Abstract 3912: ATM and PARP combined inhibition demonstrate synergistic antitumor efficacy in osteosarcoma models

Abstract Signatures of BRCAness are found in many osteosarcoma (OS) tumors, driving an interest in PARP inhibition (PARPi) for OS treatment. Although PARPi have shown limited efficacy as OS monotherapy, rational combination strategies have not yet been explored for this disease. We performed a genome-scale loss-of-function CRISPR-Cas9 screen in two OS cell lines in the presence and absence of olaparib, a small molecule PARPi. ATM knockout (KO) scored highly as a potent synergizer of PARPi across both cell lines. Here we report this screen finding as well as in vitro validation of PARPi and ATM inhibition (ATMi) synergy in OS models. OS cell lines SAOS2 and CAL72 were infected with the Avana genome-scale lentiviral CRISPR library, targeting 20,000 genes with 4 uniquely barcoded guides (sgRNAs) per gene. After infection and antibiotic selection, cells were grown in an IC40 dose of olaparib or matched control for 18 days. Following DNA sequencing of barcodes and rigorous quality control, sgRNA dropout hits were calculated against the control arm. ATM KO sensitizing to PARPi was first validated utilizing a CRISPR-based genetic approach. ATM KO in CAL72 and SAOS2 was performed via lentiviral infection. After KO confirmation by western immunoblotting (WB), ATM KO and control KO cells were treated with PARPi in a dose range of 19.5 nM-10 µM. ATP-based and Incucyte assays were used to quantify differential cell viability. Secondly, the combination of a small molecule ATMi and a PARPi was studied in a panel of OS cell lines. Synergistic cytotoxicity was quantified using the Zero Interaction Potency (ZIP) model. DNA damage levels after PARPi and ATMi (by chemical inhibition and genetic KO) were assessed by WB for γH2AX, a marker of DNA double-stranded breaks (DSBs). In our genome-scale CRISPR screens, ATM arose as a top druggable hit across both lines. Reassuringly, PARP1 KO scored as a top resistance mediator to PARPi, confirming biologic relevance of the screen and supporting the known PARP-trapping mechanism of these drugs in OS. At low-throughput, ATM KO lines trended toward increased sensitivity to PARPi in short-term viability assays. Combined chemical inhibition yielded highly synergistic ZIP scores across OS cell lines; synergy was achieved with both drugs in the low nanomolar range. γH2AX levels were substantially increased in the setting of combined PARPi and ATMi (via chemical inhibition or genetic KO) as compared to inactivation of either PARP or ATM alone, indicating increased presence of DNA DSBs. In conclusion, these data demonstrate synergy of ATM and PARP inhibition, providing promise for their potential combined use in the treatment of OS. Accumulation of DNA DSBs in response to PARP and ATM inactivation suggests a shared role in DNA damage repair as the molecular basis of synergism. Ongoing studies are investigating anti-tumor potential in in vivo OS models and exploring the mechanistic impact of the combination in OS tumors. Citation Format: Sona N. Kocinsky, Janeala J. Morsby, William C. Wright, Monika Wierdl, Caroline S. Wechsler, Gabriela Alexe, Paul Geeleher, Kimberly Stegmaier, Lillian M. Guenther. ATM and PARP combined inhibition demonstrate synergistic antitumor efficacy in osteosarcoma models [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3912.