Loss of PKM2 in Lgr5+ intestinal stem cells promotes colitis-associated colorectal cancer

The regulatory properties of pyruvate kinase M2 isoform (PKM2), the key glycolytic enzyme, influence altered energy metabolism including glycolysis in cancer. In this study, we found that PKM2 was highly expressed in patients with ulcerative colitis or colorectal cancer (CRC). We then investigated the effectiveness of conditionally ablating PKM2 in Lgr5(+) intestinal stem cells (ISC) using a mouse model of colitis-associated CRC (AOM plus DSS). Tamoxifen-inducible Lgr5-driven deletion of PKM2 in ISC (PKM2(Delta Lgr5)-Tx) significantly promoted tumor incidence and size in the colon and lower body weight compared with findings in vehicle-treated mice (PKM2(Delta Lgr5)-Veh). Histopathologic analysis revealed considerable high-grade dysplasia and adenocarcinoma in the colon of PKM2(Delta Lgr5)-Tx mice while PKM2(Delta Lgr5)-Veh mice had low-and high-grade dysplasia. Loss of PKM2 was associated with dominant expression of PKM1 in Lgr5(+) ISC and their progeny cells. Further, the organoid-forming efficiency of whole cancer cells or Lgr5(+) cells obtained from colon polyps of PKM2(Delta Lgr5)-Tx mice was significantly increased when compared with PKM2(Delta Lgr5)-Veh mice. Cancer organoids from PKM2(Delta Lgr5)-Tx mice exhibited increased mitochondrial oxygen consumption and a shift of metabolites involved in energy metabolism. These findings suggest that loss of PKM2 function in ISC promotes colitis-associated CRC.