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The DNA repair pathway homologous recombination (HR) repairs platinum\u2010induced damage, and the HR recombinase RAD51 is overexpressed in cancer. We therefore designed a REMARK\u2010compliant study of pre\u2010treatment RAD51 expression in EOC, using fluorescent quantitative immunohistochemistry (qIHC) to overcome challenges in quantitation of protein expression\n                    <jats:italic>in situ<\/jats:italic>\n                    . In a discovery cohort (\n                    <jats:italic>n<\/jats:italic>\n                    \u00a0=\u00a0284), RAD51\u2010High tumours had shorter progression\u2010free and overall survival compared to RAD51\u2010Low cases in univariate and multivariate analyses. The association of RAD51 with relapse\/survival was validated in a carboplatin monotherapy SCOTROC4 clinical trial cohort (\n                    <jats:italic>n<\/jats:italic>\n                    \u00a0=\u00a0264) and was predominantly noted in HR\u2010proficient cancers (Myriad HRDscore\u00a0&lt;\u00a042). Interestingly, overexpression of RAD51 modified expression of immune\u2010regulatory pathways\n                    <jats:italic>in vitro<\/jats:italic>\n                    , while RAD51\u2010High tumours showed exclusion of cytotoxic T cells\n                    <jats:italic>in situ<\/jats:italic>\n                    . Our findings highlight RAD51 expression as a determinant of platinum resistance and suggest possible roles for therapy to overcome immune exclusion in RAD51\u2010High EOC. The qIHC approach is generalizable to other proteins with a continuum instead of discrete\/bimodal expression.\n                  <\/jats:p>","DOI":"10.15252\/emmm.202013366","type":"journal-article","created":{"date-parts":[[2021,3,12]],"date-time":"2021-03-12T02:17:19Z","timestamp":1615515439000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":55,"title":["Quantitative imaging of RAD51 expression as a marker of platinum resistance in ovarian cancer"],"prefix":"10.1038","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0364-6080","authenticated-orcid":false,"given":"Michal M","family":"Hoppe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Jaynes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanna D","family":"Wardyn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sai Srinivas","family":"Upadhyayula","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6624-1593","authenticated-orcid":false,"given":"Tuan Zea","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanus","family":"Lie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana G Z","family":"Lim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan N K","family":"Pang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherlly","family":"Lim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joe","family":"P S Yeong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Karnezis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek S","family":"Chiu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Leung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David G","family":"Huntsman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna S","family":"Sedukhina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ko","family":"Sato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monique D","family":"Topp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clare L","family":"Scott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6687-3088","authenticated-orcid":false,"given":"Hyungwon","family":"Choi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naina R","family":"Patel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7960-5755","authenticated-orcid":false,"given":"Robert","family":"Brown","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stan B","family":"Kaye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason J","family":"Pitt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9087-5262","authenticated-orcid":false,"given":"David S P","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9816-6137","authenticated-orcid":false,"given":"Anand D","family":"Jeyasekharan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,3,11]]},"reference":[{"key":"BFEMMM202013366_CR1","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1007\/s10549-016-3915-8","volume":"159","author":"AT Alshareeda","year":"2016","unstructured":"AlshareedaAT, NegmOH, AleskandaranyMA, GreenAR, NolanC, TigHhePJ, MadhusudanS, EllisIO, RakhaEA (2016) Clinical and biological significance of RAD51 expression in breast cancer: a key DNA damage response protein. 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