Selective inhibition of parallel DNA damage response pathways optimizes radiosensitization of glioblastoma stem-like cells

Glioblastoma (GBM) is the most common form of primary brain tumor in adults that is essentially incurable. Despite aggressive treatment regimens centered on radiotherapy, tumor recurrence is inevitable and thought to be driven by GBM stem-like cells (GSCs) that are highly radioresistant. DNA damage response pathways are key determinants of radiosensitivity, but the extent to which these overlapping and parallel signaling components contribute to GSC radioresistance is unclear. Using a panel of primary patient-derived GBM cell lines and clonogenic survival assays, we confirmed that GSCs were significantly more radioresistant than paired tumor bulk populations. DNA damage response targets ATM, ATR, CHK1, and PARP-1 were upregulated in GSCs, and CHK1 was preferentially activated following ionizing radiation. Consequently, GSCs exhibited rapid G2/M cell cycle checkpoint activation and enhanced DNA repair. Inhibition of CHK1 or ATR successfully abrogated G2/M checkpoint function,
leading to increased mitotic catastrophe, but modestly increased radiation sensitivity. Conversely, ATM inhibition exerted dual effects on cell cycle checkpoint regulation and DNA repair that were associated with greater radiosensitizing effects than inhibition of CHK1, ATR or PARP alone. Combined PARP and ATR inhibition resulted in profound radiosensitization of GSCs that was greater than in bulk populations and also exceeded the effect of ATM inhibition. These data demonstrate that multiple, parallel DNA damage signaling pathways contribute to GSC radioresistance and that combined inhibition of cell cycle checkpoint and DNA repair targets provides the most effective means to overcoming therapy resistance.