Abstract 6142: Inhibition of both MAPK and AKT pathways overcomes resistance of NRAS-mutant melanoma stem cells to apoptosis

Abstract

Abstract Malignant melanoma is a lethal skin cancer containing melanoma-initiating cells (MIC) implicated in tumorigenesis, invasion, and drug resistance, and characterized by elevated expression of stem cell markers, such as CD133. We have shown that siRNA knockdown of CD133 enhanced apoptosis induced by the MEK inhibitor trametinib in melanoma cells. The current study investigates the underlying mechanisms of CD133's anti-apoptotic activity in patient-derived BAKP melanoma, harboring the difficult-to-treat NRASQ61K driver mutation, after either CRISPR-Cas9 CD133 knockout or Dox-inducible expression of CD133. CD133 knockout in BAKP cells increased trametinib-induced apoptosis by reducing anti-apoptotic BCL-xL, p-AKT, and p-BAD and increasing pro-apoptotic BAX. Conversely, Dox-induced CD133 expression diminished apoptosis in trametinib-treated cells, coincident with elevated pro-survival p-AKT, p-BAD, BCL-2, and BCL-xL and decreased activation of BAX and caspases-3 and -9. Inhibition of MEK with trametinib, in combination with pan-AKT inhibitor capivasertib (AZD5363) in BAKP cells with either CD133 overexpression or knockout in vitro reduced cell survival as measured by XTT, FACS analysis and colony formation assays. Further, in vivo studies with nude mice xenografted with Dox-inducible BAKP melanoma cells, showed significantly decreased tumor growth after xenografted mice were treated with trametinib alone or in combination with AZD5363. CD133 may therefore activate a survival pathway where (1) increased AKT phosphorylation and activation induces (2) BAD phosphorylation and inactivation, (3) decreases BAX activation, and (4) reduces caspases-3 and -9 activity and caspase-mediated PARP cleavage, leading to apoptosis suppression and drug resistance in melanoma. Targeting nodes of the AKT and MAPK survival pathways with both trametinib and AZD5363 highlights the potential for combination therapies for NRAS-mutant melanoma stem cells for the development of more effective treatments for patients with high-risk melanoma. Citation Format: Ryyan Alobaidi, Nusrat Islam, Yanjun R. Zhang, Mathew M. Shamo, Samuel Allsup, Cynthia M. Simbulan-Rosenthal, Dean S. Rosenthal. Inhibition of both MAPK and AKT pathways overcomes resistance of NRAS-mutant melanoma stem cells to apoptosis [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 6142.