Interferon-induced IDO1 mediates radiation resistance and is a therapeutic target in colorectal cancer

Colorectal cancer (CRC) is a major cause of mortality worldwide. Chemotherapy and radiation remain standard treatment for locally advanced disease, with current immune-targeting therapies applying to only a small subset of patients. Expression of the immuno-oncology target indoleamine 2,3 dioxygenase 1 (IDO1) is associated with poor CRC clinical outcomes but is understudied as a potential treatment target. In this study, we examined the interaction between the IDO1 pathway and radiation therapy in CRC. We used human and mouse CRC cell lines, organoids, mouse syngeneic CRC tumor graft models, and CRC tissues from patients who received radiation therapy. IDO1 activity was blocked using the clinical IDO1 inhibitor epacadostat and by genetic disruption. We found that radiation-induced IDO1 overexpression in CRC through Type I and II interferon signaling. IDO1 enzymatic activity directly influenced CRC radiation sensitivity. IDO1 inhibition sensitized CRC to radiation-induced cell death, whereas the IDO1 metabolite kynurenine promoted radioprotection. IDO1 inhibition also potentiated Th1 cytokines and myeloid cell-modulating factors in the tumor microenvironment and promoted an abscopal effect on tumors outside the radiation field. Conversely, IDO1 blockade protected the normal small intestinal epithelium from radiation toxicity and accelerated recovery from radiation-induced weight loss, indicating a role in limiting side-effects. These data demonstrated that IDO1 inhibition potentiates radiation therapy effectiveness in colorectal cancer. The findings also provide rationale and mechanistic insight for the study of IDO1 inhibitors as adjuvant therapy to radiation in patients with locally advanced sporadic and colitis-associated colorectal cancer.