Chemotherapy resistance due to epithelial-to-mesenchymal transition is caused by abnormal lipid metabolic balance

Elife. 2026 Jan 12:13:RP104374. doi: 10.7554/eLife.104374.

Abstract

Invasive cancer is defined by the loss of epithelial cell traits resulting from the ectopic expression of epithelial-mesenchymal transition (EMT)-related transcription factors such as Snail. Although EMT is known to impart chemoresistance to cancer cells, the precise molecular mechanisms remain elusive. We found that Snail expression confers chemoresistance by upregulating the cholesterol efflux pump ABCA1 as a countermeasure to the excess of cytotoxic free cholesterol relative to its major interaction partner in cellular membranes, sphingomyelin. This imbalance is introduced by the transcriptional repression of enzymes involved in the biosynthesis of sphingomyelin by Snail. Inhibiting esterification of cholesterol, which renders it inert, selectively suppresses growth of a xenograft model of Snail-positive kidney cancer. Our findings offer a new perspective on lipid-targeting strategies for invasive cancer therapy.

Keywords: Snail; cancer; cell biology; chemotherapy; cholesterol; epithelial–mesenchymal transition; human; mouse; sphingomyelin.

MeSH terms

  • ATP Binding Cassette Transporter 1 / genetics
  • ATP Binding Cassette Transporter 1 / metabolism
  • Animals
  • Antineoplastic Agents / pharmacology
  • Cell Line, Tumor
  • Cholesterol / metabolism
  • Drug Resistance, Neoplasm*
  • Epithelial-Mesenchymal Transition*
  • Humans
  • Kidney Neoplasms / drug therapy
  • Lipid Metabolism*
  • Mice
  • Snail Family Transcription Factors / genetics
  • Snail Family Transcription Factors / metabolism
  • Sphingomyelins / metabolism

Substances

  • Cholesterol
  • ATP Binding Cassette Transporter 1
  • Snail Family Transcription Factors
  • ABCA1 protein, human
  • Sphingomyelins
  • Antineoplastic Agents