Functional genomics approaches can overcome limitations-such as the lack of identification of robust targets and poor clinical efficacy-that hamper cancer drug development. Here we performed genome-scale CRISPR-Cas9 screens in 324 human cancer cell lines from 30 cancer types and developed a data-driven framework to prioritize candidates for cancer therapeutics. We integrated cell fitness effects with genomic biomarkers and target tractability for drug development to systematically prioritize new targets in defined tissues and genotypes. We verified one of our most promising dependencies, the Werner syndrome ATP-dependent helicase, as a synthetic lethal target in tumours from multiple cancer types with microsatellite instability. Our analysis provides a resource of cancer dependencies, generates a framework to prioritize cancer drug targets and suggests specific new targets. The principles described in this study can inform the initial stages of drug development by contributing to a new, diverse and more effective portfolio of cancer drug targets.

Morphology and functionality of the epithelial lining differ along the intestinal tract, yet tissue renewal at all sites is driven by stem cells at the base of crypts 1-3 . Whether stem cell numbers and behaviour vary at different sites is unknown. Here, we show by intravital microscopy that despite similarities in the number and distribution of proliferative cells with an Lgr5 signature, small intestinal (SI) crypts contain twice as many effective stem cells as large intestinal (LI) crypts. We find that, although passively displaced by a conveyor belt-like upward movement, SI cells positioned away from the crypt base can function as long-term effective stem cells due to Wntdependent retrograde cellular movement. By contrast, the near absence of retrograde movement in the LI restricts cell repositioning, leading to a reduced effective stem cell number. Moreover, upon suppression of the retrograde movement in the SI, the number of effective stem cells is reduced, and the rate of monoclonal conversion of crypts is accelerated. Together, these results show that effective stem cell number is determined by active retrograde movement, revealing a new channel of stem cell regulation that can be experimentally and pharmacologically manipulated.