Extracellular Matrix Stiffness Orchestrates NETs Formation and mTOR-Driven Metabolic Reprogramming in Lung Cancer.

Lung cancer is strongly associated with increased extracellular matrix (ECM) stiffness, which correlates with poor patient prognosis. Our study reveals that high-stiffness tumor niches exhibit significant upregulation of neutrophil extracellular traps (NETs), which enhance the Warburg effect and promote tumor cell proliferation. Using atomic force microscopy (AFM) and multi-immunofluorescence staining (mIF), we demonstrated a spatial correlation between NETs formation and localized ECM stiffness in lung cancer tissues. In Kras/Trp53 transgenic mouse model, bleomycin-induced lung stiffening further increased NETs generation, while genetic ablation of Pad4 (Pad4 mouse model) or pharmacological inhibition of NETs (via LOX mAb, BAPN, or DNase I) reduced tumor burden. Mechanistically, stiffness-driven NETs upregulated glycolytic enzymes and extracellular acidification rate (ECAR) through aberrant mTOR pathway activation. Ex vivo and patient-derived xenograft (PDX) models validated the therapeutic potential of targeting LOX could extracellularly attenuate stiffness of ECM and intracellularly inhibit mTOR pathway. Our findings propose a novel strategy to improve lung cancer outcomes by disrupting the stiffness-NETs-mTOR axis, offering a one target-dual function approach for tumors with stiffening ECM.