Recently, individualized and tailored molecular targeted therapy was investigated for overcoming the limit of the present modalities of cancer treatment. Detoxification enzymes (NQO1, GSTP1, MPO and MnSOD), DNA repair gene, XRCC1/2, ERCC1 and the others are studied, and the expression or mutations of these genes in human tissues are reported world-widely as a factor related to risk of cancer in lung or other sites. Furthermore, some reports investigated the difference of treatment results by expression or mutations of these genes with chemotherapy or radiation therapy. Firstly, most studies have focused on the DNA repair gene, because DNA repair enzyme is critical for the protection of the genome from carcinogenic exposure and the prevention of some types of cancer. It is possible that the DNA repair mechanism plays a key role in the response of cancer cells to ionizing radiation, because the cytotoxic effect of radiation is mediated by the single or double strand breaks in the DNA. There are 4 major DNA repair mechanisms for maintaining the genomic integrity against damage caused by mutagens: mismatch repair, base excision repair, nucleotide excision repair, and double strand break repair. The X-ray repair cross-complementing Group 1 (XRCC1) plays an important role in the DNA base excision repair pathway, giving the possibility that this enzyme has some relationship with the response to radiotherapy. Secondly, a few studies have revealed that NAD(P)H:quinine oxidoreductase (NQO1, previously called as DT-diaphorase) is manifested within epithelium and endothelium in human tissues, and is also at many tumors, particularly NSCLC, originated from epithelial cell. NQO1 is two-electron reductases which catalyze more toxic quinines to less toxic hydroquinones, so it was revealed that NQO1 may play a major role in cytoprotection and chemoprevention. NQO1 also prevents the generation of reactive oxygen (hydrogen peroxide, superoxide) to human tissue, and is revealed as scavenger of supreoxide. Radiation therapy gives cytotoxic damage to human tissue via pathway of direct or indirect DNA breakage and indirect pathway breaks DNA strands by secondary effect of free radical produced by radiation particle that a potent inducer of NQO1 expression in human tissues. β-Lapachone (3,4-dihydro-2,2-dimethyl1-2H-naphthol[1,2-b] pyran-5,6-dione) (β-Lap) was originally isolated from the bark of Lapacho tree (Tabebuia avellanedae) growing in South America. This drug has attracted considerable interest in recent years because of its potent cytotoxicity against various cancer cell lines through a mechanism that works independent of the cell cycle or p53 status. β-Lap induced cell death in vitro has been previously attributed to activation or inhibition of Topoisomerase II-α, inhibition of Topoisomerase II-α, and suppression of NF-ϰB activity. However, more recent studies have clearly indicated that none of these changes were the key determinant of cell death caused by β-Lap, particularly in vivo. Recently, NQO1 has been reported to be a key player in β-Lap induced cell death. NQO1 catalyzes a two-electron reduction of β-Lap to the hydroquinone form of β-lap, i.e., β-Lap(HQ), using NADH or NAD(P)H as electron donors. The resulting β-Lap(HQ) is unstable and consequently reoxidizes in the presence of O2 to original oxidized β-Lap, causing a futile cycling between the quinone and hydroquinone forms. This futile cycling of the drug causes a progressive depletion of NADH or NAD(P)H levels. We observed that IR sensitizes cancer cells to β-Lap by causing a long-lasting elevation of NQO1 activity. It thus appeared that the synergistic interaction of ionizing radiation (IR) and β-Lap in killing cancer cells was due to an increase in cellular susceptibility to β-Lap, probably in addition to β-lap induced radiosensitization. Importantly, the NQO1 level in many human tumors is markedly greater than this in normal tissues. The fact that NQO1 level in tumors can be increased further by IR suggests that the combination of β-Lap and radiotherapy may be a potentially effective approach to selectively damage tumors relative to normal tissue. The combination of β-Lap and radiotherapy is a potentially effective regimen for the treatment of human cancer. It is possible that genetic variations in genes mentioned above can affect the treatment result after radiation therapy, because its expression or mechanism is related to ionizing radiation. Single nucleotide polymorphisms (SNPs) make up about 90% of human genetic variations. We tried to investigated that the difference in enzymatic activity by genetic polymorphisms could affect the treatment response and might be used as genetic marker of tumor response after radiation therapy.
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