Selective Inhibition of ATM-dependent Double-strand Break Repair and Checkpoint Control Synergistically Enhances the Efficacy of ATR Inhibitors

Ataxia telangiectasia and Rad3-related protein (ATR) kinase regulate a vital cell regulatory node for maintaining genomic integrity by stopping replication fork collapse. ATR inhibition continues to be proven to improve replication stress leading to DNA double-strand breaks (DSBs) and cancer cell dying, and many inhibitors they are under clinical analysis for cancer therapy. However, activation of cell-cycle checkpoints controlled by ataxia telangiectasia-mutated (ATM) kinase could minimize the lethal effects of ATR inhibition and safeguard cancer cells. Here, we investigate ATR-ATM functional relationship and potential therapeutic implications. In cancer cells with functional ATM and p53 signaling, selective suppression of ATR catalytic activity by M6620 caused G1-phase arrest to avoid S-phase entry with unrepaired DSBs. The selective ATM inhibitors, M3541 and M4076, covered up both ATM-dependent cell-cycle checkpoints, and DSB repair decreased the p53 protective barrier and extended the existence of ATR inhibitor-caused DSBs. Combination treatment amplified the fraction of cells with structural genetic defects that has been enhanced cancer cell dying. ATM inhibitor synergistically potentiated the ATR inhibitor effectiveness in cancer cells in vitro and elevated ATR inhibitor effectiveness in vivo at doses that didn’t show overt toxicities. In addition, a mixture study in 26 patient-derived xenograft types of triple-negative cancer of the breast using the newer generation ATR inhibitor M4344 and ATM inhibitor M4076 shown substantial improvement in effectiveness and survival in contrast to single-agent M4344, suggesting a singular and potentially broad combination method of cancer therapy.