Somatic Epigenetic Silencing of RIPK3 Inactivates Necroptosis and Contributes to Chemoresistance in Malignant Mesothelioma

Yinfei Tan, Eleonora Sementino, Mitchell Cheung, Suraj Peri, Craig W. Menges, Anna Mariya Kukuyan, Ting Zhang, Vladimir Khazak, Lauren A. Fox, Eric A. Ross, Suresh Ramanathan, Suresh C. Jhanwar, Raja M. Flores, Siddharth Balachandran, Joseph R. Testa

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


Purpose: Receptor-interacting protein kinase 3 (RIPK3) phosphorylates effector molecule MLKL to trigger necroptosis. Although RIPK3 loss is seen in several human cancers, its role in malignant mesothelioma is unknown. This study aimed to determine whether RIPK3 functions as a potential tumor suppressor to limit development of malignant mesothelioma. Experimental Design: RIPK3 expression was examined in 66 malignant mesothelioma tumors and cell lines. Promoter methylation and DNMT1 siRNA studies were performed to assess the mode of RIPK3 silencing in RIPK3-deficient malignant mesothelioma cells. Restoration of RIPK3 expression in RIPK3-negative malignant mesothelioma cells, either by treatment with 5-aza-2´-deoxycytidine or lentiviral expression of cDNA, was performed to assess effects on cell viability, necrosis, and chemosensitization. Results: Loss of RIPK3 expression was observed in 42/66 (63%) primary malignant mesotheliomas and malignant mesothelioma cell lines, and RT-PCR analysis demonstrated that downregulation occurs at the transcriptional level, consistent with epigenetic silencing. RIPK3-negative malignant mesothelioma cells treated with 5-aza-2´-deoxycytidine resulted in reexpression of RIPK3 and chemosensitization. Ectopic expression of RIPK3 also resulted in chemosensitization and led to necroptosis, the latter demonstrated by phosphorylation of downstream target MLKL and confirmed by rescue experiments. Mining of RIPK3 expression and survival outcomes among patients with malignant mesothelioma available from The Cancer Genome Atlas repository revealed that promoter methylation of RIPK3 is associated with reduced RIPK3 expression and poor prognosis. Conclusions: These data suggest that RIPK3 acts as a tumor suppressor in malignant mesothelioma by triggering necroptosis and that epigenetic silencing of RIPK3 by DNA methylation impairs necroptosis and contributes to chemoresistance and poor survival in this incurable disease.

Original languageEnglish
Pages (from-to)1200-1213
Number of pages14
JournalClinical Cancer Research
Issue number4
StatePublished - Feb 15 2021


  • Aged
  • Aged, 80 and over
  • Animals
  • Cell Line, Tumor
  • DNA (Cytosine-5-)-Methyltransferase 1/genetics
  • DNA Methylation
  • Drug Resistance, Neoplasm/genetics
  • Epigenesis, Genetic
  • Female
  • Follow-Up Studies
  • Gene Expression Regulation, Neoplastic
  • Gene Knockdown Techniques
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Mesothelioma, Malignant/drug therapy
  • Mice
  • Middle Aged
  • Necroptosis/genetics
  • Promoter Regions, Genetic/genetics
  • Receptor-Interacting Protein Serine-Threonine Kinases/genetics
  • Xenograft Model Antitumor Assays


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