Send to

Choose Destination
JCI Insight. 2019 Feb 21;4(4). pii: 125693. doi: 10.1172/jci.insight.125693. eCollection 2019 Feb 21.

Direct activation of PP2A for the treatment of tyrosine kinase inhibitor-resistant lung adenocarcinoma.

Author information

Department of Molecular Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA.
Division of Hematology and Medical Oncology, Tisch Cancer Institute.
Department of Genetics and Genomic Sciences and.
Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, USA.
University Hospitals Seidman Cancer Center, Case Western Reserve University, Cleveland, Ohio, USA.
Department of Medicine and.
Department of Structural and Chemical Biology, Icahn School of Medicine at Mount Sinai, New York, USA.
Division of Genetic Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA.


Although tyrosine kinase inhibitors (TKIs) have demonstrated significant efficacy in advanced lung adenocarcinoma (LUAD) patients with pathogenic alterations in EGFR, most patients develop acquired resistance to these agents via mechanisms enabling the sustained activation of the PI3K and MAPK oncogenic pathways downstream of EGFR. The tumor suppressor protein phosphatase 2A (PP2A) acts as a negative regulator of these pathways. We hypothesize that activation of PP2A simultaneously inhibits the PI3K and MAPK pathways and represents a promising therapeutic strategy for the treatment of TKI-resistant LUAD. After establishing the efficacy of small molecule activators of PP2A (SMAPs) in a transgenic EGFRL858R model and TKI-sensitive cell lines, we evaluated their therapeutic potential in vitro and in vivo in TKI-resistant models. PP2A activation resulted in apoptosis, significant tumor growth inhibition, and downregulation of PI3K and MAPK pathways. Combination of SMAPs and TKI afatinib resulted in an enhanced effect on the downregulation of the PI3K pathway via degradation of the PP2A endogenous inhibitor CIP2A. An improved effect on tumor growth inhibition was observed in a TKI-resistant xenograft mouse model treated with a combination of both agents. These collective data support the development of PP2A activators for the treatment of TKI-resistant LUAD.


Lung cancer; Oncology; Phosphoprotein phosphatases; Therapeutics; Tumor suppressors

Supplemental Content

Full text links

Icon for American Society for Clinical Investigation Icon for PubMed Central
Loading ...
Support Center