Radiosensitization of cervical cancer cells via double-strand
DNA break repair inhibition
Christa B. Fuhrmana, Josh Kilgoreb, Yvette D. LaCoursierec, Christopher M. Leed,
Brett A. Milashe, Andrew P. Soissona, Karen A. Zempolicha,⁎
aDepartment of Gynecologic Oncology, The University of Utah, 1950 Circle of Hope, Suite 6700, Salt Lake City, UT 84112, USA
bNew York Medical College, Valhalla, NY 10591, USA
cDivision of Obstetrics and Gynecology, The University of Utah School of Medicine, 30 North 1900 East, Rm. 2B200, Salt Lake City, UT 84132, USA
dDepartment of Radiation Oncology, The University of Utah School of Medicine and Huntsman Cancer Hospital,
1950 Circle of Hope, Suite 1570, Salt Lake City, UT 84112, USA
eHSC Core Research Facilities, University of Utah School of Medicine and Huntsman Cancer Institute,
2000 Circle of Hope, Salt Lake City, UT 84112, USA
Received 18 June 2007
Purpose. LY294002, a phosphatidylinositol 3-kinase (PI3K) inhibitor, has been found to radiosensitize various human cancer cells. However,
its potential to act as an effective therapeutic agent is diminished by its toxicity levels. The purposes of this study were to determine the
mechanism by which LY294002 radiosensitizes.
Materials and methods. Cell growth curves and clonogenic assays were performed with increasing LY294002 exposure times proximate to the
radiation dose. Protein levels of downstream PI3K effectors were analyzed. Detection of phosphorylated histone H2AX (γH2AX) was used to
identify DNA double-strand breaks at various time points post-radiation.
Results. LY294002 significantly radiosensitized HeLa cervical cancer cells when administered for just 12 h following radiation. Cell growth
curves also decreased with brief LY294002 application. DNA double-strand breaks are typically repaired within 2–6 h following radiation.
Interestingly, at 48, 72, and 96 h post-irradiation, γH2AX was still significantly elevated in cells radiated in combination with LY294002. Protein
expressions of ATM and ATR downstream effectors showed no differences among the treated groups, however, DNA-PK activity was significantly
inhibited by LY294002.
Conclusions. These results lead us to conclude that the central mechanism by which LY294002 radiosensitizes is via DNA-PK inhibition which
induces DNA double-strand break repair inhibition. We are currently investigating radiosensitization induced by DNA-PK-specific inhibition in
efforts to find a less toxic, yet equally effective, chemotherapeutic agent than LY294002.
© 2007 Elsevier Inc. All rights reserved.
Keywords: LY294002; PI3K; H2AX; Cervical cancer; DSB; HeLa; DNA-PK
Cervical carcinoma significantly affects women worldwide,
especially in developing countries. It currently ranks as the
second leading cause of cancer mortality in women (following
breast cancer). Approximately 500,000 cases of cervical cancer
are diagnosed per year, with nearly 40% of those resulting in
death . Although the primary causative factor of cervical
cancer is infection with human papilloma virus (HPV), specific
aberrations of genes involved in control of cellular growth
processes have also been implicated. It has been determined that
by targeting these specific molecules, radiosensitivity and anti-
proliferating responses can either be enhanced or diminished in
cervical cancer cells .
Available online at www.sciencedirect.com
Gynecologic Oncology 110 (2008) 93–98
⁎Corresponding author. Fax: +1 801 585 3837.
E-mail address: firstname.lastname@example.org (K.A. Zempolich).
0090-8258/$ - see front matter © 2007 Elsevier Inc. All rights reserved.
Previous studies have shown the phosphatidylinositol
3-kinase (PI3K) enzymes play key roles in the regulation of
cell proliferation, differentiation, apoptosis, and cell cycle
control [3–9]. Because of its important regulatory function as
well as oncogenic properties, PI3K has been the source of much
investigation [10–12]. LY294002 (LY), a PI3K inhibitor, has
been shown to induce apoptosis, promote radiosensitivity, and
arrest cell growth in cancer cells both in vivo and in vitro [6,13–
In this study, we examine the response of PI3K inhibition by
LYin human cervical cancer cells exposed to ionizing radiation.
Specifically, we sought to explore the mechanism by which LY
radiosensitizes in order to find a more specific and less toxic
Materials and methods
LY294002 (a PI3K inhibitor) was obtained from Sigma Chemical Co. (St.
Louis, MO). PhophPlus Akt® (Ser473) Antibody Kit and Phospho-Chk1/2
Antibody Sample Kit was obtained from Cell Signaling Technology, Inc.
(Beverly, MA). SMC1 was obtained from Bethyl Laboratories, Inc. (Montgom-
ery, TX). DNA-PKcs Antibody was obtained from BioLegend (San Diego, CA).
The human cervical cancer cell line, HeLa, was kindly provided form Dr. Ray
Lee, Huntsman Cancer Institute (Salt Lake City, UT). The Propidium Iodide (PI)
stain was obtained from Molecular Probes, Inc. (Eugene, OR). The Anti-
phospho-Histone H2A.X (Ser139), clone JBW301 was obtained from Upstate
Biotechnologies (Charlottesville, VA). All cell culture reagents were obtained
from Invitrogen Co. (Carlsbad, CA).
The HeLa cell line was maintained at 37 °C in DMEM supplemented with
10% fetal bovine serum in humidified 5% CO2, 95% air. Culture medium was
by 0.05% trypsin–0.02% EDTA and replated. LY was diluted to 25 μM
concentration in media prior to each experiment from a stock solution of 10 mM
in DMSO. The concentration of DMSO in both control and test groups did not
exceed 0.5%. At the time of radiation treatment, cells were irradiated in their
a dose rate of 4.35 Gy/min.
Cell proliferation studies
For cell growth analysis, HeLa cells were plated at an initial density of
1.5×105cellsper100-mmdish. LYwas added24h afterseeding.Controldishes
received the same volume of the solvent DMSO. Irradiation (IR) was performed
30 min following addition of LY. Cells were harvested with trypsin–EDTA and
cell number was determined using a Beckman Coulter Counter.
Flow cytometry for γH2AX
Fixed cells were rinsed twice and rehydrated for 10 min in incubation buffer
(0.5% BSA in 1× PBS) and were then centrifuged and resuspended in 200 μl of
wereincubatedfor 30 min at roomtemperature, rinsedtwice, and resuspended in
200 μl of secondary antibody, Alexa 488 goat anti-mouse IgG (H+L)F(ab′)2
fragment conjugate (Molecular Probes; 1:200 dilution) for 30 min at room
temperature. Cells were rinsed and resuspended in PBS before analysis on flow
cytometer. DNA double-strand breaks were ascertained by the presence γH2AX
foci as determined by flow cytometry analysis.
Fig. 1. DNA-PK and Akt Inhibition by LY. Protein extracts of cells treated with
25 μM LY, 2 Gy radiation (IR), and in combination (LY+IR) at 90 min
following radiation. Polyclonal anti-pan Akt was used as a loading control.
Fig. 2. Cell growth assay. Cells were treated with 25 μM LY, 2 Gy radiation (IR),
and in combination (LY+IR). Cell numbers were counted at 72 h following
radiation. LY was removed at 6 h, 12 h, and 3 days following radiation.
Fig. 3. Clonogenic survival. HeLa cells treated with 0–10 Gy radiation and
25 μM LY. LY was removed at the varied times indicated following the radiation
Comparison of α (alpha) and β (beta) components of survival curves with
varying time administration of 25 μmol LY294002 (LY) combined with
increasing doses of radiation (IR)
(95% confidence interval)
(95% confidence interval)
IR alone (no LY)
6 h LY+IR
72 h LY+IR
94C.B. Fuhrman et al. / Gynecologic Oncology 110 (2008) 93–98
Cells were grown on coverslips and were fixed in 2% paraformaldehyde in
PBS for 7 min and 50 mM NH4Cl for 5 min. Cells were then permeabilized with
0.2% Triton X-100 for 3 min, rinsed twice with PBS, and then incubated for 1 h
with anti-γH2AX diluted 1:500 in 0.1% BSA in PBS. Cells were rinsed and
incubated with Alexa 488 secondary antibody (1:200 dilution) with 0.5 μg
DAPI/ml in 0.1% BSA in PBS for 1 h at room temperature. Cells were rinsed
and mounted on slides using FluorSave (CalBiochem) as the antifade mounting
reagent, and sealed. Slides were then viewed using an Olympus Fluoview™
confocal microscope. Images were taken using Olympus Magnafire™ software.
Detection of phospho-Akt (Ser473) and phospho-Chk1 (Ser317), SMC1,
and DNA-PKcs were analyzed by Western immunoblotting. Cells were treated
with LYor DMSO 30 min prior to 2 Gy IR. LYexposure remained constant until
90 min post-radiation at which time protein was extracted. The cells were lysed
in a SDS sample buffer and sonicated briefly. Samples were boiled, sheared, and
clarified by centrifugation and stored at −20 °C. Samples containing equal
amounts of protein were separated on a SDS–PAGE gel and blotted onto
nitrocellulose membrane. Samples were incubated in blocking buffer before
primary antibody addition. The membrane was probed first with the appropriate
Polyclonal anti-pan Akt was used as a loading control. Antibody binding was
detected using the Phototope®-HRP Western Detection Kit.
Determination of cell survival
The sensitivity of cells to radiation was measured using clonogenic assays.
In order to measure clonogenic survival, exponentially growing cells were
trypsinized, plated at known concentrations, and irradiated with a range of doses
(0–10 Gy). Clonogenic survival experiments were performed by adding 25 μM
LY 30 min prior to 2 Gy IR as describedbefore. At varioustime pointsfollowing
radiation, the media containing the LY was removed and fresh media was added.
Cells were grown for 9–12 days with media changes every 3 days. Cells were
then fixed with methanol and stained with methylene blue. Colonies containing
more than 50 cells were evaluated by light microscopy and scored as survivors.
In each case, the surviving fraction (SF) was calculated by dividing the number
of colonies counted by the number of cells plated times the plating efficiency.
Triplicate experiments were performed for each cell line.
Fig. 4. Flow cytometry of γH2AX showing prolonged expression. Cells were
treated with 25 μM LY, 2 Gy radiation (IR), and in combination (LY+IR).
Fig. 5. Immunofluorescent microscopy of γH2AX. Cells treated with 25 μM LYand 2 Gy radiation. Prolonged expression is seen in all combination-treated cells at all
95 C.B. Fuhrman et al. / Gynecologic Oncology 110 (2008) 93–98
The clonogenic survival data were fitted using the linear quadratic model
SF=exp[−(alpha)D−(beta)D2], where alpha equals the initial slope and beta
equals the terminal slope of the survival curve. Dose modification factors were
calculated from the fitted survival curves at the 1 log cell kill level using Prism
GraphPadsoftware.The survivingfractionwas analyzedusingthe generallinear
modeling procedure of the statistical analysis software (SAS) system. The
mathematical model included the effects of treatment and dose of radiation and
interaction of treatment with dose. In addition, tests for homogeneity of
regression were also performed by comparing the reduction of error sums of
squares by fitting a curve for each treatment rather than using a single regression
to describe all treatments.
For cell growth experiments, cell counts were evaluated between treatments
by ANOVA at each time point with Dunnett's t-test to compare treatment
differences with controls.
DNA-PK and AKT inhibition by LY294002
Western Blot analysis shows significant increase of the Akt
in radiation alone at 90 min (Fig. 1). However, when combined
with LY, Akt activation is suppressed dramatically. The catalytic
subunit of DNA-PK (DNA-dependent protein kinase) is also
significantly inhibited with the addition of LY. Western blot
analysis was also done looking at downstream effectors of ATM
and ATR, SMC1 and p-Chk1 (Ser317), respectively, with no
significant differences among the treatment groups at 90 min
following radiation (Fig. 1).
Cell growth characteristics with LY removal
Fig. 2 illustrates the cell growth of HeLa cells collected 72 h
of drug exposure, no significant decrease was seen in cell
cells show significant decrease in growth when compared to
control and LY-treated groups (p=0.002 and 0.045, respective-
ly), although no significant differences were seen among LY/IR
and IR alone. For LY alone- and combination-treated cells, a
significant decrease in cell growth was seen with 3 days of drug
exposure (pb0.008 for all group comparisons).
Radiosensitization by LY measured by clonogenic assay
Clonogenic potential was assessed by colony formation
assays following administration of LYand IR. Fig. 3 illustrates
clonogenic assay results for 0 to 10 Gy IR with varied times of
exposure to 25 μM LYpost-radiation. Our previous studies have
shown that LY alone does not alter cell survival, however,
continuous treatment with 25 μM LY has demonstrated
significant radiosensitization of the HeLa cell line with a dose
modification factor of 1.95 for 1 log cell kill . Removal of
LY at all time points tested post-radiation yielded significant
radiosensitization across 0–10 Gy (pb0.0001). The dose
modification factors for 1 log cell kill were 1.35, 1.40, and
1.61 for LYexposure of 6, 12, and 72 h post-treatment radiation.
Of note, significant radiosensitization occurred despite limited
exposure of LY for just 12 h post-radiation, indicating that LY-
induced inhibition is mechanistically effective in the hours
immediately following radiation. Analysis of α (alpha) and β
(beta) slopes of the survival curves, as expressed by a linear
quadratic equation, demonstrated alteration of both the α and β
component even in the limited 6- and 12-h exposure groups
Prolonged expression of γH2AX in cells treated with LY in
combination with radiation
The combination of concurrent PI3K inhibition by 25 μM
LY and IR with a single fraction of 2 Gy significantly induced
phosphorylation of histone H2AX from 90 min to 96 h post-
radiation. This is shown graphically by flow cytometry analysis
of the percentage of cells containing γH2AX foci (Fig. 4) and
visually by confocal microscopy (Fig. 5). As expected, IR-
treated cells (with or without LY) showed significant increase in
γH2AX at 90 min. The number of double-strand breaks (or
γH2AX nuclear foci) was significantly increased at 48, 72, and
96 h in the combination-treated cells. Interestingly, the LYonly-
treated cells also demonstrated an increase in nuclear foci at 48
and 72 h but returned to control levels by 96 h (Table 2).
Cell growth inhibition in combined treated cell groups
all time points investigated (Fig. 6). However,the groups treated
with LYand LY with IR had almost complete growth inhibition
when compared to control and IR-treated cells possibly
indicating either stalled cell cycle progression or DNA double-
strand break repair inhibition.
Average γH2AX foci per nucleus at various time points post-radiation
Time post-IR Control LY IRLY+IR
Irradiation (IR); LY294002 (LY).
Fig. 6. Cell growth analysis. Cells treated with 25 μM LY, 2 Gy radiation (IR),
and in combination (LY+IR). LY treatment was administered for the duration of
the time indicated. Growth was inhibited in all combination-treated cells at all
96 C.B. Fuhrman et al. / Gynecologic Oncology 110 (2008) 93–98
PI3K inhibition of LY has shown potent radiosensitization
in cervical cancer cell in our laboratory  and others' [13–
15]. In this study, we show that LY administration is effective
even when briefly administered during and directly after
radiation. As a broad inhibitor across all major classes of
PI3Ks and PI3K-like kinases (PIKKs), the mechanisms of LY
radiosensitization have not been fully characterized. We also
report in this study prolonged presence of radiation-induced
DNA double-strand breaks implicating the inhibition of
double-strand break repair as a major mechanism of LY
radiosensitization. The families of PIKK enzymes (ATM,
ATR, and DNA-PK) are all involved in detection of DNA
damage, activation of DNA repair machinery and, in turn, the
linking of this to cell cycle control [10,17–20]. In the current
study, despite PI3K inhibition, cervical cancer cells were able
to detect double-strand breaks as evidenced by formation of
γH2AX foci at 60 min post-radiation. It has been well
documented that ATM is the major kinase responsible for
modifying H2AX upon IR [21,22]. However, even in the
presence of the LY inhibitor, early H2AX phosphorylation is
able to be carried out. This may be possible via the ability of
ATM and DNA-PK to act in a redundant, overlapping manner
to phosphorylate H2AX . To support this theory, we have
shown that ATM is not significantly inhibited at these doses
of LY in HeLa cervical cancer cells.
DNA-PK has been strongly implicated in double-strand
break repair [24,25] and may have a regulatory role in
matching correct double-strand break ends to be joined. The
catalytic subunit of DNA-PK (DNA-PKcs) shares sequence
homology in its kinase domain with PI3K and is inhibited by
LY in an ATP-competitive manner . DNA-PK inhibition
via LY treatment on Xenopus egg extracts inhibits end-joining
of cohesive 3′-hydroxyl ends of DNA and suppresses the
processing of damaged DNA ends prior to joining .
Okayasu et al. suggest that LY radiosensitization may be due
in part by DNA-PK inhibition resulting in DNA BSB repair
inhibition as reflected in the excess number of interphase
chromosome fragments in irradiated cells pretreated with LY
Histone H2AX phosphorylation has long been used as a
standard method for detecting double-strand breaks at the site
of DNA damage. It is rapidly phosphorylated (within
seconds) at serine 139 when double-strand breaks are
introduced in mammalian cells resulting in discrete foci at
the DNA damage sites [29,30]. These foci continue to grow
for approximately 1 h following radiation and then dissipate
over time, correlating with the rejoining of DNA breaks.
Many studies have shown that the residual level of γH2AX
measured 24 h post-radiation and longer, as seen in this
particular study, directly correlates with radiation sensitivity
The significantly prolonged expression of γH2AX in
HeLa cells treated with LY in combination with radiation,
along with radiosensitization induced with brief LY applica-
tion immediately following radiation, as seen in these studies
may result from impaired DNA double-strand bread repair
and/or cell cycle arrest via DNA-PK inhibition. Ongoing
work in our lab aims to differentiate these two mechanistic
pathways. Delineation of these mechanisms and LY radio-
sensitization may allow for further targeting of relevant
pathways. These findings support future investigation of
mechanistic and therapeutic uses of DNA-PK-specific
inhibitors in combination with radiation therapy for carcino-
ma of the cervix.
Grant support: Women's Reproductive Health Research
Career Development grant 5K12HD01241 (K.A. Zempolich).
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