Activating mutations of the ALK receptor occur in a subset of
neuroblastoma tumors. We previously demonstrated that Alk mutations cooperate with MYCN overexpression to induce
neuroblastoma in mice and identified Ret as being strongly upregulated in MYCN/Alkmut
tumors. By a genetic approach in vivo, we now document an oncogenic cooperation between activated Ret and MYCN overexpression in
neuroblastoma formation. We show that MYCN/RetM919T
tumors exhibit histological features and expression profiles close to MYCN/Alkmut
tumors. We show that RET transcript levels decrease precedes RET
protein levels decrease upon ALK inhibition in
neuroblastoma cell lines. Etv5 was identified as a candidate
transcription factor regulating Ret expression from murine MYCN/Alkmut
tumor transcriptomic data. We demonstrate that ETV5 is regulated both at the
protein and
mRNA levels upon ALK activation or inhibition in
neuroblastoma cell lines and that this regulation precedes RET modulation. We document that ALK activation induces ETV5
protein upregulation through stabilization in a
MEK/ERK-dependent manner. We show that RNAi-mediated inhibition of ETV5 decreases RET expression. Reporter assays indicate that ETV5 is able to drive RET gene transcription. ChIP-seq analysis confirmed ETV5 binding on the RET promoter and identified an enhancer upstream of the promoter. Finally, we demonstrate that combining RET and ALK inhibitors reduces
tumor growth more efficiently than each single agent in MYCN and AlkF1178L-driven murine
neuroblastoma. Altogether, these results define the ERK-ETV5-RET pathway as a critical axis driving
neuroblastoma oncogenesis downstream of activated ALK.