DNAJB1-PRKACA fusion protein-regulated LINC00473 promotes tumor growth and alters mitochondrial fitness in fibrolamellar carcinoma

Fibrolamellar carcinoma (FLC) is a rare liver cancer that disproportionately affects adolescents and young adults. Currently, no standard of care is available and there remains a dire need for new therapeutics. Most patients harbor the fusion oncogene DNAJB1-PRKACA (DP fusion), but clinical inhibitors are not yet developed and it is critical to identify downstream mediators of FLC pathogenesis. Here, we identify long noncoding RNA LINC00473 among the most highly upregulated genes in FLC tumors and determine that it is strongly suppressed by RNAi-mediated inhibition of the DP fusion in FLC tumor epithelial cells. We show by loss- and gain-of-function studies that LINC00473 suppresses apoptosis, increases the expression of FLC marker genes, and promotes FLC growth in cell-based and in vivo disease models. Mechanistically, LINC00473 plays an important role in promoting glycolysis and altering mitochondrial activity. Specifically, LINC00473 knockdown leads to increased spare respiratory capacity, which indicates mitochondrial fitness. Overall, we propose that LINC00473 could be a viable target for this devastating disease. Schematic was created with BioRender.com. Fibrolamellar carcinoma (FLC) is a lethal liver cancer that is characterized by the DNAJB1-PRKACA (DP fusion) oncogene. This disease is particularly challenging to treat as it lacks non-invasive diagnostic biomarkers, known risk factors, and effective therapeutic options. Patients with FLC have a median age of 22 years and the prognosis is poor. In this study, we examined FLC tumors from independent patient cohorts and multiple disease models and found consistently elevated levels of a primate-specific long noncoding RNA named LINC00473. By leveraging single-cell analysis on patient tumors, we found that LINC00473 is enriched in tumor epithelial cells. Using multiple FLC models, we show that the DP fusion drives LINC00473 expression and that LINC00473 promotes FLC growth by mitigating cell death. We also show that LINC00473 modulates FLC energetics by increasing glycolysis and altering mitochondrial fitness. Together, this study unveils an important mechanism downstream of the signature DP fusion oncogene in FLC pathogenesis.