[ Nature vol. 512 pp. 143 - 144, 155 - 160 '14 ] Nuc-seq is an innovative sequencing method which achieves almost complete sequencing of whole genomes in single cells. It sequences DNA from cells about to divide (the G2/M stage of the cell cycle which has twice the DNA content of the usual cell). Genomes of multiple single cells from two types of human breast cancer (estrogen receptor positive and triple negative — the latter much more aggressive) and found that no two genomes of individual tumor cells were identical. Many cells had new mutations unique to them.
This brings into question what we actually mean by a cancer cell clone. They validated some of the single cell mutations by deep sequencing of a single molecule (not really sure what this is).
Large scale structural changes in DNA (amplification and deletion of large blocks of DNA) occurred early in tumor development. THey remain stable as clonal expansion of the tumor occur (e.g. they were found in all the cancer cells whose genome was sequenced). Point mutations accumulated more gradually generating extensive subclonal diversity. Many of the mutations occur in less than 10% of the tumor mass. Triple negative breast cancers (aggressive) have mutation rates 13 times greater than the slower growing estrogen receptor positive breast cancer cells.
This implies that the mutations are there BEFORE chemotherapy. This has always been a question as most types of chemotherapy attack DNA replication and are inherently mutagenic. It also implies that slamming cancer with chemotherapy early before it has extensively mutated is locking the barn door after the horse has been stolen. It still might help in preventing metastasis, so the approach remains viable.
However nuc-seq may only be useful for cancer cells without aneuploidy http://en.wikipedia.org/wiki/Aneuploidy which is extremely common in cancer cells.
Why is this such bad news? It means that before chemotherapy even starts there is a high degree of genetic diversity present in the tumor cell population. This means that natural selection (in the form of chemotherapy) has a diverse population to work on at the get go, making resistance far more likely to occur.
Had enough? Here’s more — [ Nature vol. 511 pp. 543 - 550 '14 ] A report of 230 resected lung adenocarcinomas using mRNA, microRNA and DNA sequencing found an incredible 8.8 mutations/megaBase — e.g. 3.2 * 3.8 * 1,000 == 28,000 mutations. Aberrations in NF1, MET. ERBB2 and RIT1 occured in 13% and were enriched in samples otherwise lacking an activated oncogene. Even when not mutated, mRNA splicing was different in tumors. As far as oncogenic pathways, multiple pathways were involved — p53in 63%, PI3K mTOR in 25%, Receptor Tyrosine Kinase in 76%, cell cycle regulators 64%.
This is the opposite side of the coin from the first paper, where the genomes of single tumor cells were sequenced. It is doubtful that all cells have the 28,000 mutations, which probably result from each cell having a subset. The first paper didn’t count how many mutations a single cell had (as far as i could see).
So oncologists are attacking a hydra-headed monster.