A., Yan, L., Hayes, T. K., Diehl, J. N., Goode, G. D., Chaika, N. V., Wang, Y., Zhang, G.-F., Witkiewicz, A. K., Knudsen, E. S., Petricoin, E. F., Singh, P. K., Macdonald, J. M., Tran, N. L., Lyssiotis, C. A., Ying, H., Kimmelman, A. C., Cox, A. D., & Der, C. J.
Affiliations
  • University of North Carolina at Chapel Hill (US)
  • Translational Genomics Research Institute (US)
  • University of Nebraska Medical Center (US)
  • George Mason University (US)
  • Duke University (US)
  • Roswell Park Comprehensive Cancer Center (US)
  • Mayo Clinic (US)
  • University of Michigan (US)
  • The University of Texas MD Anderson Cancer Center (US)
  • NYU Langone Health (US)
Corresponding author
Der, Channing J.
Venue
Nature Medicine
Published
2019-03-04
Volume
25
Issue
4
Pages
628-640
ISSN
  • 1078-8956 (ISSN-L)
  • 1546-170X
OpenAlex
W2920097475
Cited by
692
References
65
Citations by year
2026: 42 · 2025: 56 · 2024: 103 · 2023: 100 · 2022: 116 · 2021: 132 · 2020: 98 · 2019: 43 · 2018: 1
FWCI
77.23
Type
journal article
Language
en
Open access
Locations
  • Nature Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
  • UNC Libraries
Funders
  • U.S. Department of Defense (W81XWH-15–1-, W81XWH, CA210439, P30CA016672, W81XWH1510611)
  • American Association for Cancer Research (15-90-25-DER, P30CA016672)
  • American Cancer Society
  • Pancreatic Cancer Action Network (15-90-25-DER)
  • Lustgarten Foundation
  • Deutsche Forschungsgemeinschaft (PF-18-061, DFG PA 3051/1-1, PA 3051/1-1)
  • National Institutes of Health (5r01ca042978-30, W81XWH, CA016086, R01CA42978)
  • University of Texas MD Anderson Cancer Center (P30-CA-016672, RSG-13-298-01-TBG)
  • National Cancer Institute (F32CA200313, R01CA42978, R01CA163649, P01CA203657, R01CA175747, R01CA210439, CA016086, R35CA232113, T32CA009156, P50CA196510, F32CA239328, R01-CA042978, CA163649, R01CA188048, P50CA127297, F32CA232529, R01CA216853, R35CA232124, U01CA199235, CA216853, F30CA243253, R01CA157490, CA210439, P30CA016672, P01CA117969, P30CA036727, P30CA016086, T32CA071341)
  • National Institute of General Medical Sciences (R01GM095567)
  • National Institute of Environmental Health Sciences (P30ES010126)
  • Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill (CA016086, P30-CA016086)
  • Congressionally Directed Medical Research Programs
Topics
  • Health Sciences › Medicine › Epidemiology › Autophagy in Disease and Therapy
  • Health Sciences › Medicine › Oncology › Pancreatic and Hepatic Oncology Research
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Protein Kinase Regulation and GTPase Signaling
Keywords
pancreatic ductal adenocarcinoma, KRAS, autophagy, autophagic flux, chloroquine, combination therapy, cancer metabolism, glycolysis, mitochondrial function
MeSH terms
Animals, Autophagy, Chloroquine, Drug Synergism, Humans, Mitochondria, Mutation, Pancreatic Neoplasms, Proto-Oncogene Proteins p21(ras), MAP Kinase Signaling System, Cell Line, Tumor, Protein Kinase Inhibitors, Cell Proliferation, Mice, HEK293 Cells

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