Arsenic Trioxide Enhances the Efficacy of PD-1 Inhibitors in
Hepatocellular Carcinoma by Inducing Immunogenic Cell Death via the
ROS/ERS Pathway
Abstract
Immunotherapy for hepatocellular carcinoma (HCC) often does not achieve
the desired results. Immunogenic cell death (ICD) has significant
potential to trigger the body’s immune response against tumors, offering
a hopeful strategy to improve immunotherapy for HCC. Arsenic trioxide
(ATO), which induces ICD, may markedly increase the effectiveness of
programmed cell death protein 1 (PD-1) inhibitors in the therapy of HCC.
However, the complex mechanisms behind this synergistic effect are not
yet fully understood. This study aims to elucidate the functions and
mechanisms of ATO in HCC and to explore its potential to enhance
immunotherapy for HCC. The results showed that ATO dose-dependently
reduced the viability of HCC cells. Concurrently, ATO treatment led to
an increase in ROS levels and induced ERS, which activated ICD-related
damage associated molecular patterns (DAMPs). As a result, this process
prompted dendritic cell maturation and enhanced the tumor immune
microenvironment. ATO treatment increased the immunogenicity of HCC
cells, allowing them to function as both prophylactic and therapeutic
vaccines against HCC and to augment anti-tumor immunity. Finally, ATO
was found to improve the effectiveness of PD-1 inhibitors in treating
HCC in vivo. Therefore, we conclude that ATO effectively bolstered the
body’s immune response by triggering ROS/ERS-mediated ICD, which
significantly enhanced the therapeutic effectiveness of PD-1 inhibitors
against HCC.