B-Cell Receptor Signaling Modulates Cholesterol Biosynthesis in Diffuse Large B-Cell Lymphoma

Cholesterol levels are associated with cancer progression and targeting cholesterol biosynthesis has been proposed as a therapeutic strategy in some neoplasms. It has been shown that inhibition of cholesterol synthesis in combination with chemotherapy resulted in encouraging clinical responses in patients with hematopoietic neoplasms including diffuse large B cell lymphoma (DLBCL) (Blood 2007; 109:2999-3006; Leuk. Lymphoma 2022; 63:1302-1313). Seminal work in DLBCL has shown that blocking the expression of SYK kinase, downstream of the B-cell receptor (BCR), impacted cholesterol biosynthesis (Cancer Cell 2013; 23:826-88). Sterol regulatory element-binding proteins (SREBPs), a family of membrane-bound transcription factors in the endoplasmic reticulum, play a central role in lipid metabolism. Two genes, SREBF1, and SREBF2 codify three proteins (SREBP1a, SREBP1c, and SREBP2). SREBP1a and SREBP1c primarily regulate fatty acid metabolism, whereas SREBP2 is a master regulator of cholesterol biosynthesis. The underlying question of how BCR signaling is linked to the cholesterol biosynthesis encircling SREBP2 is not well understood.

Using publicly available NCBI's Gene Expression Omnibus (GEO) DLBCL databases, we first analyzed the expression of genes directly regulated by SREBF2 involved in the biosynthesis of cholesterol, including ACAT1-2, HMGCS, HMGCR, MVK, PVMK, IDI1, SQLE, LSS, EBP, DHCR7, DHCR24, and NSDHL in DLBCL. We observed that SREBF2-mediated genes were upregulated in DLBCL as compared to non-neoplastic germinal center (GC) B-cells or low-grade B-cell lymphomas. These data were further confirmed by HTseq analysis of 66 DLBCL PDXs tumors established from DLBCL patients in our institution. Also, protein expression of nuclear SREBP2 was analyzed using immunohistochemistry in a DLBCL tissue microarray (n=84). Nuclear SREBP2 expression serves as an active form of transcriptional factor following cleavage. We confirmed strong nuclear positivity of SREBP2 in all non-GCB DLBCL; however, a subset of GCB DLBCL exhibited moderate nuclear SREBP2 positivity as compared to low-grade follicular lymphomas or reactive lymph node (control). These data suggest that SERBP2 is a key element in cholesterol biosynthesis, specifically upregulated, in non-GCB DLBCL.

Next, in-vitro functional studies were performed to connect BCR signaling with SERBP2. We either genetically knock out the expression of IgH using CRISPR/Cas9 or pharmacologically inhibited Src kinase (downstream of the BCR signaling) with Dasatinib in non-GCB DLBCL cell lines. Both approaches reduce SREBP2 expression and its cholesterol-related downstream genes. In contrast, recovering IgH expression rescues the SREBP2-mediated cholesterol biosynthesis pathway establishing a direct role of BCR signaling in the regulation of the cholesterol pathway in non-GCB DLBCL through SREBP2. Mechanistically using Reverse Phase Protein Array (RPPA) proteomic analysis, we have identified cyclin-dependent kinase 1 (CDK1), a key player in cell cycle regulation, as a potential kinase involved in the phosphorylation of SREBP2 by activated BCR signaling. Our results suggest that CDK1 interacts with SREBP2 (as per colocalization studies), and that CDK1-mediated phosphorylation of SREBP2 preserves its stability to support enhanced cholesterol synthesis in non-GCB DLBCL cell lines.

Although directly inhibiting of SREBPs is challenging, a promising approach is to inhibit SREBP translocation from the ER to the Golgi using PF-429242. Decreasing expression of SREBP2 at the genetic level or blocking the processing of SREBP2 with PF-429242 strongly reduces cell viability of DLBCL cell lines, with non-GCB DLBCL cell lines being more sensitive (IC₅₀= 60-225nM) than the GCB DLBCL cells (IC₅₀=200-330 nM). We also observed, in vitro, that co-treatments with PF-429242 and doxorubicin resulted in a synergistic response to doxorubicin in DLBCL cell lines of GCB, non-GCB and "double hit" suggesting that inhibiting SREBP2 could be a potential adjuvant therapeutic approach for DLBCL patients.

In summary, cholesterol biosynthesis is tightly regulated by BCR signaling through SREBP2, specifically in non-GCB DLBCL. SREBP2 is a potential promising adjuvant therapeutic target for DLBCL as PF-429242 enhances responses to doxorubicin in cell lines expanding the therapeutic window of doxorubicin by increasing its efficacy.

Green:Daiichi Sankyo: Membership on an entity's Board of Directors or advisory committees; Kite/Gilead: Research Funding; Sanofi: Research Funding; Allogene: Research Funding; Monte Rosa Therapeutics: Honoraria; Tessa Therapeutics: Honoraria; KDAc Therapeutics: Current equity holder in private company. Vega:Allogene: Research Funding; Geron Corporation: Research Funding; CRISP Therapeutics: Research Funding; NCI/NIH: Research Funding; National Research Foundation of Singapore: Honoraria; Elsevier: Honoraria.