Therapy
resistance is the major cause of cancer death. As patients
respond heterogeneously, precision/personalized medicine needs to
be considered, including the application of nanoparticles (NPs). The
success of therapeutic NPs requires to first identify clinically relevant
resistance mechanisms and to define key players, followed by a rational
design of biocompatible NPs capable to target resistance. Consequently,
we employed a tiered experimental pipeline from in silico to analytical and in vitro to overcome cisplatin
resistance. First, we generated cisplatin-resistant cancer cells and
used next-generation sequencing together with CRISPR/Cas9 knockout
technology to identify the ion channel LRRC8A as a critical component
for cisplatin resistance. LRRC8A’s cisplatin-specificity was
verified by testing free as well as nanoformulated paclitaxel or doxorubicin.
The clinical relevance of LRRC8A was demonstrated by its differential
expression in a cohort of 500 head and neck cancer patients, correlating
with patient survival under cisplatin therapy. To overcome LRRC8A-mediated
cisplatin resistance, we constructed cisplatin-loaded, polysarcosine-based
core cross-linked polymeric NPs (NPCis, Ø ∼
28 nm) with good colloidal stability, biocompatibility (low immunogenicity,
low toxicity, prolonged in vivo circulation, no complement
activation, no plasma protein aggregation), and low corona formation
properties. 2D/3D-spheroid cell models were employed to demonstrate
that, in contrast to standard of care cisplatin, NPCis significantly
(p < 0.001) eradicated all cisplatin-resistant
cells by circumventing the LRRC8A-transport pathway via the endocytic delivery route. We here identified LRRC8A as critical
for cisplatin resistance and suggest LRRC8A-guided patient stratification
for ongoing or prospective clinical studies assessing therapy resistance
to nanoscale platinum drug nanoformulations versus current standard
of care formulations.