Abstract 1185: PRMT5 inhibition epigenetically regulates DNA damage response pathways in cancer cells and sensitizes to chemotherapy and PARP inhibition
Authors: Ito Koichi , Carter Jack , Thodima Venkat , Zhang Youyou , Sivakumar Monisha , Xu Mu , Bhagwat Neha , Rager Joseph , Spruance Jacob , Zhang Lin , Ruggeri Bruce , Scherle Peggy , Vaddi Kris 
Published: July 2021

Abstract
Genetic defects of DNA damage response (DDR) pathways in cancer cells induce synthetic lethality with chemotherapy and PARP inhibitors. However, many patients with advanced cancers develop resistance to these therapies mainly due to circumvention and/or restoration of the inactivated DDR genes. In the present study, we demonstrate that pharmacological inhibition of PRMT5, the major type II protein arginine methyltransferase, epigenetically downregulates multiple genes involved in the DDR/DNA replication pathways, resulting in the sensitization of cancer cells to chemotherapy and PARP inhibition. Treatment with C220 or PRT543, potent and selective PRMT5 inhibitors, downregulates expression of DDR genes and/or proteins including BRCA1/2, ATM/ATR, CHK1/2, RAD51, POLD1/3, and PNKP in multiple types of cancer cells in vitro. Mechanistically, PRT543 promotes global alternative splicing (ΔPSI) changes, including intron retention and exon skipping. In particular, PRT543 significantly increases retained intron of POLD1 and PNKP genes, which are downstream of the spliceosome subunit SRSF1, a major protein substrate of PRMT5. Additionally, PRT543 increases intron retention of ATM and ATR genes. For BRCA1/2, CHK1/2 and RAD51, no changes in alternative splicing were observed, suggesting the involvement of other mechanisms such as the CLNS1A/H4R3me2s chromatin regulation pathway. The regulation of the DDR pathway by PRT543 is associated with increased DNA damage as determined by COMET and gamma H2AX analyses. Combining PRT543 with PARP inhibitors or DNA-alkylating agents demonstrates a potent synergistic interaction in both HR proficient and HR deficient cancer cell lines in vitro. Similar combination effects are observed in primary cultures of patient-derived breast cancer and high-grade serous ovarian cancer. Moreover, combination of PRT543 with PARP inhibition effectively inhibits the growth of HCC1569 CDX breast cancer in vivo. Further ex vivo and in vivo combination studies with PRT543 and PARP inhibitors or chemotherapy in genetically defined CDX and PDX models are ongoing. These studies not only reveal a novel mechanism of PRMT5 inhibition, but also suggest beneficial combination effects with other therapies, particularly in patients with tumors that are resistant to therapies that are dependent on DNA damage as their mechanism of action. PRT543 is currently under evaluation in a Phase I clinical trial in patients with advanced solid tumors and hematological malignancies (NCT03886831).
Citation Format: Koichi Ito, Jack Carter, Venkat Thodima, Youyou Zhang, Monisha Sivakumar, Mu Xu, Neha Bhagwat, Joseph Rager, Jacob Spruance, Lin Zhang, Bruce Ruggeri, Peggy Scherle, Kris Vaddi. PRMT5 inhibition epigenetically regulates DNA damage response pathways in cancer cells and sensitizes to chemotherapy and PARP inhibition [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 1185.