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ResearchIn-Press PreviewGastroenterologyTherapeutics Open Access | 10.1172/JCI182217
1Department of Colorectal Surgery, Sir Run Run Shaw Hospital, Hangzhou, China
2School of Medicine, The Chinese University of Hong Kong, Shenzhen, China
3Key Laboratory of Regenerative Medicine of Ministry of Education, Jinan University, Guangzhou, China
Find articles by Wang, J. in: JCI | PubMed | Google Scholar
1Department of Colorectal Surgery, Sir Run Run Shaw Hospital, Hangzhou, China
2School of Medicine, The Chinese University of Hong Kong, Shenzhen, China
3Key Laboratory of Regenerative Medicine of Ministry of Education, Jinan University, Guangzhou, China
Find articles by Wang, H. in: JCI | PubMed | Google Scholar
1Department of Colorectal Surgery, Sir Run Run Shaw Hospital, Hangzhou, China
2School of Medicine, The Chinese University of Hong Kong, Shenzhen, China
3Key Laboratory of Regenerative Medicine of Ministry of Education, Jinan University, Guangzhou, China
Find articles by Zhou, W. in: JCI | PubMed | Google Scholar
1Department of Colorectal Surgery, Sir Run Run Shaw Hospital, Hangzhou, China
2School of Medicine, The Chinese University of Hong Kong, Shenzhen, China
3Key Laboratory of Regenerative Medicine of Ministry of Education, Jinan University, Guangzhou, China
Find articles by Luo, X. in: JCI | PubMed | Google Scholar
1Department of Colorectal Surgery, Sir Run Run Shaw Hospital, Hangzhou, China
2School of Medicine, The Chinese University of Hong Kong, Shenzhen, China
3Key Laboratory of Regenerative Medicine of Ministry of Education, Jinan University, Guangzhou, China
Find articles by Wang, H. in: JCI | PubMed | Google Scholar
1Department of Colorectal Surgery, Sir Run Run Shaw Hospital, Hangzhou, China
2School of Medicine, The Chinese University of Hong Kong, Shenzhen, China
3Key Laboratory of Regenerative Medicine of Ministry of Education, Jinan University, Guangzhou, China
Find articles by Meng, Q. in: JCI | PubMed | Google Scholar
1Department of Colorectal Surgery, Sir Run Run Shaw Hospital, Hangzhou, China
2School of Medicine, The Chinese University of Hong Kong, Shenzhen, China
3Key Laboratory of Regenerative Medicine of Ministry of Education, Jinan University, Guangzhou, China
Find articles by Chen, J. in: JCI | PubMed | Google Scholar
1Department of Colorectal Surgery, Sir Run Run Shaw Hospital, Hangzhou, China
2School of Medicine, The Chinese University of Hong Kong, Shenzhen, China
3Key Laboratory of Regenerative Medicine of Ministry of Education, Jinan University, Guangzhou, China
Find articles by Chen, X. in: JCI | PubMed | Google Scholar
1Department of Colorectal Surgery, Sir Run Run Shaw Hospital, Hangzhou, China
2School of Medicine, The Chinese University of Hong Kong, Shenzhen, China
3Key Laboratory of Regenerative Medicine of Ministry of Education, Jinan University, Guangzhou, China
Find articles by Liu, Y. in: JCI | PubMed | Google Scholar
1Department of Colorectal Surgery, Sir Run Run Shaw Hospital, Hangzhou, China
2School of Medicine, The Chinese University of Hong Kong, Shenzhen, China
3Key Laboratory of Regenerative Medicine of Ministry of Education, Jinan University, Guangzhou, China
Find articles by Chan, D. in: JCI | PubMed | Google Scholar
1Department of Colorectal Surgery, Sir Run Run Shaw Hospital, Hangzhou, China
2School of Medicine, The Chinese University of Hong Kong, Shenzhen, China
3Key Laboratory of Regenerative Medicine of Ministry of Education, Jinan University, Guangzhou, China
Find articles by Ju, Z. in: JCI | PubMed | Google Scholar
1Department of Colorectal Surgery, Sir Run Run Shaw Hospital, Hangzhou, China
2School of Medicine, The Chinese University of Hong Kong, Shenzhen, China
3Key Laboratory of Regenerative Medicine of Ministry of Education, Jinan University, Guangzhou, China
Find articles by Song, Z. in: JCI | PubMed | Google Scholar
Published October 22, 2024 - More info
BRAFV600E-mutant metastatic colorectal cancer (mCRC) is associated with poor prognosis. The combination of anti-BRAF/EGFR (encorafenib/cetuximab) treatment for patients with BRAFV600E-mutant mCRC improved clinical benefits; unfortunately, inevitable acquired resistance limits the treatment outcome, and the mechanism has not been validated. Here, we discovered that monoacylglycerol O-Acyltransferase 3 (MOGAT3) mediated diacylglycerol (DAG) accumulation contributed to acquired resistance to encorafenib/cetuximab by dissecting BRAFV600E-mutant mCRC patient-derived xenograft (PDX) model exposed to encorafenib/cetuximab administration. Mechanistically, upregulated MOGAT3 promotes DAG synthesis and reduces fatty acid oxidation (FAO)-promoting DAG accumulation and activating PKCα-CRAF-MEK-ERK, driving acquired resistance. Resistance-induced hypoxia promotes MOGAT3 transcriptional elevation; simultaneously, MOGAT3-mediated DAG accumulation increases HIF1A expression in translation level through PKCα-CRAF-eIF4E activation, strengthening the resistance status. Intriguingly, reducing intratumoral DAG by fenofibrate or Pf-06471553 restores the antitumor efficacy of encorafenib/cetuximab on resistant BRAFV600E-mutant mCRC, interrupted PKCα-CRAF-MEK-ERK signaling. These findings reveal the critical metabolite DAG as a modulator of encorafenib/cetuximab efficacy in BRAFV600E-mutant mCRC, suggesting that fenofibrate may prove beneficial for resistant BRAFV600E-mutant mCRC patients.