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However, therapy resistance develops via either restoration of homologous recombination or replication fork stabilization. Therapeutic targets to overcome PARPi resistance are critically needed. We identified the deubiquitinase USP37 as a key determinant of PARPi toxicity in BRCA1-deficient cells via whole-genome CRISPR screens. USP37 ablation enhanced PARPi sensitivity in BRCA1-deficient cells and also overcame PARPi resistance due to 53BP1 loss. USP37 interacts with and deubiquitinates\u00a0replication protein A (RPA) at stalled replication forks to limit excessive RPA accumulation, progressive RPA exhaustion, and the conversion of RPA-coated single-stranded DNAs to DNA double-strand breaks. Moreover, USP37 limits helicase-like transcription factor (HLTF) accumulation at replication forks and thus prevents MRE11-dependent fork degradation upon replication stress. Depletion of HLTF reversed the replication-associated damage observed in USP37 knockout cells. Our data suggest that USP37 protects replication fork stability by counteracting HLTF function and promotes survival of BRCA1-deficient cells, making it a promising drug target to overcome PARPi resistance in BRCA1-deficient tumors.<\/jats:p>","DOI":"10.1093\/nar\/gkaf544","type":"journal-article","created":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T07:47:28Z","timestamp":1749023248000},"source":"Crossref","is-referenced-by-count":2,"title":["USP37 counteracts HLTF to protect damaged replication forks and promote survival of BRCA1-deficient cells and PARP inhibitor resistance"],"prefix":"10.1093","volume":"53","author":[{"given":"Mengfan","family":"Tang","sequence":"first","affiliation":[{"name":"Department of Immunology, School of Medicine, Nanjing University of Chinese Medicine , Nanjing 210023 ,","place":["China"]},{"name":"Department of Experimental Radiation Oncology, The University of Texas MD Anderson Cancer Center , Houston , TX 77030 ,","place":["United 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