PROJECT SUMMARY
Ewing sarcoma is the second most common bone and soft tissue cancer impacting children and
adolescents worldwide. It is an aggressive malignancy requiring multimodal treatment that confers significant
morbidity, and cure rates for metastatic and relapsed disease remain poor. While Ewing sarcoma is
characterized and driven by EWSR1-ETS gene fusions, the biological factors contributing to these simple
rearrangements, and complex rearrangements known as chromoplexy in a subset of cases, are not well-
characterized. I found that inherited pathogenic variants in FANCC and other DNA damage repair (DDR)
genes are uniquely enriched among patients with Ewing sarcoma relative to other pediatric sarcoma subtypes
(Gillani et al., AJHG 2022). Much work is still needed to understand how DNA damage repair deficiency
contributes to Ewing sarcoma pathogenesis. The guiding hypothesis of this research proposal is that DNA
damage repair deficiency promotes Ewing sarcoma pathogenesis, manifesting as a unique pattern of
predisposing germline variants and tumor genomic features that are integral to oncogenesis and can
be utilized for more informed risk stratification and treatment.
We will apply computational and experimental approaches to sequencing datasets from patients with
Ewing sarcoma and cell line models to complete this research proposal. In Specific Aim 1, we will dissect the
additive contribution of larger germline structural variants impacting DDR genes in Ewing sarcoma by
analyzing a cohort of 301 parent-proband trios and evaluating the enrichment of germline structural variants in
1180 cases relative to cancer-free controls. In Specific Aim 2, we will define the phenotype of FANCC variants
seen in the germline of Ewing sarcoma patients and knock these variants into mesenchymal stem cell lines to
understand how they contribute to genomic instability in the presence of genotoxic stress. In Specific Aim 3,
we will derive genomic signatures to gain additional insight into the DNA damage processes that are operant in
Ewing sarcoma tumors and associate copy number signatures specifically with treatment response and
relapse. Finally, we will conduct in-vitro drug treatment studies to demonstrate the utility of specific copy
number signatures as biomarkers of sensitivity to DNA damage response targeting agents.
Through integrative investigations spanning the germline and tumor, we intend to drive new
understanding of how DNA damage operates in Ewing sarcoma pathogenesis, knowledge that will be central
to improved risk stratification and treatment of this aggressive pediatric cancer. Moreover, in extending our
broader understanding about germline structural variants, the role of heterozygous risk variants in cancer
predisposition, and copy number signatures as clinically relevant biomarkers, this work will also have high
relevance to other pediatric cancers.