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<p>Acquired resistance to tyrosine kinase inhibitors (TKIs) remains a major clinical challenge in the treatment of EGFR-mutant non-small cell lung cancer (NSCLC). This study established TKI-resistant variants by integrating cell lines, lung cancer organoids (LCOs), and in vivo models, revealing the pivotal role of the NF-κB/ALDH1A1 signaling in mediating non-mutational TKI resistance. Resistant cells exhibited elevated RELA phosphorylation, enhanced ALDH1A1 expression and enzymatic activity, and stem-like properties. Mechanistically, NF-κB activation occurred as an early response to TKI exposure and promoted ALDH1A1 transcription via RELA. In turn, ALDH1A1 contributed to the sustained activation of NF-κB signaling, forming a self-reinforcing positive feedback loop. Genetic ALDH1A1 or RELA silencing reversed the resistant phenotype. Pharmacologically, treatment with an EGFR-TKI and the ALDH1A1 inhibitor disulfiram or the NF-κB-targeting agent EGCG synergistically restored the antitumor efficacy of TKIs both in vitro and in vivo. These findings establish the NF-κB/ALDH1A1 signaling as a key non-genetic mechanism of acquired EGFR-TKI resistance and provide a rational combination strategy to overcome it.</p><p></p>

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Activation of the NF-κB/ALDH1A1 signaling promotes non-mutational resistance to EGFR-TKIs in non-small cell lung cancer

  • 期刊论文

  • 发表日期：

    2026年7月23日

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  • Lingyu Zhang,
  • Guibin Weng,
  • Chunjiang Liu,
  • Ruoxin Li,
  • Jieyu Li,
  • Yang Wang,
  • Chuanzhong Huang,
  • Wansong Lin,
  • Dali Zheng,
  • Yunbin Ye

摘要

Acquired resistance to tyrosine kinase inhibitors (TKIs) remains a major clinical challenge in the treatment of EGFR-mutant non-small cell lung cancer (NSCLC). This study established TKI-resistant variants by integrating cell lines, lung cancer organoids (LCOs), and in vivo models, revealing the pivotal role of the NF-κB/ALDH1A1 signaling in mediating non-mutational TKI resistance. Resistant cells exhibited elevated RELA phosphorylation, enhanced ALDH1A1 expression and enzymatic activity, and stem-like properties. Mechanistically, NF-κB activation occurred as an early response to TKI exposure and promoted ALDH1A1 transcription via RELA. In turn, ALDH1A1 contributed to the sustained activation of NF-κB signaling, forming a self-reinforcing positive feedback loop. Genetic ALDH1A1 or RELA silencing reversed the resistant phenotype. Pharmacologically, treatment with an EGFR-TKI and the ALDH1A1 inhibitor disulfiram or the NF-κB-targeting agent EGCG synergistically restored the antitumor efficacy of TKIs both in vitro and in vivo. These findings establish the NF-κB/ALDH1A1 signaling as a key non-genetic mechanism of acquired EGFR-TKI resistance and provide a rational combination strategy to overcome it.