1231 Inhibition of YAP With Vertoporfin Makes Chordomas Sensitive to Radiation in Vitro and in Vivo: New Therapies to Combat Radioresistance

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INTRODUCTION: Chordomas are locally invasive tumors of notochordal origin with a propensity to resist radiotherapy and with no FDA approved therapies. Verteporfin is a photosensitizer with the ability to inhibit the yes-associated-protein (YAP) pathway which is upregulated in chordomas and enables their resistance to radiotherapy. METHODS: We used five primary chordoma cell lines (JHC7, UCH1, UCH2, MUG-CHOR1, UM-CHOR1) to perform in vitro and in vivo experiments with 64 mice using a xenograft subcutaneous model of chordoma. We then knocked down the YAP gene in chordoma cells and performed experiments to confirm our results were secondary to verteporfin effects on YAP. RESULTS: Verteporfin has additive and synergistic effects on chordoma cells when combined with radiation. Chordoma cells treated with verteporfin have significantly more double-stranded DNA damage after radiation therapy (p < 0.0001) and verteporfin prevents repair of that DNA damage. Verteporfin significantly reduces DNA damage repair proteins and genes in chordoma cells (ATM: p = 0.0007, ATR: p < 0.0001, RADS1: p = 0.0033, BRCA1: p < 0.0001, BRCA2: p = 0.0012, PPP2R4: p < 0.0001). Verteporfin leads to significantly increased frequency of cells in G2/M phase (MUG-CHOR1: p < 0.0001, UCH2: p = 0.0021). We then performed all the above experiments using chordoma cells with the YAP gene knocked down and found that YAP knockdown led to enhanced radiation induced DNA damage (p<0.0001), diminished yH2AX response (p = 0.0264), and increased frequency of cells in G2/M phase (p < 0.0001). In vivo verteporfin treatment significantly inhibited chordoma tumor growth (p < 0.0001) and microparticles were most effective at radiosensitization. CONCLUSIONS: Inhibition of YAP using verteporfin radiosensitizes chordoma via 1) inhibition of the DNA damage repair cascade and 2) increasing frequency of the G2/M cell cycle phase when cells are most sensitive to radiation.