The Single-Stranded DNA-Binding Factor SUB1/PC4 Alleviates Replication Stress at Telomeres and is a Vulnerability of ALT Cancer Cells

To achieve replicative immortality, cancer cells must activate telomere maintenance mechanisms. In 10-15% of cancers, this is enabled by recombination-based alternative lengthening of telomeres pathways (ALT). ALT cells display several hallmarks including heterogeneous telomere length, extrachromosomal telomeric repeats and ALT-associated PML bodies. ALT cells also have high telomeric replication stress (RS) enhanced by fork-stalling structures (R-loops, G4s) and altered chromatin states. In ALT cells, telomeric RS promotes telomere elongation but above a certain threshold becomes detrimental to cell survival. Manipulating RS at telomeres has thus been proposed as a therapeutic strategy against ALT cancers.

Through analysis of genome-wide CRISPR fitness screens, we identified ALT-specific vulnerabilities and describe here our characterization of the roles of SUB1, a ssDNA-binding protein, as a novel regulator of telomere stability. SUB1 depletion further increases RS at ALT telomeres, profoundly impairing ALT cell growth without impacting telomerase-positive cancer cells. During RS, SUB1 is recruited to stalled forks and ALT telomeres via its ssDNA-binding domain. This recruitment is potentiated by RPA depletion, suggesting that these factors may compete for ssDNA. The viability of ALT cells and their resilience towards RS also requires ssDNA-binding by SUB1. SUB1 depletion accelerates cell death induced by FANCM depletion, triggering unsustainable levels of telomeric damage specifically in ALT cells. Finally, combining SUB1 depletion with RS-inducing drugs rapidly induces replication catastrophe in ALT cells. Altogether, our work identifies SUB1 as a new ALT susceptibility with important roles in the mitigation of RS at ALT telomeres and suggests new therapeutic strategies for a host of still poorly managed cancers.

S ignificance S tatement

Currently, there are few treatment options for ALT cancers with chemotherapy still occupying center stage despite often limited efficacy. ALT cancer cells experience high levels of replication stress at telomeres and its enhancement (e.g. via ATR inhibition) is a promising therapeutic strategy. Sensitivity to ATR inhibition varies amongst ALT cell lines/tumors warranting the development of additional ways to modulate telomeric replication stress. Here we identify SUB1, a single-stranded DNA-binding protein, as a vulnerability of ALT cells. SUB1 localizes to ALT telomeres and mitigates deleterious replication stress. SUB1 depletion synergizes with ATR inhibition and FANCM downregulation suggesting that co-targeting SUB1 with other regulators of replication stress at telomeres may kill ALT cancer cells more effectively.