SCD1-dependant activation of GSK3β-NRF2-SLC7A11 pathway regulates lipid metabolism and suppresses ferroptosis in KRAS/STK11/KEAP1 co-mutant lung adenocarcinoma

InactivatingSTK11/KEAP1 co-mutations are genomic drivers of primary resistance totherapies and worse outcome in KRAS-mutatedlung adenocarcinoma(LUAD), however the underlying mechanisms is still not understood.Here we provide a transcriptomic analysis of over 3800 “real-world” LUAD cases that concomitant loss of STK11 and KEAP1 in a KRAS-mutant tumorleads to significant upregulation of fatty acid metabolism, and redox signaling pathways with significantly high expression of ferroptosis evasion genes, SCD1 and SLC7A11. Global transcriptomics and kinase arrays demonstrate the role SCD1 in regulating AKT/GSK3β/NRF2 signaling mediated modulation of SLC7A11 and GSH metabolism. Furthermore, in a lipidomic assay, SCD1 knockout led to regulation of SFA-MUFA levels that promoted ferroptosis. SCD1 inhibition reverses the resistance to ferroptosis induction promoted by STK11/KEAP1 loss inmouse models. These data provide evidence that SCD1 protects ferroptosis induction and therapeutic targeting of this pathway is a promising translational strategy in KRAS mutant LUADs with concomitant loss ofSTK11 and KEAP1.