The Endosomal pH Regulator NHE9 is a Driver of Stemness in Glioblastoma

A small population of self-renewing stem cells initiate tumors and maintain therapeutic resistance in glioblastoma. Given the limited treatment options and dismal prognosis for this disease there is urgent need to identify drivers of stem cells that could be druggable targets. Previous work showed that the endosomal pH regulator NHE9 is upregulated in glioblastoma and correlates with worse survival prognosis. Here, we probed for aberrant signaling pathways in patient-derived glioblastoma cells and found that NHE9 increases cell surface expression and phosphorylation of multiple receptor tyrosine kinases by promoting their escape from lysosomal degradation. Downstream of NHE9-mediated receptor activation, oncogenic signaling pathways converged on the JAK2-STAT3 transduction axis to induce pluripotency genes Oct4 and Nanog and suppress markers of glial differentiation. We used both genetic and chemical approaches to query the role of endosomal pH in glioblastoma phenotypes. Loss-of-function mutations in NHE9 that failed to alkalinize endosomal lumen did not increase self-renewal capacity of gliomaspheres in vitro. However, monensin, a chemical mimetic of Na+/H+ exchanger activity, and the H+ pump inhibitor bafilomycin bypassed NHE9 to directly alkalinize the endosomal lumen resulting in stabilization of receptor tyrosine kinases and induction of Oct4 and Nanog. Using orthotopic models of primary glioblastoma cells we found that NHE9 increased tumor initiation in vivo. We propose that NHE9 initiates inside-out signaling from the endosomal lumen, distinct from the established effects of cytoplasmic and extracellular pH on tumorigenesis. Endosomal pH may be an attractive therapeutic target that diminishes stemness in glioblastoma, agnostic of specific receptor subtype. SignificanceA well-known hallmark of cancer is excessive acidification of tumor microenvironment, caused by upregulation of Na+/H+ exchanger activity on the cancer cell membrane. However, the role of organellar pH in tumor biology has not been established. This study identifies a mechanistic link between upregulation of the endosomal Na+/H+ exchanger NHE9 and stemness properties in glioblastoma, the most malignant and common brain tumor in adults. By increasing pH of the recycling endosome, NHE9 exerts a broad effect on post-translational stability and activation of multiple receptor tyrosine kinases, leading to increased stem cell-like properties of self-renewal and tumor initiation in glioblastoma models. Our findings suggest that targeting NHE9 or endosomal pH could be an effective strategy for receptor agnostic glioblastoma treatment.