Abstract BACKGROUND Glioblastoma (GBM) and Diffuse Intrinsic Pontine Glioma (DIPG) are devastating high-grade gliomas (HGGs) with poor prognoses. Lysine-specific demethylase 1 (LSD1) is a promising therapeutic target and a key regulator in tumor initiation and recurrence. Crosstalk between LSD1 and other signaling pathways, such as the MAPK pathway, frequently hyperactivated in HGG, offers an opportunity to enhance the efficacy of LSD1 inhibitors. This study investigates the combined inhibition of LSD1 and kinase signaling to improve therapeutic outcomes in HGG. METHODS Transcriptional changes following LSD1 knockdown in human GBM cells were analyzed using RNA-seq and GSEA. RPPA and western blotting assessed the impact of LSD1 inhibition on kinase signaling. Pharmacological LSD1 inhibition was tested using NCD38 or bomedemstat in HGG models and normal human astrocytes (NHA). The effects of combining LSD1 inhibitors with kinase inhibitors (osimertinib, afatinib, and ulixertinib) on cell viability were evaluated. Combination treatment was also assessed in orthotopic xenograft models of GBM. RESULTS GSEA revealed LSD1 expression was enriched for gene sets involved in kinase signaling processes. Increased phosphorylated ERK1/2 levels were observed following NCD38 treatment in MDA-GSC17, as shown by RPPA and western blot analyses. The LSD1 inhibitor, NCD38, increased phospho-ERK1/2 levels (72% increase from baseline), while co-treatment with osimertinib mitigated this effect. Combined LSD1 and kinase inhibition (EGFR and ERK inhibition) showed synergistic effects in vitro in GBM and DIPG models but not in the NHA. DISCUSSION Our results demonstrate that kinase activity can be modulated by inhibiting LSD1, potentially leading to a resistant subpopulation. This study underscores the potential of combining LSD1 and kinase inhibition to enhance therapeutic efficacy in HGG, including GBM and DIPG. Future research will focus on elucidating the mechanisms by which LSD1 regulates kinase signaling, aiming to optimize combination therapies.
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