RAGE is essential for oncogenic KRAS-mediated hypoxic signaling in pancreatic cancer

A hypoxic tumor microenvironment is characteristic of many cancer types, including one of the most lethal, pancreatic cancer. We recently demonstrated that the receptor for advanced glycation end products (RAGE) has an important role in promoting the development of pancreatic cancer and attenuating the response to chemotherapy. We now demonstrate that binding of RAGE to oncogenic KRAS facilitates hypoxia-inducible factor 1 (HIF1)alpha activation and promotes pancreatic tumor growth under hypoxic conditions. Hypoxia induces NF-kappa B-dependent and HIF1 alpha-independent RAGE expression in pancreatic tumor cells. Moreover, the interaction between RAGE and mutant KRAS increases under hypoxia, which in turn sustains KRAS signaling pathways (RAF-MEK-ERK and PI3K-AKT), facilitating stabilization and transcriptional activity of HIF1 alpha. Knock down of RAGE in vitro inhibits KRAS signaling, promotes HIF1 alpha degradation, and increases hypoxia-induced pancreatic tumor cell death. RAGE-deficient mice have impaired oncogenic KRAS-driven pancreatic tumor growth with significant downregulation of the HIF1 alpha signaling pathway. Our results provide a novel mechanistic link between NF-kappa B, KRAS, and HIF1 alpha, three potent molecular pathways in the cellular response to hypoxia during pancreatic tumor development and suggest alternatives for preventive and therapeutic strategies.