Abstract 151: BMP signaling determines neuroblastoma cell fate and sensitivity to retinoic acid

Abstract While retinoic acid (RA) has been successfully used for leukemia treatment for decades, the attempt to treat solid tumors with RA remains challenging, with less than 10% of neuroblastoma (NB) patients achieving complete remission when treated with RA alone. It has been believed the anti-cancer activity of retinoids is due to retinoid-induced terminal differentiation, however, what determines cell response or whether differentiation is the main effect of RA has never been fully understood. To better understand RA’s activity, we conducted genome-wide CRISPR modifier screens in RA-treated hyper-sensitive NB cell lines. Surprisingly, we found that, in these cells, RA primarily decreased cell viability via apoptosis or senescence, rather than differentiation—activities in which the CRISPR screens strongly implicated bone morphogenetic protein (BMP) signaling. BMP activation promoted apoptosis/senescence and sensitized cells to RA. Conversely, BMP inhibitors and SMAD9 (a critical transcription factor of the BMP pathway) knockout enhanced RA’s ability to induce differentiation but reduced cell sensitivity to RA. Our ChIP-seq and RNA-seq data showed these behaviors were mediated by the coordinated gene regulatory actions of RARA and BMP-family SMAD transcription factors. Furthermore, in a panel of 19 cell lines we screened with RA, we assessed the correlations between RA IC50 and the expression of all (~20,000) genes (publicly available data from the GDSC and Depmap). Remarkably, SMAD9 was the number 1 and number 10 most correlated gene, respectively, with RA IC50 (ranked by Pearson correlation coefficient; GDSC R = -0.92, P = 4.2 × 10−6; Depmap R = -0.81, P = 4.8 × 10−4). We also performed comprehensive large-scale drug screens in these cell lines with combinations of RA and a BMP activator FK506. RA exhibited a synergistic effect with FK506 in all the NB cell lines, very strikingly in some cell lines. All these data suggest BMP signaling is generally required for RA sensitivity and BMP activators are promising candidates in combination with RA to treat NB. Using published bulk and single cell RNA-seq data from NB patient samples, we found BMP signaling activity is relatively low in primary tumors, but well maintained in disseminated NB cells derived from bone marrow. This explains why RA is clinically used as a maintenance therapy and can only successfully treat the minimal residual disease and suggests that tumor microenvironment is a critical factor in determining cell response to RA. Overall, our study revealed that BMP controls NB cell fate and sensitivity in RA treatment. Notably, interactions between BMP signaling and RA are well established in developmental biology, where BMP signaling can tip cell fate decisions between differentiation, apoptosis, and senescence upon exposure to endogenous RA. Our data suggest that this developmental process can be maintained in NB cells, unveiling a novel mode of anti-neoplastic action. Citation Format: Min Pan, Yinwen Zhang, William C. Wright, Hyeong-Min Lee, Richard H. Chapple, Xueying Liu, Jonathan Low, Duane Currier, Allister J. Loughran, Dyer A. Dyer, Shondra M. Pruett, Burgess Freeman, Taosheng Chen, Brian J. Abraham, Elizabeth Stewart, John Easton, Paul Geeleher. BMP signaling determines neuroblastoma cell fate and sensitivity to retinoic acid [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 151.