31Tumor cells overcome the cytostatic and cytotoxic restraints of TP53 tumor suppressor 32 signaling through a variety of mechanisms. High-risk human papillomavirus (HPV) positive 33 tumor cells retain wild type TP53 because the HPV E6/UBE3A ubiquitin ligase complex targets 34 TP53 for proteasomal degradation. While restoration of TP53 in tumor cells holds great promise 35 for cancer therapy, attempts to functionally restore the dormant TP53 tumor suppressor in HPV 36 positive cancer cells by inhibiting the HPV E6/UBE3A ubiquitin ligase complex have not yet 37 been successful. The Damage Induced long noncoding RNA, DINO, (DINOL) is a TP53 38 transcriptional target that has been reported to bind to and stabilize TP53, thereby amplifying 39 TP53 signaling. We show that HPV positive cervical carcinoma cells contain low levels of 40 DINO because of HPV E6/UBE3A mediated TP53 degradation. Acute DINO expression 41 overrides HPV16 E6/UBE3A mediated TP53 degradation, causing TP53 stabilization and 42 increased expression of TP53 transcriptional target genes. This causes a marked sensitization to 43 chemotherapy agents and renders cells vulnerable to metabolic stress. Acute DINO expression in 44 HPV positive cervical cancer cells induces hallmarks of DNA damage response signaling and 45 TP53 activation involves ATM/CHK2 signaling. DINO upregulation in response to DNA 46 damage is independent of ATM/CHK2 and can occur in cancer cells that express mutant TP53. 47 IMPORTANCE 49 Functional restoration of the TP53 tumor suppressor holds great promise for anti-cancer therapy. 50 Current strategies are focused on modulating TP53 regulatory proteins. Long noncoding RNAs 51 (lncRNAs) have emerged as important regulators of TP53 as well as modulators of downstream 52 tumor suppressive transcriptional responses. Unlike many other cancer types, human 53 papillomavirus (HPV) positive cancer cells retain wild type TP53 that is rendered dysfunctional 54 by the viral E6 protein. We show that acute expression of the Damage Induced long Noncoding 55 RNA, DINO, a known TP53 transcriptional target and functional modulator, causes TP53 56 reactivation in HPV positive cervical cancer cells. This causes increased vulnerability to standard 57 chemotherapeutics as well as biguanide compounds that cause metabolic stress. Hence, strategies 58 that target DINO may be useful for restoring TP53 tumor suppressor activity in HPV positive 59 cancers and other tumor types that retain wild type TP53. 60 61 62 63 64 65 KEYWORDS 66 Human papillomaviruses, cervical cancer, lncRNA, DINO, DINOL, TP53, UBE3A, E6-AP, 67 DNA damage, cellular transformation, chemoresistance, metabolism 68 69 RESULTS 126 127 Low DINO levels in HPV-positive cervical cancer cells are a result of HPV E6-mediated 128
TP53 degradation 129We previously reported that DINO expression correlated with TP53 levels in HPV E6 and/or E7 130 expressing human foreskin keratinocytes (HFKs) (44). Given that HPV positive cervical cancer 131 lines express E6 and E7 and retain wild-type TP53, we hypothe...