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. 2018 Sep 3;41(6):663–675. doi: 10.1007/s13402-018-0404-6

Anti-tumor effect of CDK inhibitors on CDKN2A-defective squamous cell lung cancer cells

Eun-Hui Jeong 1, Tae-Gul Lee 1,2, Yun Jung Ko 1, Seo Yun Kim 1, Hye-Ryoun Kim 1, Hyunggee Kim 2, Cheol Hyeon Kim 1,✉
PMCID: PMC12995253  PMID: 30178167

Abstract

Background

Squamous cell lung cancer (SqCLC) is a distinct histologic subtype of non-small cell lung cancer (NSCLC). Although the discovery of driver mutations and their targeted drugs has remarkably improved the treatment outcomes for lung adenocarcinoma, currently no such molecular target is clinically available for SqCLC. The CDKN2A locus at 9p21 encodes two alternatively spliced proteins, p16INK4a (p16) and p14ARF (p14), which function as cell cycle inhibitors. The Cancer Genome Atlas (TCGA) project revealed that CDKN2A is inactivated in 72% of SqCLC cases. In addition, it was found that CDKN2A mutations are significantly more common in SqCLC than in adenocarcinoma. Down-regulation of p16 and p14 by CDKN2A gene inactivation leads to activation of cyclin-dependent kinases (CDKs), thereby permitting constitutive phosphorylation of Rb and subsequent cell cycle progression. Here, we hypothesized that CDK inhibition may serve as an attractive strategy for the treatment of CDKN2A-defective SqCLC.

Methods

We investigated whether the CDK inhibitors flavopiridol and dinaciclib may exhibit antitumor activity in CDKN2A-defective SqCLC cells compared to control cells. The cytotoxic effect of the CDK inhibitors was evaluated using cell viability assays, and the induction of apoptosis was assessed using TUNEL assays and Western blot analyses. Finally, anti-tumor effects of the CDK inhibitors on xenografted cells were investigated in vivo.

Results

We found that flavopiridol and dinaciclib induced cytotoxicity by enhancing apoptosis in CDKN2A-defective SqCLC cells, and that epithelial to mesenchymal transition (EMT) decreased and autophagy increased during this process. In addition, we found that autophagy had a cytoprotective role.

Conclusion

Our data suggest a potential role of CDK inhibitors in managing CDKN2A-defective SqCLC.

Keywords: Squamous cell lung cancer, CDKN2A, CDK inhibitors, Flavopiridol, Dinaciclib

Introduction

Squamous cell lung cancer (SqCLC) is a distinct histologic subtype of non-small cell lung cancer (NSCLC), accounting for approximately 25–30% of cases [1]. SqCLC is closely associated with tobacco smoking and has specific clinicopathologic characteristics, including older age and advanced stage at diagnosis, comorbid diseases and a central tumor location [2, 3]. Recently, the discovery of driver mutations in genes such as those encoding the epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) has remarkably improved personalized therapy for lung adenocarcinoma [4, 5]. Unfortunately, however, no such molecular targets have been found yet in NSCLC with a squamous histology, resulting in poorer treatment outcomes in patients with advanced disease than in those suffering from other NSCLC subtypes [6].

The CDKN2A locus at 9p21 encodes two alternatively spliced proteins, p16INK4a (p16) and p14ARF (p14), which function as cell cycle inhibitors [7–10]. p16 is known as a tumor suppressor that induces cell cycle arrest and functions as an inhibitor of cyclin-dependent kinase (CDK) 4 and CDK6, which can initiate the phosphorylation of Rb [8, 9]. p14 plays a role in cell cycle control by linking the p16/Rb pathway to the p53/Rb pathway. p14 sequesters MDM2 and, thereby, prevents the degradation and nuclear export of p53 [8, 9]. It is well established that both p16 and p14 play important roles in regulating the proliferation of normal and tumorigenic squamous epithelial cells [11, 12]. It has amply been shown that the CDKN2A gene is frequently inactivated in human cancers, including NSCLC [10]. The Cancer Genome Atlas (TCGA) project revealed that CDKN2A is inactivated in 72% of SqCLC cases [13], and it has been found that CDKN2A mutations are significantly more common in SqCLC than in adenocarcinoma [13, 14]. Accordingly, the modulation of CDKN2A-associated alterations may serve as a promising strategy for SqCLC prevention and/or therapy.

p16 binds to CDK4/6 and prevents its interaction with cyclin D [8, 9], whereas p14 inactivates cyclin-CDK complexes by promoting p21WAF1/CIP1 (p21) activation [8, 9]. Therefore, down-regulation of p16 and p14 by CDKN2A gene inactivation will lead to CDK activation, resulting in constitutive phosphorylation of Rb and subsequent cell cycle progression. In this context, CDK inhibition may serve as an attractive therapeutic strategy for CDKN2A-defective SqCLC. Flavopiridol is a semi-synthetic flavonoid and a potent inhibitor of CDKs, including CDK1, CDK2, CDK4 and CDK6 [15, 16]. Dinaciclib is a novel, potent, small-molecule inhibitor of multiple CDKs [17].

In this study, we investigated whether CDK inhibitors may exhibit antitumor activities in CDKN2A-defective squamous cell lung cancer-derived cells. We found that the CDK inhibitors flavopiridol and dinaciclib induced cytotoxicity by enhancing apoptosis in the CDKN2A-defective squamous cell lung cancer-derived cells tested, and that epithelial to mesenchymal transition (EMT) decreased and autophagy increased during this process. Autophagy was found to have a cytoprotective role. These findings suggest a potential role of CDK inhibitors in the clinical management of CDKN2A-defective SqCLC.

Materials and methods

Cell culture

NCI-H520 (H520), NCI-H596 (H596), NCI-H1703 (H1703) and SK-MES-1 lung squamous cancer cell lines were purchased from the American Type Culture Collection (ATCC; Manassas, VA, USA). The CDKN2A gene mutation status of each cell line was provided by the ATCC from the Sanger Institute COSMIC database. Accordingly, the H596 cell line harbors a wild-type CDKN2A gene, the H520 and SK-MES-1 cell lines exhibit a deletion of the CDKN2A gene and the H1703 cell line carries an inactivating mutation of the CDKN2A gene. H520, H596 and H1703 cells were cultured in RPMI-1640 and SK-MES-1 cells in MEM supplemented with 10% fetal bovine serum (FBS) and 1% penicillin at 37 °C under 5% CO2. All cell culture materials were purchased from HyClone Laboratories (Logan, UT, USA).

Reagents

The CDK inhibitors flavopiridol and dinaciclib were purchased from Selleck Chemicals (Houston, TX, USA). Antibodies directed against cleaved caspase 8, cleaved caspase 9, cleaved PARP, LC3B and p62 were purchased from Cell Signaling Technology (Beverly, MA, USA). Antibodies directed against p14, p16, p21, p27, p53, CDK2, CDK4, CDK6 and p-Rb were purchased from Santa Cruz Biotechnology (Santa Cruz, CA, USA). Antibodies directed against E-cadherin, N-cadherin, fibronectin and vimentin were purchased from Abcam (Cambridge, MA, USA). 3-(4,5-Dimethyl thiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) solution, crystal violet and acridine orange were purchased from Sigma (St. Louis, MO, USA).

Western blot analysis

Cell lysates were resolved by 10% SDS-PAGE and transferred to polyvinylidene difluoride membranes (Millipore; Billerica, MA, USA). The membranes were blocked with 5% skim milk–PBS–0.1% Tween 20 for 1 h at room temperature before overnight incubation with primary antibodies diluted in 5% skim milk–PBS–0.1% Tween 20. Next, the membranes were washed three times in PBS–0.1% Tween 20 and incubated with horseradish peroxidase-conjugated secondary antibodies diluted 1:5000 in 5% skim milk–PBS–0.1% Tween 20 for 1 h. After successive washes, the membranes were developed using an ECL kit (Thermo Scientific; Waltham, MA, USA) and analyzed using the ImageQuant LAS 4000 image analysis system (GE Healthcare; Buckinghamshire, UK). Each experiment was repeated more than three times, and representative figures are reported.

Cell viability assay

Cells were treated with different concentrations of flavopiridol or dinaciclib for 72 h in 96-well plates after which cell viability was measured using an MTT assay. Briefly, MTT solution was added to the cells to a final concentration of 0.5 mg/ml, after which the cells were incubated at 37 °C for 4 h. After removing the culture media, 50 μl dimethyl sulfoxide (DMSO) was added, after which the optical density of each well was read at 590 nm using a spectrophotometer.

Crystal violet staining

Cells were placed on ice, washed twice with cold PBS, and fixed for 10 min with ice-cold 100% methanol. Next, the cells were moved to room temperature and incubated with crystal violet stain solution (1% crystal violet in 25% methanol) for 10 min after which the crystal violet was removed and the wells were rinsed thoroughly with running water until the wells rinsed clear. Finally, the cells were allowed to dry and their morphology was assessed by light microscopy.

Apoptosis assay

Apoptosis was detected through a terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay carried out using an Apo-Direct kit (BD Biosciences; San Jose, CA, USA) according to the manufacturer’s instructions. Briefly, cells were treated with flavopiridol or dinaciclib for 72 h, washed with PBS, fixed with 1% paraformaldehyde and permeabilized with 70% ethanol for 30 min on ice. After washing, the cells were stained with DNA labeling solution for 1 h at 37 °C. At least 10,000 cells were assayed using fluorescence-activated cell sorting (FACS) and the data were analyzed using CellQuest software (BD Biosciences).

Scratch wound healing assay

Cells were cultured to 90% confluence in 12-well plates after which a thin scratch (wound) was made in the central area using a 10-μl pipette tip. Detached and damaged cells were carefully removed with PBS, and the medium was replaced. Wound closure was assessed after staining the cells with 2% ethanol containing 0.2% crystal violet. After drying, the stained cells were evaluated by light microscopy and images were captured.

Transwell invasion assay

A transwell invasion assay was carried out using a 24-well plate, of which each well contained two medium-containing chambers separated by a porous filter through which cells can transmigrate (Corning Life Sciences; Corning, New York, USA). Polycarbonate filters (8 μm pore size) were coated with Matrigel basement membrane matrix (Corning Life Sciences). The lower chambers were filled with medium containing 20% FBS as a chemoattractant, after which the upper chambers with filters were laid over it. Cells were seeded onto the upper chamber wells. After incubation for 48 h at 37 °C, the filters were fixed and stained with 25% methanol containing 1% crystal violet for 15 min. After drying, the stained cells on the bottom surfaces of the filters were observed by light microscopy.

Autophagy analysis by LC3B immunoflouresence

Cells were trypsinized, washed with PBS and fixed in 4% paraformaldehyde for 10 min at 37 °C. After washing with PBS, the cells were permeabilized with 90% methanol for 30 min on ice, blocked with 1% BSA in PBS for 30 min and subsequently incubated with an anti-LC3B antibody (1:100) for 1 h at room temperature. After washing, the cells were stained with FITC-conjugated secondary antibodies at a dilution of 1:500 for 30 min at room temperature and FACS analysis was performed.

Small interfering RNA (siRNA) transfection

A pool of three 19–25 nt siRNAs specific for LC3B (sc-43,390) or CDKN2A (sc-37,622) and non-targeting control siRNA was purchased from Santa Cruz Biotechnology. Transfections with the siRNAs were carried out using Oligofectamine (Invitrogen Life Technologies; Carlsbad, CA, USA) according to the manufacturer’s specifications. Specific silencing of LC3B or CDKN2A was confirmed through at least three independent experiments.

Lentiviral short hairpin RNA (shRNA) transduction

pLKO.1 lentiviral vectors expressing shRNA against CDKN2A (RHS4533-EG1029) were purchased from GE Dharmacon (Lafayette, CO, USA). Lentiviral vectors were transfected into HEK 293 T cells cultured in DMEM supplemented with 10% FBS, and supernatants containing viral particles were collected after 48 h. Next, the virus solutions were filtered through 0.45-μm membranes (Millipore; Darmstadt, Germany) and stored immediately at −70°C. The viral titer was determined using the TCID50 method. H596 cells were transduced with 20 multiplicity of infection (MOI) of virus. One day post-infection, media were removed and replaced with media containing puromycin (2 μg/ml) for selecting stable cell lines.

Recombinant CDKN2A adenoviral vector transduction

A premade adenovirus containing the CDKN2A gene (GenBank accession number NM_001195132, Cat# VH883006) was purchased from Vigene Biosciences (Rockville, MD, USA). An adenoviral LacZ vector (Qbiogene; Carlsbad, CA, USA) was used as control. For infection, cells were treated with adenoviral CDKN2A or adenoviral LacZ at 100 MOI and incubated for 48 h.

In vivo anti-tumor effect of CDK inhibitors

All animal experiments were approved by the Institutional Animal Care and Use Committee. Seven-week-old female athymic nude mice from the Nara Bio animal center (NARA Biotech; Seoul, Korea) were housed under pathogen-free conditions in microisolator cages with laboratory chow and water available ad libitum. Xenografts were established by subcutaneously injecting 5 × 106 cells per mouse mixed 1:1 with Matrigel basement membrane matrix into their right flanks. Once the tumors reached a volume of ~100 mm3, flavopiridol (5 mg/kg of body weight), dinaciclib (5 mg/kg of body weight) or PBS was injected into the peritoneal cavity daily. Six mice per group were treated with infected cells. Tumor volumes were deduced from caliper measurements of tumor length (L) and width (W) according to the formula LW2/2.

Statistical analysis

All experiments were repeated at least three times. Data are presented as mean ± standard deviation as a percentage of the control. The Mann-Whitney U-test was used for comparisons between groups, and a p value < 0.05 was considered statistically significant.

Results

CDKN2A-defective SqCLC cells exhibit increased CDK expression levels

First, we examined the basal expression level of CDKN2A and its downstream proteins in SqCLC-derived cells. The CDKN2A locus contains two overlapping genes that encode two unrelated proteins, p16 and p14, which function as cell cycle inhibitors [7–10]. CDK4/6 negatively regulates Rb protein activity by phosphorylation and p16 inhibits CDK4/6 binding to cyclin D, thereby preventing Rb inactivation [8, 9]. p14 results in the stabilization of p53 which, in turn, induces the expression of p21, a CDK inhibitor [8, 9] (Fig. 1a). As expected, we found that the expression of p16, p14, p53 and p21 was significantly decreased in CDKN2A-defective SK-MES-1, H1703 and H520 cells compared to that in H596 cells carrying a wild-type CDKN2A gene. Conversely, we found that the expression of CDK2/4/6 and phospho-Rb was clearly increased in the CDKN2A-defective cells (Fig. 1b).

Fig. 1.

Fig. 1

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a Signaling proteins of the CDKN2A pathway. b Basal expression levels of CDKN2A-related proteins assessed by Western blotting analysis in squamous cell lung cancer cells with either a wild-type (H596) or an inactivated (SK-MES-1, H1703 and H520) CDKN2A gene. GAPDH was used as a loading control

CDK inhibitors induce cytotoxicity in CDKN2A-defective SqCLC cells

Next, we evaluated the cytotoxic effect of two CDK inhibitors, flavopiridol and dinaciclib, in CDKN2A-defective SqCLC-derived cells using MTT and crystal violet assays. We found that the cell viability was significantly decreased in CDKN2A-defective cells compared to that in control wild-type CDKN2A cells after treatment with flavopiridol or dinaciclib (Fig. 2a, b). This result was confirmed by crystal violet staining (Fig. 2c).

Fig. 2.

Fig. 2

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Cytotoxic effect of CDK inhibitors on CDKN2A-defective squamous cell lung cancer cells. Cells were incubated with increasing concentrations of flavopiridol (a) or dinaciclib (b) for 72 h after which the resulting cell viability was analyzed by MTT assay. Data are shown as mean percentage of control ± standard deviation (SD) of three independent experiments. p < 0.05 for the CDKN2A-defective SK-MES-1, H520 and H1703 cells versus wild-type H596 cells. c Cells were incubated with flavopiridol (200 nM) or dinaciclib (15 nM) for 72 h and photographed (magnification ×50) after crystal violet staining

CDK inhibitors induce apoptosis in CDKN2A-defective SqCLC cells

We also performed TUNEL assays and Western blot analyses of apoptosis-related marker proteins to assess the induction of apoptosis. Using the TUNEL assay, we found that flavopiridol- and dinaciclib-induced apoptosis was remarkably enhanced in the CDKN2A-defective SqCLC-derived cells compared to that in the control wild-type CDKN2A cells (Fig. 3a, b). Using Western blotting, we also detected increased cleaved caspase 8 and cleaved caspase 9 expression levels after flavopiridol or dinaciclib treatment in H520, H1703 and SK-MES-1 cells, with a similar time course as that observed for PARP cleavage (Fig. 3c).

Fig. 3.

Fig. 3

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CDK inhibitors induce apoptosis, which increases significantly in CDKN2A-defective squamous cell lung cancer cells. a TUNEL staining was performed on cells treated with flavopiridol (200 nM) or dinaciclib (15 nM) for 72 h after which FACS analysis for TUNEL-positive apoptotic cells was performed. Representative histograms show control (gray) and drug-treated (black) cells. b Quantification of TUNEL-positive tumor cells. The percentage of TUNEL-positive cells is reported as mean ± SD of three independent experiments. *p < 0.05 and **p < 0.01 compared to control. c Time-dependent expression of apoptotic proteins in flavopiridol- or dinaciclib-treated cells. Cells were treated with flavopiridol (200 nM) or dinaciclib (15 nM) for the indicated time periods. Total cellular extracts were separated by 10% SDS-PAGE after which protein expression was analyzed by Western blotting

CDK inhibitors decrease epithelial to mesenchymal transition (EMT) in CDKN2A-defective SqCLC cells

It has previously been reported that p16 can repress the migration and invasion of breast stromal fibroblasts and inhibit EMT in breast and cervical carcinoma cells [18–20]. It has also been reported that loss of p16 results in EMT induction during mammary tumorigenesis [21, 22]. Based on these observations, we set out to examine whether CDK inhibitors may have an effect on EMT in CDKN2A-defective SqCLC-derived cells, resulting in decreased p16 and increased CDK expression. We analyzed EMT using scratch wound healing and transwell invasion assays, and by Western blotting for epithelial and mesenchymal markers in flavopiridol- or dinaciclib-treated cells. We found that treatment of CDKN2A-defective SqCLC-derived cells with flavopiridol or dinaciclib resulted in inhibition of both cell migration and invasion compared to CDKN2A wild-type control cells (Fig. 4a, b). Decreased expression of the epithelial marker E-cadherin and increased expression of mesenchymal markers (N-cadherin, fibronectin and vimentin) are fundamental events in EMT [23]. In H596 cells, we found that treatment with flavopiridol did not significantly change the expression levels of these markers. In contrast, we found that the expression of E-cadherin was increased and that of N-cadherin, fibronectin and vimentin was markedly decreased in CDKN2A-defective H1703 and SK-MES-1 cells, indicating that the EMT process was inhibited by flavopiridol treatment in these cells (Fig. 4c).

Fig. 4.

Fig. 4

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CDK inhibitors inhibit epithelial to mesenchymal transition (EMT) in CDKN2A-defective squamous cell lung cancer cells. a Scratch wound healing assay showing that CDK inhibitors suppress the migration of CDKN2A-defective cells. Representative pictures (magnification ×50) show the scratch (wound) at the indicated time points with each treatment. b Transwell invasion assay. Representative pictures (magnification ×100) of the bottom surface are shown. c Western blot of epithelial marker (E-cadherin) and mesenchymal markers (N-cadherin, fibronectin and vimentin) in flavopiridol-treated cells. p-Rb was used as a marker of CDK inhibition by each drug

CDK inhibitors induce autophagy in CDKN2A-defective SqCLC cells

Autophagy is a catabolic process whereby cytoplasmic proteins and organelles are sequestered into vacuoles and delivered to lysosomes for degradation and recycling. Environmental stressors, such as nutrient starvation, pathogen infection, high temperature and low oxygen, can induce autophagy [24, 25]. It has been reported that CDKN2A-related proteins including p14, p16 and Rb can induce autophagy in multiple cancer cell types [26–28]. We examined the effects of CDK inhibitors on autophagy in CDKN2A-defective SqCLC-derived cells. During autophagy, cytosolic LC3B-I is converted to LC3B-II through lipidation, and p62 is degraded following an increase in autophagic flux [29]. We found that treatment with flavopiridol or dinaciclib up-regulated LC3B-II and down-regulated p62 expression in CDKN2A-defective H1703 and SK-MES-1 cells compared to wild-type CDKN2A control cells (Fig. 5a). We also performed immunofluorescence staining and FACS analysis using LC3B-FITC and again observed a significantly increased LC3B expression in CDKN2A-defective cells after treatment with flavopiridol or dinaciclib (Fig. 5b, c).

Fig. 5.

Fig. 5

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CDK inhibitors induce autophagy in CDKN2A-defective squamous cell lung cancer cells. a Western blot analysis of autophagy-related proteins (LC3B and p62) at the indicated time points in cells treated with flavopiridol (200 nM) or dinaciclib (15 nM). b LC3B was labeled with an anti-LC3B-FITC antibody after which FACS analysis was performed in cells treated with flavopiridol (200 nM) or dinaciclib (15 nM) for 48 h. Gray, control cells; black, drug-treated cells. c Quantification of LC3B-FITC expression. The results are presented as mean ± SD of three independent experiments. *p < 0.05 and **p < 0.01 compared to control

Inhibiting autophagy enhances CDK inhibitor-induced cell death in CDKN2A-defective SqCLC cells

Although autophagy is required for cell survival under stress conditions, recent studies have shown that autophagy can also promote cell death [30, 31]. To examine whether autophagy induced by CDK inhibitors functions to promote cell survival or cell death, we inhibited autophagy in H1703 and SK-MES-1 cells through the transfection of a LC3B-specific siRNA. We found that the cell viability of autophagy-inhibited cells after treatment with flavopiridol or dinaciclib was significantly increased compared to that of control cells (Fig. 6a, b). These results indicate that CDK inhibitor-induced autophagy plays a cytoprotective role in CDKN2A-defective SqCLC cells.

Fig. 6.

Fig. 6

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Effect of autophagy inhibition on the viability of cells treated with CDK inhibitors. H1703 (a) and SK-MED-1 (b) cells were transfected with control siRNA (siCon) or siRNA targeting LC3B (siLC3B) for 48 h and treated with the indicated concentrations of CDK inhibitors for 72 h after which cell viability was determined by MTT assay. Bar graphs represent data in mean ± SD of three independent experiments. *p < 0.05 and **p < 0.01 versus the value of each control. Western blot analysis showing the expression of LC3B in cells treated with siCon or siLC3B

Inactive CDKN2A is essential for CDK inhibitor-induced cytotoxic effects

To confirm the relationship between CDKN2A expression and cytotoxicity induced by CDK inhibitors, we examined the effect of inhibition or exogenous expression of CDKN2A on the viability of cells treated with CDK inhibitors. First, we transfected H596 cells with siRNA or lentiviral shRNA targeting CDKN2A and compared their viability after treatment with CDK inhibitors to control cells. We found that the cell viability after treatment with CDK inhibitors was significantly decreased in CDKN2A-inhibited H596 cells compared to that in control cells (Fig. 7a, b). Next, we transduced a recombinant adenoviral-CDKN2A expression vector into CDKN2A-deficient H1703 cells. We found that restoring the expression of the CDKN2A protein decreased the cytotoxic effect of the CDK inhibitors (Fig. 7c). Taken together, these results suggest a critical role for CDKN2A in CDK inhibitor-induced cytotoxic effects in SqCLC cells.

Fig. 7.

Fig. 7

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Effect of inhibition or exogenous expression of CDKN2A on the viability of cells treated with CDK inhibitors. a H596 cells were transfected with siRNA targeting CDKN2A (siCDKN2A) or control siRNA (siControl) for 48 h and treated with the indicated concentrations of CDK inhibitors for 72 h, after which cell viability was determined by MTT assay. b H596 cells were transduced with lentiviral shRNA targeting CDKN2A (shCDKN2A) or control shRNA (shControl). Cell viability was determined by MTT assay after treatment with the indicated concentrations of CDK inhibitors for 72 h. c H1703 cells were transduced with adenoviral-CDKN2A (adCDKN2A) for 48 h. Cell viability was determined by MTT assay after treatment with the indicated concentrations of CDK inhibitors for 72 h. LacZ was used as a negative control (adControl). Results are reported as mean ± SD of three independent experiments. p < 0.05 for the control versus the treatment. Western blot analysis shows the expression of CDKN2A-related proteins in the treated cells

CDK inhibitors show significant anti-tumor effects in vivo

Finally, we investigated whether treatment with CDK inhibitors might show anti-tumor effects on xenografted H520 (Fig. 8a) and H1703 (Fig. 8b) cells in vivo. Following tumor formation, nude mice were treated with flavopiridol (5 mg/kg), dinaciclib (5 mg/kg), or PBS. We found that treatment with flavopiridol or dinaciclib led to a marked tumor shrinkage.

Fig. 8.

Fig. 8

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Anti-tumor effect of CDK inhibitors in vivo. H520 (a) or H1703 (b) cells were xenografted into nude mice. After the tumors reached a volume of ~100 mm3, flavopiridol (5 mg/kg of body weight), dinaciclib (5 mg/kg of body weight) or PBS (Control) was injected into the peritoneal cavity daily and tumor volumes were measured. Results are reported as the mean ± standard deviation from six mice in each group. **p < 0.01 for the control group versus the drug treatment group

Discussion

Recently, remarkable improvements have been made in the treatment of advanced NSCLC based on the development of novel targeted agents, including EGFR tyrosine kinase inhibitors and ALK inhibitors [4, 5, 32]. Unfortunately, this improvement is confined to patients with adenocarcinoma, whereas until now no definite targeted treatment option has become available for SqCLC patients [6]. SqCLC is the second most frequent subtype of NSCLC, accounting for approximately 25–30% of cases [1]. In SqCLC, recurrent alterations in kinase genes do not appear to represent core genomic events, with the most common genomic alterations being functional loss of p53 and CDKN2A [33]. An integrated analysis of the molecular changes of 178 resected SqCLC tumors has been reported by The Cancer Genome Atlas (TCGA) initiative. They found p53 mutations in nearly all specimens, as well as significantly altered pathways, including the NFE2L2 and KEAP1 pathways in 34%, the SOX2/TP63/NOTCH1 pathway in 44%, the phosphatidylinositol-3-OH kinase pathway in 47% and the CDKN2A and Rb1 pathways in 72% of the tumors. TCGA initiative also revealed that, whereas EGFR and KRAS mutations are the two most common oncogenic aberrations in lung adenocarcinoma, they are extremely rare in SqCLC [13].

The CDKN2A locus codes for two proteins, p16 and p14. Both act as tumor suppressors by regulating the cell cycle [7–10]. Somatic mutations in CDKN2A are common, being second after p53 [10]. TCGA project showed that CDKN2A is inactivated in 72% of SqCLC cases through epigenetic silencing by methylation (21%), deleterious mutations (18%), exon 1β skipping (4%) and homozygous deletion (29%) [13]. Accordingly, epigenetic/genetic modulation of CDKN2A alterations may be a promising strategy for SqCLC treatment. Of the two proteins encoded by CDKN2A, the clinical significance of p16 inactivation in NSCLC has amply been investigated over the past decade. Several studies have been performed to assess the prognostic value of epigenetic p16 silencing in NSCLC, but so far the results have remained controversial. Recent meta-analyses suggest that p16 hypermethylation may be associated with the overall and disease-free survival of NSCLC patients, and may be a predictive factor for a poor prognosis in surgically treated NSCLC patients [34, 35].

Aberrant activation of CDKs results in abnormal cell cycle progression and, ultimately, tumorigenesis [36]. Therefore, CDK inhibitors have been developed and are currently undergoing evaluation as anti-cancer treatment options [37]. Indeed, small molecule CDK inhibitors have been reported to have anti-tumor effects in a variety of human cancers, including breast cancer, chronic lymphocytic leukemia, melanoma and pancreatic cancer [38–41]. Several CDK-targeted drugs are currently in clinical trials, but none of them has shown significant efficacy in solid tumors, whereas some exhibit dose-limiting toxicity [42, 43]. In lung cancer, the anti-tumor effects and possible mechanisms of action of CDK inhibitors have not been thoroughly evaluated yet.

We hypothesized that application of CDK inhibition might be feasible in SqCLC with a decreased p14/p16 expression resulting from CDKN2A gene inactivation. From our data we conclude that the CDK inhibitors flavopiridol and dinaciclib have anti-tumor activity both in vitro and in vivo in CDKN2A-defective SqCLC-derived cells. We also found that EMT decreases and autophagy increases during this process. CDK inhibition may, therefore, serve as a promising therapeutic option to treat SqCLC. Further studies are warranted to substantiate this notion.

Acknowledgements

This study was supported by a grant from the Korea Institute of Radiological and Medical Sciences (KIRAMS), funded by Ministry of Science and ICT (MSIT), Republic of Korea (50474-2018).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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