Department of Gynecology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu, China.
Int J Biol Sci. 2024 Aug 19;20(11):4513-4531. doi: 10.7150/ijbs.94568. eCollection 2024.
Large-scale phase III clinical trials of Olaparib have revealed benefits for ovarian cancer patients with BRCA gene mutations or homologous recombination deficiency (HRD). However, fewer than 50% of ovarian cancer patients have both BRCA mutations and HRD. Therefore, improving the effect of Olaparib in HR-proficient patients is of great clinical value. Here, a combination strategy comprising Olaparib and CDK12-IN-3 effectively inhibited the growth of HR-proficient ovarian cancer in cell line, patient-derived organoid (PDO), and mouse xenograft models. Furthermore, the combination strategy induced severe DNA double-strand break (DSB) formation, increased NHEJ activity in the G2 phase, and reduced HR activity in cancer cells. Mechanistically, the combination treatment impaired Ku80 poly(ADP-ribosyl)ation (PARylation) and phosphorylation, resulting in PARP1-Ku80 complex dissociation. After dissociation, Ku80 occupancy at DSBs and the resulting Ku80-primed NHEJ activity were increased. Owing to Ku80-mediated DNA end protection, MRE11 and Rad51 foci formation was inhibited after the combination treatment, suggesting that this treatment suppressed HR activity. Intriguingly, the combination strategy expedited cGAS nuclear relocalization, further suppressing HR and, conversely, increasing genomic instability. Moreover, the inhibitory effect on cell survival persisted after drug withdrawal. These findings provide a rationale for the clinical application of CDK12-IN-3 in combination with Olaparib.
奥拉帕利的大型 III 期临床试验表明,该药物对携带有 BRCA 基因突变或同源重组缺陷(HRD)的卵巢癌患者有益。然而,仅有不到 50%的卵巢癌患者同时具有 BRCA 突变和 HRD。因此,提高奥拉帕利在 HR 阳性患者中的疗效具有重要的临床价值。在这里,奥拉帕利与 CDK12-IN-3 的联合治疗策略在细胞系、患者来源的类器官(PDO)和小鼠异种移植模型中有效抑制了 HR 阳性卵巢癌的生长。此外,该联合治疗策略诱导了严重的 DNA 双链断裂(DSB)形成,增加了 G2 期的非同源末端连接(NHEJ)活性,并降低了癌细胞中的 HR 活性。从机制上讲,联合治疗破坏了 Ku80 的聚(ADP-核糖)化(PARylation)和磷酸化,导致 PARP1-Ku80 复合物解离。解离后,Ku80 在 DSB 上的占有率增加,由此产生的 Ku80 启动的 NHEJ 活性增强。由于 Ku80 介导的 DNA 末端保护,联合治疗后 MRE11 和 Rad51 焦点形成受到抑制,表明该治疗抑制了 HR 活性。有趣的是,联合治疗策略加速了 cGAS 的核重定位,进一步抑制了 HR,并相反地增加了基因组不稳定性。此外,停药后对细胞存活的抑制作用仍然存在。这些发现为 CDK12-IN-3 与奥拉帕利联合应用于临床提供了依据。
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