Sustained epithelial interferon signaling modulates incomplete pathologic response in colorectal cancer

Background & AimsPatients with colorectal cancer have heterogeneous clinical responses to chemotherapy, although clinical guidelines advise little variability in treatment selection based on molecular tumor features. Precision oncology research typically utilizes patient-derived tumor organoids (PDTO) to predict clinical outcomes, but such efforts are often not directed towards identification of molecular factors underlying differential responses to therapy. MethodsBulk RNA-sequencing was performed on treatment-naive PDTOs, and gene expression data was combined to drug sensitivity data to identify transcriptomic features associated with low in vitro sensitivity to chemotherapy. Whole-exome sequencing was performed on primary tumors to infer the somatic mutations of PDTOs and used to identify somatic mutations associated with differential in vitro drug responses. Publicly available gene expression and drug sensitivity data sets were used to validate the results. RNA interference was used for functional validation. ResultsPDTOs with low chemosensitivity had high JAK-STAT pathway activity resulting from high expression of interferon-stimulated genes. Evidence from single-cell RNA-sequencing confirmed chemotherapy-induced expression of interferon-stimulated genes in epithelial cells of cancers with partial response. EPSTI1 knockdown decreased cancer cell viability and sensitized cells to chemotherapy. ConclusionsSustained interferon signaling in epithelial cancer cells contributes to incomplete pathologic response in colorectal cancer. The findings highlight the potential of JAK-STAT inhibition or TRAIL pathway activation to enhance chemotherapy efficacy. Future studies investigating pharmacologic modulation of these pathways in preclinical CRC models are needed to determine their viability as therapeutic targets.