AIM2 inflammasome and pyroptosis biomarkers in oncology

Inflammation plays a critical role in cancer progression, formation, and treatment response. However, the activation of inflammasomes and the occurrence of pyroptotic cell death are infrequently assessed in standard oncology laboratory tests. Pyroptosis is an inflammasome-regulated cell death program that releases measurable tumor and biofluid-based signals, such as inflammasome assemblies, cytokine species, nucleic acid danger signals, and cleavage products of gasdermins (e.g., GSDMD/GSDME). This review offers a fit-for-purpose translational laboratory framework of AIM2-linked inflammasome/pyroptosis biomarkers in oncology by incorporating the biological rationale, clinically actionable use cases, and validation steps that should be taken to implement them (analytical validity, clinical validity, and clinical utility). Candidate measurands are systematically categorized according to their intended applications, which include patient stratification, prognosis, therapy monitoring, and pharmacodynamic assessments. These categories primarily emphasize assays that are accessible in clinical laboratories. We review intratumoral AIM2 using immunohistochemistry, circulating ASC-associated complexes/oligomers, IL-1β and IL-18 proteoforms, upstream nucleic acid signals such as cfDNA fragmentomics, extracellular vesicle-associated dsDNA, and execution markers, including gasdermin cleavage products. Important analytical characteristics include a precise definition of the measurand/epitope (cleavage-aware), calibration/traceability/commutability, and performance characterization (LoB/LoD/LoQ, precision, linearity, and matrix effects). We also addressed immunoassay interferences (heterophilic antibodies, biotin, rheumatoid factor, complement) and therapeutic antibody effects. Finally, our translational pathway should be prioritized with orthogonal confirmation, interference testing, and clinically meaningful reporting to be adopted in the field of laboratory medicine. This supports reproducible biomarkers for clinical decision-making.