Abstract PO5-23-09: Metabolic alterations in Estrogen Receptor-positive breast cancer contributing to CDK4/6 resistance

Abstract Background CDK4/6 inhibitors (CDK4/6i) are potent FDA-approved agents for the treatment of metastatic and for high-risk early estrogen receptor positive (ER+) breast cancer. However, significant proportion of patients continue to develop disease progression. Response does not correlate well with expression of CDK4/6 or key cell cycle proteins. Ki67, a proliferation marker, is prognostic, but NOT predictive of response. Resistance to CDK4/6i is mediated by multiple mechanisms including metabolic alterations. Herein, we explore the metabolic alterations associated with development of CDK4/6i resistance. Methods To understand the key metabolic alterations associated with resistance, we first developed abemaciclib-resistant ER+ cell lines and compared their metabolic profile with their parental/sensitive counterparts. Seahorse metabolic profiles were performed on parental cells (MCF-7, LCC2, LCC9, T47D and ZR-75.1) and their resistant derivatives. In addition, spatial proteomics analysis was performed using multiplex cyclic immunofluorescence (CycIF) assay for 27 markers including 14 metabolic regulators (MCT1, GLUT1, G6PD, VDAC1/3, LDHA, GAPDH, PGC1A, HK2, ATP5A, GLUD12, CPT1A, CS, C6 Ceramide, COXIV), 9 signaling (CD36, CCND1, CCNE1, pRB, MKI67, pERK, CDH1, GPNMB and MET) and 4 segmentation markers (pan-cytokeratin for epithelial cells, concanavalin A for endoplasmic reticulum, phalloidin for actin, and wheat germ agglutinin (WGA) for Golgi and plasma membrane) in sensitive and resistant cells. Following the image registration (hiPlex) and cell segmentation (CellProfiler), multiplex protein images were clustered for cell phenotypes (HistoCAT). Results Cells resistant to abemaciclib showed G1 phase arrest, but a dramatic increase in invasive capacity. The Seahorse XFp Cell Energy Phenotype Assay demonstrated altered metabolic profiles including decreased extracellular acidification rate (ECAR) and oxygen consumption rate (OCAR) indicative of glycolysis, and mitochondrial respiration, respectively, in resistant cells. Multiplex CycIF utilized a panel of 11 cycles resulting in a total of 27 markers. We demonstrated that three metabolic enzymes, mitochondrial voltage-dependent anion channel protein (VDAC1/3), lactate Dehydrogenase A (LDHA) and PPARγ coactivator 1α (PGC1α) are significantly overexpressed in CDK4/6 resistant cells compared to the control parental sensitive cells. Further analyses are ongoing to better characterize these changes in human samples treated with CDK4/6i. Conclusion Our findings highlight the importance of metabolic pathways in development of resistance to CDK4/6i treatment. Understanding the mechanisms by which these pathways contribute to therapeutic failure will further provide with novel intervention strategies and new avenues for prevent recurrence/resistance in ER+ breast cancer. Citation Format: Mayar Allam, Ahmet Coskun, Thomas Hu, Yuan Gu, Sunil Badve, Yesim Gokmen-Polar. Metabolic alterations in Estrogen Receptor-positive breast cancer contributing to CDK4/6 resistance [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-23-09.