Abstract 3586: A Hedgehog-dependent signaling axis drives neural plasticity and oncogenic reprogramming in gastroenteropancreatic neuroendocrine tumors
Authors: Duan Suzann , Sontz Ricky A. , Deymier Martin , Merchant Juanita L. 
Published: March 2024

Background: Neuroendocrine tumors (NETs) represent heterogenous malignancies whose origins and etiology remain poorly understood. Men1-driven reprogramming of neural crest-derived glial cells was recently implicated in NET development. In these studies, aberrant Sonic hedgehog (SHH) pathway activation known to pattern neural cell fate coincided with the neuroendocrine phenotype in mice. Here, we investigated the hypothesis that loss of menin encoded by the MEN1 gene drives SHH-dependent oncogenic reprogramming of NETs by modulating the neural crest cell fate.

Methods: Glial cell specific Men1 deletion was accomplished by expressing Cre recombinase downstream of the human glial fibrillary acidic protein promoter (GFAPΔMen1). Hedgehog (HH) activation of Men1-deficient glial cells was blocked by deleting the gene encoding primary ciliary protein Kif3a required for transducing SHH signaling. The resulting GFAPΔMen1 mice were evaluated for NET development and dysregulated hormone profiles. To identify aberrant SHH activation leading to neuroendocrine reprogramming, we performed single cell RNA- and Assay for Transposase Accessible Chromatin sequencing on GFAPΔMen1 NETs and primary glial cultures. Hyperactivation of SHH in human gastroenteropancreatic (GEP)-NETs was confirmed by immunofluorescent staining and western blot. Lastly, primary mouse and human NET organoids were treated with an agonist and inhibitors of HH signaling and evaluated for ERK/AKT activation, proliferation, and transcript fluctuations indicative of neural crest cell reprogramming.

Results: GFAPΔMen1 mice developed NETs in the pancreas, pituitary, and small intestine. Astonishingly, impaired SHH activation in GFAP+/Men1−/− cells abolished the development of NETs and restored hormone levels to that of wild type mice. GFAPΔMen1 NETs and glial cultures showed increased SHH signaling and chromatin accessibility of HH pathway genes, whereas additive Kif3a deletion blocked HH activation. Moreover, menin negative glial cells demonstrated a phenotypic shift in neuroglial lineages that suggested SHH-mediated reprogramming of neural crest-derived cells following the loss of menin. Consistent with hyperactive SHH activation in the GFAPΔMen1 mice, human GEP-NETs overexpressed SHH and downstream signaling targets. Functionally, SHH induced ERK/AKT activation, cell proliferation, and neuroendocrine transcript expression in human and mouse NET organoids, whereas pharmacological inhibition of HH signaling reversed these effects.

Conclusions: Our observations implicate neural crest-derived glial cells as potential neuroendocrine cell precursors that are susceptible to transformation through increased HH signaling. These studies warrant future investigation into the delivery of Hedgehog inhibitors in the adjuvant setting for NET treatment.

Citation Format: Suzann Duan, Ricky A. Sontz, Martin Deymier, Juanita L. Merchant. A Hedgehog-dependent signaling axis drives neural plasticity and oncogenic reprogramming in gastroenteropancreatic neuroendocrine tumors [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 3586.