Browsing by Subject "Replication"

Now showing 1 - 1 of 1

Hyperthermie steigert die Zytotoxizität von Cisplatin und Doxorubicin durch Hemmung der Poly(ADP-Ribosyl)ierung und der damit einhergehenden Verhinderung der Replikationsblockade
(2015) Schaaf, Lea; Aulitzky, Walter E.
Peritoneal carcinomatosis describes widespread metastases of cancerous tumors in the peritoneal cavity particularly arising from ovarian and colon cancers. For long time this far advanced tumor disease was considered extremely difficult to treat. Therefore, only palliative measures were carried out in most cases. This has changed significantly in recent years with the introduction of multimodal treatment options consisting of a complete macroscopic tumor reduction (CRS) followed by an intraoperative intraperitoneal hyperthermic chemotherapy (HIPEC). It is undisputed that this local chemotherapy application allows treatment with much higher drug concentrations as compared to the systemic therapy. However, the role of hyperthermia in this multimodal approach has not been fully clarified so far. There is still no clinical study available showing a clear benefit of elevated temperature in the intraperitoneal chemotherapy. Largely unknown is also which level of temperatures are really needed for an elevated cytotoxicity of chemotherapeutics. Furthermore, the molecular mechanisms behind this synergistic effect are poorly investigated. To answer these questions, an in vitro model was established mimicking the situation of the HIPEC procedure as closely as possible. This model allowed to define a very precise temperature threshold of 40°C. An effective increase in cytotoxicity of cisplatin and doxorubicin was only observed at temperatures of 40°C or above. Importantly, this temperature threshold was also of clinical relevance. Patients who reached this temperature over at least 40 minutes at two sites in the abdominal cavity, namely omental bursa and pelvis, showed a significantly increased overall and progression free survival. In-vitro hyperthermia leads to an increased intracellular concentration of doxorubicin. Interestingly, however, the synergy of hyperthermia with doxorubicin was observed even after reducing the drug concentrations to values which are also reached at 37° C. Together with the finding that hyperthermia had no effect on the amount of DNA-cisplatin adducts, these results clearly indicate that the increased intracellular drug accumulation is not the predominant mechanism behind the synergistic effects of chemotherapeutics and hyperthermia. Rather a compromised repair of cisplatin and doxorubicin induced DNA damages upon hyperthermia treatment could be identified to be important for the observed effects. This significantly delayed DNA repair depends on inhibition of the poly(ADR-ribosyl)ation (PARylation) by hyperthermia. Interestingly, hyperthermia selectively increased the efficiency of cytotoxic agents that induce PARylation. The hypothesis that inhibition of PARylation plays a key role for the synergy between hyperthermia and chemotherapy is further supported by the finding that the treatment with specific pharmacological PARP inhibitors resulted in a comparable elevation of cisplatin and doxorubicin induced cytotoxicity. In this respect PARylation could be identified as a molecular marker for a preclinical substance-screen to identify drugs acting together with hyperthermia. In addition, these in-vitro results for the first time show that there are alternatives to the hyperthermic treatment, which is associated with considerable side effects. Thus, intraperitoneal chemotherapy could be combined with systemic PARP inhibitor pre-treatment. Clinically approved specific PARP inhibitors are far better tolerated by patients than hyperthermia. Hyperthermia mediated inhibition of PARylation led to an increase in the percentage of cells with DNA double-strand breaks (DSB). Interestingly, the results of this work indicate a hyperthermia-induced switch from HR to the error-prone NHEJ. In combination with hyperthermia there was a significant increase in P-53BP1 foci formation, while both the percentage of cells with Rad51 foci and Rad51 protein level remained unchanged. The finding that these DSBs occur only in S-phase cells points to a replication-associated mechanism. In fact, in the framework of this work it could be demonstrated for the first time that drug-induced stalled replication forks are circumvented by the hyperthermia-mediated inhibition of PARylation. The unhindered progression of replication forks upon inhibition of PARylation by hyperthermia or pharmacological PARP inhibition presumably results in the increase of DNA DSBs as well as in the significantly reduced long-term-survival