Mitochondrial DNA abundance is a determinant of immunogenic cell death in cancer

Cells experiencing mitochondrial stress can undergo apoptosis or cell death that triggers innate immune activation. We examined the mechanisms determining these distinct outcomes in cancer. Abundant mitochondrial DNA (mtDNA) and high expression of the cGAS-STING pathway were features of KRAS-mutant cancers. In a pharmacological screen, MEK inhibitor (MEKi) effectively induced mtDNA release into the cytosol in KRAS-mutant cancer cells. However, MEKi also induced PRKN-mediated mitophagy, which limited mtDNA release by eliminating damaged mitochondria. Inhibition of mitophagy sustained mtDNA efflux and amplified cGAS-STING signaling. Mechanistically, PRKN-mediated mitophagy restrained mitochondrial outer membrane permeabilization (MOMP) to limit mtDNA efflux. The balance between mtDNA and cytochrome c (cyt.c) release defined two immunologically distinct outcomes: immunogenic cell death (ICD) and apoptosis. In preclinical models, combined inhibition of MEK and mitophagy induced robust dendritic cell (DC) activation and promoted CD8⁺ T cell-mediated antitumor immunity. Consistently, PRKN expression negatively correlated with immune infiltration in human cancers. Collectively, these findings provide a rationale for combination strategies targeting mitochondrial dynamics to augment antitumor immunity.