PTEN loss confers sensitivity to rapalogs in clear cell renal cell carcinoma

Xiao-lian Liu1,2, Gui-ming Zhang2, Si-si Huang2, Wen-hui Shi2, Lin-xuan Ye2, Zhong-lu Ren3,4, Jia-jie Zhang2, Shu-wen Liu2, Le Yu2, Yi-lei Li1
1 Department of Pharmacy, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
2 School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
3 College of Medical Information Engineering, Guangdong Pharmaceutical University, Guangzhou 510006, China
4 Medicinal Information and Real World Engineering Technology Center of Universities, Guangzhou 510006, China
Correspondence to: Le Yu:, Yi-lei Li:,
DOI: 10.1038/s41401-022-00862-1
Received: 7 July 2021
Accepted: 7 January 2022
Advance online: 14 February 2022


Rapalogs (everolimus and temsirolimus) are allosteric mTORC1 inhibitors and approved agents for advanced clear cell renal cell carcinoma (ccRCC), although only a subset of patients derive clinical benefit. Progress in genomic characterization has made it possible to generate comprehensive profiles of genetic alterations in ccRCC; however, the correlations between recurrent somatic mutations and rapalog efficacy remain unclear. Here, we demonstrate by using multiple patient-derived ccRCC cell lines that compared to PTEN-proficient cells, PTEN-deficient cells exhibit hypersensitivity to rapalogs. Rapalogs inhibit cell proliferation by inducing G0/G1 arrest without inducing apoptosis in PTEN-deficient ccRCC cell lines. Using isogenic cell lines generated by CRISPR/Cas9, we validate the correlation between PTEN loss and rapalog hypersensitivity. In contrast, deletion of VHL or chromatin-modifying genes (PBRM1, SETD2, BAP1, or KDM5C) fails to influence the cellular response to rapalogs. Our mechanistic study shows that ectopic expression of an activating mTOR mutant (C1483F) antagonizes PTEN-induced cell growth inhibition, while introduction of a resistant mTOR mutant (A2034V) enables PTEN-deficient ccRCC cells to escape the growth inhibitory effect of rapalogs, suggesting that PTEN loss generates vulnerability to mTOR inhibition. PTEN-deficient ccRCC cells are more sensitive to the inhibitory effects of temsirolimus on cell migration and tumor growth in zebrafish and xenograft mice, respectively. Of note, PTEN protein loss as detected by immunohistochemistry is much more frequent than mutations in the PTEN gene in ccRCC patients. Our study suggests that PTEN loss correlates with rapalog sensitivity and could be used as a marker for ccRCC patient selection for rapalog therapy.
Keywords: clear cell renal cell carcinoma; mTOR; PTEN; rapalogs; recurrent mutations; sensitivity

Article Options

Download Citation

Cited times in Scopus