1. Introduction
Medulloblastomas (MBs) are the most common primary central nervous system tumors in childhood, thought to originate from a specific group of cells called precursors of the granule cells (GCPs) in the developing cerebellum [
1,
2]. Between the second and fourth postnatal days (P2–P4) in mice, various signaling pathways stimulate the proliferation of GCPs. Among these, the Sonic hedgehog (Shh) pathway plays a key role in significantly increasing the GCP population during the early postnatal period [
3,
4]. Importantly, abnormalities in the Shh pathway predispose both mice and humans to MB. Mice with genetic mutations constitutively activating the Shh pathway are prone to developing MB [
5,
6,
7], and SHH-activated MBs make up a significant proportion of MB cases in patients [
1].
The Shh pathway is crucial for the development of almost all organs and for maintaining postnatal homeostasis and regeneration. This pathway transmits signals through two transmembrane proteins, Smoothened (SMO) and its negative regulator, Patched1 (PTCH1). Heterozygous germline mutations in the
PTCH1 gene in humans cause Gorlin syndrome, also known as nevoid basal cell carcinoma syndrome. This rare autosomal dominant disorder is characterized by multiple clinical manifestations, including the early onset of cutaneous basal cell carcinomas (BCCs). Remarkably, mice with a single functional copy of the
Ptch1 gene (
Ptch1+/−) recapitulate most features of Gorlin syndrome, including susceptibility to MB and other tumors development, as well as radiation hypersensitivity [
5,
6,
8,
9]. Neonatal irradiation dramatically increases the occurrence of BCCs and MBs in
Ptch1+/− mice [
9,
10].
The genetic background hosting the
Ptch1 mutation can dramatically alter the individual risk for developing tumors, and this incomplete mutation penetrance suggests that other signaling molecules cooperate with Shh to enhance tumor formation. In the
Ptch1+/− mouse model, higher spontaneous MB incidence is shown in a C57BL/6 background compared with a CD1 background (40.9% vs. 7.7%) [
11,
12], suggesting that a larger proportion of dividing cells may acquire tumor-initiating mutations in the early postnatal cerebellum depending on the genetic background [
11]. However, while irradiation of newborn
Ptch1+/− mice with a CD1 background with a single dose of 3 Gy X-rays dramatically increased MBs over the spontaneous rate [
9], no increase in MB incidence was observed in
Ptch1+/− mice bred with a C57BL/6 background after neonatal irradiation [
11]. These findings indicate that a CD1 background can be considered permissive, or that C57BL/6 can be considered suppressive, to radiogenic MBs, and that different sets of genes may control susceptibility to spontaneous and radiation-induced MBs.
Understanding how individual susceptibility to radiation affects health outcomes remains a top priority in radiation protection [
13]. This study employs multiple approaches to investigate the genetic background-related mechanisms that regulate radiation-induced cellular response and oncogenesis. These approaches include: (i) the analysis of endpoints and characteristic mechanisms of cellular radiosensitivity in GCPs isolated from
Ptch1+/− mice bred with CD1 or C57Bl/6 backgrounds; (ii) the search for differentially expressed genes in spontaneous and radiation-induced MBs from the two mouse lines, including genes associated with DNA damage (
γ-H2AX and
Trp53bp1) and DNA damage response (DDR) pathways (
p53,
p21,
p16, and
Bax), as well as cell cycle regulation and stemness markers; (iii) the use of bioinformatics analysis to correlate the expression levels of identified radiation-induced genes with survival outcomes in MB patients; and (iv) the analysis of the identified genes in ex vivo MBs after single or repeated irradiation fractions.
A mechanistic understanding of susceptibility to radiation oncogenic responses might have important implications in translational research and is crucial for developing personalized and effective treatment strategies for cancer patients.
2. Materials and Methods
2.1. Mice and Cell Cultures
Mice lacking one
Ptch1 allele were maintained on CD1 (CD1
Ptch1+/− [CD1.129-Ptch1
tm1Zim/Cnrm]) or C57Bl/6 (C57Bl/6
Ptch1+/− [B6.129-Ptch1
tm1Zim/Cnrm]) backgrounds [
6,
11]. Throughout the experimental duration, animals were housed under conventional conditions with food and water available ad libitum and a 12 h light–dark cycle.
For in vitro investigations, GCPs were purified from CD1
Ptch1+/− and C57Bl/6
Ptch1+/− mouse cerebella at P2 and maintained in culture as described [
14]. They were cultured in a Neurobasal medium with penicillin–streptomycin and L-Glutamine plus a B27 supplement without vitamin A. Unless otherwise indicated, media and supplements for cell culture were purchased from Gibco-Invitrogen (Carlsbad, CA, USA) and chemicals were purchased from Sigma-Aldrich (St. Louis, MO, USA). Cultured GCPs were exposed to doses of 2 Gy or 6 Gy of X-rays, using a Gilardoni CHF 320 G X-ray generator (Gilardoni S.p.A., Mandello del Lario, Italy) operated at 250 kVp, with HVL = 1.6 mm Cu (additional filtration of 2.0 mm Al and 0.5 mm Cu), or left untreated. For growth kinetics, GCPs from CD1
Ptch1+/− and C57Bl/6
Ptch1+/− mice were seeded at clonal density (28,000 cells/cm
2). On the following day, they were irradiated or left untreated. Cells were counted at fixed days (1, 5, 8, and 9).
For ex vivo investigations on the radiation response of MBs to a single or two repeated X-ray treatments, spontaneous MBs (n = 4 for each group) from C57Bl/6Ptch1+/− and CD1Ptch1+/− mice were explanted and cultured in Ultraculture medium (Lonza Walkersville Inc., Walkersville, MD, USA), supplemented with 20 ng/mL EGF, 20 ng/mL bFGF (Peprotech, Cranbury, NJ, USA), penicillin–streptomycin, L-Glutamine, and a B27 supplement without vitamin A, and 5 mM Sag (Smoothened agonist; Sigma-Aldrich, St. Louis, MO, USA). MB cells were seeded and exposed to 2 Gy of X-rays. They were then either collected 3 days later or given a second 2 Gy dose and collected 3 days after the final exposure.
For the in vivo and ex vivo analysis of gene expression, radiogenic and spontaneous MBs were explanted from irradiated or unexposed CD1Ptch1+/− and C57Bl/6Ptch1+/− mice and snap frozen for subsequent q-PCR analysis.
2.2. Silencing of Nanog and Oct-4 in GCPs and Neurospheres Assay
GCPs from CD1Ptch1+/− and C57Bl/6Ptch1+/− mice were transfected with siRNA duplexes (40 nM) directed against Nanog and Oct-4 mRNA coding sequences [siGENOME Mouse Nanog siRNA SMART Pool, siGENOME Mouse Oct-4 Dharmacon Inc. Lafayette, CO, USA] using the INTERFERin™ siRNA Transfection Reagent (Polyplus, Illkirich, France) according to the manufacturer’s instructions. Control transfections were carried out with a pool of validated siRNA controls (siGENOME Non-Targeting siRNA Pool #1, Dharmacon). One day after transfection, GCPs were seeded for the neurosphere assay and irradiated with 2 Gy.
For the neurosphere-forming assay, cells were plated at clonal density (1–2 cells/mm2) into 96-well plates and cultured in a selective medium, DMEM/F12 supplemented with 0.6% glucose, 25 μg/mL insulin, 60 μg/mL N-acetyl-L-cysteine, 2 μg/mL, heparin, 20 ng/mL EGF, 20 ng/mL bFGF, penicillin–streptomycin, and a B27 supplement without vitamin A. For the morphometric analysis of neurospheres, images were captured with a Leica digital camera and analyzed using the image analysis software LASCore (Leica Application Suite Version 4.3, Leica Microsystems, Milan, Italy).
2.3. Flow Cytometry Analysis
For cell cycle analysis, propidium iodide staining was performed using 1 × 106 fixed cells (Fixation/Permeabilization solution BD Biosciences, San Jose, CA, USA), incubated at 4 °C. Cells were centrifuged, and pellets were suspended in PI/RNase staining buffer (BD Biosciences, Franklin Lakes, NJ, USA). Cells were incubated for 5 min at room temperature using a coulter flow cytometer (CytoFLEX S, Beckman, Indianapolis, IN, USA).
For γ-H2AX staining, 2 × 106 cells were fixed (Fixation/Permeabilization solution, BD Biosciences, Franklin Lakes, NJ, USA) and incubated at 4 °C. For the endogenous visualization of γ-H2AX by CytoFLEX, we used anti-phospho γ-H2AX (Ser139) (Cell Signaling Technology, Inc., Danvers, MA, USA). The primary antibody was prepared in 0.5% BSA (Sigma-Aldrich, St. Louis, MO, USA) PBS buffer, incubated for 1 h on ice, and washed in 1X PBS. The fluorochrome-conjugated secondary antibody was diluted (in 3% BSA/PBS) and incubated for 1 h on ice, washed, and analyzed by flow cytometry using CytoFLEX.
For Annexin V staining, we used an Annexin V-FITC Early Apoptosis Detection Kit (Cell Signaling Technology, Danvers, MA, USA), following the manufacturer’s instructions. Cell cycle distribution and hypo diploid DNA content, as well as γ-H2AX and Annexin V staining, were evaluated by FCS express Cytometry 7 plus (version 7.12.0007) (DeNovo Software, Pasadena, CA, USA).
2.4. p53 Functional Test
GCPs from CD1Ptch1+/− and C57Bl/6Ptch1+/− mice were seeded and transfected with a Nanoluc-p53 Response Element (p53 RE) pNL vector (Promega Corporation, Madison, WI, USA) using Lipofectamine 2000 (Thermofisher scientific, Waltham, MA, USA). The following day, GCPs were irradiated with 2 Gy of X-rays or left untreated. At 2 h post-irradiation, we measured firefly and NanoLuc luciferase activities in single samples. We used the Nano-Glo® Dual-Luciferase® Reporter Assay System (Promega Italia Srl, Milan, Italy), following the manufacturer’s instructions.
2.5. RNA Isolation and Real-Time qPCR
RNA isolation from GCPs and MBs (obtained from the ENEA archive of frozen tumors) was performed with a miRNeasy Mini Kit (QIAGEN, Hilden, Germany). A total of 2 μg of total RNA was reverse transcribed with a High-Capacity cDNA Reverse Transcription Kit (Applied Biosystems, Foster City, CA, USA), and qPCR reactions were performed in triplicate from each biological replicate in the QuantStudio™ 5 Real-Time PCR System (Applied Biosystems) using the Power up SYBR
® Green PCR Master Mix (Applied Biosystems). Relative quantification was carried out using the ΔΔCt method, with Glyceraldehyde-3-phosphate (
Gapdh) as the endogenous housekeeping control. The oligonucleotide primers used for quantitative RT-PCR are listed below.
Gene | Forward Primer | Reverse Primer |
Oct-4 | 5′-AAAGCCCTGCAGAAGGAGCTAGAA-3′ | 5′-AACACCTTTCCAAAGAGAACGCCC-3′ |
Nanog | 5′-AAGCAGAAGATGCGGACTG-3′ | 5′-GCTTGCACTTCATCCTTTGG-3′ |
p53 | 5′-TGCATGGACGATCTGTTGCT-3′ | 5′-TTCACTTGGGCCTTCAAAAAA-3′ |
p21 | 5′-CGAGAACGGTGGAACTTTGAC-3′ | 5′-CAGGGCTCAGGTAGACCTTG-3′ |
Trp53bp1 | 5′-TCACTGCCATGGAGGAGC-3′ | 5′-GGATGCCTGGTACTGTTTGG-3′ |
Cyclin-D1 | 5′-TCCGCAAGCATGCACAGA-3′ | 5′-AGGGTGGGTTGGAAATGAACT-3′ |
Bax | 5′-ATCCAGGATCGAGCAGGGCG-3′ | 5′-ACTCGCTCAGCTTCTTGGTG-3′ |
p16 | 5′-CCGAACTCTTTCGGTCGTAC-3′ | 5′-AGTTCGAATCTGCACCGTAGT-3′ |
Gapdh | 5′-CATGGCCTTCCGTGTTCCTA-3′ | 5′-GCGGCACGTCAGATCCA-3′ |
2.6. Bioinformatics Analysis
Dataset interrogation was conducted on the R2 Genomic Analysis and Visualization Platform (Amsterdam UMC,
https://hgserver1.amc.nl/cgi-bin/r2/; accessed on 16 July 2024) to perform a Kaplan–Meier survival analysis. An observational experiment on the RNA-seq profile of 331 primary tumors from patients diagnosed with MB was selected [
15]. Survival analysis was performed using the R2 KaplanScanner tool to find the optimal 2-group segregation based on gene expression (
Figure S1). Kaplan–Meier plots were generated from two groups (high and low gene expression) for the following genes:
TP53BP1,
BAX,
CYCLIN D1,
P21,
P16,
OCT-4, and
NANOG.
2.7. Statistical Analysis
Statistical tests were performed with Graph Pad Prism v.7 software. The p-values were determined using a non-parametric two-tailed t-test or an Anova test. * p < 0.05, ** p < 0.01, *** p < 0.001, and **** p < 0.0001. Results are expressed as average biological replicates ± SD.
For survival distributions, p-values were determined using a log-rank test on the R2 Genomic Analysis and Visualization Platform.
4. Discussion
It is well-known that the genetic background on which a highly penetrant cancer gene is studied can dramatically alter the individual risk of developing a specific tumor [
17]. The genetic component may also limit or enhance the effect of exposure to environmental cancer-causing agents [
18].
In the present study, we have employed the Ptch1 heterozygous mouse model bred on two genetic backgrounds with opposite susceptibilities to radiogenic MBs, permissive (CD1) or suppressive (C57BL/6), to assess the early radiation response of GCPs, as well as the tumorigenic consequences of ionizing radiation exposure, and elucidate the biological factors responsible for the differential oncogenic response following irradiation.
This study employs a multifaceted approach that includes: (i) examining the endpoints and mechanisms of cellular radiosensitivity in GCPs, MB cells of origin; (ii) identifying differentially expressed genes in both spontaneous and radiation-induced MBs; (iii) employing bioinformatics analyses to link the expression levels of selected radiation-induced genes with survival outcomes in MB cancer patients; and (iv) investigating the expression of these genes in ex vivo MBs subjected to single or repeated irradiation treatments. These results offer a robust dataset to explore correlations between potential determinants of radiosensitivity. In this manner, we generated an intricate network view, which enabled the identification of genes and pathways associated with susceptibility to radiation-induced tumors.
Of note, Shh signaling activation has been reported to induce replication stress in GCPs, detected through increased γ-H2AX and
Trp53bp1 markers [
19]. Such Shh-dependent enhanced replication stress, resulting from increased origin firing and fork velocity and mediated by helicase loading and activation, has been implicated in the loss of the wild-type
Ptch1 allele in tumor-prone GCPs [
20]. In fact, reduction of replication origins, through Cdc7 inhibition, in Shh-exposed GCPs blocks replication stress along with MB initiation in tumor-prone mice [
20].
Our study reveals that GCPs
C57Bl-Ptch1+/− and GCPs
CD1-Ptch1+/− exhibit distinct responses to DNA damage and apoptosis, impacting tumorigenesis. GCPs
CD1-Ptch1+/− show higher DNA damage markers (Trp53bp1 and γ-H2AX) post-irradiation than GCPs
C57Bl-Ptch1+/−, with unexposed GCPs
CD1Ptch1+/− displaying high spontaneous apoptosis (
Bax and Annexin V), which only moderately increases after irradiation. This spontaneous apoptosis may clear potentially tumor-prone GCPs with
Ptch1 LOH derived from replicative stress [
20], contributing to the lower spontaneous tumor incidence (7.7%) in CD1
Ptch1+/− mice. Conversely, the increase in apoptotic rates in GCPs
C57Bl-Ptch1+/− after irradiation may prevent the accumulation of radiogenic DNA damage and reduce oncogenic potential, despite a higher spontaneous tumor incidence (40%). Our data—underscoring the pivotal role of genetic backgrounds in shaping DNA damage responses and tumor suppression mechanisms, with strain-dependent distinct strategies to maintain cellular homeostasis and prevent tumorigenesis—also highlight the importance of the genetic context in therapeutic strategies and risk assessment for radiation exposure and cancer.
The present study shows that growth kinetics, as well as the stemness response of GCPs after irradiation, are strongly influenced by the genetic background, possibly affecting radiosensitivity to MB induction. Both GCPs
CD1-Ptch1+/− and GCPs
C57Bl-Ptch1+/− showed a significant initial decrease in growth after irradiation. However, GCPs
CD1-Ptch1+/− recovered and surpassed the proliferation rate of unirradiated cells after eight days, while GCPs
C57Bl-Ptch1+/− showed persistent slow growth. This difference is likely linked to the expression of stemness genes
Oct-4 and
Nanog, which were upregulated in GCPs
CD1-Ptch1+/− but downregulated in GCPs
C57Bl-Ptch1+/− after irradiation. This is in line with our previous results demonstrating that irradiation of GCPs
CD1-Ptch1+/− induces the expansion of the stem-like cell compartment through a Nanog-dependent mechanism [
14], linking this to the induction of MBs by irradiation.
In addition, our neurosphere assay results provide further insights into the stem cell dynamics post-irradiation. GCPsCD1-Ptch1+/− can grow as neurospheres, and this growth potential is significantly diminished when Oct4 or Nanog is silenced. This contrasts sharply with GCPsC57Bl-Ptch1+/−, which are unable to grow in a selective stem cell medium. This supports the idea that stemness genes such as Oct-4 and Nanog are crucial for modulating cell growth following irradiation.
Furthermore,
Oct-4 is known to regulate growth, proliferation, the cell cycle, EMT, and DNA repair [
21,
22], which aligns with the enhanced recovery seen in GCPs
CD1-Ptch1+/−. Moreover,
Oct4 involvement in radioresistance is supported by clinical findings where
Oct4-positive head and neck squamous cell carcinoma patients had reduced survival post-radiotherapy compared to Oct4-negative cases [
23]. Thus, the impact of the genetic background on GCP recovery and differential expression of stemness genes suggests a mechanism for differing radiosensitivity and potential treatment resistance.
These findings collectively suggest that the amplification of stem-like cells driven by Oct4 and Nanog after irradiation enhances the likelihood of radiation-induced MBs in CD1Ptch1+/− mice. Conversely, the inability of GCPsC57Bl-Ptch1+/− to form neurospheres, due to the downregulation of these stemness genes, may correlate with resistance to in vivo radiation-induced MBs. This highlights the pivotal role of Oct4 and Nanog in influencing the radiosensitivity and potential for tumor progression in different genetic backgrounds.
Upon radiation exposure, the DNA damage response enhances p53 protein levels in cells primarily by promoting protein translation [
24] and inhibiting its degradation [
25]. Consistent with this, our functional p53 assay showed a significant increase in active p53 in GCPs
C57Bl-Ptch1+/− following ionizing radiation exposure, but not in GCPs
CD1-Ptch1+/−. Notably, there is a known link between p53 and
Nanog expression, as p53 binds to the
Nanog promoter and suppresses its expression after DNA damage [
26]. This suggests that the increased p53 and low Nanog expression levels observed in GCPs
C57Bl-Ptch1+/− may be connected.
In irradiated GCPsC57Bl-Ptch1+/−, increased p53 activation was accompanied by a persistent G2/M cell cycle block lasting 24 h. In contrast, GCPsCD1-Ptch1+/− exhibited only a weak G1 block, which resolved 24 h post-irradiation. This indicates a genetic background-related difference in the mechanism of radiation-induced cell cycle delay.
In CD1
Ptch1+/− mice, MBs are characterized by the loss of the normal remaining
Ptch1 allele through chromosome deletions, suggesting that genome rearrangements may be key events in MB development [
27]. Two distinct DSB repair pathways, homologous recombination (HR) and non-homologous end joining (NHEJ), have been developed in mammalian cells to counteract the harmful genotoxic effects [
28]. The cell cycle stage at the time of DNA damage induction influences the choice of DSB repair pathway [
29]. Most HR-based DNA repair happens in the S and G2 phases of the cell cycle when an undamaged sister chromatid is available for use as a repair template. NHEJ, taking place when the cells are blocked in G1, does not require homology for DSB repair and corrects the break in an error-prone manner.
On this issue, our previous data, obtained from CD1
Ptch1+/− mice, indicated a prominent role for HR in genome stability, as
Rad54 deficiency increased both spontaneous and radiation-induced MB development in
Ptch1+/−/
Rad54−/− mice. Instead, loss of NHEJ function led to the suppression of MB tumorigenesis in
Ptch1+/−/
DNA-PKcs−/− mice through increased DSBs and apoptosis in GCPs, leading to the killing of tumor-initiating cells [
30]. It is therefore plausible to speculate that GCPs from CD1
Ptch1+/− mice, which arrest in G1 following irradiation, primarily employ NHEJ for DSB repair. This can lead to extensive genome rearrangements, driving MB oncogenesis. Supporting this, the Nanog protein, which is upregulated upon irradiation in CD1
Ptch1+/−, has been identified as a Rad51 inhibitor, blocking HR and promoting NHEJ repair through its binding [
31]. Additionally,
Trp53bp1, upregulated following irradiation in CD1
Ptch+/− mice, binds ubiquitinated histones within chromatin associated with DSBs to promote NHEJ [
32,
33,
34]. Conversely, GCPs
C57Bl-Ptch1+/−, which markedly and persistently arrest in G2/S after damage, undergo HR repair, thereby preventing the induction of radiogenic MBs.
To determine the molecular basis of differences between C57Bl/6Ptch1+/− and CD1Ptch1+/− mice, we also performed gene expression analysis in spontaneous and radiation-induced MBs. Our data highlight the significant influence of the genetic background on the expression of several genes associated with DNA damage response (Trp53bp1 and p21), apoptosis (Bax), senescence (p16), and stemness (Nanog and Oct-4) in MBs. These genetic differences help distinguish spontaneous MBs in C57Bl/6Ptch1+/− mice from those in CD1Ptch1+/− mice. Furthermore, we observed distinct genetic background-related features in MBs from irradiated C57Bl/6Ptch1+/− and CD1Ptch1+/− mice.
In irradiated C57Bl/6Ptch1+/− mice, MBs exhibited elevated levels of Bax and p21 compared to MBs from unirradiated mice, indicating a heightened apoptotic and DNA damage response. In contrast, radiation-induced MBs in CD1Ptch1+/− mice showed reduced senescence (p16), increased proliferation (Cyclin D1), and elevated stemness (Nanog, Oct-4) relative to spontaneous tumors. These differences reflect the distinct responses of GCPs to irradiation based on genetic background, with CD1Ptch1+/− mice demonstrating a more pronounced stemness and proliferation response, potentially contributing to increased tumor progression following radiation exposure.
In the scheme of
Figure 7, to simplify the comparison of data on GCPs and MBs, we have summarized the frequency of spontaneous and radiogenic MBs in C57Bl/6
Ptch1+/− (left side) and CD1
Ptch1+/− (right side) mice with the expression of gene markers for DSBs (γ-H2AX and
Trp53bp1), DNA damage response (
Bax,
p21,
p16, and p53), cell cycle, and stemness (
Cyclin D1,
Nanog,
Oct-4,
p21, and
p16) in GCPs (yellow panel) and MBs (grey panel). These findings highlight that cellular processes, such as DNA damage response, apoptosis, cell growth, cell cycle regulation, and stemness, critical to determining cellular outcomes after exposure to ionizing radiation are differently regulated in C57Bl/6
Ptch1+/− and CD1
Ptch1+/− mice. Therefore, we proposed a potential panel of genes whose expression varies with genetic background and might influence the susceptibility to radiogenic MBs. These signature genes include
Nanog,
Trp53bp1,
Bax,
Cyclin D1,
p21, and
p16 (red circle in
Figure 7), which are believed to affect radiation response.
Survival analysis performed using the R2 Genomic Analysis and Visualization Platform, interrogating a dataset of 331 primary MBs with clinical pathological annotation and based on genes differentially expressed in our radiation-induced murine MBs (i.e., TRP53BP1, BAX, CYCLIN D1, P21, NANOG, OCT-4, and P16), revealed significant decreases in survival among MB patients with high expression levels of CYCLIN D1 (p < 0.011), P21 (p < 0.019), BAX (p < 0.028), NANOG (p < 0.022), and OCT-4 (p < 0.017), and with decreased expression of TP53BP1 (p < 0.0002), strongly supporting the translational relevance of the results obtained from our mouse models.
Our findings, derived from the genetic backgrounds of susceptible or resistant radiation-induced MBs and validated through bioinformatics survival analyses of MB patients, support the presence of a potential gene expression signature. This signature, comprising TRP53BP1, P21, BAX, CYCLIN D1, OCT-4, and NANOG, appears to influence tumor response to radiation. Notably, in ex vivo murine spontaneous MBs, the expression of Trp53bp1, Bax, Cyclin D1, p21, and Nanog gradually increases following either single or repeated radiation exposure in the CD1 genetic background but not in the C57Bl/6 background. This observation suggests that such a genetic background-related signature could be a valuable tool for predicting tumor response to radiation therapy.
Beyond predictive work, a better understanding of protective DDRs—whose functioning obviously confers radioresistance—is crucial for targeting DNA damage repair in tumors, which has become an attractive strategy in radiotherapy and provides critical therapeutic opportunities for overcoming tumor radioresistance [
35]. Identifying treatment-resistant genotypes and therapeutic targets that may influence tumor response is at the center of current radiation biology research.