High levels of DNA replication initiation factors indicate ATRi sensitivity via excessive origin firing

Inhibitors of ATR, a central kinase controlling DNA replication origin firing and cellular checkpoint activity, are currently in multiple clinical trials, yet mechanisms underpinning sensitivity and robust patient stratification biomarkers are lacking. We used functional genomics approaches to identify molecular mechanisms driving sensitivity to the ATR inhibitor (ATRi) ceralasertib. Replication stress-associated patterns of DNA copy number alterations identified a subset of sensitive breast cancer cell lines. In parallel, we performed proteomics, phosphoproteomics and gene expression analyses and discovered that sensitive cell lines had higher expression of DNA replication origin firing factors, and massively increased origin firing in response to ATRi. ATRi sensitivity was partly rescued upon co-treatment with XL-413, a CDC7 inhibitor that decreases origin firing. High expression of replication initiation factors correlated with ATRi sensitivity across multiple cancer types, and in acute myeloid leukemia patient samples. Together, this study reveals a novel contribution of lethal origin firing capacity in determining the sensitivity of cancer cells to ATR inhibition and demonstrates the predictive potential of mechanism-specific copy number alterations, providing key steps towards developing a multimodal clinically applicable biomarker for ATR inhibitors.