The overexpression of the human epidermal growth factor receptor-2 (HER-2) in 20-25% of human breast cancers was investigated as a target for development of a gold nanoparticle (AuNP) based radiosensitizer for improving the efficacy of neoadjuvant X-radiation therapy of the disease. HER-2 targeted AuNPs were developed by covalently conjugating trastuzumab, a Health Canada approved monoclonal antibody for the treatment of HER-2-overexpressing breast cancer, to 30 nm AuNPs. Trastuzumab conjugated AuNPs were efficiently internalized by HER-2-overexpressing breast cancer cells (as assessed by darkfield microscopy and transmission electron microscopy) and increased DNA damage from X-radiation in these cells by more than 5-fold. To optimize delivery of AuNPs to HER-2-overexpressing tumors, high resolution microSPECT/CT imaging was used to track the in vivo fate of 111In-labelled non-targeted and HER-2 targeted AuNPs following intravenous (i.v.) or intratumoral (i.t.) injection. For i.v. injection, the effects of GdCl3 (for deactivation of macrophages) and non-specific (anti-CD20) antibody rituximab (for blocking of Fc mediated liver and spleen uptake) were studied. It was found that HER-2 targeting via attachment of trastuzumab paradoxically decreased tumor uptake as a result of faster elimination of the targeted AuNPs from the blood while improving internalization in HER-2-positive tumor cells as compared to non-targeted AuNPs. This phenomenon could be attributed to Fc-mediated recognition and subsequent sequestration of trastuzumab conjugated AuNP by the reticuloendothelial system (RES). Blocking of the RES did not increase tumor uptake of either HER-2 targeted or non-targeted AuNPs. Following i.t. injection, our results suggest that Au-NTs redistribute over time and traffick to the liver via the ipsilateral axillary lymph node leading to comparable exposure as seen with i.v. administration. In contrast, targeted AuNPs are bound and internalized by HER-2-overexpressing tumor cells following i.t. injection, with a lower proportion of AuNPs redistributing to normal tissues. In vivo, the combination of HER-2 targeted AuNPs injected i.t. and X-radiation (11 Gy) yielded a 46% decrease in tumor size over a 4 month period in contrast to an 11.5% increase in tumor size for X-radiation treatment alone. Toxicology studies (evaluated through complete blood cell counts, by serum transaminase and creatinine measurements and by monitoring the body weight) demonstrated no apparent normal organ toxicity from the combination of HER-2 targeted AuNPs and X-radiation. These results are promising for the clinical translation of HER-2-targeted AuNPs for radiosensitization of tumors to X-radiation.

The overexpression of the human epidermal growth factor receptor-2 (HER-2) in 20-25% of human breast cancers was investigated as a target for development of a gold nanoparticle (AuNP) based radiosensitizer for improving the efficacy of neoadjuvant X-radiation therapy of the disease. HER-2 targeted AuNPs were developed by covalently conjugating trastuzumab, a Health Canada approved monoclonal antibody for the treatment of HER-2-overexpressing breast cancer, to 30 nm AuNPs. Trastuzumab conjugated AuNPs were efficiently internalized by HER-2-overexpressing breast cancer cells (as assessed by darkfield microscopy and transmission electron microscopy) and increased DNA damage from X-radiation in these cells by more than 5-fold. To optimize delivery of AuNPs to HER-2-overexpressing tumors, high resolution microSPECT/CT imaging was used to track the in vivo fate of 111In-labelled non-targeted and HER-2 targeted AuNPs following intravenous (i.v.) or intratumoral (i.t.) injection. For i.v. injection, the effects of GdCl3 (for deactivation of macrophages) and non-specific (anti-CD20) antibody rituximab (for blocking of Fc mediated liver and spleen uptake) were studied. It was found that HER-2 targeting via attachment of trastuzumab paradoxically decreased tumor uptake as a result of faster elimination of the targeted AuNPs from the blood while improving internalization in HER-2-positive tumor cells as compared to non-targeted AuNPs. This phenomenon could be attributed to Fc-mediated recognition and subsequent sequestration of trastuzumab conjugated AuNP by the reticuloendothelial system (RES). Blocking of the RES did not increase tumor uptake of either HER-2 targeted or non-targeted AuNPs. Following i.t. injection, our results suggest that Au-NTs redistribute over time and traffick to the liver via the ipsilateral axillary lymph node leading to comparable exposure as seen with i.v. administration. In contrast, targeted AuNPs are bound and internalized by HER-2-overexpressing tumor cells following i.t. injection, with a lower proportion of AuNPs redistributing to normal tissues. In vivo, the combination of HER-2 targeted AuNPs injected i.t. and X-radiation (11 Gy) yielded a 46% decrease in tumor size over a 4 month period in contrast to an 11.5% increase in tumor size for X-radiation treatment alone. Toxicology studies (evaluated through complete blood cell counts, by serum transaminase and creatinine measurements and by monitoring the body weight) demonstrated no apparent normal organ toxicity from the combination of HER-2 targeted AuNPs and X-radiation. These results are promising for the clinical translation of HER-2-targeted AuNPs for radiosensitization of tumors to X-radiation.

Background: A highly desmoplasmic microenvironment, the mutational landscape, and intra-tumoral heterogeneity contribute to the therapy resistance in pancreatic ductal adenocarcino-ma (PDAC). Due to higher precision, proton beam therapy is regarded beneficial compared to standard photon radiotherapy, although the role of radiotherapy is still ambiguous in PDAC. Cellular adhesion to the extracellular matrix (ECM) via integrins is well-known to mediate radi-ochemoresistance in various tumor entities. In PDAC, β1 integrins are associated with tumor progression. However, their role in radiochemoresistance is yet to be unraveled. Consequently, a comparative evaluation of cell survival and therapy sensitization after inhibition of β1 integ-rins or other survival-promoting protein kinases combined with either photon or proton irradia-tion and the underlying molecular mechanisms was carried out in this work. Materials and Methods: The expression of β1 integrins in PDAC and the correlation with pa-tient survival were assessed using publicly available patient data. The effect of β1 integrin inhi-bition by inhibitory antibodies or depletion on PDAC cell survival upon photon and proton irra-diation was explored using the tumoroid formation assay in three therapy-naïve and one radio-resistant PDAC cell lines grown in more physiological 3D laminin-rich ECM. Protein expression and cellular localization of β1 integrins were analyzed applying Western blot and immunofluo-rescence in the cell line panel. Basal molecular differences and those upon β1 integrin inhibi-tion were determined by a broad-spectrum kinome profiling in therapy-naïve and radioresistant 3D PDAC cultures. A potential interrelation of specific kinases with β1 integrin signaling in re-sponse to radiation was investigated in a single and double knockdown screen. The effects of photon and proton irradiation on PDAC cell survival of five 3D cultured PDAC cell lines were comparatively assessed using the 3D tumoroid formation assay. Molecular alterations upon both radiation types were identified by a broad-spectrum phosphoproteome analysis and Western blot. The exploitation of uniquely altered molecules and other signal transduction and DNA repair molecules for specific sensitization to photon and proton radiation was evaluated using specific biologicals in 3D cultured PDAC cell lines. Results: β1 integrins are overexpressed in PDAC compared to the normal pancreas, and the expression correlates with poorer patient survival. β1 integrin expression and localization var-ied cell line-dependently in the PDAC cell line panel. β1 integrin inhibition elicited an increase in radiosensitivity in all analyzed therapy-naïve and radioresistant 3D PDAC cultures, although less prominent in the latter. In line, the extent of kinase deregulation induced by AIIB2 was lower in the radioresistant 3D PDAC cultures. Double targeting of specific kinases with β1 in-tegrins further increased the radiosensitization in the therapy-naïve 3D PDAC cell cultures, whereas in the radioresistant counterpart, the effect was weak. Further, Erk2, PKD1, and CK1δ were revealed as potential interactors in the β1 integrin-mediated response to radiation. Proton irradiation showed a higher efficacy in the reduction of PDAC cell survival than photon irradia-tion. On the molecular level, irradiation with protons induced more phosphoproteomic altera-tions than photon radiation. Targeting of molecules uniquely altered upon irradiation failed to sensitize 3D PDAC cultures radiation type-specifically. However, a similar degree of radiosen-sitization for proton and photon irradiation in 3D PDAC cultures was observed upon targeting signal transduction and DNA repair proteins. Targeting non-homologous end joining (NHEJ)-specific proteins increased cellular radiosensitivity exceedingly for both radiation types in all 3D PDAC cell cultures. Conclusion: This work revealed a fundamental role of β1 integrins in intrinsic and acquired radioresistance of PDAC. However, to substantially overcome acquired radioresistance, further investigation is needed. Furthermore, a similar efficacy of proton and photon irradiation when combined with targeted therapies was demonstrated. These results suggest that multitargeting approaches based on targeting of β1 integrins or NHEJ-specific molecules combined with pho-ton or proton irradiation may turn out particularly promising. The strong radiosensitizing poten-tial of targeting these molecules may enable a more frequent use of radiotherapy for PDAC patient treatment. / Hintergrund: Ein stark desmoplasmatisches Mikromilieu, das Mutationsprofil und die intra-tumorale Heterogenität tragen zur Therapieresistenz des Pankreaskarzinoms bei. Aufgrund der höheren Präzision wird die Protonentherapie als vorteilhaft gegenüber der Standard Pho-tonentherapie angesehen, obwohl ihre Wirksamkeit im Pankreaskarzinom noch ungewiss ist. Es ist bekannt, dass die zelluläre Adhäsion an die extrazelluläre Matrix (EZM) über Integrine die Radiochemoresistenz in verschiedenen Tumorentitäten vermittelt. Hierbei stehen β1 In-tegrine in Zusammenhang mit dem Fortschreiten der Erkrankung. Welche Rolle die β1 Integri-ne in der Radiochemoresistenz im Pankreaskarzinom spielen ist jedoch noch nicht bekannt. In dieser Arbeit wurde daher eine vergleichende Analyse des Zellüberlebens und der Therapie-empfindlichkeit nach Hemmung von β1 Integrinen oder anderen überlebensfördernden Pro-teinkinasen in Kombination mit Photonen- oder Protonenbestrahlung sowie der zugrundelie-genden molekularen Mechanismen durchgeführt. Material und Methoden: Die Expression von β1 Integrinen im Pankreaskarzinom und die Kor-relation mit dem Patientenüberleben wurden mittels öffentlich verfügbarer Patientendaten be-stimmt. Die Wirkung der β1-Integrin-Hemmung durch inhibitorische Antikörper oder mittels knockdown auf das Überleben von Pankreaskarzinomzellen bei Bestrahlung mit Photonen und Protonen wurde durch den Tumoroidbildungsassay in drei therapienaiven und einer strahlen-resistenten Pankreaskarzinomzelllinien untersucht. Diese wurden in physiologischer, 3D Lami-nin-reicher EZM kultiviert. Die Proteinexpression und die zelluläre Lokalisation von β1 Integri-nen wurden in allen Zelllinien mittels Western Blot und Immunfluoreszenz analysiert. Basale molekulare Unterschiede und solche nach Hemmung von β1 Integrinen wurden durch eine Breitspektrum-Kinomanalyse in therapienaiven und strahlenresistenten 3D-Pankreaskarzinomkulturen bestimmt. Eine mögliche Wechselbeziehung spezifischer Kinasen mit der β1 Integrin-vermittelten Strahlenantwort wurde in einem Einzel- und Doppel-knockdown Screen untersucht. Die Effekte der Bestrahlung mit Photonen und Protonen auf das Überleben von Pankreaskarzinomzellen wurden vergleichend anhand des Tumoroidbildungsassays in fünf 3D-kultivierten Pankreaskarzinomzelllinien bewertet. Durch beide Strahlungstypen indu-zierte molekulare Veränderungen wurden durch eine Breitspektrum-Phosphoproteomanalyse und mittels Western Blot identifiziert. Die Nutzung einzigartig veränderter Moleküle sowie an-derer Signaltransduktions- und DNA-Reparaturmoleküle zur spezifischen Sensibilisierung für Photonen- und Protonenstrahlung wurde untersucht. Dies erfolgte durch eine gezielte Hem-mung dieser Moleküle durch spezifische Biologika in 3D-kultivierten Pankreaskarzinomzellli-nien. Ergebnisse: β1 Integrine sind im Pankreaskarzinom im Vergleich zum gesunden Pankreas überexprimiert und ihre Expression korreliert negativ mit dem Patientenüberleben. Die Expres-sion und Lokalisierung der β1 Integrine variierte zelllinienabhängig in den Pankreaskarzinom-zelllinien. Die Hemmung der β1 Integrine führte zu einer Erhöhung der Strahlenempfindlichkeit in allen analysierten therapienaiven und strahlenresistenten 3D kultivierten Pankreaskarzinom-zelllinien, auch wenn diese in den letzteren weniger stark ausfiel. Auch der Grad der durch die Hemmung induzierten Deregulierung von Kinasen in den strahlenresistenten 3D Pankreaskar-zinomzellkulturen war geringer. Der gleichzeitige knockdown spezifischer Kinasen mit β1 In-tegrinen potenzierte die Strahlenempfindlichkeit in den therapienaiven 3D Pankreaskarzinom-zellkulturen, während diese im strahlenresistenten Pendant nur wenig beeinflusst wurde. Fer-ner wurden Erk2, PKD1 und CK1δ als potenziell beteiligte Kinasen in der durch β1 Integrine vermittelten Strahlenantwort entdeckt. Die Bestrahlung mit Protonen zeigte eine höhere Wirk-samkeit bei der Verringerung des Pankreaskarzinomzellüberlebens als die Photonenbestrah-lung. Auf molekularer Ebene induzierte die Protonenbestrahlung mehr Veränderungen im Phosphoproteom als die Photonenbestrahlung. Die gezielte Hemmung von einzigartig verän-derten Molekülen sensibilisierte die 3D Pankreaskarzinomzellkulturen nicht Strahlungsart-spezifisch. Jedoch konnte eine ähnliche Effizienz der beiden Strahlungstypen nach Hemmung gewisser Signaltransduktions- und DNA-Reparaturproteine in 3D Pankreaskarzinomzellkultu-ren gezeigt werden. Die zelluläre Strahlenempfindlichkeit gegenüber beiden Strahlungsarten wurde hierbei besonders durch die Hemmung spezifischer Proteine des non-homologous end joining (NHEJ) in allen 3D Pankreaskarzinomzellkulturen erhöht. Schlussfolgerung: Diese Arbeit konnte eine wesentliche Rolle von β1 Integrinen bei der intrinsischen und erworbenen Strahlenresistenz im Pankreaskarzinom ermitteln. Um die Strah-lenresistenz jedoch gänzlich zu überwinden, sind weitere Untersuchungen erforderlich. Des Weiteren wurde eine ähnliche Wirksamkeit von Protonen- und Photonenbestrahlung in Kombi-nation mit gezielten Therapien gezeigt. Diese Ergebnisse legen nahe, dass Multi-Targeting-Ansätze, die auf der Hemmung von β1 Integrinen oder NHEJ-spezifischen Molekülen in Kom-bination mit Photonen- oder Protonenbestrahlung basieren, ausgesprochen vielversprechend sein können. Angesichts des enormen Potentials zur Steigerung der Strahlenempfindlichkeit durch die Hemmung dieser Moleküle könnte eine häufigere Anwendung der Strahlentherapie bei Pankreaskarzinompatienten ermöglicht werden.