Patients with advanced-stage
non-small-cell lung cancer (NSCLC) are susceptible to
malnutrition and develop
folate deficiency (FD). We previously found that
folate deprivation induces drug resistance in
hepatocellular carcinoma; here, we assessed whether disrupted cytoplasmic
folate metabolism could mimic FD-induced
metastasis and affect the sensitivity of NSCLC cells to
epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs). We examined whether cytosolic
folate metabolism in NSCLC cells was disrupted by FD or the
folate metabolism blocker
pemetrexed for 1-4 weeks. Our results revealed an increase in NF-κB overexpression-mediated epithelial-mesenchymal transition
biomarkers:
N-cadherin,
vimentin,
matrix metalloproteinases (
MMPs), SOX9, and SLUG. This finding suggests that the disruption of
folate metabolism can drastically enhance the metastatic properties of NSCLC cells. Cytosolic FD also affected EGFR-TKI cytotoxicity toward NSCLC cells. Because SLUG and
N-cadherin are resistance effectors against
gefitinib, the effects of SLUG knockdown in
folate antagonist-treated CL1-0 cells were evaluated. SLUG knockdown prevented SLUG/NF-κB/SOX9-mediated invasiveness and
erlotinib resistance acquisition and significantly reduced
pemetrexed-induced
gelatinase activity and
MMP gene expression. To summarize, our data reveal two unprecedented adverse effects of
folate metabolism disruption in NSCLC cells. Thus, the
folic acid status of patients with NSCLC under treatment can considerably influence their prognosis.