Oncogenic memory underlying minimal residual disease in breast cancer

Tumor relapse is responsible for most breast cancer related deaths1,2. The disease recurrence stems from treatment refractory cancer cells that persist as minimal residual disease (MRD) for years following initial therapy3. Yet, the molecular characteristics defining the malignancy of MRD remain elusive due to difficulties in observing these rare cells in patients or in model organisms. Here, we use a tractable organoid system and multi-omics analysis to show that the dormant MRD cells retain metabolic peculiarities reminiscent of the tumor state. While the MRD cells were distinct from both normal and tumor cells at a global transcriptomic level, their metabolomic and lipidomic profile markedly resembled that of the tumor state. The MRD cells particularly exhibited a de-regulated urea cycle and elevated glycolysis. We find the latter being crucial for their survival and could be selectively targeted using a small molecule inhibitor of glycolytic activity. We validated these metabolic peculiarities of the MRD cells in corresponding tissues obtained from the mouse model as well as in transcriptomic data from patients following neo-adjuvant therapy. Together, our results show that the treatment surviving MRD cells retain features of the tumor state over an extended period suggestive of an oncogenic memory. In accord, we found striking similarity in DNA methylation profiles between the tumor and the MRD cells. The distinction of MRD from normal breast cells comes as a surprise, considering their phenotypic similarity with regards to proliferation and polarized epithelial organization. The metabolic aberrances of the MRD cells offer a therapeutic opportunity towards tackling emergence of breast tumor recurrence in post-treatment care.