Modulation of almonertinib resistance in non-small cell lung cancer by cancer-associated fibroblasts through HK2-mediated glycolysis and SKP2 signaling.

Background: Almonertinib is a third-generation EGFR-TKI, and studies on its resistance mechanisms are lacking. Cancer-associated fibroblasts (CAFs) can influence resistance to targeted therapeutics, but their role and mechanism of action in relation to almonertinib resistance are unclear. The study explored relationships among glycolysis, cancer-associated fibroblasts (CAFs), and almonertinib resistance. Methods: A dose-escalation method was used to develop the almonertinib-resistant cell line H1975AR. Hexokinase 2 (HK2) effects on almonertinib resistance were evaluated using Cell Counting Kit-8 assays, transcriptome sequencing, western blotting, real-time PCR, siRNA assays, glucose consumption, and lactate production assays. Differential gene expression analysis and siRNA assays in H1975 cells cultured with CAF-conditioned medium (H1975/CAF-CM) revealed S-phase kinase-associated protein 2 (SKP2) as a target driving the effects of HK2. The impact of almonertinib and HK2 inhibitors on H1975/CAF-CM cells was assessed using colony formation, wound healing, transwell, and flow cytometry apoptosis assays. Results: H1975AR cells displayed elevated glycolysis and HK2. Subsequently, we showed that knockdown reduced almonertinib resistance in cells. H1975/CAF-CM induced almonertinib resistance and upregulation of HK2, which was reversed by knockdown of SKP2. CAFs regulate HK2-mediated glycolysis through SKP2, promoting almonertinib resistance in NSCLC. Conclusions: CAFs regulate HK2-mediated glycolysis through SKP2, which promotes almonertinib resistance in NSCLC. [ABSTRACT FROM AUTHOR]