SPOT-003 Thymidylate synthase maintains the undifferentiated state of aggressive breast cancers

Introduction De-differentiation is a highly lethal feature of aggressive breast cancers (BC), and is achieved through the epithelial-to-mesenchymal transition (EMT) and the cancer stem cell (CSC) programs. Targeting the mechanisms controlling BC de-differentiation can lead to more effective therapeutics. Recent studies indicated that nucleotide metabolism can regulate cancer stemness and EMT. Here we investigated the expression of the nucleotide metabolism enzyme and drug target thymidylate synthase (TS) in the BC subtypes and analysed its impact on BC de-differentiation. Material and methods Cells with TS knockdown and overexpression were tested in vitro and in vivo. Proteins were analysed by western blot, FACS and ELISA. Differential gene expression in TS-deficient cells was determined by RNA-seq. Immunohistochemistry (IHC) was used to stain samples from patients with different BC subtypes. Results and discussions TS mRNA expression was found to be significantly differentially expressed among the BC subtypes, exhibiting the highest levels in aggressive triple-negative BC (TNBC). shRNA-mediated TS knockdown in TNBC cell lines (n=3) increased the population of differentiated cells (CD24high) and strongly attenuated the stem-like phenotype, like the formation of mammospheres from single cells and the migration in a cell culture wound. TS-deficient cells also showed an altered ability to form metastasis in vivo, consistent with previous observations in EMT-repressed BC cells. A rescue experiment performed by overexpressing either a wild-type or catalytically inactive TS indicated that the enzymatic activity was essential for the maintenance of the BCSC phenotype. Along with a strong repression of EMT-signature genes, RNA-seq profiling indicated a reduction of inflammatory and NF-κB signalling pathways in TS deficient cells, which dramatically reduced IL-1β production and secretion. A TS-specific gene signature was generated, which significantly associated with worst survival in BC patients. IHC staining on FFPE samples from a series of BC patients (n=120) confirmed higher TS expression in tumours that were poorly differentiated and in TNBC. Conclusion We discovered a novel role for the TS enzyme in the maintenance of a de-differentiated and stem-like state of BC. These findings may not only open the possibility to study in-depth the role of nucleotide metabolism at the crossroad between proliferation and differentiation, but may provide the rationale for novel drug combinations with TS-inhibiting agents for the treatment of BC.