Accelerated drug resistant variant discovery with an enhanced, scalable mutagenic base editor platform

Personalized cancer therapeutics bring directed treatment options to patients based on the genetic signatures of their tumors. Unfortunately, tumor genomes are remarkably adaptable, and acquired resistance to these drugs through genetic means is an all-too-frequent occurrence. Identifying mutations that promote resistance within drug-treated patient populations can be cost, resource, and time intensive. Accordingly, base editing, enabled by Cas9-deaminase domain fusions, has emerged as a promising approach for rapid, large-scale resistance variant screening in situ. We adapted and optimized a conditional activation-induced cytidine deaminase (AID)-dCas9 system, which demonstrated greater heterogeneity of edits with an expanded footprint compared to the most commonly utilized cytosine base editor, BE4. When combined with a custom sgRNA library, we were able to identify both individual and complex, compound variants in EGFR and BRAF that confer resistance to established EGFR inhibitors. This system and the developed analytical pipeline provide a simple, highly-scalable platform for cis or trans drug-modifying variant discovery and for uncovering unique insights into protein structure-function relationships. ### Competing Interest Statement The authors have declared no competing interest.