# Spotlights on ubiquitin-specific proteases in lung cancer: from multifaceted pathophysiological mechanisms to potential therapeutic targets

## TL;DR

This paper explores how ubiquitin-specific proteases (USPs) contribute to lung cancer development and resistance to treatment, highlighting their potential as therapeutic targets.

## Contribution

The paper systematically reviews the roles of multiple USP family members in lung cancer pathophysiology and their potential as therapeutic targets.

## Key findings

- USP7 promotes non-small cell lung cancer proliferation and osimertinib resistance by stabilizing ERβ, c-Abl, and KRAS.
- USP9X mediates radiotherapy resistance through regulation of KDM4C and REV1, while USP10 affects chemotherapy sensitivity via PTEN/AKT/mTOR and HDAC6 pathways.
- Small-molecule inhibitors like P5091 and IU1 show potential in reversing drug resistance and enhancing immunotherapy in lung cancer.

## Abstract

Lung cancer ranks as the leading cause of cancer-related mortality worldwide, characterised by complex molecular mechanisms and high therapeutic resistance. Ubiquitin-specific proteases, as core members of the deubiquitinating enzyme family, extensively participate in the initiation, progression, metastasis, and treatment resistance of lung cancer by regulating the stability of key proteins. Recent studies indicate that multiple Ubiquitin-Specific Proteases (USP) family members play pivotal roles in lung cancer: Ubiquitin-Specific Peptidase 7 (USP7) promotes proliferation and osimertinib resistance in non-small cell lung cancer by stabilising proteins such as ERβ, c-Abl, and KRAS; Ubiquitin-Specific Peptidase 9, X-linked (USP9X) mediates radiotherapy resistance by regulating KDM4C and REV1; USP10 influences cellular metabolism and chemotherapy sensitivity via PTEN/AKT/mTOR and HDAC6 pathways; Ubiquitin-Specific Peptidase 14 (USP14) enhances tumour migration by regulating β-catenin and Acf7 stability; Ubiquitin-Specific Peptidase 22 (USP22) amplifies tumour stem cell properties and suppresses ferroptosis via EGFR and BMI1 signalling; Ubiquitin-Specific Peptidase 35 (USP35) and Ubiquitin-Specific Peptidase 38 (USP38) respectively modulate apoptosis resistance and proliferation through BIRC3 and KLF5; while Ubiquitin-Specific Peptidase 39 (USP39) influences mitochondrial metabolism via PDHA, thereby promoting tumour growth. This paper systematically reviews the mechanisms of action of the aforementioned USPs in multiple key signalling pathways, including KRAS, TGF-β/SMAD, ferroptosis, and DNA damage repair. It further explores the potential value of small-molecule inhibitors targeting USPs (such as P5091, IU1, and gentiopicroside) in reversing drug resistance, inducing apoptosis, and enhancing immunotherapy. Nevertheless, current research remains subject to certain limitations, including insufficient systematic and synergistic understanding of USP family members’ functions, poor inhibitor selectivity and preclinical toxicity concerns, as well as unresolved functional heterogeneity across different molecular subtypes of lung cancer. This paper reviews the molecular mechanisms and targeting strategies of USPs in lung cancer based on a systematic literature search of PubMed and Web of Science databases. It further explores their potential applications in precision lung cancer therapy, providing theoretical foundations and directional guidance for future research.