Cancer cell elimination by cytotoxic T cell cooperation and additive damage

Cytotoxic T lymphocytes (CTL) eliminate tumor target cells in an antigen and cell-contact dependent manner. Lethal hit delivery occurs as a rapid and binary, "yes/no" process when immunogenicity is very high1-3, however in vivo CTL often fail to kill solid tumor cells during 1:1 conjugations4-6. Using long-term time-lapse microscopy in three distinct tumor cytotoxicity models and statistical modeling, we here show that migrating CTL transit between target cells and initiate apoptosis by a series of sublethal interactions ( additive cytotoxicity), while individual conjugations rarely induced apoptosis. Sublethal damage included perforin-dependent membrane pore formation, nuclear lamina rupture and DNA damage, and these events resolved within minutes to hours. In immunogenic B16F10 melanoma tumors in vivo, frequent serial engagements and sublethal hit delivery of CTL was largely confined to interstitial niches in the invasion front, resulting in eradication of invading tumor cells. Thus, additive cytotoxicity is a probabilistic process achieved by a series of CTL-target cell engagements and sublethal events. The need for additive "hits" has implications for the topographic mechanisms of elimination or immune evasion of tumor cells and microenvironmental regulation of CTL accumulation and cooperation by targeted therapy.