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A TNF–JNK–Axl–ERK signaling axis mediates primary resistance to EGFR inhibition in glioblastoma

Nature Neuroscience volume 20, pages 1074–1084 (2017)Cite this article

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Abstract

Aberrant epidermal growth factor receptor (EGFR) signaling is widespread in cancer, making the EGFR an important target for therapy. EGFR gene amplification and mutation are common in glioblastoma (GBM), but EGFR inhibition has not been effective in treating this tumor. Here we propose that primary resistance to EGFR inhibition in glioma cells results from a rapid compensatory response to EGFR inhibition that mediates cell survival. We show that in glioma cells expressing either EGFR wild type or the mutant EGFRvIII, EGFR inhibition triggers a rapid adaptive response driven by increased tumor necrosis factor (TNF) secretion, which leads to activation in turn of c-Jun N-terminal kinase (JNK), the Axl receptor tyrosine kinase and extracellular signal–regulated kinases (ERK). Inhibition of this adaptive axis at multiple nodes rendered glioma cells with primary resistance sensitive to EGFR inhibition. Our findings provide a possible explanation for the failures of anti-EGFR therapy in GBM and suggest a new approach to the treatment of EGFR-expressing GBM using a combination of EGFR and TNF inhibition.

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Figure 1: EGFR inhibition triggers an adaptive response in glioma cells.
Figure 2: EGFR inhibition–induced Axl and ERK activation is mediated by JNK.
Figure 3: EGFR inhibition leads to an increase in GAS6 via a JNK-dependent mechanism.
Figure 4: EGFR inhibition leads to increased TNF signaling that triggers an adaptive signaling pathway.
Figure 5: Inhibition of JNK and ERK renders glioma cells sensitive to EGFR inhibition.
Figure 6: TNF inhibition sensitizes glioma cells to EGFR inhibition.
Figure 7: JNK or TNF inhibition sensitizes mouse tumors to EGFR inhibition in vivo.

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Acknowledgements

We thank F. Furnari (University of California, San Diego), C.D. James (Northwestern University) and E. Burstein (UT Southwestern Medical Center) for providing cell lines and reagents. This work was supported in part by NIH grants RO1 NS062080 and by the Office of Medical Research, Departments of Veterans Affairs to A.A.H. (I01BX002559). S.B. is supported by grants from the National Institutes of Health (RO1CA149461, RO1CA197796 and R21CA202403) and the National Aeronautics and Space Administration (NNX16AD78G). This work was also supported by NIH grant 1R01CA194578 to D.Z.

Author information

Authors and Affiliations

  1. Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas, USA

    Gao Guo, Ke Gong, Sonia Ali, Neha Ali, Shahzad Shallwani, Edward Pan & Amyn A Habib

  2. Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA

    Kimmo J Hatanpaa

  3. Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA

    Bruce Mickey

  4. Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA

    Sandeep Burma

  5. Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA

    David H Wang

  6. Veterans Affairs North Texas Health Care System, Dallas, Texas, USA

    David H Wang & Amyn A Habib

  7. Department of Translational Neuro-Oncology and Neurotherapeutics, John Wayne Cancer Institute at Providence Saint John's Health Center, Santa Monica, California, USA

    Santosh Kesari

  8. Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA

    Jann N Sarkaria

  9. Departments of Biomedical Engineering and Cancer Biology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA

    Dawen Zhao

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Contributions

A.A.H., G.G. and K.G. designed experiments. G.G., K.G., S.A., N.A., S.S. and D.H.W. performed or assisted with experiments. B.M., K.J.H., J.N.S. and S.K. provided tumor samples. E.P., S.B., D.Z., J.N.S., G.G. and A.A.H. analyzed data. A.A.H. and G.G. wrote the manuscript with contributions from K.G., E.P. and K.J.H. A.A.H. supervised the study.

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Correspondence to Amyn A Habib.

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Integrated supplementary information

Supplementary Figure 1 EGFR inhibition activates signaling pathways

(a-b) EGFR inhibition activates signaling pathways (a) U251EGFR cells were treated with erlotinib (1μM) for the indicated times followed by Western blot with the indicated antibodies. (b) GBM9 neurospheres were treated with afatinib (100nM) for the indicated time points followed by Western blot with the indicated antibodies. (c-g) EGFR inhibition decreases pSTAT3 and pAKT activation. Glioma cells were treated with high dosage of erlotinib (10μM) or afatinib (10μM). Western blot showing that pSTAT3 and pAKT decrease upon treatment with erlotinib or afatinib. Western blots are representative of at least three independent replicates. (h-j) pERK is activated in U87EGFRwt and blocked by cetuximab. (h) U87EGFRwt cells were cultured in medium with (10%) or without serum in DMEM. pERK is activated under both conditions. (i) Cells were serum starved and treated overnight with cetuximab (100 μg/ml). Cetuximab treatment blocks both EGFR and ERK activation. (j) Cells were treated wtith EGF (50 ng/ml) for 15 min. EGF increases pERK level in U87EGFRwt cells. SF:Serum free. Western blots are representative of at least three independent replicates. Full-length blots are presented in Supplementary Figure 15.

Supplementary Figure 2 Intracellular signaling networks and biological responses to EGFR inhibition in glioma cells.

(a-b) EGFR inhibition does not activate NF-κB transcriptional activity. (a) A luciferase reporter assay shows that EGFR inhibition with erlotinib does not result in an increase in NF-κB reporter activity in GBM9 neurospheres and U87EGFRwt cells. Erlotinib was used for 24h at a concentration of 100 nM for GBM9 neurospheres and 1uM for U87EGFRwt cells. GBM9: Ctrl vs erlotinib: P =0.88, t=0.16, d.f.=4; U87EGFRwt: Ctrl vs erlotinib: P =0.60, t=0.57, d.f.=4. (b) As a positive control we used LPS (1μg/ml) which activates the NF-κB reporter. Renilla luciferase was used as an internal control. Ctrl vs LPS: P =0.0012, t=8.27, d.f.=4. Data are presented as mean±s.e.m; **P < 0.01 from two-tailed unpaired Student's t-test (n = 3 biologically independent experimental replicates). n.s. not significant. (c-d) Upregulation of TNF in response to EGFR inhibition in multiple patient derived samples and established cell lines. (c) SK987, SK748. SK1422, and GBM622 are patient derived primary GBM cells cultured as neurospheres and treated with erlotinib (100nM) for 24h followed by extraction of RNA and qRT-PCR for TNF. SB19vIII and U251EGFRwt cells are established GBM cell lines that were treated with erlotinib (1μM) for 24h followed by qRT-PCR for TNF. SB19vIII: Ctrl vs Erlotinib: P =0.0014,t=7.88, d.f.=4; SK987: Ctrl vs erlotinib: P =0.0024,t=6.83, d.f.=4; SK748: Ctrl vs Erlotinib: P =0.0019, t=7.32, d.f.=4; SK1422: Ctrl vs erlotinib: P =0.0030,t=6.45, d.f.=4; GBM622: Ctrl vs erlotinib: P =0.21,t=1.5, d.f.=4; U251EGFRwt: Ctrl vs erlotinib: P =0.0005, t=10.4, d.f.=4. Data are presented as mean±s.e.m; **P < 0.01, ***P<0.001 from two-tailed unpaired Student's t-test (n = 3 biologically independent experimental replicates). n.s. not significant. (d) Western blot showing EGFR levels in various neurospheres and cell lines. No increase in TNF is detected in GBM622 cells expressing a very low level of EGFR. Western blots are representative of at least three independent replicates. Full-length blots are presented in Supplementary Figure 15. (e) Downregulation of TNFR1 in response to EGFR inhibition in patient derived primary GBM neurosphere cultures and established cell lines. GBM9, SK987 and U87EGFRwt cells were treated with erlotinib for the indicated time points followed by Western blot with TNFR1 antibodies. Erlotinib was used at a concentration of 100 nM for GBM9 and SK987 and 1uM for U87EGFRwt cells. Western blots are representative of at least three independent replicates. (f) EGFR inhibition induced effects on cell viability are influenced by specific inhibitors of downstream signaling pathways. In this experiment primary GBM9 neurospheres were exposed to various inhibitors alone or in combination with erlotinib (100 nM) for 72h followed by Alamarblue Cell Viability assay. The concentrations of the various drugs were: SB203850 (10uM), SP600125 (1uM), U0126 (1uM), BMS-345541 (10uM), XL765 (10uM), Necrostatin-1 (300nM). Erlotinib vs erlotinib +SP600125: P =0.0001,t=14.96, d.f.=4; Erlotinib vs erlotinib +U0126: P =0.0018, t=7.42, d.f.=4. Data are presented as mean±s.e.m; **P < 0.01, ***P<0.001 from two-tailed unpaired Student's t-test (n = 3 biologically independent experimental replicates). (g-i) Western blot showing efficient silencing of JNK1/2, Axl and TNFR1. For cell viability experiments involving siRNA knockdown of JNK1/2, Axl and TNFR1, we confirmed silencing by Western blot. Western blots are representative of at least three independent replicates. Full-length blots are presented in Supplementary Figure 15.

Supplementary Figure 3 EGFR inhibition induces a biologically significant upregulation of TNF in glioma cells.

(a-b) Thalidomide blocks EGFR inhibition induced upregulation of TNF. Patient derived GBM9 neurospheres or established GBM cell line U87EGFRwt cells were treated with erlotinib with or without thalidomide (1μM) followed by collection of supernatants and TNF ELISA. (a) Erlotinib vs erlotinib +thalidomide: P =0.0015, t=7.77, d.f.=4. (b) Erlotinib vs erlotinib +thalidomide: P =0.0008, t=8.98, d.f.=4. Data are presented as mean±s.e.m; **P < 0.01, ***P<0.001 from two-tailed unpaired Student's t-test (n = 3 biologically independent experimental replicates). (c-d) A neutralizing antibody to TNF sensitizes cells to EGFR inhibition. Patient derived GBM9 neurospheres or established GBM cell line U87EGFRwt cells were exposed to erlotinib plus either normal mouse IgG (Ctrl) or a neutralizing antibody to TNF. The TNF neutralizing antibody sensitizes cells to EGFR inhibition as shown by the Alamarblue Cell Viability assay. (c) Erlotinib vs erlotinib+TNF Ab: P =0.0013,t=8.07, d.f.=4. (d) Erlotinib vs erlotinib+TNF Ab: P =0.0012, t=8.13, d.f.=4. Data are presented as mean±s.e.m; **P < 0.01 from two-tailed unpaired Student's t-test (n =3 biologically independent experimental replicates). (e-f) Thalidomide sensitizes patient derived primary GBM9 and GBM39 neurospheres to EGFR inhibiton. GBM9 or GBM39 neurospheres were exposed to EGFR inhibition using afatinib (100nM) and thalidomide (1μM) alone or in combination concurrently for 72h followed by Alamarblue Cell Viability Assay. DMSO was used as a control (Ctrl). (e) Afatinib vs afatinib+thalidomide: P =0.0001,t=14.47, d.f.=4. (f) Afatinib vs afatinib+thalidomide: P =0.0005, t=10.4, d.f.=4. Data are presented as mean±s.e.m; ***P<0.001 from two-tailed unpaired Student's t-test (n =3 biologically independent experimental replicates).

Supplementary Figure 4 Inhibition of JNK and ERK sensitizes glioma cells to EGFR inhibition.

(a-b) GBM9 cells were treated with erlotinib and/or JNK inhibitor SP600125 (1μM), ERK inhibitor U0126 (1μM) for 72 hours followed by Annexin-FACS assay. Unstained cells represent viable cells. Annexin positive cells are undergoing apoptosis. PI (Propidium iodide) positive cells are undergoing late apoptosis. In “Control” cells are treated with control vehicle (DMSO). The combination treatment decreases the number of viable cells and there is an increase in double stained cells (Annexin+PI Positive). (b) Unstained: Erlotinib vs Erlotinib+SP600125: P =0.0008, t=9.10, d.f.=4; Erlotinib vs erlotinib+U0126: P =0.0036, t=6.14, d.f.=4. Annexin+PI: Erlotinib vs erlotinib+SP600125: P =0.0003, t=11.37, d.f.=4; Erlotinib vs erlotinib+U0126: P =0.0021,t=7.04, d.f.=4. (c-d) A similar experiment was conducted in U87EGFR cells with a similar result. (d) Unstained: Erlotinib vs erlotinib+SP600125: P =0.0045, t=5.77, d.f.=4; Erlotinib vs erlotinib+U0126: P =0.0013,t=8.06, d.f.=4. Annexin+PI: Erlotinib vs erlotinib+SP600125: P =0.0017, t=7.53, d.f.=4; Erlotinib vs erlotinib+U0126: P =0.0006, t=10.04, d.f.=4. Data are presented as mean±s.e.m; **P<0.01, ***P<0.001 using two-tailed unpaired Student's t-test (n =3 biologically independent experimental replicates).

Supplementary Figure 5 Axl and TNF inhibition renders glioma cells sensitive to EGFR inhibition.

(a-b) GBM9 cells were treated with erlotinib and/or Axl inhibitor R428 (1μM), Thalidomide (1μM) for 72 hours followed by Annexin-FACS assay. Unstained cells represent viable cells. Annexin positive cells are undergoing apoptosis. PI (Propidium iodide) positive cells are undergoing late apoptosis. In “Control” cells are treated with control vehicle (DMSO). The combination treatment decreases the number of viable cells and there is an increase in both PI and double stained cells (Annexin+PI Positive). (b) Unstained: Erlotinib vs erlotinib+R428: P =0.0051,t=5.58, d.f.=4; Erlotinib vs erlotinib+thalidomide: P =0.0009,t=8.75, d.f.=4. Annexin+PI: Erlotinib vs erlotinib+R428: P =0.015, t=4.10, d.f.=4; Erlotinib vs erlotinib+thalidomide: P =0.0011,t=8.32, d.f.=4. (c-d) A similar experiment was conducted in U87EGFR cells with a similar result. (d) Unstained: Erlotinib vs erlotinib+R428: P =0.0045, t=5.71, d.f.=4; Erlotinib vs erlotinib+thalidomide: P =0.0036, t=6.13, d.f.=4. Annexin+PI: Erlotinib vs erlotinib+R428: P =0.0014, t=7.83, d.f.=4; Erlotinib vs erlotinib+thalidomide: P =0.0022, t=6.98, d.f.=4. Data are presented as mean±s.e.m; *P<0.05, **P<0.01, ***P<0.001 using two-tailed unpaired Student's t-test (n =3 biologically independent experimental replicates).

Supplementary Figure 6 Etanercept renders glioma cells sensitive to EGFR inhibition.

(a-b) GBM9 cells were treated with erlotinib and/or enbrel (1μM) for 72 hours followed by Annexin-FACS assay. Unstained cells represent viable cells. Annexin positive cells are undergoing apoptosis. PI (Propidium iodide) positive cells are undergoing late apoptosis. In “Control” cells are treated with control vehicle (DMSO). The combination treatment decreases the number of viable cells and there is an increase in double stained cells (Annexin+PI Positive). (b) Unstained: Erlotinib vs erlotinib+Enbrel: P =0.0008, t=9.11, d.f.=4; Annexin+PI: Erlotinib vs erlotinib+Enbrel: P=0.0012, t=8.18, d.f.=4. (c-d) A similar experiment was conducted in U87EGFRwt cells with a similar result. (d) Unstained: Erlotinib vs erlotinib+Enbrel: P =0.0006, t=9.6, d.f.=4; Annexin+PI: Erlotinib vs erlotinib+Enbrel: P =0.0003, t=11.34, d.f.=4. Data are presented as mean±s.e.m; **P<0.01, ***P<0.001 using two-tailed unpaired Student's t-test (n =3 biologically independent experimental replicates).

Supplementary Figure 7 Combination treatment increases caspase 3/7 activity in glioma cells.

(a) GBM9 cells were treated by erlotinib and/or SP600125, U1026 for 72 hours followed by Caspase-Glo 3/7 Assay. Caspase3/7 activity was evaluated in GBM9 cells exposed to erlotinib plus SP600125. Similar results were obtained using a combination of erlotinib and U1026. Erlotinib vs erlotinib+SP600125: P =0.001, t=8.66, d.f.=4; Erlotinib vs erlotinib+U0126: P =0.0002, t=13.24, d.f.=4. Similar procedures were performed in b-f and similar results were obtained. (b) Erlotinib vs erlotinib+R428: P =0.0004, t=10.76, d.f.=4; Erlotinib vs erlotinib+thalidomide: P=0.0004, t=10.64, d.f.=4. (c) Erlotinib vs erlotinib+SP600125: P<0.0001, t=21.41, d.f.=4; Erlotinib vs erlotinib+U1026: P =0.0007, t=9.49, d.f.=4. (d) Erlotinib vs erlotinib+R428: P=0.0001, t=14.8, d.f.=4; Erlotinib vs erlotinib+T: P <0.0001, t=16.77, d.f.=4. (e) Erlotinib vs erlotinib+enbrel: P =0.0096, t=8.72, d.f.=4. (f) Erlotinib vs erlotinib+enbrel: P =0.0017, t=7.43, d.f.=4. Data are presented as mean±s.e.m; **P<0.01, ***P<0.001, ****P<0.0001 from two-tailed unpaired Student's t-test (n =3 biologically independent experimental replicates).

Supplementary Figure 8 Combination treatment inhibits glioma cell proliferation.

(a) GBM9 cells were plated in 6 well plated and treated with drugs as indicated. Cell proliferation was measured through cell counting using the trypan blue dye exclusion test. A combination of erlotinib and SP600125 (SP) significantly reduces cell growth after 72 hours. Similar results were shown using a combination of erlotinb and U1026 (U). Erlotinib vs erlotinib+SP: P =0.0016, t=7.60, d.f.=4; Erlotinib vs erlotinib+U: P =0.0012, t=8.24, d.f.=4. Similar procedures were performed in b-f and similar results were obtained. (b) Erlotinib vs erlotinib+R428: P =0.0008, t=9.24, d.f.=4; Erlotinib vs erlotinib+T: P =0.0004, t=11.18, d.f.=4. (c) Erlotinib vs erlotinib+SP: P =0.0004, t=10.78, d.f.=4; Erlotinib vs erlotinib+U: P =0.0014, t=7.85, d.f.=4. (d) Erlotinib vs erlotinib+R428: P =0.001, t=8.62, d.f.=4; Erlotinib vs erlotinib+T: P =0.0003, t=11.58, d.f.=4. (e) Erlotinib vs erlotinib+enbrel: P =0.0014, t=7.85, d.f.=4. (f) Erlotinib vs erlotinib+enbrel: P =0.0005, t=10.37, d.f.=4. SP: SP600125; U:U0126; T: Thalidomide. Data are presented as mean±s.e.m; **P<0.01, ***P<0.001 from two-tailed unpaired Student's t-test (n =3 biologically independent experimental replicates).

Supplementary Figure 9 TNF inhibition sensitizes mouse tumors to EGFR inhibition with afatinib in vivo.

(a) Combined treatment of afatinib and thalidomide prolonged survival and suppressed tumor growth in an orthotropic model. Kaplan-Maier survival curves were calculated using GraphPad Prism 7. Statistical significance verified by the log rank test, P=0.0015,**P<0.01. (b) Representative bioluminescence images from afatinib and afatinib plus thalidomide group at day 1, 10 and 20 post-treatment. Since all mice in vehicle and thalidomide group died within 20 days after transplant, images at day 20 post-treatment were not available. (c-d) Body weight of xenograft mice were monitored regularly and recorded every 2 days. No significant change of body weight was observed in subcutaneous mouse model between groups. (e) Body weight of orthotopic models. Body weight losses are found in vehicle, erlotinib and thalidomide group but not in combination therapy (erlotinib+thalidomide). Erlotinib vs erlotinib+thalidmoide: P<0.0001, t=6.32, d.f.=14; (f) Similar results were obtained in orthotopic models treated by afatinib and/or thalidmide. Afatinib vs afatinib+thalidomide: P =0.0003, t=4.79, d.f.=14.

Supplementary Figure 10 Erlotinib treatment activates Axl–JNK–ERK signaling in orthotopic models; this is suppressed by TNF inhibition.

(a) Immunostainig of pAXL, pJNK and pERK proteins from a representative brain section from vehicle, erlotinb and erlotinib plus thalidomide group. Cells with brown staining are considered as positive. Erlotinib group shows higher expression of pAxl, pJNK and pERK compared to vehicle group, whereas thaldimide inhibits erlotinib induced pAxl-pJNK-pERK activation. (b-d) Semi-quantitative analysis of pAxl, pJNK and pERK immunostaining. Four random fields in 3 tissue blocks at x200 magnification were scored semiquantitatively as: 0=No positive staining; 1=1-25% tumor cells stained, 2=26%-75% tumor cells stained and 3=>75% tumor cells stained. Differences between treatment groups were analyzed by the Mann-Whitney U test (n=12). (b) pAXL: Erlotinib vs. vehicle, p=0.0062, U=26; Erlotinib vs. erlotinib+thalidomide, p=0.0093, U=28. (c) pJNK: Erlotinib vs. vehicle, p=0.022, U=32; Erlotinib vs. erlotinib+thalidomide, p=0.014, U=29.5. (d) pERK: Erlotinib vs. vehicle, p=0.0040, U=23.5; Erlotinib vs. erlotinib+thalidomide, p=0.0026, U=21.

Supplementary Figure 11 Full-length western blots.

Full-length Western blots for cropped images in Fig. 1.

Supplementary Figure 12 Full-length western blots and DNA agarose gel.

Full-length Western blots for cropped images in Fig. 2 and Fig. 3f, 3h, 3i.

Supplementary Figure 13 Full-length western blots.

Full-length Western blots for cropped images in Fig. 4g, 4h, 4i.

Supplementary Figure 14 Full-length western blots.

Full-length Western blots for cropped images in Fig. 6j-l and Fig. 7f, 7g.

Supplementary Figure 15 Full-length western blots.

Full-length Western blots for cropped images in Supplementary Fig. 1 and 2d,e,g–i.

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Guo, G., Gong, K., Ali, S. et al. A TNF–JNK–Axl–ERK signaling axis mediates primary resistance to EGFR inhibition in glioblastoma. Nat Neurosci 20, 1074–1084 (2017). https://doi.org/10.1038/nn.4584

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