Ionizing radiation (IR) creates lethal DNA damage that can effectively kill
tumor cells. However, the high dose required for a therapeutic outcome also damages healthy tissue. Thus, a therapeutic strategy with predictive
biomarkers to enhance the beneficial effects of IR allowing a
dose reduction without losing efficacy is highly desirable.
NAD(P)H:
quinone oxidoreductase 1 (NQO1) is overexpressed in the majority of recalcitrant solid
tumors in comparison with normal tissue. Studies have shown that NQO1 can bioactivate certain
quinone molecules (e.g.,
ortho-naphthoquinone and β-
lapachone) to induce a futile redox cycle leading to the formation of oxidative DNA damage, hyperactivation of
poly(ADP-ribose) polymerase 1 (PARP1), and catastrophic depletion of NAD+ and
ATP, which culminates in cellular lethality via
NAD+-Keresis. However, NQO1-bioactivatable drugs induce
methemoglobinemia and
hemolytic anemia at high doses. To circumvent this, NQO1-bioactivatable agents have been shown to synergize with PARP1 inhibitors,
pyrimidine radiosensitizers, and IR. This therapeutic strategy allows for a reduction in the dose of the combined agents to decrease unwanted side effects by increasing
tumor selectivity. In this review, we discuss the mechanisms of radiosensitization between NQO1-bioactivatable drugs and IR with a focus on the involvement of base excision repair (BER). This combination therapeutic strategy presents a unique
tumor-selective and minimally toxic approach for targeting solid
tumors that overexpress NQO1.