Abstract Rhabdomyosarcoma (RMS), a pediatric soft tissue sarcoma, comprises two major subtypes: fusion-positive (FP), driven by PAX3/7-FOXO1 fusions, and fusion-negative (FN), often harboring RAS pathway mutations. High-risk RMS exhibits intrinsic resistance to radiotherapy (RT), posing a significant clinical hurdle. Emerging evidence implicates EZH2, the catalytic subunit of the Polycomb Repressive Complex 2 (PRC2), in promoting RT resistance through gene silencing via H3K27me3. To dissect the molecular basis of RMS radioresistance, we employed an integrative multi-omics approach encompassing phosphoproteomics and transcriptomics. Radioresistant RMS cell models (RMS CRR ) displayed enhanced cancer stem cell features, evasion of RT-induced G2/M arrest, and reduced apoptosis compared to their parental counterparts (RMS PR ). Phosphoproteomic profiling revealed activation of prosurvival and proliferative pathways across both FN and FP subtypes. Transcriptomic analysis identified a robust downregulation of EZH2 target genes, with distinct gene sets modulated in FN-RMS CRR versus FP-RMS CRR cells, highlighting subtype-specific epigenetic rewiring. These multi-omics findings pointed to hyperactive PRC2/EZH2 signaling as a driver of radioresistance. Therapeutically, combining the EZH2 inhibitor Tazemetostat (TZM) with RT significantly impaired clonogenic survival, enhanced G2/M arrest, and promoted apoptosis in both RMS PR and RMS CRR cells. In vivo, RT and TZM co-treatment fully suppressed FN-RMS PR tumor growth and delayed FP-RMS PR progression. Notably, TZM monotherapy inhibited tumor growth in both FN- and FP-RMS CRR xenografts, uncovering a therapy-induced vulnerability. Our integrative multi-omics analysis reveals EZH2-dependent molecular programs underpinning radioresistance and supports EZH2 targeting as a rational radiosensitizing and therapeutic strategy in RMS, including recurrent and RT-refractory disease.
Cassandri et al. (Mon,) studied this question.
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