EZH2 Inhibition Induces an Integrated Stress Response Driving Glutamine-Dependent Vulnerability in TNBC

EZH2, the catalytic subunit of Polycomb Repressive Complex II, is highly expressed and associated with poor prognosis in triple-negative breast cancer (TNBC). Despite inducing significant changes in chromatin profiles and gene expression, EZH2 inhibition in TNBC models has limited impact on growth, suggesting adaptive compensatory mechanisms. Here, we demonstrate that EZH2 inhibition induces accumulation of double-stranded RNA and misfolded proteins in TNBC, activating an integrated stress response (ISR) via the PKR/PERK-eIF2α pathway. We identify Activating Transcription Factor 4 (ATF4) as a key effector upon EZH2 inhibition, driving metabolic changes characterized by increased amino acid uptake and glutamine dependency. Targeting this ISR-ATF4-mediated metabolic response using glutaminase inhibitor in combination with EZH2 inhibition significantly impairs TNBC cell proliferation and tumor progression. These findings reveal a stress-driven metabolic adaptation that enables TNBC survival upon EZH2 blockade, highlighting inhibition of this pathway as a strategy to enhance the efficacy of EZH2 inhibitors in TNBC.