† Senior authors
One Sentence Summary:Novel NIS interactors ARF4 and VCP alter NIS trafficking in vitro, and FDA-approved VCP inhibitors can significantly enhance radioiodine uptake.2 ABSTRACT Radioiodine treatment fails ≥25% of patients with thyroid cancer and has been proposed as a potential treatment for breast cancer. Cellular iodide uptake is governed by the sodium iodide symporter (NIS), which is frequently mislocalized in thyroid and breast tumours. However, the trafficking of NIS to the plasma membrane (PM) is ill-defined. Through mass spectrometry, co-immunoprecipitation, cell surface biotinylation and proximity ligation assays we identify two proteins which control NIS subcellular trafficking: ADP-ribosylation factor 4 (ARF4) and valosin-containing protein (VCP). HiLo microscopy revealed ARF4 enhanced NIS trafficking in co-incident PM vesicles, governed by a Cterminal VXPX motif, whilst papillary thyroid cancers (PTC) demonstrate repressed ARF4 expression.In contrast, VCP, the central protein in ER-associated degradation, specifically bound NIS and decreased its PM localization. Five chemically distinct allosteric VCP inhibitors all overcame VCPmediated repression of NIS function. In mice, two re-purposed FDA-approved VCP inhibitors significantly enhanced radioiodine uptake into thyrocytes, whilst human primary thyrocytes showed similar increases. Critically, PTC patients with high tumoural VCP expression who received radioiodine had strikingly worse disease-free survival. These studies now delineate the mechanisms of NIS trafficking, and for the first time open the therapeutic possibility of systemically enhancing radioiodine uptake in patients via FDA-approved drugs. 24), MAPK pathway/BRAF inhibitors (5,6, 25), multi-targeted kinase inhibitors (26) and HDAC inhibitors (27). Multiple biologically-targeted drugs have been evaluated in phase I, II and III trials, with several agents including sorafenib (6), lenvatinib (28) and dabrafenib (7) showing promising responses and/or disease stabilisation. However, issues of toxicity and drug resistance remain.To actively transport iodide for thyroid hormone biosynthesis and radioiodine treatment, NIS must be present in the basolateral PM of thyroid follicular cells. However, relatively little is known about the mechanisms that govern NIS trafficking. TSH induces iodide uptake through upregulation of NIS expression and modulation of its subcellular localisation (29-31).Yet, many thyroid cancers demonstrate reduced NIS activity through diminished PM retention (32-34). BRAF-mutant tumours (60-70% of thyroid cancers) are more likely to be resistant to radioiodine, partly due to decreased NIS expression (13,35), but also due to impaired PM targeting (11, 14), through mechanisms which remain ill-defined. Currently, PTTG1-binding factor (PBF) is the only protein shown to bind NIS and modulate its subcellular localisation (36).Early studies identified that breast tumours can uptake radioiodine (37,38), and subsequent studies confirmed functional NIS expression in up to...