posted on 2025-11-25, 13:07authored byGonzalo Rodriguez-Berriguete, Marco Ranzani, Remko Prevo, Rathi Puliyadi, Nicole Machado, Hannah R. Bolland, Val Millar, Daniel Ebner, Marie Boursier, Aurora Cerutti, Alessandro Cicconi, Alessandro Galbiati, Diego Grande, Vera Grinkevich, Jayesh B. Majithiya, Desiree Piscitello, Eeson Rajendra, Martin L. Stockley, Simon J. Boulton, Ester M. Hammond, Robert A. Heald, Graeme C.M. Smith, Helen M.R. Robinson, Geoff S. Higgins
<p>Polθ inhibitor ART899 combined with radiation causes significant tumor growth delay <i>in vivo</i> and is well tolerated. <b>A,</b> ART899 plasma concentration following oral dosage of ART899 at 50 or 150 mg/kg. Mouse plasma samples (<i>n</i> = 3 per treatment group) were collected at 30 minutes, 1, 2, 4, 8, and 12 hours after last dose. <b>B–E,</b> HCT116 tumor-bearing mice treated with 150 mg/kg Polθ inhibitor ART899 twice daily for 12 days and/or 10 × 2 Gy (days 1–5 and 8–12). Vehicle (<i>n</i> = 9); ART899 (<i>n</i> = 10); 10 × 2 Gy + vehicle (<i>n</i> = 10); 10 × 2 Gy + ART899 (<i>n</i> = 10). <b>B,</b> Mean ± SEM relative tumor size. <i>P</i> value from mixed effect model and Dunnett post-test. Comparison of tumor size at the latest common timepoint for 10 × 2 Gy versus 10 × 2 Gy + ART899 are shown in Supplementary Fig. S6A. <b>C,</b> Individual mouse graphs. <b>D,</b> Kaplan–Meier plot for a tumor size threshold of 1,000 mm<sup>3</sup>. HR: Hazard ratio (hazard rate of IR arm / hazard rate of IR + ART899 arm); <i>P</i> value from the log-rank (Mantel-Cox) test comparing IR alone and IR + ART558. The median time to a tumor size of 1,000 mm<sup>3</sup> for the IR + ART899 arm versus the IR arm and the corresponding ratio are shown in Supplementary Fig. S6B. <b>E,</b> Average mouse weight ± SD from all treatment groups over time. Individual mouse weights are shown in Supplementary Fig. S6C.</p>
Funding
Cancer Research UK Radnet Oxford Centre
Howat Foundation (The Howat Foundation)
HORIZON EUROPE European Research Council (ERC)
Wellcome Trust (WT)
Cancer Research UK (CRUK)
Engineering and Physical Sciences Research Council (EPSRC)
DNA polymerase theta (Polθ, encoded by the POLQ gene) is a DNA repair enzyme critical for microhomology mediated end joining (MMEJ). Polθ has limited expression in normal tissues but is frequently overexpressed in cancer cells and, therefore, represents an ideal target for tumor-specific radiosensitization. In this study we evaluate whether targeting Polθ with novel small-molecule inhibitors is a feasible strategy to improve the efficacy of radiotherapy.
We characterized the response to Polθ inhibition in combination with ionizing radiation in different cancer cell models in vitro and in vivo.
Here, we show that ART558 and ART899, two novel and specific allosteric inhibitors of the Polθ DNA polymerase domain, potently radiosensitize tumor cells, particularly when combined with fractionated radiation. Importantly, noncancerous cells were not radiosensitized by Polθ inhibition. Mechanistically, we show that the radiosensitization caused by Polθ inhibition is most effective in replicating cells and is due to impaired DNA damage repair. We also show that radiosensitization is still effective under hypoxia, suggesting that these inhibitors may help overcome hypoxia-induced radioresistance. In addition, we describe for the first time ART899 and characterize it as a potent and specific Polθ inhibitor with improved metabolic stability. In vivo, the combination of Polθ inhibition using ART899 with fractionated radiation is well tolerated and results in a significant reduction in tumor growth compared with radiation alone.
These results pave the way for future clinical trials of Polθ inhibitors in combination with radiotherapy.