Kinome-wide RNA interference screen reveals a role for PDK1 in acquired resistance to CDK4/6 inhibition in ER-positive breast cancer

To discover mechanisms of resistance to CDK4/6 inhibitors, we used a kinome-wide siRNA screen to identify kinases that, when downregulated, promote sensitivity to ribociclib. We identified 3-phosphoinositide dependent protein kinase 1 (PDK1) as the top siRNA that sensitized ER+ MCF-7 cells to ribociclib. Pharmacological inhibition of PDK1 with GSK2334470 in combination with ribociclib or palbociclib, synergistically inhibited proliferation and increased apoptosis in a panel of ER+ breast cancer cell lines. Ribociclib-resistant MCF-7, T47D and HCC1428 cells, selected after chronic drug exposure, displayed increased levels of PDK1, P-RSK2, P-AKT and P-S6 compared to parental drug-sensitive cells. Cell cycle analysis revealed that CDK4/6 inhibition failed to induce G1 arrest, a reduction in S phase, and senescence in ribociclib-resistant cells, suggesting an upregulation of S-phase cyclins/CDKs. The resistant cells exhibited significantly higher levels of P-CDK2, cyclin A, cyclin D1, cyclin E and S477/T479 P-AKT, a CDK2-dependent phosphorylation site within AKT required for full kinase activity and limited to the S-phase of the cell cycle. Treatment with GSK2334470 or the CDK2 inhibitor dinaciclib re-sensitized ribociclib-resistant cells to CDK4/6 inhibitors; however, ribociclib/GSK2334470 inhibited the ribociclib-resistant cells more potently than ribociclib/dinaciclib. Ribociclib/GSK2334470 but not ribociclib/dinaciclib completely abrogated P-Rb, P-S6, P-RSK2, P-CDK2, cyclin A, cyclin D1 and cyclin E expression. Further, ribociclib in combination with GSK2334470 or the PI3Kα inhibitor alpelisib induced regression of MCF-7 xenografts. Finally, primary ER+ tumors displayed increased PDK1, P-S6 and cyclin D1 levels after short treatment with palbociclib. These data support a role for PI3K/PDK1 in mediating acquired resistance to CDK4/6 inhibitors.