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Purpose The recent implementation of MR-Linacs has highlighted theranostic opportunities of contrast agents in both imaging and radiotherapy. There is a lack of data exploring the potential of superparamagnetic iron oxide nanoparticles (SPIONs) as radiosensitisers. Through preclinical 225 kVp exposures, this study aimed to characterise the uptake and radiobiological effects of SPIONs in tumour cell models in vitro and to provide proof-of-principle application in a xenograft tumour model. Methods SPIONs were also characterised to determine their hydrodynamic radius using dynamic light scattering and uptake was measured using ICP-MS in 6 cancer cell lines; H460, MiaPaCa2, DU145, MCF7, U87 and HEPG2. The impact of SPIONs on radiobiological response was determined by measuring DNA damage using 53BP1 immunofluorescence and cell survival. Sensitisation Enhancement Ratios (SERs) were compared with the predicted Dose Enhancement Ratios (DEFs) based on physical absorption estimations. In vivo efficacy was demonstrated using a subcutaneous H460 xenograft tumour model in SCID mice by following intra-tumoural injection of SPIONs. Results The hydrodynamic radius was found to be between 110 and 130 nm, with evidence of being monodisperse in nature. SPIONs significantly increased DNA damage in all cell lines with the exception of U87 cells at a dose of 1 Gy, 1 h post-irradiation. Levels of DNA damage correlated with the cell survival, in which all cell lines except U87 cells showed an increased sensitivity (P P Conclusions SPIONs showed radiosensitising effects in 5 out of 6 cancer cell lines. No correlation was found between the cell-specific uptake of SPIONs into the cells and DNA damage levels. The in vivo study found a significant decrease in the tumour growth rate.

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Abiraterone acetate and Enzalutamide are novel anti-androgens that are key treatments to improve both progression-free survival and overall survival in patients with metastatic castration-resistant prostate cancer. In this study, we aimed to determine whether combinations of AR inhibitors with radiation are additive or synergistic, and investigated the underlying mechanisms governing this. This study also aimed to compare and investigate a biological rationale for the selection of Abiraterone versus Enzalutamide in combination with radiotherapy as currently selection is based on consideration of side effect profiles and clinical experience. We report that AR suppression with Enzalutamide produces a synergistic effect only in AR-sensitive prostate models. In contrast, Abiraterone displays synergistic effects in combination with radiation regardless of AR status, alluding to potential alternative mechanisms of action. The underlying mechanisms governing this AR-based synergy are based on the reduction of key AR linked DNA repair pathways such as NHEJ and HR, with changes in HR potentially the result of changes in cell cycle distribution, with these reductions ultimately resulting in increased cell death. These changes were also shown to be conserved in combination with radiation, with AR suppression 24 hours before radiation leading to the most significant differences. Comparison between Abiraterone and Enzalutamide highlighted Abiraterone from a mechanistic standpoint as being superior to Abiraterone for all endpoints measured. Therefore, this provides a potential rationale for the selection of Abiraterone over Enzalutamide.

Radical radiotherapy, often in combination with hormone ablation, is a safe and effective treatment option for localised or locally-advanced prostate cancer. However, up to 30% of patients with locally advanced PCa will go on to develop biochemical failure, within 5 years, following initial radiotherapy. Improving radiotherapy response is clinically important since patients exhibiting biochemical failure develop castrate-resistant metastatic disease for which there is no curative therapy and median survival is 8&ndash, 18 months. The aim of this research was to determine if loss of PTEN (highly prevalent in advanced prostate cancer) is a novel therapeutic target in the treatment of advanced prostate cancer. Previous work has demonstrated PTEN-deficient cells are sensitised to inhibitors of ATM, a key regulator in the response to DSBs. Here, we have shown the role of PTEN in cellular response to IR was both complex and context-dependent. Secondly, we have confirmed ATM inhibition in PTEN-depleted cell models, enhances ionising radiation-induced cell killing with minimal toxicity to normal prostate RWPE-1 cells. Furthermore, combined treatment significantly inhibited PTEN-deficient tumour growth compared to PTEN-expressing counterparts, with minimal toxicity observed. We have further shown PTEN loss is accompanied by increased endogenous levels of ROS and DNA damage. Taken together, these findings provide pre-clinical data for future clinical evaluation of ATM inhibitors as a neoadjuvant/adjuvant in combination with radiation therapy in prostate cancer patients harbouring PTEN mutations.

Abiraterone acetate and Enzalutamide are novel anti-androgens shown to be one of the few treatments to improve both progression-free survival and overall survival in patients with metastatic castration-resistant prostate cancer. However, many questions exist regarding the optimal combination and scheduling with radiation, the degree of additivity or synergism and the underlying mechanisms governing any potential synergy. This study is attesting the biological rationale for the selection of Abiraterone or Enzalutamide as, currently, the choice of therapy is a clinical decision based on experience and side effect profiles. As well as external beam radiotherapy a key unexplored area of interest is the combination of these inhibitors with the α-emitter radium-223, which targets bone metastases, with preliminary studies, such as the ERA-223 study, highlighting the need for further studies to mechanistically determine if these combinations are effective and safe. To better understand this, we conducted a detailed analysis of the effects of Abiraterone (10µM), Enzalutamide (10µM) or DMSO (Control) alone or in combination with a dose range of X-rays and radium-223 exposure on cell cycle, DNA damage, DNA repair and cell viability across a panel of androgen-insensitive (PC3), androgen-sensitive (LNCaP) and osteoblastic bone models (SJSA-1, SAOS-2). We report significant differences in the synergy of these AR inhibitors in combination with radiation, with Abiraterone causing significant radiosensitisation regardless of AR status and radiosensitisation with Enzalutamide being dependent on AR-sensitivity. This suggests a potential alternative mechanism of action of Abiraterone, not dependent on AR status. AR suppression alone was also shown to impact cell-cycle distribution, with most notable changes being increases in sub-G1 at the expense of S phase, with observed increases in PARP-cleavage supporting this being a result of increased levels of apoptosis and potential reductions in RAD51 levels. Studies with radium-223 confirmed the highly damaging nature of α-particles, with radium-223 treatments shown to be highly cytotoxic compared to equivalent doses of X-rays. Compared to X-rays, radium-223 induced cell cycle distribution changes in the form of much larger shifts towards G2, which also took longer to recover. As well as increased levels of apoptosis through observed increases in PARP-cleavage. Combinations of radium-223 with Abiraterone or Enzalutamide led to a loss of all additive or synergistic effects previously measured with X-rays. Most likely due to the highly cytotoxic nature of α-particles due to the induction of non-reparable DNA dsb. In conclusion, these results support the use of Abiraterone and Enzalutamide in combination with X-rays and radium-223 to enhance tumor response independently of androgen receptor status. Citation Format: Timothy Wright, Victoria Dunne, Aidan Cole, Kevin Prise. Androgen deprivation and its impact on DNA repair in combination with ionising radiation and Radium-223 in prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2070.

Radium-223 dichloride (Ra-223, Xofigo®) is the first approved α-particle-emitting radionuclide for the treatment of symptomatic bone metastases in patients with castration-resistant prostate cancer (CRPC) with no known evidence of visceral metastases. Ra-223 is a calcium-mimetic that preferentially binds with the bone mineral hydroxyapatite at areas of high bone turnover, such as bone metastases. This highly localized radiotherapy causes a high frequency of unrepairable double-stranded DNA breaks (DSBs), resulting in a potent antitumor effect on bone metastases. Recent evidence has suggested that patients with mutations in the DNA damage response pathway (DDR), may have differential outcomes to Ra-223 treatment (1).DDR comprises a dynamic network of signaling pathways for the maintenance of genomic integrity. Ataxia telangiectasia mutated (ATM) and Rad3-related (ATR) are critical proteins which orchestrate the DDR and their activation is dependent on the type of DNA lesion. ATM is the primary responder to DSBs whilst ATR is activated by a range of lesions including single strand DNA structures at resected ends of DBSs and after replication fork stalling. In this study, we evaluated the impact of combining DDR kinase inhibitors with Ra-223 to investigate whether a greater radiosensitization response occurs in comparison to standard X-rays in PC3 and DU145 human prostate cell lines and normal prostate epithelial RWPE-1 cells. Cell assays including clonogenic survival, DNA damage assays and flow cytometry were used to assess the effect of DDR kinase inhibitors in combination with ionizing radiation. Cells were pre-treated with DDR inhibitors one-hour before exposure to 2Gy X-rays or an equivalent dose of 0.25Gy Ra-223. Our data show that, in all prostate models, DDR kinase inhibitors in combination with Ra-223 significantly enhanced radiosensitivity (p {{References}}:1.Velho PI, Qazi F, Hassan S, et al. Efficacy of Radium-223 in Bone-metastatic Castration-resistant Prostate Cancer with and Without Homologous Repair Gene Defects. European Urology. 2019; 76: 170-176. Citation Format: Victoria L. Dunne, Timothy Wright, Francisco Liberal, Joe M. O'Sullivan, Kevin M. Prise. Synergistic activity of DNA damage response kinase inhibitors in combination with the targeted alpha therapy radium-223 dichloride for metastatic castration-resistant prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 3054.

Background and purpose: To evaluate the impact of ATR inhibition using AZD6738 in combination with radiotherapy on the response of non-small cell lung cancer (NSCLC) tumour models and a murine model of radiation induced fibrosis. Materials and methods: AZD6738 was evaluated as a monotherapy and in combination with radiation in vitro and in vivo using A549 and H460 NSCLC models. Radiation induced pulmonary fibrosis was evaluated by cone beam computed tomography (CBCT) and histological staining. Results: AZD6738 specifically inhibits ATR kinase and enhanced radiobiological response in NSCLC models but not in human bronchial epithelial cells (HBECs) in vitro. Significant tumour growth delay was observed in cell line derived xenografts (CDXs) of H460 cells (p < 0.05) which were less significant in A549 cells. Combination of AZD6738 with radiotherapy showed no significant change in lung tissue density by CBCT (p > 0.5) and histological scoring of radiation induced fibrosis (p > 0.5). Conclusion: Inhibition of ATR with AZD6738 in combination with radiotherapy increases tumour growth delay without observable augmentation of late radiation induced toxicity further underpinning translation towards clinical evaluation in NSCLC.

Despite a major paradigm shift in radiotherapy planning and delivery over the past three decades with continuing refinements, radiation induced lung damage (RILD) remains a major dose limiting toxicity in patients receiving thoracic irradiations. Our current understanding of the biological processes involved in RILD which includes DNA damage, inflammation, senescence and fibrosis, is based on clinical observations and experimental studies in mouse models using conventional radiation exposures. Whilst these studies have provided vital information on the pulmonary radiation response, the current implementation of small animal irradiators is enabling refinements in the precision and accuracy of dose delivery to mice which can be applied to studies of RILD. This review presents the current landscape of preclinical studies in RILD using small animal irradiators and highlights the challenges and opportunities for the further development of this emerging technology in the study of normal tissue damage in the lung.

PURPOSE: The aim of this study was to define the dose and dose-volume relationship of radiation induced pulmonary toxicities occurring in and out-of-field in mouse models of early inflammatory and late fibrotic response.MATERIALS AND METHODS: Early radiation induced inflammation and fibrosis were investigated in C3H/NeJ and C57BL/6J mice respectively. Animals were irradiated with 20 Gy delivered to the upper region of the right lung as a single fraction or as three consecutive fractions using the Small Animal Radiation Research Platform (SARRP, Xstrahl Inc., Camberley, UK). Cone Beam Computed Tomography (CBCT) was performed for image guidance prior to irradiation and to monitor late toxicity. Histological sections were examined for neutrophil and macrophage infiltration as markers of early inflammatory response, type I collagen staining as a marker of late occurring fibrosis. Correlation was evaluated with the Dose Volume Histogram (DVH) parameters calculated for individual mice and changes in the observed CBCT values.RESULTS: Mean Lung Dose (MLD) and the volume receiving over 10 Gy (V10) showed significant correlation with late responses for single and fractionated exposures in directly targeted volumes. Responses observed outside the target volume were attributed to non-targeted effects and showed no dependence on either MLD or V10.CONCLUSIONS: Quantitative assessment of normal tissue response closely correlates early and late pulmonary response with clinical parameters demonstrating this approach as a potential tool to facilitate clinical translation of preclinical studies. Out-of-field effects were observed but did not correlate with dosimetric parameters suggesting non-targeted effects may have a role in driving toxicities outside the treatment field.

Introduction: WEE1 kinase is a key component in maintaining the G2/M cell cycle checkpoint for pre-mitotic DNA repair, and is overexpressed in several cancer types. Novel therapeutics are currently being developed to target WEE1 kinase in cancer, however, to date no predictive biomarkers have been approved to aid patient stratification and clinical trial design. To address this, we employed a siRNA screening to identify tumour suppressor genes (TSGs) whose loss mediates sensitivity to WEE1 inhibition. Experimental procedures: U2OS cells were reverse transfected with a customised siRNA library containing 3 independent siRNAs targeting 178 tumour suppressor genes and 24 hours later treated with either DMSO control or MK-1775 (Wee1 Kinase Inhibitor). Cell viability was measured using a cell titer-glo luminescent Cell Viability Assay 72 hours post-treatment. Hits were selected based on robust z-score analysis. Those genes with 2 or more targeted siRNAs demonstrating a robust z-score of ±1 median absolute deviation (MAD) were taken forward for validation studies. Sensitive hits were selected on a z-score of 1. siRNA knockdown of WEE1 was performed in multiple human cancer cell lines and confirmed by western blotting and RT-q-PCR. Basal expression levels of phosphorylated WEE1, total WEE1, FOS and JUNB were assessed by western blotting. Results: Consistent with previously published findings, the siRNA screen demonstrated that loss of BRCA2 conferred increased sensitivity to WEE1 inhibition (Aarts et al. 2015). The siRNA screen also identified an additional 12 TSGs whose loss mediated sensitivity and 14 TSGs whose loss mediated resistance to WEE1 kinase inhibition. Interestingly, we found that loss of two early response genes, FOS and JUNB conferred resistance to WEE1 inhibition. FOS and JUNB interact to form the AP1 heterodimer, and previous published work has demonstrated the presence of an AP1 binding motif on the WEE1 promoter (Kawasaki et al. 2003). Using publically available gene expression data (TCGA) we have shown a significant correlation between expression of WEE1 with FOS and JUNB in multiple cancer types. Conclusions: Using a TSG siRNA screen, we have identified that loss of JUNB and FOS confers resistance to the WEE1 inhibitor MK1775. Future studies will investigate the mechanisms by which the loss of these genes affects response to WEE1 inhibition, and will also investigate the utility of these genes as predictive biomarkers for response to WEE1 inhibition in clinical samples, thereby aiding patient stratification. Citation Format: Victoria L. Dunne, Niamh McGivern, Kienan I. Savage, Nuala McCabe, Richard Kennedy. The role of early response genes (ERG’s) as a biomarker of response to Wee1 targeted therapies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 3163.

This study sought to determine the therapeutic efficacy of AZD6738, a small molecule inhibitor of ataxia telangiectasia related 3 kinase (ATR), in combination with ionising radiation (IR) for the treatment of PTEN deficient non-small cell lung cancer (NSCLC). An isogenic PTEN deficient cell model were generated in H460 and A549 cell lines by HuSH PTEN shRNA constructs in pGFP-V-RS vectors from Origene. Radiosensitivity was determined at various concentrations of AZD6738 by clonogenic assay following IR with 225 kV X-rays. Target validation and mechanistic evaluation of the ATR radiation treatments was performed by western blotting. Cell cycle distribution was obtained using propidium iodine flow cytometry analysis which was performed 48 hours following treatment with AZD6738 alone or in combination with IR. In vivo efficacy was determined using cell line derived xenografts in female SCID mice treated with AZD6738 at a concentration of 25 mg/kg per day by oral gavage for 28 days. Animals were exposed to size fraction and hypofractionated radiation dose under CBCT image guidance using the small animal radiotherapy research platform (SARRP). Radiation induced toxicity in normal lung tissue effects was investigated in a model of radiation induced fibrosis in C57BL6/J mice. In-vitro, combined treatment with AZD6738 and IR selectively targets PTEN-deficient tumour cells causing a significant reduction in clonogenic survival for both H460- and A549-PTEN KO cell models (p= Currently in vivo tumour response experiments are underway to investigate IR and ATR kinase inhibitor AZD6738 using H460-WT and H460-PTEN KO cell models as well as determining the effects of AZD6738 in a radiation induced model of lung fibrosis. Approximately 10% of NSCLC patients have mutations in PTEN. This research therefore elucidates PTEN loss as a therapeutic target for combined IR with pharmacological inhibition of ATR in NSCLC. Targeting ATR inhibition in PTEN-deficient NSCLC may serve to increase radiation sensitivity in an in vivo model thus highlighting its clinical relevance as a potential personalised medicine approach for patients with PTEN deficient NSCLC. Citation Format: Victoria Louise Dunne, Kelly Redmond, Caroline Coffey, Karl Butterworth, Kevin Prise, Gerard Hanna. Sensitivity of PTEN deficient non-small cell lung cancer to ionising radiation through inhibition of ataxia terangiectasia related 3 kinase (ATR) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 835. doi:10.1158/1538-7445.AM2017-835