Breast cancer is the most commonly observed cancer type in women and is the second leading cause of cancer death in women. Radiation can be used to debulk tumors prior to surgery as well as to treat patients after surgery and/or chemotherapy. Previous studies from our laboratory have shown that the anti –malarial drug chloroquine sensitizes breast cancer cell lines to radiation by suppression of autophagy which is a conservative catabolic process that can be cytoprotective. The scientific literature has demonstrated that many tumor cell systems undergo cytoprotective autophagy and that pharmacological or genetic inhibition of autophagy leads to other modes of cell death such as apoptosis. Acridine orange staining was used for determination of acidic vacuole formation, an indication of autophagy and DAPI/TUNEL staining was used to identify apoptotic cells. Our studies in Hs578t breast tumor cells show the lack of sensitization by chloroquine upon autophagy inhibition with minimal apoptosis when cells are treated with 5 × 2Gy radiation. The extent of apoptosis was not increased upon autophagy inhibition by Chloroquine as determined by DAPI/TUNEL assays and quantified by Flow Cytometry using AnnexinV/PI. The potential role of senescence in the effects of radiation in the Hs578t cells was determined with the use of β-Galactosidase dye staining for senescence. It appears from these studies that autophagy need not to be cytoprotective in all breast cancer cell lines. Additional studies are in progress to effort to identify the factors that might distinguish between cytoprotective and non-cytoprotective autophagy.

In general, ionizing radiation promotes cytoprotective autophagy in a majority of breast tumor cells. Previous studies from our laboratory indicated that radiation (5x2 Gy) induces cytoprotective autophagy in MCF-7 cells. In the current work, inhibition of autophagy by silencing of Beclin-1 in MCF-7 cells resulted in an increase in sensitivity to radiation based both on cell number and clonogenic survival; however, there was no increase in apoptosis and the basis for this sensitization is currently under investigation. Unexpectedly, enhancement of autophagy by silencing of Bcl-2 also led to an increase in sensitivity to radiation, possibly through the conversion of cytoprotective to cytostatic autophagy. In contrast to the MCF-7 cells, radiation (5x2 Gy) induces non-protective autophagy in Hs578t cells. Interference with autophagy through silencing of Beclin-1 or induction of Bcl-2 did not alter radiation sensitivity in the Hs578t cells. Since the induction of cytoprotective autophagy can represent an impediment to radiation therapy, it is important to understand the types of autophagy that occur in response to radiation in specific cellular settings and whether interference with autophagy can increase sensitivity to different forms of cancer treatment.