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Mechanisms and Novel Therapeutic Approaches for KRAS-Mediated Resistance to Anti-EGFR Therapy in Colorectal Cancer Cells

Knickelbein, Kyle (2017) Mechanisms and Novel Therapeutic Approaches for KRAS-Mediated Resistance to Anti-EGFR Therapy in Colorectal Cancer Cells. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Colorectal cancer (CRC) is the third-leading cause of cancer-related deaths in the United States. The treatment of metastatic disease remains a significant clinical challenge, with nearly 90% of patients dying within five years after diagnosis. The successful treatment of CRC is heavily dependent upon the genetic makeup of the tumors. Mutations in the KRAS oncogene, which occur in 35-40% of CRCs, generally exhibit lack of response to anti-epidermal growth factor receptor (EGFR) antibody targeted therapy, a front-line treatment option that improves the efficacy of standard chemotherapy regimens. Unfortunately, despite intensive efforts, direct therapeutic targeting of mutant KRAS has been largely unsuccessful. As a result, it is necessary to further elucidate the underlying mechanisms of sensitivity and resistance to anti-EGFR therapy in CRC cells in order to uncover novel therapeutic strategies. In this study, we found that clinically-utilized anti-EGFR antibodies kill CRC cells by upregulating the pro-apoptotic B cell CLL/lymphoma-2 (Bcl-2) family protein p53-upregulated modulator of apoptosis (PUMA) through the p53 homologue p73. In CRC cells with acquired resistance to anti-EGFR antibodies due to KRAS mutations or genetic amplification, PUMA expression was strongly suppressed when compared to parental cells after antibody treatment. To overcome resistance to anti-EGFR therapy, we first conducted a compound screen which revealed that Aurora kinase inhibition can preferentially kill isogenic CRC cells with KRAS mutations. Aurora kinase inhibition was found to enhance the induction of apoptosis in combination with anti-EGFR antibody treatment in resistant CRC cells with KRAS amplification in cell culture. We also found that the combination treatment completely suppressed tumor growth and promoted apoptosis in resistant cell tumors in nude mice. Collectively, our data indicate that PUMA and other Bcl-2 family proteins play a critical role in mediating the sensitivity and resistance to anti-EGFR antibodies. Furthermore, our results indicate that targeting apoptotic pathways can be utilized to overcome KRAS-mediated resistance to targeted therapies.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Knickelbein, Kylekjk76@pitt.edukjk76
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Thesis AdvisorZhang,
Committee ChairGalbiati,
Committee MemberOpresko,
Committee MemberRomero,
Committee MemberSobol,
Date: 18 January 2017
Date Type: Publication
Defense Date: 18 August 2016
Approval Date: 18 January 2017
Submission Date: 31 December 2016
Access Restriction: 5 year -- Restrict access to University of Pittsburgh for a period of 5 years.
Number of Pages: 124
Institution: University of Pittsburgh
Schools and Programs: School of Medicine > Pharmacology and Chemical Biology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: KRAS; Anti-EGFR Antibodies; Colorectal Cancer; PUMA; Apoptosis; Aurora Kinases
Date Deposited: 18 Jan 2017 20:27
Last Modified: 18 Jan 2022 06:15


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