Suppression of RIPK3 by EZH2 contributes to cigarette smoking-induced chemoresistance in lung cancer

Lung cancer remains the leading cause of cancer-related mortality worldwide, with cigarette smoking (CS) representing its primary risk factor. In addition to promoting tumorigenesis, chronic CS exposure contributes to chemotherapy resistance, although the underlying mechanisms remain poorly understood. Here, we established a long-term CS exposure model by repeatedly treating Lewis lung carcinoma (LLC) cells with cigarette smoke extract (CSE). After 4 months of exposure, CSE-treated cells exhibited enhanced proliferation, migration, and resistance to chemotherapy-induced cell death. Mechanistically, chronic CSE exposure suppressed receptor-interacting protein kinase 3 (RIPK3) expression by upregulating the epigenetic regulator enhancer of zeste homolog 2 (EZH2), which promoted repressive histone methylation at the RIPK3 promoter. Loss of RIPK3 impaired chemotherapy-induced cell death primarily by inhibiting ferroptosis rather than necroptosis. Importantly, genetic depletion or pharmacological inhibition of EZH2 restored RIPK3 expression and sensitized lung cancer cells to gemcitabine treatment both in vitro and in vivo. Furthermore, analysis of human lung cancer datasets revealed an inverse correlation between EZH2 and RIPK3 expression, with RIPK3 levels progressively decreasing with smoking history. Collectively, these findings identify the EZH2/RIPK3 axis as a critical mediator of smoking-associated chemoresistance and uncover a previously unrecognized role for RIPK3 in ferroptosis regulation. Targeting EZH2-mediated RIPK3 suppression may represent a promising therapeutic strategy to overcome chemoresistance in lung cancer patients with a history of smoking.