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Mex3a marks drug-tolerant persister colorectal cancer cells that mediate relapse after chemotherapy

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Colorectal cancer (CRC) patient-derived organoids predict responses to chemotherapy. Here we used them to investigate relapse after treatment. Patient-derived organoids expand from highly proliferative LGR5(+) tumor cells; however, we discovered that lack of optimal growth conditions specifies a latent LGR5(+) cell state. This cell population expressed the gene MEX3A, is chemoresistant and regenerated the organoid culture after treatment. In CRC mouse models, Mex3a(+) cells contributed marginally to metastatic outgrowth; however, after chemotherapy, Mex3a(+) cells produced large cell clones that regenerated the disease. Lineage-tracing analysis showed that persister Mex3a(+) cells downregulate the WNT/stem cell gene program immediately after chemotherapy and adopt a transient state reminiscent to that of YAP(+) fetal intestinal progenitors. In contrast, Mex3a-deficient cells differentiated toward a goblet cell-like phenotype and were unable to resist chemotherapy. Our findings reveal that adaptation of cancer stem cells to suboptimal niche environments protects them from chemotherapy and identify a candidate cell of origin of relapse after treatment in CRC. Batlle and colleagues report that after chemotherapy, Mex3a(+) colorectal cancer cells represent drug-tolerant persister cells that lead to recurrence by downregulating the WNT-Lgr5(+) stem cell program and adopting a transient regenerative state.

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ALVAREZ VARELA, Adrián, NOVELLASDEMUNT, Laura, BARRIGA, Francisco m., HERNANDO MOMBLONA, Xavier, CAÑELLAS SOCIAS, Adrià, CANO CRESPO, Sara, SEVILLANO, Marta, CORTINA, Carme, STORK, Diana, MORRAL, Clara, TURON, Gemma, SLEBE, Felipe, JIMÉNEZ GRACIA, Laura, CARATU, Ginevra, JUNG, Peter, STASSI, Giorgio, HEYN, Holger, TAURIELLO, Daniele v. f., MATEO, Lidia, TEJPAR, Sabine, SANCHO, Elena, ATTOLINI, Camille stephan-otto, BATLLE, Eduard. Mex3a marks drug-tolerant persister colorectal cancer cells that mediate relapse after chemotherapy. _Nature Cancer_. 2022. Vol. 3, núm. 1052–1070. [consulta: 21 de gener de 2026]. ISSN: 2662-1347. [Disponible a: https://hdl.handle.net/2445/191038]

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