Splicing of HPV16 E6 promotes aggressive invasion in oropharyngeal cancer via endocytosis of E-cadherin

Abstract

Human papillomavirus-positive oropharyngeal squamous cell carcinoma (HPV+ OPSCC) has become the most common HPV-associated cancer in developed countries, yet a significant subset of patients develops recurrence despite favorable treatment responses. Biomarkers that identify aggressive tumors at diagnosis are therefore needed. In HPV+ cancers, the viral E6 transcript can be expressed as two main variants, the full-length isoform (E6FL) and the spliced E6*I isoform. Here, we investigated the functional and clinical impact of E6FL and E6*I in HPV+OPSCC. Across multiple preclinical models, E6*I promoted migration and aggressive invasion relative to E6FL and was associated with redistribution of E-cadherin away from the cell membrane. In multi-institutional patient cohorts, a previously developed E6FL:E6ALL influence score, which captures E6 splicing-associated host transcriptional biology, was associated with clinical outcomes. Lower scores, reflecting greater E6*I impact, were associated with worse overall survival and recurrence-free survival. Multiplexed immunofluorescence of 75 primary pretreatment biopsies further showed that a lower influence score was linked to reduced membrane and increased cytoplasmic localization of E-cadherin, while a tissue-based E-cadherin localization score was associated with recurrence. Mechanistically, E6*I overexpression promotes E-cadherin internalization, likely through the Rab11-associated trafficking pathway. Splice-switching oligonucleotides that shifted endogenous E6 splicing toward E6FL reduced invasion in two HPV+ OPSCC models. Together, these findings position HPV E6 splicing as a regulatory axis underlying aggressive HPV+ OPSCC biology and support E6 splicing and membrane-to-cytoplasmic ECAD localization as candidate risk-stratification biomarkers.