Usp14 Is A Potential Target To Improve The Efficacy Of Radiotherapy In Combination With Immune-Checkpoint Inhibitors In Non-Small Cell Lung Cancer.

Abstract Non-small cell lung cancer (NSCLC) represents ~85% of lung cancer cases and has a 5-year survival rate of ~23%. Thus, research aimed at determining more effective treatment strategies is critical. Immune checkpoint inhibitors (ICis), e.g. anti-PD-L1 antibodies, have transformed cancer treatment in recent years. Clinical trial studies have indicated that radiotherapy enhances the curative effect of ICis. However, most patients do not respond to immune-radiotherapy combinations. While best known to induce DNA double strand break (DSB)-mediated cytotoxicity, ionizing radiation (IR) induces an increase of cytosolic DNA and activates the cyclic GMP-AMP synthase/stimulator of interferon genes (cGAS/STING) signaling pathway that leads to the type 1 interferon (IFN) response, essential to achieve anti-tumor immunity in combination with ICis. Homologous recombination (HR) DNA repair deficiency is an important determinant of radiation response that can also increase the immune recognition of cancers by increasing the number of non-synonymous mutations, as well as by increasing the cGAS/STING-mediated type1 IFN response. We have shown an important role for ubiquitin specific protease (USP14) in regulating DNA repair (1, 2,3). Here, we identify a novel role of USP14 in regulating HR and the cGAS/STING pathway in response to IR in NSCLC. USP14 is a proteasomal deubiquitinase that we show to have a prominent role in NSCLC. Knockdown of USP14 (shUSP14) or its pharmacological inhibition (IU1 or VLX1570) led to: (i) radio-sensitization, as shown by reduced clonogenic survival in NSCLC cell lines, and delayed growth of NSCLC tumor xenografts in nude mice; increased (ii) HR-deficiency; (iii) chromosomal aberrations and micronuclei formation; as well as (iv) cGAS puncta in response to IR. Further, USP14 interacts with and deubiquitinates cGAS in IR-treated NSCLC cells. USP14-mediated deubiquitination of cGAS has been shown to inhibit cGAS protein turn-over and increase the levels of cGAS in response to virus infection. Unexpectedly, however, in response to IR shUSP14 NSCLC cells have significantly higher cytoplasmic cGAS puncta and type 1 IFN response. Overall, these findings identify USP14 as a potential target to enhance sensitization to immune-radiotherapy by both regulation of HR and direct regulation of cGAS ubiquitination, leading to type 1 IFN response. Understanding the mechanisms that regulate DSB repair and cGAS/STING pathways holds potential for developing strategies to enhance the effectiveness of immune-radiotherapy combinations in NSCLC. References 1. Sharma et al, (2108) USP14 regulates DNA damage repair by targeting RNF168-dependent ubiquitination. Autophagy, 14: 1976-90. 2. Sharma et al. USP14 is a deubiquitinase for Ku70 and critical determinant of non-homologous end joining repair in autophagy- and PTEN-deficient cells. Nucleic Acids Res. 48: 736-47. 3. Sharma, Almasan (2020). USP14 regulates DNA damage response and is a target for radiosensitization in non-small cell lung cancer. Int J Mol Sci. 21: 6383. Citation Format: Arishya Sharma, Yvonne Parker, Claudia Marcela Diaz-Montero, Daniel Lindner, Alexandru Almasan. USP14 is a potential target to improve the efficacy of radiotherapy in combination with immune-checkpoint inhibitors in non-small cell lung cancer [abstract]. In: Proceedings of the AACR Virtual Special Conference on Radiation Science and Medicine; 2021 Mar 2-3. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(8_Suppl):Abstract nr PO-029.