A telomerase-SUCLG2 signaling axis drives drug resistance by protecting persister cells
Yu Liu1, Kejia Zhao2, Binbin Hu3
1Department of Thoracic Surgery and Institute of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China; Western China Collaborative Innovation Center for Early Diagnosis and Multidisciplinary Therapy of Lung Cancer, Chengdu, Sichuan 610041, China; Faculty of Dentistry, The University of Hong Kong, Sai Ying Pun 999077, Hong Kong The Hong Kong Special Administrative Region (HKSAR).
Abstract:
The evolution of drug-tolerant persister (DTP) cells into resistant clones remains a major clinical obstacle to targeted therapies. Transcriptomic profiling across melanoma (A375, SK-MEL-28), non-small cell lung cancer (NSCLC; HCC827, PC-9), and colorectal cancer (CRC; SW480) models revealed a conserved biphasic telomerase regulation during DTP evolution. Combining targeted therapies with the telomere dysfunction-inducing agent 6-thio-dG effectively suppressed DTP outgrowth and resistance in vitro and in vivo. Mechanistically, 6-thio-dG induces telomere dysfunction-driven chromatin remodeling, which reduces the accessibility of the SUCLG2 locus to transcription factors. The subsequent downregulation of this mitochondrial enzyme severely disrupts the metabolic stability required for DTP survival. Consistently, SUCLG2 knockdown recapitulated these therapeutic effects. Furthermore, bulk RNA sequencing (RNA-seq) of HCC827 xenograft-derived samples confirmed that this combination therapy coordinately suppresses mitochondrial metabolism, telomere maintenance, and persister transcriptional programs. Collectively, preemptively combining 6-thio-dG with targeted therapies offers a potent strategy to disrupt DTP evolution and overcome adaptive resistance across diverse malignancies.
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