par Najem, Ahmad
Président du jury Kauffmann, Jean-Michel
Promoteur Ghanem, Ghanem Elias ;Badran, Bassam
Publication Non publié, 2017-09-11
Thèse de doctorat
Résumé : Melanoma is the deadliest form of skin cancer and one of the most difficult cancers to treat. Gene alterations identified in melanoma pointed to distinct molecular subsets of tumors with direct implications in therapeutic strategies. Activating mutations in NRAS, found in 20-30% of melanomas have been associated with aggressive clinical behavior and a poor prognosis. Nevertheless, there is lack of effective targeted therapies for NRAS mutant melanoma.Out of the few MEK inhibitors, pimasertib, a potent inhibitor of both MEK1 and MEK2 has showed promising results in NRAS mutant advanced melanoma. However, as a single agent and similar to other MEK inhibitors, it showed a limited clinical benefit due to its rather cytostatic effect and high toxicity. Our and other preliminary studies clearly indicated a stimulation of MITF (Microphthalmia associated transcription factor), the master transcription factor regulating cell growth and differentiation in the melanocyte, under MEK inhibition challenge. Thus, in a context where the tumor suppressor p53 is largely inactivated in melanoma, the stimulation of MITF may be the cause of the restraint cytotoxic effects of MEK inhibitors. Therefore, we aimed to further investigate the downstream MITF targets that can explain the resistance to the drugs.First, we showed that, MEK inhibition (by Pimasertib) led to a significant inhibition of cell proliferation but with a very limited effect on apoptosis that may be explained by the systematic MITF upregulation in all lines tested. Indeed, Mimicking MITF activation of expression by stimulating cAMP conferred resistance to MEK inhibition and interestingly up-regulated Bcl-2 expression. Further evidence was provided by the fact that, acquired resistance to MEK inhibition is associated with substantial upregulation of the anti-apoptotic signaling MITF/Bcl-2. More importantly, selective Bcl-2 inhibition by ABT-199 or Bcl-2 knock out using CRISPER/Cas9 system restores the sensitivity of NRAS mutant melanoma cells to MEK inhibition and breaks the acquired resistance.Given the known p53 regulating effect on Bcl-2, we evaluated p53 reactivation by PRIMA-1Met (APR-246) under MEK inhibition on the promotion of apoptosis in a panel of Q61NRAS mutant melanoma cells. Strikingly and similarly, this combination not only resulted in a synergistic effect to induce massive apoptosis but also broke resistance to MEK inhibitors both in cells with wild type or mutant p53 alike.In conclusion, we showed that the activation of cAMP/MITF/Bcl-2 pathway is a main anti-apoptotic mechanism associated with resistance to MEK inhibition in NRAS mutant melanoma. We propose drug combinations cotargeting MEK and other proteins regulating apoptosis -p53/Bcl-2- as a promising and clinically relevant therapeutic strategy to not only act in synergy to cause massive apoptosis but also to overcome resistance to MEK inhibitors in NRAS mutant melanoma

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