Improving patient outcome by personalized therapy involves a thorough
understanding of an agent’s mechanism of action. β-Lapachone
(clinical forms, Arq501/Arq761) has been developed to exploit dramatic
cancer-specific elevations in the phase II detoxifying enzyme, NAD(P)H:quinone
oxidoreductase (NQO1). NQO1 is dramatically elevated in solid cancers, including
primary and metastatic (e.g., triple-negative (ER-, PR-, Her2/Neu-)) breast
cancers. To define cellular factors that influence the efficacy of
β-lapachone using knowledge of its mechanism of action, we confirmed
that NQO1 was required for lethality and mediated a futile redox cycle where
~120 moles of superoxide were formed per mole of β-lapachone in
5 min. β-Lapachone induced reactive oxygen species (ROS), stimulated DNA
single strand break-dependent PARP1 hyperactivation, caused dramatic loss of
essential nucleotides (NAD+/ATP) and elicited programmed necrosis in breast
cancer cells. While PARP1 hyperactivation and NQO1 expression were major
determinants of β-lapachone-induced lethality, alterations in catalase
expression, including treatment with exogenous enzyme, caused marked
cytoprotection. Thus, catalase is an important resistance factor, and highlights
H2O2 as an obligate ROS for cell death from this
agent. Exogenous superoxide dismutase (SOD) enhanced catalase-induced
cytoprotection. β-Lapachone-induced cell death included AIF
translocation from mitochondria to nuclei, TUNEL+ staining, atypical PARP1
cleavage, and GAPDH S-nitrosylation, which were abrogated by catalase. We
predict that the ratio of NQO1:catalase activities in breast cancer versus
associated normal tissue are likely to be the major determinants affecting the
therapeutic window of β-lapachone and other NQO1 bioactivatable
drugs.