AQB improves carboplatin sensitivity in endometrial cancer through dual DNA repair modulation: suppression of the p21-E2F1-RAD51 and ATF3-HDAC1-BRCA1 signaling

Abstract Endometrial cancer (EC) is an increasingly common malignancy among women, and associated mortality rates continue to rise. Preferred treatment options for advanced or recurrent EC patients include a combination of carboplatin and paclitaxel, with modest clinical outcomes. Chemoresistance and drug toxicity are important factors that significantly affect the clinical efficacy of carboplatin. Therefore, there is an urgent need for therapeutic strategies that enhance carboplatin sensitivity, reduce its dose while maintaining efficacy, and ensure treatment safety. This study identified the novel small-molecule inhibitor AC1Q3QWB (AQB) as a potent enhancer of carboplatin efficacy. AQB disrupts the binding of HOTAIR to EZH2 and upregulates a series of tumor suppressor genes, such as CDKN1A , ATF3 , and BBC3 , thereby epigenetically suppressing the homologous recombination repair (HRR) pathway in EC, causing cell cycle arrest and inducing apoptosis. AQB inhibits carboplatin-induced RAD51 expression via the p21-E2F1 axis. Additionally, AQB epigenetically silences BRCA1 via ATF3-HDAC1 interactions at the BRCA1 promoter. In vivo studies using subcutaneous xenografts and a stage IV EC patient-derived xenograft (PDX) model demonstrated that AQB enhanced carboplatin’s antitumor effects, reduced the required carboplatin dose, and alleviated associated toxicity. The combination of AQB with standard chemotherapy holds promise for improving outcomes in patients with advanced or recurrent EC.