Abstract 7107: Clustered DNA double strand breaks for cancer treatment via multi-gRNA CRISPR system
Authors: Badakul Gamze , Sharma Neelam , Nickoloff Jac A. 
Published: March 2024

Abstract
Radiation therapy is one of the most common cancer treatments. Ionizing radiation generates DNA double-strand breaks (DSBs), which are the most lethal type of DNA damage. The dominant pathway for repairing DSBs is non-homologous end joining (NHEJ), but homologous recombination (HR) is also important. NHEJ is dominant pathway in all cell cycle phases while HR is largely restricted to S and G2 phases. Unrepaired or misrepaired DSBs can lead to cell death. KU70/80 and DNA-PKcs are essential for NHEJ. KU70/80 binds to broken ends, and DNA-PKcs binds to DNA-bound KU70/80, which activates DNA-PKs kinase allowing NHEJ to proceed. Clustered DSBs (two or more DSBs separated by &lt;200 bp) generate small DNA fragments that are efficiently bound by KU70/80 and DNA-PKcs, but fail to activate DNA-PKcs kinase, inhibiting NHEJ and shifting repair toward HR. Thus, clustered DSBs are poorly repaired and more cytotoxic than dispersed DSBs. There are two types of ionization radiation: high LET and low LET. High LET radiation has a higher ionization density and therefore induces more clustered DSBs than low LET, which explains why high LET radiation is more cytotoxic at a given dose. A major limitation of radiotherapy is normal tissue damage. We hypothesize that mimicking high-LET-induced clustered DSBs using CRISPR/Cas9 targeted to cancer-specific DNA sequences (e.g., indel mutations) will effectively kill cancer cells but spare normal cells. In this approach, DSBs are not targeted to specific genes, nor is CRISPR/Cas9 used for gene editing. Instead, cancer cell killing is achieved by inducing poorly repaired DSBs anywhere in cancer cell DNA. Thus, this therapeutic approach is distinct from conventional targeted therapies that are oncogenic pathway-dependent, and this eliminates oncogenic pathway-dependent resistance mechanisms. However, types of resistance are possible, such as upregulated DSB repair. Our data indicate that the cytotoxicity of clustered DSBs depends on the number of small DNA fragments induced, thus we observe similar cytotoxicity with a localized, 4-DSB cluster and with three non-localized 2-DSB clusters, as each generates 3 small fragments per target chromosome. This finding significantly increases available targets as 2-DSB clusters can be induced at indels and flanking (wild-type) sites, generating clustered DSBs in cancer cells but efficiently repaired dispersed DSBs in normal cells lacking the cancer indel. Data also indicates that a single DSB targeted to each amplicon of highly amplified regions is also cytotoxic, and we are exploring the effectiveness of combination clustered DSBs targeted to amplified regions. We are also exploring how DSB repair inhibitors (like ATMi, DNA-PKcsi or RAD51i) can augment cytotoxic DSB effects, potentially mitigating that resistance pathway. These proof-of-principal studies represent the first approach to targeted cancer therapy that is oncogenic pathway-independent.
Citation Format: Gamze Badakul, Neelam Sharma, Jac A. Nickoloff. Clustered DNA double strand breaks for cancer treatment via multi-gRNA CRISPR system [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 7107.