Examining chromatin modifiers essential for glioma growth and drug response

Glioblastoma (GBM) is a highly aggressive primary brain tumor associated with low survival rates. Standard-of-care involves surgery, irradiation, and chemotherapy utilizing Temozolomide (TMZ), a DNA alkylating agent. Despite its high effectiveness, the efficacy of TMZ can be compromised by various epigenetic mechanisms, including the transcriptional regulation of 0-6-methylguanine methyltransferase (MGMT) enzyme expression. The promoter methylation status of MGMT is a crucial prognostic factor, as its epigenetic suppression enhances the response to TMZ. Novel epigenetic factors regulating the survival and resistance to therapy in GBM remain undiscovered. To explore resistance mechanisms in GBM, we first generated TMZ-resistant cell lines starting from naïve cells and escalating TMZ doses over a long period. We demonstrated that TMZ-resistance phenotype was sustainable both in vitro and in vivo. Transcriptome analysis revealed MGMT as an upregulated gene in TMZ-resistant models along with many differentially expressed genes. Considering that resistance may be associated with adaptive epigenetic changes, we investigated the functional roles of chromatin regulators in TMZ-resistant cells. To this end, we employed a targeted CRISPR/Cas9-based screen with our Epigenetic Knock-Out sgRNA Library (EPIKOL), focusing on various chromatin modifiers and epigenetic enzymes. Applying EPIKOL screens in multiple naïve and TMZ-resistant cell lines, we first identified key epigenetic factors regulating GBM cell viability. We then explored selective vulnerability of TMZ-resistant cell lines and identified Retinoblastoma Binding Protein 4 (RBBP4) as a regulator of acquired TMZ resistance. Knock-out of RBBP4 in resistant models resulted in increased apoptosis and G2/M arrest. RNA sequencing of control and RPPB4 knock-out cells revealed G2/M checkpoint and E2F targets as downregulated pathways. We demonstrated that the expression of MGMT was not significantly altered by RBBP4 in TMZ-resistant models, providing strong evidence for RBBP4-mediated regulation of cell proliferation and TMZ response in an MGMT-independent manner. Overall, our findings hold promise for the development of innovative epigenetic-based therapeutic strategies targeting GBM in the future.