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There are several hundreds of genes overexpressed in a typical breast cancer cell, and their overexpression is often assumed to have a pro-cancer function, but what percentage of these overexpressed genes have a role in promoting and maintaining tumorigenicity isn’t known. To address this question, we screened an unbiased set of seventy-five genes overexpressed in breast cancer for their ability to induce malignant transformation and for breast cancer cell expression dependency. Barcoded open-reading frames under the control of a constitutive promoter were tested by pooled screening for their ability to promote tumor formation of premalignant mammary epithelial cells and growth in 2D and 3D culture. We found that growth in 3D cell culture was more strongly correlated with tumorigenic growth than was 2D growth, validating a long-standing hypothesis. Genes with high activity in promoting both 3D growth and in vivo tumor formation included CEACAM5, CXCL8, NKX2-5, PYGO2 and WWTR1/TAZ. To screen for corresponding tumor dependencies on these six genes, we performed shRNA screening of breast cancer cell lines and found uniform dependency on expression of the Hippo pathway transcriptional activator WWTR1, selective dependencies on CEACAM5 expression, but no consistent effects for the other three genes. Since breast cancer dependency upon WWTR1 is well established, we focused our follow-up studies on CEACAM5. We confirmed that CEACAM5 overexpression conferred tumorigenicity to pre-malignant mammary epithelial cells and that reduced expression selectively decreased the clonogenicity of luminal breast cancer cell lines. Protein analysis indicated that CEACAM5 activated Cdk4/6 and mTOR signaling. We also determined that CEACAM5 overexpression strongly promoted cell number increase in 3D spheroid culture by a novel mechanism that increased the number of epithelial cell layers from a single layer to multiple layers. These results outline a strategy for functional genomic identification of cancer targets, starting with a set of genes overexpressed in cancer, then using pooled approaches to identify those that promote tumorigenicity and cancer cell dependency, followed by validation experiments and exploration of oncogenic mechanisms. We propose that larger screens would substantially increase the number of potential targets for treating breast cancer.

Drug resistance continues to be a major obstacle to curing cancer. Resistance can evolve from a subpopulation of cancer cells that initially survive drug treatment and then gradually form a pool of slowly growing drug-tolerant cells. Several studies have pinpointed activation of a specific bypass pathway that appears to provide the critical therapeutic target for preventing drug tolerance. Here we take a systems-biology approach using proteomics and genomics to examine the development of drug tolerance to EGFR inhibitors in EGFR-mutant lung adenocarcinoma cells and BRAF inhibitors in BRAF-mutant melanoma cells. We found that there are numerous alternative mitogenic pathways that become activated in both cases, including YAP, STAT3, IGFR1, and phospholipase C (PLC)/protein kinase C (PKC) pathways. Our results suggest that an effective therapeutic strategy to prevent drug tolerance will need to take multiple alternative mitogenic pathways into account rather than focusing on one specific pathway.

GNE myopathy is a rare, autosomal recessive, inborn error of sialic acid metabolism, caused by mutations in GNE, the gene encoding UDP-N-acetyl-glucosamine-2-epimerase/N-acetylmannosamine kinase. The disease manifests as an adult-onset myopathy characterized by progressive skeletal muscle weakness and atrophy. There is no medical therapy available for this debilitating disease. Hyposialylation of muscle glycoproteins likely contributes to the pathophysiology of this disease. N-acetyl-D-mannosamine (ManNAc), an uncharged monosaccharide and the first committed precursor in the sialic acid biosynthetic pathway, is a therapeutic candidate that prevents muscle weakness in the mouse model of GNE myopathy. We conducted a first-in-human, randomized, placebo-controlled, double-blind, single-ascending dose study to evaluate safety and pharmacokinetics of ManNAc in GNE myopathy subjects. Single doses of 3 and 6g of oral ManNAc were safe and well tolerated; 10g was associated with diarrhea likely due to unabsorbed ManNAc. Oral ManNAc was absorbed rapidly and exhibited a short half-life (~2.4h). Following administration of a single dose of ManNAc, there was a significant and sustained increase in plasma unconjugated free sialic acid (Neu5Ac) (Tmax of 8-11h). Neu5Ac levels remained above baseline 48h post-dose in subjects who received a dose of 6 or 10g. Given that Neu5Ac is known to have a short half-life, the prolonged elevation of Neu5Ac after a single dose of ManNAc suggests that intracellular biosynthesis of sialic acid was restored in subjects with GNE myopathy, including those homozygous for mutations in the kinase domain. Simulated plasma concentration-time profiles support a dosing regimen of 6g twice daily for future clinical trials.

GNE myopathy is an adult-onset progressive myopathy, resulting from mutations in GNE, the key enzyme of sialic acid synthesis. The pathomechanism of GNE myopathy likely involves aberrant sialylation, since administration of sialic acid itself, or its precursor, N-acetylmannosamine (ManNAc), rescued hyposialylation of GNE myopathy mice. Recently, clinical trials for GNE myopathy patients were initiated. A robust, noninvasive biomarker is highly desirable for diagnosis of GNE myopathy and for evaluating response to therapy. Since muscle biopsies of patients with GNE myopathy demonstrated hyposialylation of predominantly O-linked glycans, we analyzed the O-linked glycome of patients’ plasma proteins using mass spectrometry. Most patients showed increased plasma levels of the core 1 O-linked glycan, Thomsen-Friedenreich (T)-antigen and/or decreased amounts of its sialylated form, ST-antigen. In addition, compared to unaffected individuals, all analyzed patients had a consistently increased ratio of T-antigen to ST-antigen. Importantly, the T/ST ratios were in the normal range in a GNE myopathy patient treated with intravenous immunoglobulins as a source of sialic acid, indicating response to therapy. Natural history and clinical trial data will reveal whether T/ST ratios can be correlated to muscle function. These findings not only highlight plasma T/ST ratios as a robust blood-based biomarker for GNE myopathy, but may also help explain the pathology and course of the disease.

The GNE gene encodes the rate-limiting, bifunctional enzyme of sialic acid biosynthesis, uridine diphosphate-N-acetylglucosamine 2-epimerase/N-acetylmannosamine kinase (GNE). Biallelic GNE mutations underlie GNE myopathy, an adult-onset progressive myopathy. GNE myopathy-associated GNE mutations are predominantly missense, resulting in reduced, but not absent, GNE enzyme activities. The exact pathomechanism of GNE myopathy remains unknown, but likely involves aberrant (muscle) sialylation. Here, we summarize 154 reported and novel GNE variants associated with GNE myopathy, including 122 missense, 11 nonsense, 14 insertion/deletions, and seven intronic variants. All variants were deposited in the online GNE variation database (http://www.dmd.nl/nmdb2/home.php?select_db=GNE). We report the predicted effects on protein function of all variants well as the predicted effects on epimerase and/or kinase enzymatic activities of selected variants. By analyzing exome sequence databases, we identified three frequently occurring, unreported GNE missense variants/polymorphisms, important for future sequence interpretations. Based on allele frequencies, we estimate the world-wide prevalence of GNE myopathy to be ∼4-21/1,000,000. This previously unrecognized high prevalence confirms suspicions that many patients may escape diagnosis. Awareness among physicians for GNE myopathy is essential for the identification of new patients, which is required for better understanding of the disorder's pathomechanism and for the success of ongoing treatment trials.

GNE myopathy is an adult-onset distal myopathy caused by mutations in the GNE gene, which codes for a bifunctional enzyme important in sialic acid biosynthesis. GNE myopathy is characterized by gradually progressive weakness and atrophy that preferentially involves distal extremities. Muscle degeneration occurs, with accumulation of inclusion bodies and rimmed vacuoles in muscle fibers. Although GNE myopathy is known to preferential affect skeletal muscles, there had been a few reports demonstrating involvement of the cardiac muscles. Through our Natural History Study (NCT01417533), we found that cardiac involvement in GNE myopathy patients may have a higher occurrence than expected. In this study we established a systematic evaluation of the cardiac involvement in GNE myopathy by analyzing the mouse model Gne-/-hGNED176VTg. Histopathology showed the presence of rimmed vacuoles and disorganization of cardiac myofibrils. Lectin staining array corroborated the hyposialylation of O-linked glycoproteins. Echocardiogram revealed decreased ejection fraction and fractional shortening, and increased left ventricle mass, indicating a decrease of cardiac function. These data were also confirmed by functional MRI on the mouse model. Our findings provide evidence that cardiac muscles are involved in GNE myopathy. We propose that hyposialylation of cardiac muscles can lead to impaired cardiac muscle contractility, and may be improved with sialylation-increasing therapies. It is important for clinicians to be aware of the possible occurrence of cardiac disease in GNE myopathy for careful examination of the cardiac function in patients and proper management.