Abstract 6139: Clinical implication of EZH2 inhibitors in hepatocellular carcinoma

Abstract

Abstract Background & Aim: Aberrant upregulation of EZH2 is frequently observed in hepatocellular carcinoma (HCC) and significantly associated with poor prognosis of HCC patients. While EZH2 inhibitors (EZH2i) are recently approved for treatment of lymphoma and sarcoma, their antitumor effect alone is not optimally efficacious against solid tumors like HCC. Ferroptosis is a newly discovered nonapoptotic type of cell death characterized by the iron-dependent accumulation of lipid hydroperoxides in cell membrane to lethal levels. Owing to anti-cancer effects of ferroptosis, many oncogenes are known to suppress ferroptosis. However, their mechanisms in HCC are currently unknown. We aim to uncover a novel mechanism for EZH2-mediated resistance to ferroptosis in HCC. Methods: Multi-step analyses were performed with genomic data from mouse models (Ezh1/2 KO), cancer cell lines treated with EZH2i GSK126, and primary tumors including HCC to identify genetic networks or signaling/metabolic pathways associated with EZH2 in cancer cells. Functional connection of identified networks or pathways from the prediction analyses was tested in cell line models with various molecular biology approaches including western blots, colony forming assay, overexpression and/or depletion of genes of interest. Results: Gene network analysis predicted that ferroptosis pathway is inhibited by EZH2. Interestingly, lipid biosynthesis is also identified as an inhibited metabolic pathway by EZH2. Since polyunsaturated fatty acid (PUFA) is essential for executing ferroptosis, we hypothesize that EZH2 suppresses ferroptosis by inhibiting synthesis of PUFA. HCC cells with high EZH2 expression have higher IC50 values to erastin, a ferroptosis inducer, than those with low EZH2 expression. Moreover, inhibition or depletion of EZH2 sensitize HCC cells to erastin-induced ferroptotic cell death, strongly suggesting that EZH2 accounts for resistance to ferroptosis. Mechanistically, EZH2 increases H3K27me3 methylation near PUFA gene promoters, leading to suppression of PUFA gene expression and subsequently low cellular PUFA level. Most interestingly, treatment of EZH2i significantly sensitized HCC cells with high EZH2 expression to erastin-induced ferroptosis, suggesting potential therapeutic opportunity for treatment of HCC patients with high EZH2 expression. Conclusion: EZH2 is a novel suppressor of ferroptosis by negatively regulating lipid metabolism. Thus, our study provides scientific evidence for developing a novel therapeutic strategy for treatment of HCC patients with co-treatment of ferroptosis inducers and EZH2 inhibitors. Citation Format: Bo Hwa Sohn, Sung Hwan Lee, Yun Seong Jeong, Ju-Seog Lee. Clinical implication of EZH2 inhibitors in hepatocellular carcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6139.