CRISPR/Cas9 screens implicate RARA and SPNS1 in doxorubicin cardiotoxicity

Abstract

Doxorubicin (DOX) is an efficacious chemotherapy compound used to treat various cancers which elicits severe side effects, including heart failure. Uptake of DOX by cardiomyocytes causes metabolic dysfunction and cell death but causal mechanisms remain largely undefined. We applied genome-wide CRISPR/Cas9 knockout screens to discover genetic modifiers of DOX-induced cardiomyocyte cell death, and independently, DOX uptake and clearance. Both screens discovered known and novel factors. In cell death screens and validation studies, loss of retinoic acid receptor-α (RARA) predisposed cardiomyocytes to DOX-mediated cell death. Conversely, RARA activation reduced DOX cytotoxicity in wild type cardiomyocytes. RNA-Seq analysis revealed that whilst DOX caused large-scale suppression of metabolic and mitochondrial gene expression, RARA activation mitigated this effect. In DOX accumulation screens, an essential role for lysosomes in DOX clearance was observed. Loss of Sphingolipid Transporter 1 (SPNS1) led to DOX hyperaccumulation, suppression of autophagy, increased DNA damage, and increased cell death. Hence, SPNS1 plays a key role in buffering against DOX accumulation and toxicity. Collectively, our study nominated hundreds of drug-gene interactions, providing a springboard for exploration of causal mechanisms, and a technical framework for future screening campaigns.