BCL-X directly modulates RAS signalling to favour cancer cell stemness.

In tumours, accumulation of chemoresistant cells that express high levels of anti-apoptotic proteins such as BCL-X is thought to result from the counter selection of sensitive, low expresser clones during progression and/or initial treatment. We herein show that BCL-X expression is selectively advantageous to cancer cell populations even in the absence of pro-apoptotic pressure. In transformed human mammary epithelial cells BCL-X favours full activation of signalling downstream of constitutively active RAS with which it interacts in a BH4-dependent manner. Comparative proteomic analysis and functional assays indicate that this is critical for RAS-induced expression of stemness regulators and maintenance of a cancer initiating cell (CIC) phenotype. Resistant cancer cells thus arise from a positive selection driven by BCL-X modulation of RAS-induced self-renewal, and during which apoptotic resistance is not necessarily the directly selected trait.