Ultra-high dose rate radiotherapy overcomes radioresistance in head and neck squamous cell carcinoma

Abstract Radiotherapy (RT) resistance in head and neck squamous cell carcinoma (HNSCC) significantly hampers local control and patient prognosis. This study investigated the efficacy and molecular mechanisms of high-energy X-ray-based ultra-high dose rate radiotherapy (UHDR-RT) in overcoming RT resi...

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Main Authors: Hong-Shuai Li, Ruo Tang, Hua-Shan Shi, Zi-Jian Qin, Xiao-Yang Zhang, Yun-Fei Sun, Zhi-Gong Wei, Chao-Fan Ma, Liu Yang, Ye Chen, Zhe-Ran Liu, Li-Li Zhu, Wen Yang, Li Yang, Ai-Ning Xu, Zhuo Zhang, Shu-Qing Liao, Jin-Shui Shi, Jian-Jun Deng, Xiao-Zhong He, Xing-Chen Peng
Format: Article
Language:English
Published: Nature Publishing Group 2025-03-01
Series:Signal Transduction and Targeted Therapy
Online Access:https://doi.org/10.1038/s41392-025-02184-0
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author Hong-Shuai Li
Ruo Tang
Hua-Shan Shi
Zi-Jian Qin
Xiao-Yang Zhang
Yun-Fei Sun
Zhi-Gong Wei
Chao-Fan Ma
Liu Yang
Ye Chen
Zhe-Ran Liu
Li-Li Zhu
Wen Yang
Li Yang
Ai-Ning Xu
Zhuo Zhang
Shu-Qing Liao
Jin-Shui Shi
Jian-Jun Deng
Xiao-Zhong He
Xing-Chen Peng
author_facet Hong-Shuai Li
Ruo Tang
Hua-Shan Shi
Zi-Jian Qin
Xiao-Yang Zhang
Yun-Fei Sun
Zhi-Gong Wei
Chao-Fan Ma
Liu Yang
Ye Chen
Zhe-Ran Liu
Li-Li Zhu
Wen Yang
Li Yang
Ai-Ning Xu
Zhuo Zhang
Shu-Qing Liao
Jin-Shui Shi
Jian-Jun Deng
Xiao-Zhong He
Xing-Chen Peng
author_sort Hong-Shuai Li
collection DOAJ
description Abstract Radiotherapy (RT) resistance in head and neck squamous cell carcinoma (HNSCC) significantly hampers local control and patient prognosis. This study investigated the efficacy and molecular mechanisms of high-energy X-ray-based ultra-high dose rate radiotherapy (UHDR-RT) in overcoming RT resistance. The established RT-resistant HNSCC cell lines and animal models were subjected to UHDR-RT or conventional RT (Conv-RT) via a high-power rhodotron accelerator. Cellular assays assessed the malignant phenotype, viability, and degree of DNA damage, whereas in vivo evaluations focused on tumor proliferation and the tumor immune microenvironment (TiME). Transcriptome sequencing and Olink proteomics were employed to explore the underlying mechanisms involved. In vitro experiments indicated that UHDR-RT suppressed radioresistant cell proliferation and invasion, while promoting apoptosis and exacerbating DNA damage. In contrast, its efficacy in radiosensitive cells was comparable to that of Conv-RT. In vivo studies using patient-derived xenograft nude mice models demonstrated that UHDR-RT only partially reversed RT resistance. Transcriptomic and proteomic analyses of C57BL/6J mice models revealed the predominant role of TiME modulating in reversing radioresistance. Immunofluorescence and flow cytometry confirmed increased CD8+ T cells and an increased M1/M2 macrophage ratio post-UHDR-RT. Mechanistically, UHDR-RT activated CD8+ T cells, which stimulated M1 macrophages through paracrine IFN-γ signaling, thereby enhancing TiME activation. Furthermore, the activated M1 macrophages secreted CXCL9, which in turn reactivated CD8+ T cells, forming a feedforward loop that amplified TiME activation. This study elucidates the dual role of UHDR-RT in directly inducing DNA damage and modulating the TiME, highlighting its potential in treating radioresistant HNSCC.
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spelling doaj-art-4187e4cf8f564d83b2f97bfdb53ea2322025-08-20T02:59:57ZengNature Publishing GroupSignal Transduction and Targeted Therapy2059-36352025-03-0110111710.1038/s41392-025-02184-0Ultra-high dose rate radiotherapy overcomes radioresistance in head and neck squamous cell carcinomaHong-Shuai Li0Ruo Tang1Hua-Shan Shi2Zi-Jian Qin3Xiao-Yang Zhang4Yun-Fei Sun5Zhi-Gong Wei6Chao-Fan Ma7Liu Yang8Ye Chen9Zhe-Ran Liu10Li-Li Zhu11Wen Yang12Li Yang13Ai-Ning Xu14Zhuo Zhang15Shu-Qing Liao16Jin-Shui Shi17Jian-Jun Deng18Xiao-Zhong He19Xing-Chen Peng20Department of Biotherapy, Cancer Center, and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan UniversityInstitute of Fluid Physics, Chinese Academy of Engineering PhysicsDepartment of Biotherapy, Cancer Center, and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan UniversityDepartment of Biotherapy, Cancer Center, and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan UniversityInstitute of Fluid Physics, Chinese Academy of Engineering PhysicsInstitute of Fluid Physics, Chinese Academy of Engineering PhysicsDepartment of Biotherapy, Cancer Center, and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan UniversityInstitute of Fluid Physics, Chinese Academy of Engineering PhysicsInstitute of Fluid Physics, Chinese Academy of Engineering PhysicsDepartment of Biotherapy, Cancer Center, and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan UniversityDepartment of Biotherapy, Cancer Center, and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan UniversityDepartment of Biotherapy, Cancer Center, and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan UniversityInstitute of Fluid Physics, Chinese Academy of Engineering PhysicsDepartment of Biotherapy, Cancer Center, and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan UniversityDepartment of Applied Statistics, Social Science, and Humanities, New York UniversityInstitute of Fluid Physics, Chinese Academy of Engineering PhysicsInstitute of Fluid Physics, Chinese Academy of Engineering PhysicsInstitute of Fluid Physics, Chinese Academy of Engineering PhysicsInstitute of Fluid Physics, Chinese Academy of Engineering PhysicsInstitute of Fluid Physics, Chinese Academy of Engineering PhysicsDepartment of Biotherapy, Cancer Center, and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan UniversityAbstract Radiotherapy (RT) resistance in head and neck squamous cell carcinoma (HNSCC) significantly hampers local control and patient prognosis. This study investigated the efficacy and molecular mechanisms of high-energy X-ray-based ultra-high dose rate radiotherapy (UHDR-RT) in overcoming RT resistance. The established RT-resistant HNSCC cell lines and animal models were subjected to UHDR-RT or conventional RT (Conv-RT) via a high-power rhodotron accelerator. Cellular assays assessed the malignant phenotype, viability, and degree of DNA damage, whereas in vivo evaluations focused on tumor proliferation and the tumor immune microenvironment (TiME). Transcriptome sequencing and Olink proteomics were employed to explore the underlying mechanisms involved. In vitro experiments indicated that UHDR-RT suppressed radioresistant cell proliferation and invasion, while promoting apoptosis and exacerbating DNA damage. In contrast, its efficacy in radiosensitive cells was comparable to that of Conv-RT. In vivo studies using patient-derived xenograft nude mice models demonstrated that UHDR-RT only partially reversed RT resistance. Transcriptomic and proteomic analyses of C57BL/6J mice models revealed the predominant role of TiME modulating in reversing radioresistance. Immunofluorescence and flow cytometry confirmed increased CD8+ T cells and an increased M1/M2 macrophage ratio post-UHDR-RT. Mechanistically, UHDR-RT activated CD8+ T cells, which stimulated M1 macrophages through paracrine IFN-γ signaling, thereby enhancing TiME activation. Furthermore, the activated M1 macrophages secreted CXCL9, which in turn reactivated CD8+ T cells, forming a feedforward loop that amplified TiME activation. This study elucidates the dual role of UHDR-RT in directly inducing DNA damage and modulating the TiME, highlighting its potential in treating radioresistant HNSCC.https://doi.org/10.1038/s41392-025-02184-0
spellingShingle Hong-Shuai Li
Ruo Tang
Hua-Shan Shi
Zi-Jian Qin
Xiao-Yang Zhang
Yun-Fei Sun
Zhi-Gong Wei
Chao-Fan Ma
Liu Yang
Ye Chen
Zhe-Ran Liu
Li-Li Zhu
Wen Yang
Li Yang
Ai-Ning Xu
Zhuo Zhang
Shu-Qing Liao
Jin-Shui Shi
Jian-Jun Deng
Xiao-Zhong He
Xing-Chen Peng
Ultra-high dose rate radiotherapy overcomes radioresistance in head and neck squamous cell carcinoma
Signal Transduction and Targeted Therapy
title Ultra-high dose rate radiotherapy overcomes radioresistance in head and neck squamous cell carcinoma
title_full Ultra-high dose rate radiotherapy overcomes radioresistance in head and neck squamous cell carcinoma
title_fullStr Ultra-high dose rate radiotherapy overcomes radioresistance in head and neck squamous cell carcinoma
title_full_unstemmed Ultra-high dose rate radiotherapy overcomes radioresistance in head and neck squamous cell carcinoma
title_short Ultra-high dose rate radiotherapy overcomes radioresistance in head and neck squamous cell carcinoma
title_sort ultra high dose rate radiotherapy overcomes radioresistance in head and neck squamous cell carcinoma
url https://doi.org/10.1038/s41392-025-02184-0
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