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The abscopal effect: a sense of DNA damage is in the air
Timothy P. Lippert, Roger A. Greenberg
Timothy P. Lippert, Roger A. Greenberg
Published May 3, 2021
Citation Information: J Clin Invest. 2021;131(9):e148274. https://doi.org/10.1172/JCI148274.
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The abscopal effect: a sense of DNA damage is in the air

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Abstract

Tumor metastasis is a singularly important determinant of survival in most cancers. Historically, radiation therapy (RT) directed at a primary tumor mass was associated infrequently with remission of metastasis outside the field of irradiation. This away-from-target or “abscopal effect” received fringe attention because of its rarity. With the advent of immunotherapy, there are now increasing reports of abscopal effects upon RT in combination with immune checkpoint inhibition. This sparked investigation into underlying mechanisms and clinical trials aimed at enhancement of this effect. While these studies clearly attribute the abscopal effect to an antitumor immune response, the initial molecular triggers for its onset and specificity remain enigmatic. Here, we propose that DNA damage–induced inflammation coupled with neoantigen generation is essential during this intriguing phenomenon of systemic tumor regression and discuss the implications of this model for treatment aimed at triggering the abscopal effect in metastatic cancer.

Authors

Timothy P. Lippert, Roger A. Greenberg

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Figure 2

Sensing of self-nucleotides upon DNA damage triggers innate immunity.

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Sensing of self-nucleotides upon DNA damage triggers innate immunity.
Cy...
Cytoplasmic DNA may arise upon DNA damage in the main nucleus where replication intermediates are cleaved during repair and released into the cytoplasm. Other sources of cytoplasmic DNA include the release of mitochondrial DNA (mtDNA) and micronuclear DNA. Such molecules have been shown to be recognized by cGAS, which facilitates the generation of cGAMP and subsequent downstream signaling by activation and phosphorylation of ER-associated STING. This triggers a phosphorylation cascade involving many factors, including TBK1 and various IKK family proteins. Similarly, DNA damage results in the release of RNA into the cytoplasm as a result of deregulated transcription, especially of repetitive elements including SINEs, as well as the release of mtRNA. These molecules are sensed by RIG-I and MDA5, depending on their length, and trigger immune signaling by engagement with mitochondrial membrane–associated MAVS. Upon activation, MAVS is polyubiquitinated by factors such as TRIM25 and engages in a phosphorylation cascade similar to that of activated STING. Ultimately, both of these result in the phosphorylation and nuclear translocation of IRF3 and NF-κB, which induces transcription of innate immune effector genes.

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ISSN: 0021-9738 (print), 1558-8238 (online)

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