Lysosomal membrane permeabilization enhances the anticancer effects of RNA Polymerase I transcription inhibitors

Lysosomes are known to contribute to the development of drug resistance through a variety of mechanisms that include the sequestration of drugs within their compartments and the activation of adaptive stress pathways. Although targeting POL I (RNA polymerase I) exhibits anticancer effects, little attention has been paid to the contribution of lysosomes to the efficacy and resistance of RNA POL I inhibitors. In this study, we investigated this aspect in the context of two potent POL I inhibitors, CX-3543 (Quarfloxin) and CX-5461 (Pidnarulex). Unexpectedly, CX-3543 was found to be sequestered in the lysosomal compartment. This resulted in the permeabilization of lysosomal membranes (LMP) and the subsequent activation of cellular stress adaptation pathways, including the transcription factor (TFEB) and autophagy. Disruption of TFEB or autophagy increased cell sensitivity to CX-3543, highlighting the cytoprotective role of these processes against cell death induced by this compound. Moreover, targeting lysosomal membranes using chloroquine derivatives or blue light excitation induced substantial LMP, resulting in the liberation of CX-3543 from lysosomes. This effect amplified both the inhibition of DNA-to-RNA transcription and cell death induced by CX-3543. Similar effects were observed when chloroquine derivatives were combined with CX-5461. Furthermore, combining CX-3543 with the chloroquine derivative DC661 reduced the growth of fibrosarcoma established in immunocompetent mice more efficiently than either agent alone. Altogether, our results uncover an unanticipated lysosome-related mechanism that contributes to the resistance of cancer cells to POL I transcription inhibitors, as well as a strategy to combat this resistance.