Targeting REV1 Exposes Context-Dependent Therapeutic Responses in Colorectal Cancer

Translesion synthesis (TLS) promotes DNA damage tolerance and contributes to chemotherapy resistance by enabling replication across damaged DNA templates. REV1, a central TLS regulator, is a potential therapeutic target to enhance the efficacy of genotoxic chemotherapy. Here, we investigated the therapeutic consequences of pharmacologic and genetic REV1 targeting in colorectal cancer (CRC) and evaluated the sensitivity of patient-derived CRC organoids to the REV1 inhibitor JH-RE-06. JH-RE-06 enhanced oxaliplatin sensitivity in HCT116 cells and 5-fluorouracil (5-FU) sensitivity in HT-29 cells, whereas reciprocal combinations produced limited sensitization, indicating treatment- and cellular context-dependent responses. siRNA-mediated REV1 depletion similarly enhanced chemotherapy sensitivity, supporting REV1 involvement in these responses. MNNG sensitivity assays and MLH1 expression analyses did not reveal consistent treatment-associated changes in mismatch repair function, while targeted HPRT1 sequencing identified no detectable sequence alterations in the region examined. Chemosensitization was not accompanied by consistent increases in caspase-3/7 activation under the conditions tested. REV1 inhibition also caused LC3-II accumulation and, after prolonged inhibitor exposure, reduced beta-tubulin abundance, indicating additional autophagy-associated and cytoskeletal responses. In two patient-derived CRC organoid models, JH-RE-06 exhibited single-agent growth-inhibitory activity, with mean IC50 values of 2.01 micromolar and 1.4 micromolar, respectively. Together, these findings demonstrate context-dependent chemosensitization and organoid growth inhibition following REV1 targeting, suggesting that its therapeutic consequences may extend beyond canonical TLS-mediated DNA damage tolerance.