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Selective Inhibition of ATM-dependent Double-strand Break Repair and Checkpoint Control Synergistically Enhances the
Audrey Turchick1, Astrid Zimmermann2, Li-Ya Chiu1
1Translational Innovation Platform Oncology and Immuno-Oncology, EMD Serono, Billerica, MA.
Abstract:
Ataxia telangiectasia and Rad3-related protein (ATR) kinase regulate a key cell regulatory node for maintaining genomic integrity by preventing replication fork collapse. ATR inhibition has been shown to increase replication stress resulting in DNA double-strand breaks (DSBs) and cancer cell death, and several inhibitors are under clinical investigation for cancer therapy. However, activation of cell-cycle checkpoints controlled by ataxia telangiectasia-mutated (ATM) kinase could minimize the lethal consequences of ATR inhibition and protect cancer cells. Here, we investigate ATR-ATM functional relationship and potential therapeutic implications. In cancer cells with functional ATM and p53 signaling, selective suppression of ATR catalytic activity by M6620 induced G1-phase arrest to prevent S-phase entry with unrepaired DSBs. The selective ATM inhibitors, M3541 and M4076, suppressed both ATM-dependent cell-cycle checkpoints, and DSB repair lowered the p53 protective barrier and extended the life of ATR inhibitor-induced DSBs. Combination treatment amplified the fraction of cells with structural chromosomal defects and enhanced cancer cell death. ATM inhibitor synergistically potentiated the ATR inhibitor efficacy in cancer cells in vitro and increased ATR inhibitor efficacy in vivo at doses that did not show overt toxicities. Furthermore, a combination study in 26 patient-derived xenograft models of triple-negative breast cancer with the newer generation ATR inhibitor M4344 and ATM inhibitor M4076 demonstrated substantial improvement in efficacy and survival compared with single-agent M4344, suggesting a novel and potentially broad combination approach to cancer therapy.
Insights
Combining ATR and ATM kinase inhibitors enhances cancer cell death by increasing DNA damage and chromosomal defects. This synergistic approach shows promise for improved cancer therapy, particularly in triple-negative breast cancer models.
Area of Science:
- Oncology
- Molecular Biology
- Genetics
Background:
- Ataxia telangiectasia and Rad3-related protein (ATR) kinase is crucial for maintaining genomic integrity by preventing replication fork collapse.
- ATR inhibition induces replication stress, DNA double-strand breaks (DSBs), and cancer cell death, with several inhibitors in clinical trials.
- Activation of ataxia telangiectasia-mutated (ATM) kinase checkpoints can protect cancer cells from ATR inhibition's lethal effects.
Purpose of the Study:
- To investigate the functional relationship between ATR and ATM kinases.
- To explore the therapeutic potential of combining ATR and ATM inhibitors in cancer treatment.
Main Methods:
- Investigated ATR-ATM functional relationship in cancer cells with functional ATM and p53 signaling.
- Utilized selective ATR inhibitor (M6620) and selective ATM inhibitors (M3541, M4076).
- Conducted in vitro and in vivo studies, including patient-derived xenograft models of triple-negative breast cancer.
Main Results:
- Selective ATR inhibition induced G1-phase arrest in cells with functional ATM/p53.
- ATM inhibitors suppressed cell-cycle checkpoints and DSB repair, lowering the p53 protective barrier.
- Combination treatment amplified chromosomal defects, enhanced cancer cell death, and improved efficacy in vivo.
- Combination therapy with ATR inhibitor M4344 and ATM inhibitor M4076 showed significant improvements in triple-negative breast cancer models.
Conclusions:
- ATM inhibition synergistically potentiates ATR inhibitor efficacy in cancer cells.
- Combination therapy targeting both ATR and ATM kinases represents a novel and potentially broad approach to cancer therapy.
- This combination strategy demonstrated significant improvements in efficacy and survival in preclinical models.
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