Non-Darwinian dynamics in therapy-induced cancer drug resistance

Development of drug resistance, the prime cause of failure in cancer therapy, is commonly explained by the selection of resistant mutant cancer cells. However, dynamic non-genetic heterogeneity of clonal cell populations continuously produces meta-stable phenotypic variants (persisters), some of which represent stem-like states that confer resistance. Even without genetic mutations, Darwinian selection can expand these resistant variants, which would explain the invariably rapid emergence of stem-like resistant cells. Here, using quantitative measurements and modeling we show that appearance of multi-drug resistance in HL60 leukemic cells following treatment with vincristine is not explained by Darwinian selection but by Lamarckian induction. Single-cell longitudinal monitoring confirms the induction of multi-drug resistance in individual cells. Associated transcriptome changes indicate a lasting stress-response consistent with a drug-induced switch between high-dimensional cancer attractors. Resistance-induction correlates with Wnt-pathway up-regulation and is suppressed by β-catenin knock-down, revealing a new opportunity for early therapeutic intervention against resistance development.