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EUROPEAN JOURNAL OF CANCER 4 6 ( 2 0 1 0 ) 2 8 8 9 –2 8 9 5 available at www.sciencedirect.com journal homepage: www.ejconline.com Review A lethal combination for cancer cells: Synthetic lethality screenings for drug discovery Elisa Ferrari a, Chiara Lucca a, Marco Foiani a b a,b,* Fondazione IFOM (Istituto FIRC di Oncologia Molecolare), IFOM-IEO Campus, via Adamello 16, 20139 Milan, Italy DSBB-Università degli Studi di Milano, Milan, Italy A R T I C L E I N F O A B S T R A C T Article history: In recent years, cancer drug discovery has faced the challenging task of integrating the Received 2 July 2010 huge amount of information coming from the genomic studies with the need of developing Accepted 21 July 2010 highly selective target-based strategies within the context of tumour cells that experience Available online 17 August 2010 massive genome instability. Keywords: and has contributed to efficiently transfer certain approaches typical of basic science to Synthetic lethality screens drug discover projects. An example comes from the synthetic lethal approaches, very pow- Cancer erful procedures that employ the rational used by geneticists working on model organisms. Saccharomyces cerevisiae Applying the synthetic lethality (SL) screenings to anticancer therapy allows exploiting the Drug discovery typical features of tumour cells, such as genome instability, without changing them, as The combination between genetic and genomic technologies has been extremely useful opposed to the conventional anticancer strategies that aim at counteracting the oncogenic signalling pathways. Recent and very encouraging clinical studies clearly show that certain promising anticancer compounds work through a synthetic lethal mechanism by targeting pathways that are specifically essential for the viability of cancer cells but not of normal cells. Herein we describe the rationale of the synthetic lethality approaches and the potential applications for anticancer therapy. Ó 2010 Elsevier Ltd. All rights reserved. 1. Introduction The majority of chemotherapeutic drugs were identified for their ability to kill rapidly growing cells. Consequently, most of these drugs hit not only cancer cells but also normal dividing cells like bone marrow haematopoietic precursors, stomach, intestine and hair follicle cells.1 This lack of selectivity for tumour cells is one of the major causes of chemotherapeutic failure in cancer treatment. Genetic instability is a hallmark of tumour cells. Cancer cells genetically differ from normal cells as they have accumulated a large number of mutations including growth-promoting mutations. In fact, the genetic and epigenetic alterations that characterise cancer cells can be instrumental for developing more selective pharmacological approaches. As Paul Workman said, ‘What do cancer cells have that normal cells don’t?. . .They have mutations, and you can take advantage of those’.2 Cancer genetic instability may indeed provide the key to tumour vulnerability. * Corresponding author at: Fondazione IFOM (Istituto FIRC di Oncologia Molecolare), IFOM-IEO Campus, via Adamello 16, 20139 Milan, Italy. E-mail address: [email protected] (M. Foiani). 0959-8049/$ - see front matter Ó 2010 Elsevier Ltd. All rights reserved. doi:10.1016/j.ejca.2010.07.031 2890 EUROPEAN JOURNAL OF CANCER Recent years have witnessed a change in the drug discovery strategies in the cancer field. Thanks to the genomic and post genomic technologies, the integration between basic and translational research is becoming extremely productive. An example comes from the synthetic lethal approach, a very promising drug discovery procedure that employs the rational used by geneticists working on model organisms. While the conventional anticancer strategies aim at counteracting the oncogenic signalling pathways, the synthetic lethal approach seeks to exploit the typical features of tumour cells without changing them. Synthetic lethality (SL) is a genetic phenomenon originally observed in Drosophila melanogaster by Bridges in 1922, while the term was coined by Dobzhansky in 1946, to describe complementary lethal systems in wild-type population of Drosophila pseudoobscura.3,4 It refers to cases in which the combination of two non-lethal mutations yields to lethality; the less severe situation, in which the final phenotype corresponds to reduced fitness, is defined as synthetic sickness (SS). The two synthetically lethal mutations have an addictive negative impact on a function required for the cell viability. 4 6 ( 2 0 1 0 ) 2 8 8 9 –2 8 9 5 This effect can be derived from the loss-of-function of two genes that act in parallel redundant pathways, or belong to the same essential pathway or act in two distant pathways that are needed to react to a specific cellular perturbation (Fig. 1). 2. The synthetic lethal approach for cancer therapy In 1997, Hartwell and colleagues pioneered the idea of applying genetic approaches to drug discovery through the concept of synthetic lethality.5 They extended the use of the term beyond classical genetics to all the cases in which the combination of a mutation and a drug causes cellular death, whereas the presence of the mutation alone or the drug alone is viable. The rationale behind this approach is that the effect of a drug that targets a specific gene product resembles the phenotype caused by a mutation in the gene encoding the same protein. The authors emphasised two fundamental advantages of relying on genetic screens for drug discovery: first, a gene mutation represents an ideal model for designing a new drug that can mimic the loss-of-function of a specific protein by Fig. 1 – Different mechanisms leading to synthetic lethality. The possible SL gene pairs are reported on the right side of each panel. Synthetic lethality can arise form the absence of two genes acting in redundant parallel pathways (a1) or distant pathways (a2). Alternatively, it can originate from the lack of two subunits of an essential protein complex (b1) or two proteins of the same essential pathway (b2). EUROPEAN JOURNAL OF CANCER inhibiting or poisoning it; second, genetic screens are unbiased, without precluding any unexpected possibility. The application of the synthetic lethality rationale offers new possibilities for cancer research as shown in Fig. 2. A cancer-related mutated gene can sensitise the tumour cells to a drug that specifically inhibits its synthetic lethal partner. In addition to this, the same drug should not affect normal cells, thus allowing higher therapeutic selectivity. Moreover, in principle, this approach is applicable to any type of cancer mutation, not only loss-of-function mutations in tumour suppressors but also gain-of-function mutations leading to oncogene expression. In retrospect, the mechanism of action of many clinical compounds is based on synthetic lethality as documented by an increasing number of cases in the literature. For example, the rapamycin derivative CCI-779 exhibits enhanced activity against tumours with mutations in PTEN compared to tumours with normal PTEN.6 PTEN is a tumour suppressor gene encoding a phosphatase that regulates the PI3-K/AKT pathway, which plays a central role in growth and anti-apoptotic mechanisms. The target of CCI-779 is the protein kinase mTOR that acts downstream of the PI3-K/AKT pathway, which is, in turn, up-regulated in PTEN null cancers. These observations explain the higher responsiveness to mTOR inhibition of PTEN-deficient cells compared to PTEN-proficient cells, even if CCI-779 inhibits the mTOR pathway in both cells types. Another example, which is becoming a paradigm for SL applications, is the genetic interaction between BRCA1 or BRCA2 and PARP1.7,8 PARP is involved in the repair of DNA single strand breaks: it binds to the break region and, through autopoly(ADP-rybosil)ation, attracts proteins involved in the repair process. Conversely, the products of BRCA1 and BRCA2 genes are implicated in homology-directed DNA double-strand break repair, so both pathways participate in the repair of DNA lesions. Therefore, the inhibition of PARP1 in BRCA1- or BRCA2-defective cells results in the accumulation of DNA lesions that cannot be repaired and causes cell lethality. The validation of synthetic lethal interactions in human cells may also provide a mechanistic rationale for clinical 4 6 ( 2 0 1 0 ) 2 8 8 9 –2 8 9 5 2891 trials studies. Methotrexate, for example, is currently under phase II evaluation for its efficacy in the treatment of advanced colorectal cancer with defects in the DNA mismatch repair genes.9 Methotrexate is able to induce oxidative DNA lesions and it has been shown to be highly selective for MSH2-defective cells.10 Differently from MSH2 wild-type cells, in MSH2 mutant cells these DNA lesions are not repaired and so the methotrexate treatment should be lethal. Therefore, the subtype of colorectal cancer characterised by a deficiency in mismatch repair may represent a selective hit of methotrexate. These examples clearly pinpoint the potential offered by the synthetic lethal approach when applied to drug discovery. The synthetic lethality strategy can be relevant in cancer research in different ways: (I) It can contribute to the identification of novel pharmacological targets. Most of cancer therapies aim at inhibiting hyperactive oncoproteins, but often these targets are not ‘druggable’. Moreover, only 10% of the most common cancer genes are oncogenes, while the vast majority is tumour suppressor genes. Synthetic lethality interactions may provide a source of cancer-selective drug targets: a cancer gene that is frequently inactivated in tumours embodies the first SL partner while any other gene that once mutated exhibits SL interactions with the original cancer gene represents the second SL partner and, therefore, a potential drug target. (II) Synthetic lethal screens may contribute to the identification of novel biomarkers by unmasking those genes that are absolutely required for cell viability following treatment with a specific drug. This approach allows the identification of not only those genetic profiles that sensitise the cells to the drug of interest but also those mutations that cause resistance to the pharmacological compound. (III) Another application comes from the integration of the synthetic lethal genetic profiles with the chemicalgenetic profiles.11 A loss-of-function mutation in a gene that encodes the target of an inhibitory drug mimics Fig. 2 – Synthetic lethality in chemotherapy. Differently from healthy cells, cancer cells are characterised by mutations; in the figure, yfg2 represents the cancer mutation (YFG: your favourite gene). If YFG1 and YFG2 represent a SL-pair, a drug that inhibits YFG1 can selectively damage the tumour cells, without affecting the normal cells. 2892 EUROPEAN JOURNAL OF CANCER the effect of the compound. Therefore, the comparison between the chemical-genetic profiles and genetic synthetic lethal interactions panels may help to identify those pathways that are altered by the drug treatment. In the following paragraph, we will review the available technologies for large-scale identification of gene–gene and gene–compound SL interactions (GGSL and GCSL screens, respectively12; Fig. 3). 3. High-throughput synthetic lethal screens Synthetic lethal studies have been carried out in many different model organisms including D. melanogaster and Caernorhabditis elegans by employing RNA-interference (RNAi) approaches13, but the concept of synthetic lethality has been mainly applied in the budding yeast Saccharomyces cerevisiae. S. cerevisiae represents a powerful tool for studying basic cellular functions of eukaryotic cells, including those processes controlling genome integrity. Thanks to its genetic amenability and versatility, it has received enormous attention and is a widely used model organism for studying a variety of eukaryotic cellular processes including those that have relevance for human health. The budding yeast represents a key experimental option for determining the function of a conserved gene of interest through the phenotypic analysis of the corresponding mutants. Gene ablation can be easily performed, in haploid or diploid cells, using a polymerase chain reaction (PCR)-based strategy. The Saccharomyces Genome Deletion Consortium has created a complete knockout collection of all the annotated yeast genes, the yeast knockout library (YKO).14 Each open reading frame (ORF) was replaced 4 6 ( 2 0 1 0 ) 2 8 8 9 –2 8 9 5 by a genetic marker and uniquely tagged with two 20-nucleotide TAGs (molecular barcodes).15 Four different YKOs were generated: Mata, Mat haploids and homozygous diploids for non-essential genes, heterozygous diploids for both essential and non-essential genes. The libraries have been widely used for high-throughput synthetic lethality analysis: in 2001, Tong and colleagues set up a systematic approach called synthetic genetic array (SGA).16 Using robotic stations, haploid double mutants are generated by mating and meiotic recombination: the query strain (in question) carrying the mutation of interest is crossed to the array of deletion mutants to produce heterozygous diploids that can be easily induced to sporulate, thus generating the haploid combinations. The final selection steps are aimed at identifying those double mutants exhibiting synthetic lethal or synthetic sick phenotypes. In 2003, Ooi and colleagues developed an alternative technique termed synthetic lethality analysis by microarray (SLAM) for the investigation of global synthetic lethality interactions.17 This method exploits the transformation of the YKO library with the query mutation to create double mutants. The strains are grown in pools and the genomic DNA isolated from the transformants is amplified by PCR using the molecular barcodes. The TAGs are flanked by universal priming sites, which allow the amplification of all the strains in the same PCR. By hybridising the amplified molecular barcodes to DNA microarray and by evaluating the hybridisation intensities, it is possible to estimate the growth rate of the different strains. A third technology called genetic interaction mapping (GIM) has been described. It is very sensitive as it allows the identification of subtle synthetic and epistatic interactions.18 This method combines SGA and SLAM approaches: it relies on mating yeast cells to obtain double mutants, which Fig. 3 – Gene–gene and gene–compound SL interactions (GGSL and GCSL). The figure represents one of the different technologies available for large-scale analysis of GGSL and GCSL: generation of S. cerevisiae double mutants through synthetic genetic array (SGA) (a), analysis of drug-sensitivity of the Yeast Knock Out library (b). The concept of synthetic lethality is extended to cancer research: a drug can mimic the absence of a protein generating a gene–compound SL interaction. See the text for details. EUROPEAN JOURNAL OF CANCER are grown in pools; the fitness of the query population relative to a reference population is assessed by quantifying microarray hybridisation signals. A systematic mapping of synthetic lethal interactions has recently been performed in S. cerevisiae by SGA analysis.19 Over 1700 query genes have been screened and a total of nearly 5.4 million gene pairs analysed allowing the identification of 170,000 interactions. This represents the first example of a global genome scale interaction map: it comprises 75% of (all) yeast genes and embodies a huge source of information. All those genes, whose mutation or deletion enhances or reduces the activity of a chemical compound, represent the chemical-genomic profile and have an enormous importance for drug discovery. The chemical-genetic profile can be assimilated to a synthetic lethal profile. Numerous studies employed yeast YKO libraries to analyse the differential response of the mutant collections to drug treatments. These studies have relevant implications: (i) the chemicalgenetic profile identifies all those genes whose function is crucial for the efficacy of the drug treatment and some of these genes may represent useful biomarkers. (ii) The chemical-genetic profiles may change according to the concentration of the drug, thus providing key information for designing the treatment protocol. (iii) Comparing the chemical-genetic profile of a compound of interest with the ones of other known drugs may help to unmask potential synergistic interactions between drugs. (iv) Integrating the chemicalgenetic interaction profiles with the genetic interaction data provided by the SGA studies may help in elucidating the mechanism of action of the drug. The GCSL screens also include screens aimed at testing the effect of a collection of chemicals on a mutant of interest. This type of GCSL screens represents nowadays a very powerful drug discovery tool. A large variety of small-molecule libraries are now available, ranging from collections of Drug Administration-approved drugs or compounds with known activities to collections of novel and uncharacterised chemicals. In 2002, Dunstan and colleagues screened a library of more than 85,000 compounds on yeast strains deficient in DNA double-strand break repair (rad50 and rad52 mutants) and were able to identify 126 compounds that showed higher toxicity towards these mutants.20 The results obtained from the small-molecule librarybased screens can then be integrated with the genetic interaction information derived from the SL screens by clustering the profiles. Recently, an increasing number of studies are facing the problem of investigating GGSL and GCSL interactions in metazoans. The major setback to these strategies in higher organisms is the mode of delivery of the small interference RNA (siRNA) molecule. In C. elegans, RNA-interference (RNAi) can be easily induced by feeding, injection, soaking and in vivo-delivery of double-stranded RNA (dsRNA21); RNA-interference can be combined with a query strain characterised by a loss-of-function mutation to obtain a panel of genetic interactions. Although the introduction of dsRNA in D. melanogaster is more complicated than in C. elegans, Wheller and colleagues devel- 4 6 ( 2 0 1 0 ) 2 8 8 9 –2 8 9 5 2893 oped living cell microarrays that allow the screening of large collections of RNAi and, by reducing the expression of two genes simultaneously, the identification of synthetic lethal interactions.22 In 2001 it was demonstrated that RNA-interference is also feasible in mammalian cells and systematic SL studies became possible.23 Several approaches are now available to gain RNA-interference: short duplex RNAs (called small interference RNA (siRNA)), short hairpin vector encoded RNAs (shRNA) and endoribonuclease prepared-siRNAs (esiRNA).24 siRNAs and esiRNAs can be used for high-throughput single-well assays, in which each well contains a single siRNA reagent. shRNAs can be used in both single-well or polyclonal assays, in which a single dish of cells is infected with a pool of shRNA vectors.25 A recent study identified the genetic interactors of the human oncogene KRAS in cancer cells by targeting 1011 human genes in eight cancer cell lines through shRNA constructs; STK33 turned out to be a component of a signalling pathway essential in the context of mutant KRAS, thus establishing a potential drug target in cancers bearing KRAS mutations.26 High-throughput chemical SL screens in mammalian cells have been performed in various ways over the past decade, but the most recent approaches employed RNA-interference. The two categories of GCSL screens described above for the yeast model can be now performed in mammalian cells. In 2008, following the successful identification of synthetic lethality between PARP1 and BRCA1 or BRCA2, an RNAi library made up by genes with known roles in DNA repair was tested for KU0058948 (PARP inhibitor) sensitivity. This screen identified novel determinants of the PARP inhibition response such as the transcription coupled DNA repair proteins DDB1 and XAB2.27 These novel SL partners may contribute to the development of PARP inhibitors-based pharmacological strategies. High-throughput chemical screens in mammalian cells have been realised by means of different approaches: one method is based on the complementation of the mutated gene of interest through a low-copy number unstable episomal plasmid expressing the wild-type copy of the gene. The retention of the plasmid is forced in all the cases in which there is a synthetic lethal interaction between the gene and the drug.28,29 As illustrated for yeast, another approach consists in the treatment of the cell line with the genotype of interest with compound libraries; cells are grown in multi-well plates and tested for viability. Recently, Ji et al. performed a chemical-genetic screen aimed at the identification of drugs able to selectively target pancreatic cancer cells with gain-of-function the KRAS mutation. KRAS is an oncogene mutated in more than 90% of pancreatic cancers, playing an essential role in the initiation and progression of these tumours. The authors screened almost 3200 chemical compounds and they found one KRAS synthetic lethal inhibitor that may be further characterised.30 4. Conclusions Cancer is a heterogeneous disease and this diversity results in different and often unpredictable responses to the therapies. 2894 EUROPEAN JOURNAL OF CANCER The concept of synthetic lethality applied to drug discovery is nowadays receiving increasing interest and a growing number of clinically relevant SL interactions are proving its efficacy. The integration of the data obtained from GGSL and GCSL screens owns powerful applications. Firstly, knowing the mutations that are responsible for particular types of tumours, the concept of SL permits the identification of drugs that spare normal tissues while selectively killing cancer cells characterised by a specific background. As was pointed out above, gene–gene synthetic lethality data represent also a source of potential targets to address the discovery of novel clinically useful compounds. Once verified, the SL interactions may be exploited before planning clinical trials. Actually this information allows the stratification of the patients in subpopulations on the basis of responsiveness prediction: the knowledge of which genetic alterations lead to drug-sensitivity/resistance may foretell which patients will benefit from the treatment and which will not or even be harmed by it. In the end, this approach may allow to save lives, time and money. As shown above, new methods to identify genetic and chemical-genetic SL interactions are emerging in the literature. RNAi collections are now available, covering the whole mammalian genome and being compatible with highthroughput studies also in mammals. Despite the enormous progress made in recent years, obtaining SL data for metazoans is still technically complex and has some limitations as gene inactivation efficacy can vary. However, an increasing number of systematic studies based on RNA-interference are coming out, some with promising results. Therefore, SL studies are possible and are showing nowadays their enormous potentialities also in mammals. Moreover, Zender and colleagues recently performed an RNAi screen for shRNAs that promote tumourigenesis in a mouse cancer model showing the feasibility of in vivo RNAi31; this new technique paves the way to in vivo mammalian SL screens. Is yeast still meaningful in drug discovery despite the progress that took place in mammalian system? S. cerevisiae shows a high degree of conservation with mammalian cells: 40% of yeast proteins share aminoacid sequence similarity with a human protein.32 Thanks to conservation, the data obtained in this model system may be used to predict new metazoans genetic interactions. RNAi is a powerful technique but it possesses some drawbacks: apart from the variation in gene expression abolishment, it is time-consuming and expensive. Moreover, differently from yeast cells, the high genomic redundancy that characterised human cells can impede the discovery of novel genetic interactions. As described previously, Costanzo et al. revealed the genetic interaction profile for 75% of yeast genes; the integration of this huge amount of data with the other SL studies available in the literature can open to new research directions, focusing on interesting interactions and validating them in higher eukaryotic systems. This approach allows reducing the number of combinations that have to be analysed in mammalian systems and, as a consequence, diminishing the costs. 4 6 ( 2 0 1 0 ) 2 8 8 9 –2 8 9 5 Hence, the SL interactions found in yeast can help elucidating the mammalian SL interactions; in 2009, McManus and colleagues exemplify the validation of a yeast prediction in mammalian cells. The 5 0 –3 0 exonuclease Rad27 was shown to be SL with homologous recombination mutants, members of the Rad52 epistasis group.33 Differently from RAD54-proficient cells, RAD54B-deficient human colorectal cancer cells resulted sensitive to shRNA-mediated silencing of FEN1, confirming the prediction made in a model organism such as S. cerevisiae. In summary, the concept of synthetic lethality has huge potentialities for anticancer drug discovery; its most important features consist in the possibility to selectively affect cancer cells and to hit ‘undruggable targets’. Conflict of interest statement None declared. Acknowledgements We wish to thank Linda Cairns and all members of our laboratory for helpful comments. Work in M.F. laboratory is supported by grants from Italian Association for Cancer Research, from Telethon-Italy, European Community, Regione Lombardia and Italian Ministry of Health. R E F E R E N C E S 1. Kaelin Jr WG. 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