A High Content Clonogenic Survival Drug Screen Identifies MEK Inhibitors as Potent Radiation Sensitizers for KRAS Mutant Non–Small-Cell Lung Cancer Steven.

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A High Content Clonogenic Survival Drug Screen Identifies MEK Inhibitors as Potent Radiation Sensitizers for KRAS Mutant Non–Small-Cell Lung Cancer Steven H. Lin, MD, PhD, Jing Zhang, PhD, Uma Giri, PhD, Clifford Stephan, PhD, Mary Sobieski, BS, Ling Zhong, BS, Kathy A. Mason, MS, Jessica Molkentine, BS, Howard D. Thames, PhD, Stephen S. Yoo, PhD, John V. Heymach, MD, PhD Journal of Thoracic Oncology Volume 9, Issue 7, Pages 965-973 (July 2014) DOI: 10.1097/JTO.0000000000000199 Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 The high content clonogenic survival assay (HCSA) recapitulates results from traditional clonogenic survival assay and allows the identification of radiation sensitizers. A, comparison in techniques between traditional and HCSA methods. The workflow on the left panel depicts the typical workflow of the traditional assay, whereas the right panel depicts workflow for the HCSA. The length of arrows corresponds to the relative length of time it takes to execute each of the steps. (B) Left panel: crystal violet stain and low magnification images of the triplicate wells from a 96 well plate with cells seeded at various densities per well. Right panel: INCell6000 images of the corresponding wells. (C) A comparison of the colonies formed by two lung cancer cell lines with different morphologies, one the H460 that forms tighter aggregates whereas the A549 expresses mesenchymal characteristics and grows colonies in patterns that are more spread out. The image software was able to enumerate colonies of both types, as depicted by the image analysis. (D) Comparison in survival curves between the traditional and HCSA methods. HCSA recapitulates a similar survival curve as produced by the traditional method. (E) The survival fraction at 2 Gy (SF2) comparing various cell types: glioblastoma (U251), prostate cancer (DU145, PC3), and pancreatic cancer (Miapaca2). Journal of Thoracic Oncology 2014 9, 965-973DOI: (10.1097/JTO.0000000000000199) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 Validation of the HCSA method to identify radiation sensitizers using vorinostat and PI-103. A, one micromolar vorinostat was used for the tCSA method, but at such doses no clonogens were produced in the HCSA, and therefore lower doses (200 and 400 nM) were used (B-C). High content clonogenic survival assay had very similar enhancement effects compared with tCSA, with a dose-dependent radiation enhancement effect. DER, dose enhancement ratio as a radiation dose of control over drug at survival fraction 0.5 (SF0.5). (D) 500 nM PI-103 was added to seeded cells for 6 hours before irradiation at indicated doses. Media was changed at 72 hours of total drug exposure. (E) PI-103 at 25 or 50 nM (F) was added to seeded cells for 6 hours before irradiation at corresponding doses. Cells were not perturbed until crystal violet staining on day 5. Journal of Thoracic Oncology 2014 9, 965-973DOI: (10.1097/JTO.0000000000000199) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 3 High content clonogenic survival assay enables the identification of classes of radiation sensitizers through drug screening. A, representative screening results of plate one of the Custom Clinical Collection (CC1) and plate two of the collection (CC2) on the H460 cells, with the identity of the drugs on the right side of each row of cells. The columns represent one drug concentration or sham control, and each row depicts one particular drug. #N/A are blanks with 0.1% DMSO or RPMI. A green block represents single agent activity without apparent radiation enhancement effect, a pink block represents drugs that are weakly enhancing (<1 log10 shifted) and red block represents drugs that are strongly enhancing (≥1 log10 shifted). (B) List of drugs that are identified in the screen to have significant enhancement effects. Drugs within the same class are listed together. The inset figure illustrates with asterisks a few of the proteins along the signaling cascade of activated KRAS that radiosensitize when blocked. (C) Examples of three classes of radiosensitizing drugs identified in the screen, namely the HDAC inhibitors, PARP inhibitors, and MEK inhibitors. Journal of Thoracic Oncology 2014 9, 965-973DOI: (10.1097/JTO.0000000000000199) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 4 The MEK inhibitor trametinib is a selective radiation sensitizer in KRAS mutant lung cancer cells. A, traditional clonogenic survival assay was used to determine the relative potency of trametinib (MEKi) in various lung cancer cell lines, with or without KRAS mutations. This effect seems to be selective in cells lines with KRAS mutations, also the potency differ between the KRAS mutant lines. No effect was apparent in the wild-type (WT) cells. (B) Radiation-induced pERK activation that was seen in the H460 but not in the WT H661 cell line. This activation was fully blocked by treating cells with trametinib. (C) Cell cycle analysis in two KRAS mutant and two KRAS WT cells. Significant S phase prolongation and diminution of G1/S cells was apparent in the KRAS mutant cells treated with trametinib and radiation, but not seen with either agent alone or in the WT cell lines. (D) Xenograft model of H460 cells to determine the amount of growth delay with combined treatments versus single agent alone. Drug treatment lasted 14 days, the first 5 were combined with radiation at 2 Gy per day. Drugs were given by oral gavage at 2 mg/kg 4 hours before radiation administration. Journal of Thoracic Oncology 2014 9, 965-973DOI: (10.1097/JTO.0000000000000199) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions