Cancer Cells Enter an Adaptive Persistence to Survive Radiotherapy and Repopulate Tumor
Open accessAbstract
Repopulation of residual tumor cells impedes curative radiotherapy, yet the mechanism is not fully understood. It is recently appreciated that cancer cells adopt a transient persistence to survive the stress of chemo‐ or targeted therapy and facilitate eventual relapse. Here, it is shown that cancer cells likewise enter a “radiation‐tolerant persister” (RTP) state to evade radiation pressure in vitro and in vivo. RTP cells are characterized by enlarged cell size with complex karyotype, activated type I interferon pathway and two gene patterns represented by CST3 and SNCG. RTP cells have the potential to regenerate progenies via viral budding‐like division, and type I interferon‐mediated antiviral signaling impaired progeny production. Depleting CST3 or SNCG does not attenuate the formation of RTP cells, but can suppress RTP cells budding with impaired tumor repopulation. Interestingly, progeny cells produced by RTP cells actively lose their aberrant chromosomal fragments and gradually recover back to a chromosomal constitution similar to their unirradiated parental cells. Collectively, this study reveals a novel mechanism of tumor repopulation, i.e., cancer cell populations employ a reversible radiation‐persistence by poly‐ and de‐polyploidization to survive radiotherapy and repopulate the tumor, providing a new therapeutic concept to improve outcome of patients receiving radiotherapy.
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Cystatin C plays a critical role in enabling cancer cells to enter a radiation-tolerant state, allowing them to evade radiation and repopulate the tumor.
“Importantly, cystatin C plays a critical role in enabling cancer cells to enter a radiation-tolerant state, allowing them to evade radiation and repopulate the tumor11.”
From Oligomeric cystatin C supports the immunosuppressive activity of myeloid cells through interaction with inhibitory receptors (2025) · cites this paper as [11]
The Results (‘Gene Profiling Verified by 10× scRNA-seq and Functional Studies’; page not provided) report that CST3 knockout reduced progeny production and radiation survival. But knockout did not prevent formation of radiation-tolerant persister cells, so the claim that cystatin C enables cancer cells to enter that state is not supported. The Abstract likewise links CST3 depletion to reduced budding and tumor repopulation, not reduced entry into the state. (LLM, conf=0.91)
Experimental — accuracy not yet measuredCystatin C promotes tumor growth and therapy resistance by enhancing cancer cell survival during radiotherapy and facilitating tumor repopulation.
“While cystatin C has been reported to promote tumor growth and therapy resistance by enhancing cancer cell survival during radiotherapy and facilitating tumor repopulation11”
From Oligomeric cystatin C supports the immunosuppressive activity of myeloid cells through interaction with inhibitory receptors (2025) · cites this paper as [11]
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- [31]X.‐R. Tang, Y.‐Q. Li, S.‐B. Liang, W. Jiang, F. Liu, W.‐X. Ge, L.‐L. Tang, Y.‐P. Mao, Q.‐M. He, X.‐J. Yang, Y. Zhang, X. Wen, J. Zhang, Y.‐Q. Wang, P.‐P. Zhang, Y. Sun, J.‐P. Yun, J. Zeng, L. Li, L.‐Z. Liu, N. Liu, J. Ma, Lancet Oncol. 2018, 19, 382.29428165
Cited by
Sorted by citations
Autocrine regulation of tumor cell repopulation by Hsp70-HMGB1 alarmin complex
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Mirzayans, R., & Murray, D. L. (2024) · Cancers · doi:10.3390/cancers16173106 · Cited by 10 · see citing works
Tracing Quiescent Cancer Cells In Vivo
Kim, M. J. (2024) · Cancers · doi:10.3390/cancers16223822 · Cited by 8 · see citing works
“Aging and epigenetic implications in radiotherapy: The promise of BNCT”
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Zhao, R., Song, Y., Xie, J., Sun, H., Gong, Y., Hu, B., Cheng, J. Q., Deng, Z., Zhao, Y., & Huang, Q. (2025) · Cancer Letters · doi:10.1016/j.canlet.2025.218017 · Cited by 8 · see citing works
Self-citationPreclinical evaluation of CXCR4 peptides for targeted radionuclide therapy in glioblastoma
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Polyploid Cancer Cell Models in Drosophila
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Surviving the Storm: The Role of Poly‐ and Depolyploidization in Tissues and Tumors
Zhao, Y., He, S., Zhao, M., & Huang, Q. (2024) · Advanced Science · doi:10.1002/advs.202306318 · Cited by 7 · see citing works
Self-citationEffects of PreOperative radiotherapy in a preclinical glioblastoma model: a paradigm-shift approach
Fernández-Gil, B. I., Schiapparelli, P. V., de Llano, J. P. N.-G., Otamendi-Lopez, A., Ulloa-Navas, M. J., Michaelides, L., Vazquez-Ramos, C. A., Herchko, S. M., Murray, M. E., Cherukuri, Y., et al. (2024) · Journal of Neuro-Oncology · doi:10.1007/s11060-024-04765-5 · Cited by 5 · see citing works
Huang, C., Lu, J., Yang, J., Wang, Z., Hang, D., & Fu, Z. (2024) · Frontiers in Molecular Biosciences · doi:10.3389/fmolb.2024.1209349 · Cited by 5 · see citing works
Martynov, I., Dhaka, L., Wilke, B., Hoyer, P., Vahdad, M. R., & Seitz, G. (2024) · Frontiers in Oncology · doi:10.3389/fonc.2024.1333129 · Cited by 4 · see citing works
Defining melanoma combination therapies that provide senolytic sensitivity in human melanoma cells
Tchelougou, D., Malaquin, N., Cardin, G. B., Desmul, J., Turcotte, S., & Rodier, F. (2024) · Frontiers in Cell and Developmental Biology · doi:10.3389/fcell.2024.1368711 · Cited by 4 · see citing works
Zhang, C., He, Y., Liu, X., Xie, J., Fang, M., Yang, X., Huang, R., Lou, Q., Li, B., Gupta, A., et al. (2025) · Signal Transduction and Targeted Therapy · doi:10.1038/s41392-025-02462-x · Cited by 2 · see citing works
Self-citationThe LRP4/YAP axis drives the radiation-tolerant persister (RTP) cell state in breast cancer
Forissier, V., Wicinski, J., Castagné, M., Pinna, G., Lin, S., Grandon, A., Bonnet, C., Macario, M., Castellano, R., Valdenaire, S., et al. (2025) · Theranostics · doi:10.7150/thno.101393 · Cited by 2 · see citing works
Deng, Z. C., Sun, H., Cheng, J. Q., Zhao, R., Xie, J., Song, Y., Zhao, Y., Lin, C., Hu, B., Gong, Y., et al. (2025) · Advanced Science · doi:10.1002/advs.202519698 · Cited by 2 · see citing works
Self-citationJiang, M. J., Yu, Y., Jiao, Z., Wu, T., Ning, K., Yang, Z., Chen, W., & Yang, A. (2026) · Cell Communication and Signaling · doi:10.1186/s12964-026-02777-4 · Cited by 2 · see citing works
The influence of cell-cell fusion on cancer heterogeneity and its promise for targeted treatments
Liu, K., Shi, J., Liu, J., Zhang, Y., Liang, J., Xu, J., Chen, S., & Zhang, S. (2026) · Cellular Oncology · doi:10.1007/s13402-025-01153-7 · Cited by 1 · see citing works
Pepele, E. K., Karagöz, I. D., Khair, H., & Dırıcan, B. (2026) · International Journal of Radiation Biology · doi:10.1080/09553002.2026.2675631 · Cited by 1 · see citing works
A Caspase 3‐Hijacking Nanosystem Enhances Cancer Radiotherapy by Suppressing Tumor Repopulation
Zhao, X. R., Jiang, W., Wang, A., Zhao, K., Li, J., Xie, Y., Zhang, Z., Shi, J., Liu, W., & Liu, J. (2024) · Advanced Functional Materials · doi:10.1002/adfm.202414622 · Cited by 1 · see citing works
Self-citationAdditional file 1 of Autocrine regulation of tumor cell repopulation by Hsp70-HMGB1 alarmin complex
Sverchinsky, D. V., Alhasan, B. A., Mikeladze, M. A., Lazarev, V. F., Kuznetcova, L. S., Morshneva, A. V., Nikotina, A. D., Ziewanah, A., Koludarova, L. V., Starkova, T. Y., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26631577
Waked, A., Crabbé, M., Neirinckx, V., Pérez, S. R., Wellens, J., Rogister, B., Benotmane, M. A., & Vermeulen, K. (2024) · Figshare · doi:10.6084/m9.figshare.26749421
Zhu, J., Fang, G., Li, J., Wu, Z., Feng, Y., Zhang, Q., & Jia, C. (2026) · Industrial & Engineering Chemistry Research · doi:10.1021/acs.iecr.5c04488
Self-citationDecoding the metabolic-immune axis for novel therapeutics in bladder cancer
Zhou, M., Xue, X., Li, H., Chen, Z., Nie, Q., & Lai, Y. (2026) · Biochimica et Biophysica Acta (BBA) - Reviews on Cancer · doi:10.1016/j.bbcan.2026.189569
Evolutionary Trajectory of Radioresistance in Lung Cancer Brain Metastasis Organoids
Chen, J., Gao, C., Wang, L., Wu, L., Pang, B., & Su, C. (2026) · Biological Procedures Online · doi:10.1186/s12575-026-00339-z
Macrophages Drive Ferroptosis Resistance after Radiotherapy
Chung, H., Kim, S. W., Oh, J. W., Park, G. M., Cho, Y., Choi, H. S., Kim, M., Kim, K. P., Na, Y. R., Lee, H. S., et al. (2026) · 癌症：英文版 · doi:10.34133/cancomm.0039
Anatskaya, O. V., & Vinogradov, A. E. (2026) · International Journal of Molecular Sciences · doi:10.3390/ijms27156671
An, R., Li, J., Liu, T., Tang, C., & Lu, H. (2026) · Frontiers in Immunology · doi:10.3389/fimmu.2026.1866358
Self-citation
- Authors
- Zhao, Y., Lu, T., Song, Y., Wen, Y., Deng, Z., Fan, J., Zhao, M., Zhao, R., Luo, Y., xie, J., Hu, B., Sun, H., Wang, Y., He, S., Gong, Y., Cheng, J., Liu, X., Yu, L., Li, J., Li, C., Shi, Y., & Huang, Q.
- Affiliations
- Shanghai Jiao Tong University (CN)
- Bio‐X Institutes Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education) Shanghai Jiao Tong University Shanghai 200030 China
- Sun Yat-sen University (CN)
- Department of Dermatology Duke University Medical Center Box 3135 Durham NC 27710 USA
- Qingdao University (CN)
- Corresponding author
- Shi, Yongyong
- Huang, Qian
- ORCID
- Venue
- Advanced Science
- Publisher
- Wiley
- Published
- 2023-01-19
- Volume
- 10
- Issue
- 8
- Pages
- e2204177-e2204177
- ISSN
- 2198-3844 (ISSN-L)
- PMC
- PMC10015890
- OpenAlex
- W4317568172
- Cited by
- 29
- References
- 81
- Citations by year
- 2026: 9 · 2025: 6 · 2024: 12 · 2023: 2
- FWCI
- 3.54
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Advanced Science (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Natural Science Foundation of China (81972843, 81572951, 81120108017)
- Topics
- Health Sciences › Medicine › Oncology › Cancer Cells and Metastasis
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Effects of Radiation Exposure
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Cell death mechanisms and regulation
- Keywords
- tumor repopulation, radiotherapy resistance, type I interferon signaling, CST3, SNCG, polyploidy, karyotype instability
- MeSH terms
- Humans, Neoplasms, Cell Line, Tumor
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