LPIN2 contributes to tyrosine kinase inhibitor resistance via activation of PI3K pathway

Background: Acquired resistance to tyrosine kinase inhibitors (TKIs), e.g., osimertinib for epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC) and alectinib for anaplastic lymphoma kinase (ALK)-fusion NSCLC is a critical clinical barrier, with most patients progressing within 1 year of treatment. Previous studies on TKI resistance have mainly focused on target-dependent and target-independent mechanisms. Among target-independent mechanisms, the main research directions have centered on the activation of bypass signaling pathways, tumor microenvironment (TME) remodeling, cell phenotypic transition and metabolic reprogramming. The role of triglyceride (TG) synthesis—a key branch of metabolic reprogramming—in this process remains unclear.

Methods: Osimertinib-resistant (PC-9 OR) and alectinib-resistant (NCI-H3122 ALR) cell lines were established via a dose-escalation strategy. The resistant cells were then compared with their original sensitive cells under both drug-present and drug-withdrawn conditions. Metabolomic liquid chromatography-mass spectrometry (LC-MS) and transcriptomic analyses revealed shared differential features, which were selected as candidate key metabolic enzymes in TKI resistance. From this pathway, LPIN2 was selected as a consistently upregulated key enzyme for validation. The LPIN2 gene was knocked out using CRISPR/Cas9 technology; a series of functional assays (e.g., drug sensitivity, colony formation), complemented by lipid supplementation, pathway inhibition (PI3K/mTOR), and a mouse xenograft model to verify the underlying mechanism.

Results: LPIN2 was identified as a key driver of TKI resistance in NSCLC, with its mRNA and protein levels significantly upregulated (~2-fold) in osimertinib-resistant (PC-9 OR) and alectinib-resistant (NCI-H3122 ALR) cells. CRISPR/Cas9-mediated LPIN2 knockout restored TKI sensitivity, displaying oncogene-specific magnitudes of reduction in the half-maximal inhibitory concentration (IC₅₀): decreasing from 3,585 nM to 229–477 nM in EGFR-mutant PC-9 OR cells, and exhibiting a more moderate reduction from 2,264 nM to 325–488 nM in ALK-fusion NCI-H3122 ALR cells, while suppressing tumor growth in vivo (Ki67 downregulation). Mechanistically, LPIN2 promoted TG accumulation and lipid droplet deposition; exogenous TG supplementation (1,2-dioleoyl-3-arachidoyl-sn-glycerol) induced TKI resistance in parental cells and rescued drug tolerance in LPIN2-knockout cells, whereas inhibition of downstream TG synthesis enzymes [diacylglycerol O-acyltransferase1/2 (DGAT1/2)] recapitulated the knockout phenotype. Furthermore, perturbation of the LPIN2-TG axis was associated with modulation of the PI3K-AKT-mTOR survival pathway, regulating apoptosis-related proteins (BCL-XL/BCL2 downregulation, BAX upregulation). Combined treatment with osimertinib and a PI3K inhibitor (Wortmannin) synergistically suppressed tumor growth and prolonged survival in xenograft models.

Conclusions: LPIN2 contributes to TKI resistance in NSCLC through a novel LPIN2-TG metabolic node that is functionally associated with PI3K-AKT signaling: it enhances TG biosynthesis and lipid droplet accumulation, thereby indirectly modulating the PI3K-AKT pathway to inhibit apoptosis. Targeting this axis reverses TKI resistance in vitro and in vivo, identifying LPIN2 as a drug stress-independent resistance driver and potential biomarker for metabolic-targeted combination therapy.