5-Fluorouracil (5-FU) has been extensively used in the treatment of gastrointestinal, pancreatic, and breast cancers. Studies in human pancreatic carcinoma cells have revealed that 5-FU induces EGFR and Akt phosphorylation [
22]. As PI3K/Akt signaling pathway promotes survival, these findings have led to the suggestion of a role for induced EGFR/ERK/Akt pathway in reducing chemosensitivity [
4,
23–
25]. The mechanisms of chemoresistance to 5-FU in gastric cancer are however less clear. Studies presented here support a role for Cbl-b E3 ubiquitin ligase in promoting chemosensitivity of gastric cancer cells to 5-FU through a mechanism that involves Cbl-b-dependent limitation of ERK and Akt survival signaling downstream of EGFR.
Our studies demonstrated that 5-FU triggered dose-dependent cytotoxicity in three gastric cancer cell lines (SGC7901, MGC803, and BGC823), and induced apoptosis in a time-dependent manner. Western blot analyses indicated that after 5-FU treatment, the levels of phospho-EGFR and phospho-Akt elevated in a short time and finally decreased at 48 h. The levels of phospho-ERK transiently decreased and then elevated by 48 h in MGC803 cells, which implied that the EGFR/ERK/Akt signaling pathway may be involved in 5-FU activity in gastric cancer cells. Knockdown studies of Cbl-b directly showed that loss of Cbl-b led to chemoresistance to 5-FU, as well as enhanced activation of EGFR, ERK and Akt signaling. These results indicated that Cbl-b enhanced the chemosensitivity of gastric cancer cells to 5-FU through the regulation of levels of active (phosphorylated) EGFR, ERK and Akt.
Our suggestion that Cbl-b functions together with EGFR/ERK/Akt pathway regulating the balance between chemosensitivity and chemoresistance to 5-FU is supported by findings in the literature. In related studies, we have shown that the chemotherapeutic agent, oxaliplatin, can sensitize gastric cancer cells to TRAIL by regulating components of the apototic/survival machinery such as caspase-3, caspase-8, Bax, and Bcl-2 protein expression [
26]. Cbl proteins are known to function as E3-ubiquitin ligases and restrict receptor tyrosine kinase (RTK) signaling, most notably EGFR [
27–
30]. While Cbl-b function has been predominantly studied in the context of hematopoietic cells, its ability to negatively regulate EGFR signaling has been well documented in model cell systems. For example, Ettenberg demonstrated that Cbl-b was phosphorylated and recruited to EGFR upon EGF stimulation, and was found to bind to the Grb2 adaptor protein. Furthermore, 32D/EGFR cells overexpressing Cbl-b showed markedly reduced proliferative response to EGF, and increased the number of cells undergoing apoptosis [
31]. Ahsan reported that Cbl-dependent EGFR degradation might contribute to sensitivity of head and neck cancer cells to cisplatin [
32]. Our previous results also showed that an involvement of Cbl-b in apoptosis induced by anthracyclines in gastric cancer cells [
19]. Together, these previous studies further support an involvement of Cbl-b and its potential regulation of EGFR signaling in determining chemosensitivity of gastric cancer cells. The knockdown studies of Cbl-b and biochemical analyses of EGFR signaling in the present study directly support this idea. Notably, while the role of Cbl proteins as physiological negative regulators of tyrosine kinases is now well-established, modulation of these ubiquitin ligases to regulate the balance between pro-survival and apoptotic signaling during anticancer therapy is an emerging area with substantial clinical implications. Thus, insights gained here should be helpful in the design of further studies to identify ways to enhance the effectiveness of chemotherapy by modulating Cbl protein-dependent degradation of tyrosine kinases.