Nucleic Acid Sensing Pathways in DNA Repair Targeted Cancer Therapy

Multilevel Mechanisms of Cancer Drug Resistance

Cancer drug resistance represents one of the most significant challenges in oncology and manifests through multiple interconnected molecular and cellular mechanisms. Objective: To provide a comprehensive analysis of multilevel processes driving treatment resistance by integrating recent advances in understanding genetic, epigenetic, and microenvironmental factors. This is a systematic review of the recent literature focusing on the mechanisms of cancer drug resistance, including genomic studies, clinical trials, and experimental research. Key findings include the following: (1) Up to 63% of somatic mutations can be heterogeneous within individual tumors, contributing to resistance development; (2) cancer stem cells demonstrate enhanced DNA repair capacity and altered metabolic profiles; (3) the tumor microenvironment, including cancer-associated fibroblasts and immune cell populations, plays a crucial role in promoting resistance; and (4) selective pressure from radiotherapy drives the emergence of radioresistant phenotypes through multiple adaptive mechanisms. Understanding the complex interplay between various resistance mechanisms is essential for developing effective treatment strategies. Future therapeutic approaches should focus on combination strategies that target multiple resistance pathways simultaneously, guided by specific biomarkers.

The crosstalk between DNA-damage responses and innate immunity

DNA damage is typically caused during cell growth by DNA replication stress or exposure to endogenous or external toxins. The accumulation of damaged DNA causes genomic instability, which is the root cause of many serious disorders. Multiple cellular organisms utilize sophisticated signaling pathways against DNA damage, collectively known as DNA damage response (DDR) networks. Innate immune responses are activated following cellular abnormalities, including DNA damage. Interestingly, recent studies have indicated that there is an intimate relationship between the DDR network and innate immune responses. Diverse kinds of cytosolic DNA sensors, such as cGAS and STING, recognize damaged DNA and induce signals related to innate immune responses, which link defective DDR to innate immunity. Moreover, DDR components operate in immune signaling pathways to induce IFNs and/or a cascade of inflammatory cytokines via direct interactions with innate immune modulators. Consistently, defective DDR factors exacerbate the innate immune imbalance, resulting in severe diseases, including autoimmune disorders and tumorigenesis. Here, the latest progress in understanding crosstalk between the DDR network and innate immune responses is reviewed. Notably, the dual function of innate immune modulators in the DDR network may provide novel insights into understanding and developing targeted immunotherapies for DNA damage-related diseases, even carcinomas.

When DNA-damage responses meet innate and adaptive immunity

When cells proliferate, stress on DNA replication or exposure to endogenous or external insults frequently results in DNA damage. DNA-Damage Response (DDR) networks are complex signaling pathways used by multicellular organisms to prevent DNA damage. Depending on the type of broken DNA, the various pathways, Base-Excision Repair (BER), Nucleotide Excision Repair (NER), Mismatch Repair (MMR), Homologous Recombination (HR), Non-Homologous End-Joining (NHEJ), Interstrand Crosslink (ICL) repair, and other direct repair pathways, can be activated separately or in combination to repair DNA damage. To preserve homeostasis, innate and adaptive immune responses are effective defenses against endogenous mutation or invasion by external pathogens. It is interesting to note that new research keeps showing how closely DDR components and the immune system are related. DDR and immunological response are linked by immune effectors such as the cyclic GMP-AMP synthase (cGAS)-Stimulator of Interferon Genes (STING) pathway. These effectors act as sensors of DNA damage-caused immune response. Furthermore, DDR components themselves function in immune responses to trigger the generation of inflammatory cytokines in a cascade or even trigger programmed cell death. Defective DDR components are known to disrupt genomic stability and compromise immunological responses, aggravating immune imbalance and leading to serious diseases such as cancer and autoimmune disorders. This study examines the most recent developments in the interaction between DDR elements and immunological responses. The DDR network's immune modulators' dual roles may offer new perspectives on treating infectious disorders linked to DNA damage, including cancer, and on the development of target immunotherapy.

Prognostic and immunotherapeutic significance of immunogenic cell death-related genes in colon adenocarcinoma patients

In recent years, genes associated with immunogenic cell death (ICD)-related genes have garnered significant interest as potential targets for immunotherapy. As a frontier in cancer treatment, immunotherapy has notably enhanced the therapeutic outcomes for cancer patients. However, since only a subset of patients benefits from this treatment approach, there is an imperative need for biomarker research to enhance patient sensitivity to immunotherapy. Expression of ICD-related genes and clinical patient data were sourced from The Cancer Genome Atlas (TCGA) database. Utilizing univariate Cox regression analysis, we constructed a signature for predicting the overall survival of colon adenocarcinoma (COAD) patients. A genomic feature analysis was performed, incorporating tumor mutation burden (TMB) and copy number variation (CNV). The immunological characteristics were analyzed via the ssGSEA and GSEA algorithms, with the resulting data visualized using R software (version 4.2.1). According to the univariate regression analysis for COAD, AIM2 emerged as the gene most significantly associated with overall survival among the 32 ICD-related genes in the TCGA dataset. Patients were divided into two groups based on high or low AIM2 expression, and genomic differences between the groups were explored. Patients expressing high levels of AIM2 had a higher TMB and a lower CNV. In addition, these patients had elevated immune checkpoint, immune cell, and immune function scores, thus indicating increased sensitivity to immunotherapy. TIDE analysis further confirmed that these patients were likely to respond more effectively to immunotherapy. Subclass mapping analysis corroborated our findings, demonstrating that patients with high AIM2 expression responded more positively to immunotherapy. Additionally, our study found that the suppression of AIM2 could significantly enhance the proliferation, invasion, and migration capabilities of colon cancer cells. In this research, we identified a novel prognostic signature suggesting that patients with higher AIM2 expression levels are more likely to respond favorably to immunotherapy.

Immunomodulatory effects of targeted radionuclide therapy

It is now clear that conventional radiation therapy can reinstate cell death immunogenicity. Recent preclinical data indicate that targeted radionuclide therapy that irradiate tumors at continuous low dose rate also can elicit immunostimulatory effects and represents a promising strategy to circumvent immune checkpoint inhibitor resistance. In this perspective, we discuss the accumulating preclinical and clinical data suggesting that activation of the immune system through the cGAS-STING axis and the release of extracellular vesicles by irradiated cells, participate to this antitumor immunity. This should need to be considered for adapting clinical practices to state of the art of the radiobiology and to increase targeted radionuclide therapy effectiveness.