ERK-mTOR crosstalk suppresses autophagy and upregulates proteasomal degradation pathway to confer chronic myeloid leukemia cells resistant to imatinib.

Drug resistance remains a critical barrier in effective cancer therapy. Previously, we demonstrated that expression of antiapoptotic protein (X-linked inhibitor of apoptosis protein [XIAP]), contributes to the development of TRAIL resistance in chronic myeloid leukemia (CML) cells. However, upon acquiring drug resistance (K562R and KCL22R), XIAP degradation shifted from the lysosomal to the proteasomal pathway. Consistently, XIAP expression was markedly elevated in tumor samples compared with normal controls and was significantly higher in patients with an imatinib failure (IMA-FL) than in their counterparts who were imatinib responsive (IMA-RP) within the patient cohort. Moreover, we have found that proteasomal activity increased in imatinib-resistant cells and lysosomal pathway is inhibited. Mechanistically, we found that H₂O₂-induced activation of the ERK-mTOR axis suppressed autophagy in resistant cells, facilitating this shift in degradation pathway. Interestingly, dual intervention by restoring autophagic flux via mTOR inhibition and inducing XIAP degradation using H2O2 reverted imatinib resistance in K562R cells. Thus, our findings uncover a novel ERK-mTOR-axis for upregulation of proteasomal degradation of XIAP, which could be targeted to overcome imatinib resistance by combinatorial inhibition of mTOR and XIAP in CML. This study holds the promise of a new therapeutic strategy for overcoming drug resistance in cancer.