Ewing sarcoma is characterized by oncogenic gene fusions and elevated lysine-specific demethylase-1 (LSD1) expression. While Theisen and colleagues previously devised a small molecule LSD1 inhibitor that demonstrates therapeutic efficacy against Ewing sarcoma — SP-2509 — treatment with SP-2509 alone potentiates drug resistance. In this study, Tokarsky et al., sought to elucidate molecular mechanisms underlying SP-2509 resistance by using a CRISPR–Cas9 loss-of-function screen in SP-2509–sensitive Ewing sarcoma cell lines. Results from the screen demonstrated that abrogating expression of mitochondrial ribosomal protein L45 (MRPL45) as well as members of electron transport chain complexes III (CIII) and IV (CIV) reduces SP-2509 responsiveness. Accordingly, CIII inhibitors and targeted removal of genes encoding CIII constituents ubiquinone-cytochrome c reductase, Rieske iron-sulfur polypeptide 1 (UQCRFS1) and cytochrome c1 (CYC1) using CRISPR–Cas9 induces SP-2509 resistance in Ewing sarcoma cell lines. Silencing UQCRFS1, CYC1, or MRPL45 expression diminishes transcriptional responses to SP-2509, indicating that mitochondrial function contributes to...

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