c-MYC-directed NRF2 drives malignant progression of head and neck cancer via glucose-6-phosphate dehydrogenase and transketolase activation

Ya Chu Tang, Jenn Ren Hsiao, Shih Sheng Jiang, Jang Yang Chang, Pei Yi Chu, Ko Jiunn Liu, Hsun Lang Fang, Li Mei Lin, Huang Hui Chen, Yen Wen Huang, Yu Tsen Chen, Fang Yu Tsai, Su Fang Lin, Yung Jen Chuang, Ching Chuan Kuo

Research output: Contribution to journalArticlepeer-review

53 Citations (Scopus)


Rationale: NRF2, a redox sensitive transcription factor, is up-regulated in head and neck squamous cell carcinoma (HNSCC), however, the associated impact and regulatory mechanisms remain unclear. Methods: The protein expression of NRF2 in HNSCC specimens was examined by IHC. The regulatory effect of c-MYC on NRF2 was validated by ChIP-qPCR, RT-qPCR and western blot. The impacts of NRF2 on malignant progression of HNSCC were determined through genetic manipulation and pharmacological inhibition in vitro and in vivo. The gene-set enrichment analysis (GSEA) on expression data of cDNA microarray combined with ChIP-qPCR, RT-qPCR, western blot, transwell migration/ invasion, cell proliferation and soft agar colony formation assays were used to investigate the regulatory mechanisms of NRF2. Results: NRF2 expression is positively correlated with malignant features of HNSCC. In addition, carcinogens, such as nicotine and arecoline, trigger c-MYC-directed NRF2 activation in HNSCC cells. NRF2 reprograms a wide range of cancer metabolic pathways and the most notable is the pentose phosphate pathway (PPP). Furthermore, glucose-6-phosphate dehydrogenase (G6PD) and transketolase (TKT) are critical downstream effectors of NRF2 that drive malignant progression of HNSCC; the coherently expressed signature NRF2/G6PD/TKT gene set is a potential prognostic biomarker for prediction of patient overall survival. Notably, G6PD- and TKT-regulated nucleotide biosynthesis is more important than redox regulation in determining malignant progression of HNSCC. Conclusions: Carcinogens trigger c-MYC-directed NRF2 activation. Over-activation of NRF2 promotes malignant progression of HNSCC through reprogramming G6PD- and TKT-mediated nucleotide biosynthesis. Targeting NRF2-directed cellular metabolism is an effective strategy for development of novel treatments for head and neck cancer.

Original languageEnglish
Pages (from-to)5232-5247
Number of pages16
Issue number11
Publication statusPublished - Mar 11 2021
Externally publishedYes


  • C-MYC
  • Glucose-6-phosphate dehydrogenase (G6PD)
  • Head and neck squamous cell carcinoma (HNSCC)
  • Nuclear factor erythroid 2-related factor 2 (NRF2)
  • Pentose phosphate pathway (PPP)
  • Transketolase (TKT)

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Pharmacology, Toxicology and Pharmaceutics (miscellaneous)


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