Patients with BRAFV600E-mutated metastatic colorectal cancer (mCRC) experience a worse prognosis and demonstrate only a 5% response rate to BRAF inhibitor treatment. In this study, adaptive resistance, and a potential combination of standard therapies in BRAFV600E CRC were unveiled. Intriguingly, a robust association of BRAFV600E mutation and DNA hypermethylation suggests this is a unique subgroup harboring aberrant epigenetic phenotype. Firstly, DNA methyltransferase (DNMT) inhibitor treatment induced profound DNA hypomethylation in vivo, but minimal change in gene expression due to adaptive elevation of the repressive histone methylation, H3K27me3, leading to compensatory suppression of key tumor suppressor genes, including Wnt pathway genes. EZH2 inhibitors targeting H3K27me3 additively sensitized DNMT inhibitors in BRAFV600E CRC. Additionally, the combination of bromodomain and extra-terminal protein (BET) inhibition in vivo with standard MAPK-targeted therapies showed deeper inhibition of the MAPK signaling and improved efficacy. Enhancer blockade disrupted the regulation of core transcription factors (TFs) of CRC, including the ETS family, downstream of MAPK signaling. BET plus MAPK combination successfully depleted proliferative and less differentiated cell populations enriched with MAPK signaling associated TFs, suggesting treatment impact on epigenetic reprogramming. Overall, the novelty of the studies lies in revealing abnormal chromatin dynamics of BRAFV600E CRC and the determination of optimal epigenetic therapeutic intervention in BRAFV600E CRC patients. Based on the preclinical data, the combination of BET, BRAF, and EGFR inhibition will be assessed in patients with BRAFV600E CRC (NCT06102902).
","abstract_html":"<p>Patients with BRAF<sup>V600E</sup>-mutated metastatic colorectal cancer (mCRC) experience a worse prognosis and demonstrate only a 5% response rate to BRAF inhibitor treatment. In this study, adaptive resistance, and a potential combination of standard therapies in BRAF<sup>V600E</sup> CRC were unveiled. Intriguingly, a robust association of BRAF<sup>V600E</sup> mutation and DNA hypermethylation suggests this is a unique subgroup harboring aberrant epigenetic phenotype. Firstly, DNA methyltransferase (DNMT) inhibitor treatment induced profound DNA hypomethylation in vivo, but minimal change in gene expression due to adaptive elevation of the repressive histone methylation, H3K27me3, leading to compensatory suppression of key tumor suppressor genes, including Wnt pathway genes. EZH2 inhibitors targeting H3K27me3 additively sensitized DNMT inhibitors in BRAF<sup>V600E</sup> CRC. Additionally, the combination of bromodomain and extra-terminal protein (BET) inhibition in vivo with standard MAPK-targeted therapies showed deeper inhibition of the MAPK signaling and improved efficacy. Enhancer blockade disrupted the regulation of core transcription factors (TFs) of CRC, including the ETS family, downstream of MAPK signaling. BET plus MAPK combination successfully depleted proliferative and less differentiated cell populations enriched with MAPK signaling associated TFs, suggesting treatment impact on epigenetic reprogramming. Overall, the novelty of the studies lies in revealing abnormal chromatin dynamics of BRAF<sup>V600E</sup> CRC and the determination of optimal epigenetic therapeutic intervention in BRAF<sup>V600E</sup> CRC patients. Based on the preclinical data, the combination of BET, BRAF, and EGFR inhibition will be assessed in patients with BRAF<sup>V600E</sup> CRC (NCT06102902). </p>","abstract_has_math":false,"creators":["Lee, Hey Min","0000-0001-7792-4226
"],"institution":null,"degree_name":"Doctor of Philosophy (PhD)","degree_level":"Dissertation (PhD)","degree_discipline":null,"degree_department":null,"school":null,"contributors":["Scott Kopetz, M.D., Ph.D.","Kunal Rai, Ph.D.","Robert C. Bast, M.D."],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2024,"date_issued":"2024-05-01T07:00:00Z","date_published":"2024-05-01T07:00:00Z","updated_at":"2026-07-24T05:48:59Z","subjects":["colorectal cancer","BRAF","epigenetics","CIMP","methylation","DNMT","BET","enhancer","combination therapy","Cancer Biology","Computational Biology","Genetics","Molecular Biology"],"languages":[],"rights":[],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"https://digitalcommons.library.tmc.edu/utgsbs_dissertations/1329","outbound_label":"Repository record","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor","label":"Contributor","values":["Scott Kopetz, M.D., Ph.D.","Kunal Rai, Ph.D.","Robert C. Bast, M.D."]},{"key":"dc:creator","label":"Author","values":["Lee, Hey Min","0000-0001-7792-4226
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"]},{"key":"dc:title","label":"Title","values":["Epigenetic Modification as a Therapeutic Target in BRAFV600E-mutated Metastatic Colorectal Cancer"]}]}],"canonical_facts":{"dc:contributor":["Scott Kopetz, M.D., Ph.D.","Kunal Rai, Ph.D.","Robert C. Bast, M.D."],"dc:creator":["Lee, Hey Min","0000-0001-7792-4226
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"],"dc:identifier":["https://digitalcommons.library.tmc.edu/utgsbs_dissertations/1329"],"dc:subject":["colorectal cancer","BRAF","epigenetics","CIMP","methylation","DNMT","BET","enhancer","combination therapy","Cancer Biology","Computational Biology","Genetics","Molecular Biology"],"dc:title":["Epigenetic Modification as a Therapeutic Target in BRAFV600E-mutated Metastatic Colorectal Cancer"],"thesis:degree_level":["Dissertation (PhD)"],"thesis:degree_name":["Doctor of Philosophy (PhD)"]},"updated_at":"2026-07-24T05:48:59Z"}