Gastrointestinal stromal tumour (GIST), originating from the interstitial cells of Cajal (ICCs), is characterized by frequent activating mutations of the KIT receptor tyrosine kinase. Despite the clinical success of imatinib that targets KIT, most advanced GIST patients develop resistance and eventually die of the disease. The ETS family transcription factor, ETV1, is a master regulator of the ICC lineage. Using mouse models of Kit activation and Etv1 ablation, we demonstrate that Etv1 is required for GIST initiation and proliferation in vivo, validating it as a therapeutic target. We further uncover a positive feedback circuit where MAP kinase activation downstream of KIT stabilizes the ETV1 protein and ETV1 positively regulates KIT expression. Combined targeting of ETV1 stability by imatinib and MEK162 resulted in increased growth suppression in vitro and complete tumour regression in vivo. The combination strategy to target ETV1 may provide an effective therapeutic strategy in GIST clinical management.

Summary Ecto-5'-nucleotidase (ecto-S'-NT) is a phosphatidylinositol anchored membrane structure recently defined as the lymphocyte differentiation antigen CD73. Using CD73 (I E9.28. 1) monoclonal antibody, normal mammary gland and breast carcinoma were immunohistochemically investigated for ecto-5'-NT expression. In normal breast epithelium, CD73 was differentially expressed in lobular, ductal and myoepithelial cells and was most frequently detected in the myoepithelial compartment. The glandular stroma contained fibrocytes, a subset of which was also CD73-positive. Among 102 unselected breast carcinoma primary lesions, only 9 contained CD73-positive tumour cells, whereas in 95 cases, stromal fibroblasts and fibrocytes showed variable degrees of CD73 expression. The extent of stromal CD73 expression correlated positively with the estrogen receptor (ER) status of the tumour (P < 0.038). We conclude that ecto-5'-NT-expression reflects a still unknown state of activity of normal breast epithelium which is lost in the majority of carcinomas derived therefrom. It may also be indicative of some functional activity of stromal fibroblasts which is significantly enhanced in ER-positive carcinomas.

<p>Supplementary Figure 1: Etv1 is required for intramuscular and myenteric ICC development. Supplementary Figure 2: Etv1 ablation with tamoxifen decreases Etv1 and Kit expression in Kit^delta558/+;Etv1^flox/flox;Rosa26^CreERT2/CreERT2 mice. Supplementary Figure 3: Etv1 positively regulates Kit expression in murine stomach. Supplementary Figure 4: ETV1 regulates KIT expression in GIST48 cells. Supplementary Figure 5: MAP kinase pathway inhibition decreases ETV1 target gene expression. Supplementary Figure 6: Dual lineage inhibition inhibits tumor initiation in vivo.</p>

<p>Supplementary Table 3: Gene sets enriched among genes UPregulated by tamoxifen treatment (Etv1 ablation) in murine GIST-like tumors.</p>