Abstract 550: Identification of isoform switching events linked with esophageal adenocarcinoma patient survival informs novel prognostic and therapeutic targets

Abstract Esophageal adenocarcinoma (EAC) represents a growing health problem characterized by rising incidence and poor prognosis. Although it is a cancer with a high mutational burden, it lacks highly prevalent oncogenic drivers that can be therapeutically targeted. Recently, our group characterized isoform switching events, defined by the changing of dominant gene isoforms between conditions, associated with EAC progression and identified 75 switching events comparing Barrett’s low-grade dysplasia (BE.LGD) and Barrett’s high-grade dysplasia (BE.HGD) patient samples. Herein, we further investigated whether isoform-switching events may offer prognostic or therapeutic value in EAC. Isoform switching analysis was performed using RNA-seq data derived from patient samples between BE.LGD and BE.HGD combined with EAC (BE.HGD + EAC) alone or in combination with TP53 mutations. Patients were further stratified into tertiles based on isoform expression level followed by survival analysis. Thirty isoforms were significantly (P≤0.05) linked with all-cause mortality, comparing BE.LGD with BE.HGD + EAC, whereas 20 isoforms were identified when TP53 mutation status was included. In terms of cancer-specific mortality, 10 isoforms were significantly linked with survival comparing BE.LGD with BE.HGD+EAC. With the inclusion of TP53 mutation, 16 isoforms were also significantly linked with cancer-specific mortality. Isoform-specific genetic knockdown experiments were designed targeting the top isoforms identified in the analysis, including TTLL12 and HM13 isoforms. Knockdown of TTLL12 and HM13 isoforms led to significant inhibition of cell viability and migration in two EAC cell lines (OE19 and OE33). Chemotherapeutic agents (Paclitaxel + Carboplatin) further decreased cell viability with synergistic effects observed in both siRNA-treated cell lines suggesting a role for specific isoform switches in therapeutic sensitization. Protein-interaction prediction using STRING and immunoblot analysis suggest different mechanisms leading to the inhibition of cell viability and migration. TTLL12 is linked with the activation of chaperon-medicated autophagy (LAMP2A and HSC70) and protein translation, whereas HM13 is linked with unfolded protein response (IRE1α, PERK, and ATF6) and may be linked with immunotherapy outcome. An antigen-dependent cell-mediated cytotoxicity assay is currently underway to investigate whether the knockdown of HM13 isoforms can sensitize EAC cells to PD-1/PD-L1 immunotherapy agents. Future direction includes using FDA-approved agents to target the two major pathways identified above. In conclusion, isoform switching may provide fresh insight for the identification of prognostic markers and inform new potential therapeutic targets for EAC treatment or prevention. Citation Format: Yun Zhang, Rachel Israel, Bryce Vandenburg, Shari Barnett, Jean-Jack Riethoven, Jennifer L. Clarke, Michelle P. Lee, Kiran Lagisetty, Jules Lin, Rishindra Reddy, Andrew Chang, Laura A. Kresty. Identification of isoform switching events linked with esophageal adenocarcinoma patient survival informs novel prognostic and therapeutic targets [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 550.