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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Oncol.</journal-id>
<journal-title>Frontiers in Oncology</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Oncol.</abbrev-journal-title>
<issn pub-type="epub">2234-943X</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fonc.2022.861266</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Oncology</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>A Low Membrane Hsp70 Expression in Tumor Cells With Impaired Lactate Metabolism Mediates Radiosensitization by NVP-AUY922</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Schwab</surname><given-names>Melissa</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="author-notes" rid="fn001"><sup>*</sup></xref>
<uri xlink:href="https://loop.frontiersin.org/people/1649074"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Multhoff</surname><given-names>Gabriele</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<uri xlink:href="https://loop.frontiersin.org/people/30408"/>
</contrib>
</contrib-group>
<aff id="aff1"><sup>1</sup><institution>Radiation Immuno-Oncology Group, Center for Translational Cancer Research (TranslaTUM), School of Medicine, Klinikum Rechts der Isar, Technical University of Munich (TUM)</institution>, <addr-line>Munich</addr-line>, <country>Germany</country></aff>
<aff id="aff2"><sup>2</sup><institution>Department of Radiation Oncology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich (TUM)</institution>, <addr-line>Munich</addr-line>, <country>Germany</country></aff>
<author-notes>
<fn fn-type="edited-by">
<p>Edited by: Ira Ida Skvortsova, Innsbruck Medical University, Austria</p>
</fn>
<fn fn-type="edited-by">
<p>Reviewed by: Yanmei Zou, Huazhong University of Science and Technology, China; Kang-Seo Park, University of Ulsan, South Korea</p>
</fn>
<fn fn-type="corresp" id="fn001">
<p>*Correspondence: Melissa Schwab, <email xlink:href="mailto:melissa.schwab@tum.de">melissa.schwab@tum.de</email>
</p>
</fn>
<fn fn-type="other" id="fn002">
<p>This article was submitted to Radiation Oncology, a section of the journal Frontiers in Oncology</p>
</fn>
</author-notes>
<pub-date pub-type="epub">
<day>07</day>
<month>04</month>
<year>2022</year>
</pub-date>
<pub-date pub-type="collection">
<year>2022</year>
</pub-date>
<volume>12</volume>
<elocation-id>861266</elocation-id>
<history>
<date date-type="received">
<day>24</day>
<month>01</month>
<year>2022</year>
</date>
<date date-type="accepted">
<day>15</day>
<month>03</month>
<year>2022</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#xa9; 2022 Schwab and Multhoff</copyright-statement>
<copyright-year>2022</copyright-year>
<copyright-holder>Schwab and Multhoff</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p>
</license>
</permissions>
<abstract>
<p>As overexpression and membrane localization of stress proteins together with high lactate levels promote radioresistance in tumor cells, we studied the effect of the Hsp90 inhibitor NVP-AUY922 on the cytosolic and membrane expression of heat shock proteins (HSPs) and radiosensitivity in murine melanoma (B16F10) and human colorectal (LS174T) wildtype (WT) and <italic>lactate dehydrogenases A/B</italic> double knockout (LDH<sup>&#x2212;/&#x2212;</sup>) tumor cells. Double knockout for <italic>LDHA/B</italic> has been found to reduce cytosolic as well as membrane HSP levels, whereas treatment with NVP-AUY922 stimulates the synthesis of Hsp27 and Hsp70, but does not affect membrane Hsp70 expression. Despite NVP-AUY922-inducing elevated levels of cytosolic HSP, radiosensitivity was significantly increased in WT cells and even more pronounced in LDH<sup>&#x2212;/&#x2212;</sup> cells. An impaired lipid metabolism in LDH<sup>&#x2212;/&#x2212;</sup> cells reduces the Hsp70 membrane-anchoring sphingolipid globotriaosylceramide (Gb3) and thereby results in a decreased Hsp70 cell surface density on tumor cells. Our results demonstrate that the membrane Hsp70 density, but not cytosolic HSP levels determines the radiosensitizing effect of the Hsp90 inhibitor NVP-AUY922 in LDH<sup>&#x2212;/&#x2212;</sup> cells.</p>
</abstract>
<kwd-group>
<kwd><italic>LDHA/B</italic> double knockout</kwd>
<kwd>stress response</kwd>
<kwd>membrane Hsp70</kwd>
<kwd>radiosensitization</kwd>
<kwd>Hsp90 inhibitor NVP-AUY922</kwd>
</kwd-group>
<contract-num rid="cn001">KU3500/2-1, SFB824, STA1520/1-1</contract-num>
<contract-num rid="cn002">ZF4320104AJ8, ZF4320102CS7</contract-num>
<contract-sponsor id="cn001">Deutsche Forschungsgemeinschaft<named-content content-type="fundref-id">10.13039/501100001659</named-content>
</contract-sponsor>
<contract-sponsor id="cn002">Bundesministerium f&#xfc;r Wirtschaft und Energie<named-content content-type="fundref-id">10.13039/501100006360</named-content>
</contract-sponsor>
<counts>
<fig-count count="2"/>
<table-count count="1"/>
<equation-count count="0"/>
<ref-count count="38"/>
<page-count count="7"/>
<word-count count="2871"/>
</counts>
</article-meta>
</front>
<body>
<sec id="s1" sec-type="intro">
<title>Introduction</title>
<p>Many tumor cell types including colorectal carcinoma and melanoma, exhibit an increased synthesis of heat shock proteins (HSPs) such as Hsp90, Hsp70 and Hsp27 which in turn promotes tumor progression, malignant transformation and therapy resistance (<xref ref-type="bibr" rid="B1">1</xref>). In recent years, the therapeutic potential of several different HSP-targeting drugs has been tested in preclinical and clinical trials (<xref ref-type="bibr" rid="B2">2</xref>). Although, the Hsp90 inhibitor AUY-NVP922 exhibited promising radiosensitizing potential by impairing the DNA damage repair and the cell cycle, not only in different tumor cell entities including lung cancer cells, uterine cervical carcinoma, head and neck squamous cell carcinoma and colorectal carcinoma cells but also in a human head and neck squamous cell carcinoma xenograft model (<xref ref-type="bibr" rid="B3">3</xref>&#x2013;<xref ref-type="bibr" rid="B5">5</xref>), its efficacy is limited due to its hepatotoxicity and a compensatory upregulation of the transcription of other HSPs, especially the major stress-inducible, anti-apoptotic Hsp70. As a consequence, combined treatment strategies with inhibitors targeting different HSP families concomitantly are currently under investigation, although clinical data are not yet available (<xref ref-type="bibr" rid="B2">2</xref>).</p>
<p>Our laboratory has previously demonstrated that a pharmacological inhibition of the lactate dehydrogenase (LDH) as well as a <italic>lactate dehydrogenase A/B</italic> (LDHA/B) double knockout (LDH<sup>&#x2212;/&#x2212;</sup>) has the capacity to decrease the expression of Hsp90, Hsp70 and Hsp27 and thereby can increase the radiosensitivity in cancer cells (<xref ref-type="bibr" rid="B6">6</xref>). An increased LDH activity causes high lactate concentrations and an acidic tumor microenvironment which further enhances tumor growth (<xref ref-type="bibr" rid="B7">7</xref>), suppresses immune cell functions including effector T and NK cells (<xref ref-type="bibr" rid="B8">8</xref>&#x2013;<xref ref-type="bibr" rid="B10">10</xref>), correlates with an aggressive tumor phenotype and increases the risk of metastatic spread and tumor recurrence (<xref ref-type="bibr" rid="B11">11</xref>).</p>
<p>Compared to normal cells, tumor cells frequently overexpress Hsp70 in the cytosol and present it on their plasma membrane in a tumor-specific manner. A high cell surface density of Hsp70 stabilizes plasma membranes of tumor cells and thereby contributes to cell survival and radioresistance (<xref ref-type="bibr" rid="B12">12</xref>&#x2013;<xref ref-type="bibr" rid="B14">14</xref>). Herein, we assessed the mechanism(s) <italic>via</italic> which an impaired lactate metabolism in combination with an Hsp90 inhibition impacts the stress protein expression and membrane localization of tumor cells in context with their radiosensitivity.</p>
</sec>
<sec id="s2" sec-type="materials|methods">
<title>Materials and Methods</title>
<sec id="s2_1">
<title>Cells and Cell Culture</title>
<p>The wildtype (WT) B16F10 murine melanoma (ATCC<sup>&#xae;</sup> CRL-6475TM; ATCC, Manassas, VA, USA) and LS174T human colorectal adenocarcinoma (ATCC<sup>&#xae;</sup> CL-188&#x2122;; ATCC, Manassas, VA, USA) cell lines and their <italic>LDHA/B</italic> double knockout (LDH<sup>&#x2212;/&#x2212;</sup>) counterparts (kindly provided by Marina Kreutz and Jacques Pouyssegur (<xref ref-type="bibr" rid="B15">15</xref>) were grown in complete growth medium, consisting of Rosewell Park Memorial Institute (RPMI)-1640 medium (Sigma-Aldrich, St. Louis, MO, USA) or high glucose Dulbecco`s Eagle`s Minimum Essential Medium (DMEM) (Sigma-Aldrich) respectively, supplemented with 10% v/v heat inactivated fetal bovine serum (FBS, Sigma-Aldrich), 1% antibiotics (10,000 IU/mL penicillin, 10 mg/mL streptomycin, Sigma-Aldrich), 2 mM L-glutamine (Sigma-Aldrich) and 1 mM sodium pyruvate (Sigma-Aldrich). Cells were routinely checked and confirmed negative for mycoplasma contamination.</p>
</sec>
<sec id="s2_2">
<title>Reagents and Treatment</title>
<p>A stock solution (10 mM) of the Hsp90 inhibitor NVP-AUY922 (Santa Cruz Biotechnology, Dallas, TX, USA) was prepared in dimethyl sulfoxide (DMSO) and further diluted in phosphate buffered saline (PBS). Control cells were incubated with the respective amounts of DMSO. Cells were treated with NVP-AUY922 for 24 h.</p>
</sec>
<sec id="s2_3">
<title>Western Blot Analysis</title>
<p>Cells were lysed in Radioimmunoprecipitation Assay (RIPA) buffer containing 50 mM Tris-HCl (pH 8.0), 150 mM NaCl, 1 mM EDTA, 1% v/v Triton-X-100, 0.1% w/v sodium dodecyl sulphate (SDS), 0.5% w/v sodium deoxycholate, protease inhibitor cocktail (Roche, Basel, Switzerland). The protein amount was measured using the Pierce&#x2122; BCA Protein Assay Kit (Thermo Fisher Scientific, Waltham, MA, USA). Proteins were separated by SDS-PAGE, transferred on nitrocellulose membranes and detected by immunoblotting with the following primary and secondary antibodies: Hsp27 (NBP2-32972, clone G3.1, Novus Biologicals, Centennial, CO, USA), Hsp70 (clone cmHsp70.1, murine IgG1, multimmune GmbH, Munich, Germany), LDHA (NBP1-48336, rabbit polyclonal, Novus Biologicals), LDHB (NBP2-53421, rabbit polyclonal, Novus Biologicals), AKT (9272S, rabbit, Cell Signaling Technology, Danvers, MA, USA), &#xdf;-Actin (A2228, clone AC-74, Sigma-Aldrich), horseradish peroxidase (HRP)-conjugated rabbit anti-mouse immunoglobulins (P0260, Dako-Agilent, Santa Clara, CA, USA) and HRP-conjugated swine anti-rabbit immunoglobulins (P0217, Dako-Agilent). The Pierce&#x2122; ECL Western Kit (Thermo Fisher Scientific) was used to detect immune complexes which were then imaged digitally (ChemiDoc&#x2122; Touch Imaging System, Bio-Rad, Hercules, CA, USA). The Fiji software (<xref ref-type="bibr" rid="B16">16</xref>) was used for quantifying Western Blot signals.</p>
</sec>
<sec id="s2_4">
<title>Lactate Dehydrogenase (LDH) Activity Measurement</title>
<p>LDH activity was measured using the Lactate Dehydrogenase Activity kit (Sigma-Aldrich) according to the manufacturer&#x2019;s protocol.</p>
</sec>
<sec id="s2_5">
<title>Cell Counting</title>
<p>Cell count and viability were determined using a Sigma-Aldrich Cell Counting Kit-8 (CCK-8), following the manufacturer&#x2019;s protocol.</p>
</sec>
<sec id="s2_6">
<title>Irradiation</title>
<p>Tumor cells were irradiated with a single dose of 0 Gy (sham), 0.5 Gy, 1 Gy and 2 Gy using the Gulmay RS225A device (Gulmay Medical Ltd., Camberley, UK) at a dose rate of 1.1 Gy/min (15 mA, 200 kV).</p>
</sec>
<sec id="s2_7">
<title>Clonogenic Assay</title>
<p>Tumor cells were seeded into 12-well plates and one day later they were treated with 5 nM NVP-AUY922 for 24 h and then irradiated with the indicated doses. After irradiation cells were cultured in fresh, drug-free medium. After 9-10 days colonies were washed with PBS, fixed with ice-cold methanol and stained with 0.1% w/v crystal violet. The number of colonies consisting of &#x2265; 50 cells were counted automatically by a Bioreader<sup>&#xae;</sup> 3000 (Bio-Sys GmbH, Karben, Deutschland). Survival curves were fitted to the linear quadratic model using SigmaPlot (Systat Software Inc, San Jose, CA, USA).</p>
</sec>
<sec id="s2_8">
<title>Analysis of Membrane Hsp70 (mHsp70) Expression by Flow Cytometry</title>
<p>The membrane Hsp70 (mHsp70) phenotype was analyzed by flow cytometry using the FITC-conjugated cmHsp70.1 monoclonal antibody (mAb, IgG1, multimmune GmbH, Munich, Germany) on a FACSCalibur flow cytometer (BD Biosciences, Heidelberg, Germany). Tumor cells (0.2 x 10<sup>6</sup> cells) were washed with flow cytometry buffer (PBS/10% v/v fetal bovine serum, FBS) and incubated either with the cmHsp70.1 mAb or with an isotype matched FITC-labeled control immunoglobulin (mouse IgG1 FITC, 345815, BD Biosciences) on ice in the dark for 30 min. After a second washing step, viable cells (propidium iodide negative cells) were gated upon, and the proportion of positively stained cells were analyzed.</p>
</sec>
<sec id="s2_9">
<title>Statistics</title>
<p>Each experiment was performed independently at least 3 times (biological replicates). Comparative analysis of two or multiple groups was carried out using the Student&#x2019;s t-test or the Tukey Test respectively (*p &#x2264; 0.05, **p &#x2264; 0.01, ***p &#x2264; 0.001). Data are presented as mean values with standard deviation (SD).</p>
</sec>
</sec>
<sec id="s3" sec-type="results">
<title>Results</title>
<sec id="s3_1">
<title>Hsp90 Inhibition by NVP-AUY922 Increases Cytosolic Hsp70 and Hsp27 Expression in B16F10 and LS174T WT and LDH<sup>&#x2212;/&#x2212;</sup> Cells</title>
<p>The radiosensitizing effects of the Hsp90 inhibitor NVP-AUY922 was studied using murine (B16F10) and human (LS174T) wildtype (WT) and CRISPR/Cas9 <italic>lactate dehydrogenases A/B</italic> (LDH<sup>&#x2212;/&#x2212;</sup>) double knockout tumor cells with an impaired lactate metabolism (<xref ref-type="bibr" rid="B6">6</xref>, <xref ref-type="bibr" rid="B15">15</xref>). The Hsp90 inhibitor NVP-AUY922 induced a comparable and concentration-dependent reduction in the viability of WT and LDH<sup>&#x2212;/&#x2212;</sup> tumor cells (B16F10, LS174T; <xref ref-type="fig" rid="f1"><bold>Figures&#xa0;1A, B</bold></xref>). In line with our previous data, a <italic>LDHA/B</italic> double knockout significantly reduced the cytosolic Hsp70 and Hsp27 expression (<xref ref-type="fig" rid="f1"><bold>Figures&#xa0;1C, D</bold></xref>) (<xref ref-type="bibr" rid="B6">6</xref>). Despite significant differences in their basal levels of HSP expression, NVP-AUY922 caused a comparable upregulation of intracellular Hsp70 and Hsp27 in WT and LDH<sup>&#x2212;/&#x2212;</sup> cells above the initial levels of WT cells (<xref ref-type="fig" rid="f1"><bold>Figures&#xa0;1C, D</bold></xref>). Due to a very low Hsp27 expression, Hsp27 levels could not be quantified in B16F10 cells.</p>
<fig id="f1" position="float">
<label>Figure&#xa0;1</label>
<caption>
<p>Hsp90 inhibition reduces cell viability in a concentration-dependent manner and increases cytosolic Hsp70 and Hsp27 levels. <bold>(A, B)</bold> Toxicity assay of B16F10 <bold>(A)</bold> and LS174T <bold>(B)</bold> WT and LDH<sup>&#x2212;/&#x2212;</sup> cells treated with NVP-AUY922 (0, 5, 10, 50, 100 nM) for 24 h. <bold>(C, D)</bold> Representative immunoblot showing intracellular Hsp70, Hsp27 and &#x3b2;-Actin levels in B16F10 <bold>(C)</bold> and LS174T <bold>(D)</bold> cells upon treatment with NVP-AUY922 (100 nM) for 24 h. Quantification of the heat shock protein (HSP) levels are shown in the adjacent bar chart (**p &#x2264; 0.01, ***p &#x2264; 0.001).</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fonc-12-861266-g001.tif"/>
</fig>
</sec>
<sec id="s3_2">
<title>Low Hsp90 Inhibitor Concentration Potentiates Radiosensitivity Especially in LDH<sup>&#x2212;/&#x2212;</sup> Cells</title>
<p>In line with previous data, clonogenic cell survival assays revealed that LS174T WT cells are significantly more radioresistant than LDH<sup>&#x2212;/&#x2212;</sup> cells (<xref ref-type="fig" rid="f2"><bold>Figure&#xa0;2A</bold></xref>) (<xref ref-type="bibr" rid="B6">6</xref>). Despite elevated cytosolic HSP levels a low concentration of the Hsp90 inhibitor NVP-AUY922 (5 nM) increased radiosensitivity in WT and LDH<sup>&#x2212;/&#x2212;</sup> cells. This radiosensitizing effect was significantly more pronounced in LDH<sup>&#x2212;/&#x2212;</sup> cells (<xref ref-type="fig" rid="f2"><bold>Figures&#xa0;2B&#x2013;D</bold></xref>). Since a low concentration of 5 nM NVP-AUY922 completely inhibited clonogenic cell survival of B16F10 cells (<xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Figure&#xa0;1</bold></xref>) an additive radiosensitizing effect could not be shown in this cell line.</p>
<fig id="f2" position="float">
<label>Figure&#xa0;2</label>
<caption>
<p>Hsp90 inhibition potentiates radiosensitivity in LS174T cells. <bold>(A)</bold> Colony forming assay of LS174T WT and LDH<sup>&#x2212;/&#x2212;</sup> cells after irradiation with 0, 0.5, 1 and 2 Gy (**p &#x2264; 0.01). Colony forming assay of LS174T WT <bold>(B)</bold> and LDH<sup>&#x2212;/&#x2212;</sup> <bold>(C)</bold> cells after treatment with a low concentration of NVP-AUY922 (5 nM) for 24 h and irradiation with 0, 0.5, 1 and 2 Gy (*p &#x2264; 0.05, **p &#x2264; 0.01, ***p &#x2264; 0.001). <bold>(D)</bold> Comparison of WT and LDH<sup>&#x2212;/&#x2212;</sup> cells treated with a low dose of NVP-AUY922 (5 nM) (**p &#x2264; 0.01). <bold>(E)</bold> Representative immunoblot showing the expression of AKT and &#x3b2;-Actin in LS174T cells upon treatment with NVP-AUY922 (5 nM) for 24 h. <bold>(F, G)</bold> Membrane Hsp70 expression on B16F10 <bold>(F)</bold> and LS174T <bold>(G)</bold> cells treated with 100 nM NVP-AUY922 for 24 h, as determined by flow cytometry using the cmHsp70.1 mAb. The proportion of positively stained cells is shown (*p &#x2264; 0.05, **p &#x2264; 0.01, ***p &#x2264; 0.001).</p>
</caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fonc-12-861266-g002.tif"/>
</fig>
<p>As demonstrated in <xref ref-type="table" rid="T1"><bold>Table&#xa0;1</bold></xref>, the D<sub>50</sub> value of NVP-AUY922-treated WT versus LDH<sup>&#x2212;/&#x2212;</sup> cells was 1.54 Gy and 1.0 Gy, respectively, and the sensitizing enhancement ratio (SER) was greater 1.20 (1.58 and 1.79, respectively) in both cell types. A downregulation of the Hsp90 client protein AKT (<xref ref-type="fig" rid="f2"><bold>Figure&#xa0;2E</bold></xref>) confirmed the activity of the Hsp90 inhibitor NVP-AUY922 at a low concentration of 5 nM.</p>
<table-wrap id="T1" position="float">
<label>Table&#xa0;1</label>
<caption>
<p> Summary of radiobiological parameters depicted in <xref ref-type="fig" rid="f2"><bold>Figures&#xa0;2A&#x2013;D</bold></xref>.</p>
</caption>
<table frame="hsides">
<thead>
<tr>
<th valign="top" align="left">LS174T</th>
<th valign="top" align="center">D<sub>50</sub> [Gy]<xref ref-type="table-fn" rid="fnT1_1"><sup>a</sup></xref>
</th>
<th valign="top" align="center">SER<xref ref-type="table-fn" rid="fnT1_2"><sup>b</sup></xref>
</th>
<th valign="top" align="center">&#x3b1; [Gy<sup>-1</sup>]<xref ref-type="table-fn" rid="fnT1_3"><sup>c</sup></xref>
</th>
<th valign="top" align="center">&#x3b2; [Gy<sup>-1</sup>]c</th>
</tr>
</thead>
<tbody>
<tr>
<td valign="top" colspan="5" align="left"><bold>WT</bold>
</td>
</tr>
<tr>
<td valign="top" align="left">0 nM NVP</td>
<td valign="top" align="center">2.43</td>
<td valign="top" align="center">1.00</td>
<td valign="top" align="center">0.04</td>
<td valign="top" align="center">0.10</td>
</tr>
<tr>
<td valign="top" align="left">5 nM NVP</td>
<td valign="top" align="center">1.54</td>
<td valign="top" align="center"><bold>1.58</bold>
</td>
<td valign="top" align="center">0.08</td>
<td valign="top" align="center">0.24</td>
</tr>
<tr>
<td valign="top" colspan="5" align="left"><bold>LDH<sup>&#x2212;/&#x2212;</sup>
</bold>
</td>
</tr>
<tr>
<td valign="top" align="left">0 nM NVP</td>
<td valign="top" align="center">1.79</td>
<td valign="top" align="center">1.00</td>
<td valign="top" align="center">0.14</td>
<td valign="top" align="center">0.14</td>
</tr>
<tr>
<td valign="top" align="left">5 nM NVP</td>
<td valign="top" align="center">1.00</td>
<td valign="top" align="center"><bold>1.79</bold>
</td>
<td valign="top" align="center">0.32</td>
<td valign="top" align="center">0.37</td>
</tr>
</tbody>
</table>
<table-wrap-foot>
<fn id="fnT1_1">
<label>a</label>
<p>D<sub>50</sub>, dose [Gy] required for 50% inactivation of a tumor cell population.</p>
</fn>
<fn id="fnT1_2">
<label>b</label>
<p>SER, Sensitizing enhancement ratio = D<sub>50</sub> (control)/D<sub>50</sub> (drug treatment). A SER greater than 1.20 indicates a radio sensitization (indicated in bold).</p>
</fn>
<fn id="fnT1_3">
<label>c</label>
<p>&#x3b1; and &#x3b2; values were derived from the linear quadratic equation f = exp(-&#x3b1;*x-&#x3b2;*x<sup>2</sup>).</p>
</fn>
</table-wrap-foot>
</table-wrap>
<p>In contrast to the cytosolic Hsp70 levels, the low membrane Hsp70 expression (<xref ref-type="bibr" rid="B6">6</xref>) remained unaltered low by Hsp90 inhibition in LDH<sup>&#x2212;/&#x2212;</sup> B16F10 and LS174T tumor cells (<xref ref-type="fig" rid="f2"><bold>Figures&#xa0;2F, G</bold></xref>).</p>
</sec>
</sec>
<sec id="s4" sec-type="discussion">
<title>Discussion</title>
<p>Since many cells of different tumor entities including lung, breast, pancreatic and colorectal overexpress HSPs and are thus more resistant to therapy including radiotherapy, efforts are being made to develop HSP inhibitors (<xref ref-type="bibr" rid="B1">1</xref>, <xref ref-type="bibr" rid="B17">17</xref>, <xref ref-type="bibr" rid="B18">18</xref>). Although the synthetic, isoxazole/resorcinol-based Hsp90 inhibitor NVP-AUY922 has shown promising results in tumor cell lines and a human head and neck squamous cell carcinoma xenograft model (<xref ref-type="bibr" rid="B3">3</xref>, <xref ref-type="bibr" rid="B5">5</xref>), its hepatotoxicity and a compensatory upregulated expression of anti-apoptotic HSPs limits its broader clinical application. The effectiveness of combination therapies using inhibitors targeting different HSP have therefore recently been investigated, although clinical data are still missing (<xref ref-type="bibr" rid="B2">2</xref>, <xref ref-type="bibr" rid="B19">19</xref>). Our previous data demonstrated that combining the Heat Shock Factor 1 (HSF1) knockdown with Hsp90 inhibition using NVP-AUY922 radiosensitizes H1339 human lung cancer cells by impairing the DNA double-strand break repair (<xref ref-type="bibr" rid="B20">20</xref>). Furthermore, we have shown recently that targeting the lactate/pyruvate metabolism in cancer cells by a pharmacological or genetic inhibition of <italic>LDHA/B</italic> results in decreased cytosolic Hsp90, Hsp70 and Hsp27 levels and a reduced membrane Hsp70 expression (<xref ref-type="bibr" rid="B6">6</xref>). Therefore, we studied the radiosensitization effect of NVP-AUY922 in B16F10 and LS174T cells having an impaired lactate metabolism, and correlated radiosensitization with the cytosolic expression of different HSPs including Hsp27 and Hsp70 and the membrane Hsp70 positivity. A <italic>LDHA/B</italic> double knockout diminishes the HSP transcription and thereby reduces the cytosolic amounts of HSF1-regulated Hsp27 and Hsp70 (<xref ref-type="fig" rid="f1"><bold>Figures&#xa0;1C, D</bold></xref>). However, the addition of NVP-AUY922 reversed this beneficial effect and resulted in a significant upregulation of cytosolic Hsp70 and Hsp27 in both, WT and LDH<sup>&#x2212;/&#x2212;</sup> cells, even highly above initial levels (<xref ref-type="fig" rid="f1"><bold>Figures&#xa0;1C, D</bold></xref>).</p>
<p>In contrast to the elevated cytosolic HSP levels, membrane Hsp70 expression remained unaffected by Hsp90 inhibition in both tumor cell types (<xref ref-type="fig" rid="f2"><bold>Figures&#xa0;2F, G</bold></xref>). Tumor cells with an impaired lactate metabolism had a significantly lower membrane Hsp70 expression than WT cells after Hsp90 inhibition. Since the radiosensitizing effect of NVP-AUY922, even at low concentrations, was significantly more pronounced in LDH<sup>&#x2212;/&#x2212;</sup> compared to WT cells (<xref ref-type="fig" rid="f2"><bold>Figures&#xa0;2B&#x2013;D</bold></xref>), despite the fact that both cell types exhibited comparably high cytosolic HSP levels, we propose that the increased radiosensitivity of LDH<sup>&#x2212;/&#x2212;</sup> cells is associated with a reduced membrane Hsp70 positivity (<xref ref-type="fig" rid="f2"><bold>Figures&#xa0;2F, G</bold></xref>) (<xref ref-type="bibr" rid="B6">6</xref>). The localization and anchorage of Hsp70 on the plasma membrane of tumor cells is enabled by a spontaneous interaction of Hsp70 with negatively charged sphingolipids including sulfogalactosyl ceramide (<xref ref-type="bibr" rid="B21">21</xref>) or globotriaosylceramide Gb3 (<xref ref-type="bibr" rid="B22">22</xref>) which are elevated in tumor cells and reside in cholesterol rich domains also termed lipid rafts (<xref ref-type="bibr" rid="B23">23</xref>). Atomic force microscopy studies (<xref ref-type="bibr" rid="B24">24</xref>) as well as the formation of ion conductance channels (<xref ref-type="bibr" rid="B25">25</xref>, <xref ref-type="bibr" rid="B26">26</xref>) revealed a dimerization/clustering of Hsp70 in artificial lipid membranes which may affect the stability/fluidity of lipid membranes (<xref ref-type="bibr" rid="B27">27</xref>&#x2013;<xref ref-type="bibr" rid="B29">29</xref>). Interference with the lactate/pyruvate metabolism results in an altered lipid metabolism (<xref ref-type="bibr" rid="B6">6</xref>) which also affects the production of Gb3. A reduction in the amount of the Hsp70-anchoring glycolipid Gb3 causes a significant decrease in the amount of plasma membrane-bound Hsp70 in LDH<sup>&#x2212;/&#x2212;</sup> cells compared to WT cells. It remains to be determined whether an interference of the lactate/pyruvate metabolism also affects the trafficking of cytosolic Hsp70 to the plasma membrane and the release of Hsp70 in exosomes (<xref ref-type="bibr" rid="B30">30</xref>) into the extracellular milieu. Transport inhibitor studies revealed that membrane transport and exosomal export of Hsp70 are mediated <italic>via</italic> a non-classical liposomal but not a classical ER/Golgi pathway (<xref ref-type="bibr" rid="B31">31</xref>). Live cell STED nanoscopy has demonstrated that tumor cell-to-tumor cell connections are enabled by tunneling nanotubes that originate form membrane Hsp70 residing in cholesterol rich microdomains (<xref ref-type="bibr" rid="B32">32</xref>). It is conceivable that these nanotubes and cell interactions might also be impaired by an interference with the lactate metabolism.</p>
<p>A plasma membrane expression of Hsp70 on tumor cells correlates with the localization of Hsp70 in lysosomal membranes (<xref ref-type="bibr" rid="B33">33</xref>). Functionally, Hsp70 not only stabilizes plasma but also lysosomal membranes and thereby mediates resistance to chemical and/or physical-induced membrane permeabilization, such as anticancer drugs or radiation (<xref ref-type="bibr" rid="B13">13</xref>, <xref ref-type="bibr" rid="B33">33</xref>, <xref ref-type="bibr" rid="B34">34</xref>). Murakami et&#xa0;al. have demonstrated that not only cytosolic, but also plasma membrane-bound Hsp70 affects radiosensitivity (<xref ref-type="bibr" rid="B14">14</xref>). In this study, we demonstrate that the membrane Hsp70 status, not cytosolic Hsp70 levels, regulated by the lactate/pyruvate metabolism, determines the radiosensitizing effect of the Hsp90 inhibitor NVP-AUY922 in tumor cells.</p>
<p>Based on these findings, combining LDH and Hsp90 inhibition might provide a promising strategy to combat radioresistance, however further studies are necessary to identify more potent LDH inhibitors for clinical use with an improved efficacy, higher stability and lower off-target effects (<xref ref-type="bibr" rid="B35">35</xref>). The clinically approved, nonsteroidal anti-inflammatory drug (NSAID) diclofenac could be a potential candidate for efficiently inhibiting LDH activity (<xref ref-type="bibr" rid="B35">35</xref>&#x2013;<xref ref-type="bibr" rid="B38">38</xref>).</p>
</sec>
<sec id="s5" sec-type="data-availability">
<title>Data Availability Statement</title>
<p>The original contributions presented in the study are included in the article/<xref ref-type="supplementary-material" rid="SM1"><bold>Supplementary Material</bold></xref>. Further inquiries can be directed to the corresponding author.</p>
</sec>
<sec id="s6" sec-type="author-contributions">
<title>Author Contributions</title>
<p>Conceptualization, MS and GM. Methodology, MS. Investigation, MS. Writing&#x2014;original draft preparation, MS. Writing&#x2014;review and editing, GM. Supervision, GM. Project administration, GM. Funding acquisition, GM. All authors have read and agreed to the published version of the manuscript.</p>
</sec>
<sec id="s7" sec-type="funding-information">
<title>Funding</title>
<p>This research was supported by grants of the DFG (KU3500/2-1, SFB824, STA1520/1-1) and by BMWi (ZF4320104AJ8, ZF4320102CS7).</p>
</sec>
<sec id="s8" sec-type="COI-statement">
<title>Conflict of Interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec id="s9" sec-type="disclaimer">
<title>Publisher&#x2019;s Note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
</body>
<back>
<ack>
<title>Acknowledgments</title>
<p>The authors would like to thank Marina Kreutz and Jacques Pouyssegur for providing the B16F10 and LS174T WT and LDH<sup>&#x2212;</sup>/<sup>&#x2212;</sup> cell lines. The authors also acknowledge that antibody cmHsp70.1 provided by CSO of multimmune GmbH.</p>
</ack>
<sec id="s10" sec-type="supplementary-material">
<title>Supplementary Material</title>
<p>The Supplementary Material for this article can be found online at: <ext-link ext-link-type="uri" xlink:href="https://www.frontiersin.org/articles/10.3389/fonc.2022.861266/full#supplementary-material">https://www.frontiersin.org/articles/10.3389/fonc.2022.861266/full#supplementary-material</ext-link>
</p>
<supplementary-material xlink:href="DataSheet_1.docx" id="SM1" mimetype="application/vnd.openxmlformats-officedocument.wordprocessingml.document"/>
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