Epigenetics and DNA Base Substitutions of Epstein–Barr Virus (EBV)-Related Gastric Cancers: Implications for Targeted Therapies

Background: Gastric adenocarcinomas constitute a histologically and genomically heterogeneous group of cancers. The genomic classification of gastric cancers in four groups by The Cancer Genome Atlas (TCGA) has defined a framework for pathogenic discoveries. One of the groups is associated with infection by the gamma herpes virus Epstein–Barr virus (EBV) and represents a distinct subset of gastric cancers with potential therapeutic opportunities. Methods: The EBV-associated cancers from the TCGA gastric cancer cohort were analyzed to determine specific mutational and mRNA expression profiles that set these cancers apart from other gastric cancer subtypes. The cBioportal for Cancer Genomics site was used for downloading and analyzing the primary data. Results: EBV-associated cancers represented about 7% of the cohort. Mutations in the catalytic alpha subunit of PI3K kinase, PIK3CA, and the epigenetic modifiers ARID1A and BCOR were common. PIK3CA mutations were observed in 80% of EBV-associated cancers and frequently affected the hotspot codons E542 and E545. The few cases without PIK3CA mutations displayed frequent alterations in ERBB2 or in the regulatory unit of PI3K. EBV-associated cancers did not display excess cytidine to thymine (C>T) transitions compared with other gastric cancer genomic subtypes, as would be expected from the high genome methylation caused by the virus. In contrast, an increased rate of T to G (T>G) transversions was observed in EBV-associated cancers. Translesion polymerase eta (POLH), which produces a signature characterized by a preponderance of T>G, was up-regulated in EBV-associated gastric cancers and may be a contributing factor in this increase, up-regulated by wild-type p53 and over-expression of transcription factor IRF1. Conclusions: The data presented here suggest that mutagenesis in the EBV-associated gastric cancers is not a direct consequence of the virus-derived hypermethylation. Up-regulation of kinase PI3K and its pathway is a prerequisite for EBV transformation, and epigenetic alterations are frequently present, suggesting therapeutic avenues.