Mechanistic insights into the dynamics of plasma membrane repair in cancer.

Cancer cells are well equipped with plasma membrane repair to survive mechanical tension, chemical stress, immune assaults and therapeutic interventions. Maintaining plasma membrane integrity is quintessential for tumor cells as it plays a pivotal role in communication between the internal environment of the tumor cell and the extracellular surroundings. Therefore, tumor cells achieve plasma membrane repair by several dynamic repair pathways such as calcium (Ca2+) guided lysosomal exocytosis, annexins (ANXs) mediated membrane repair and shedding, damaged oriented membrane repair via endocytosis, ESCRT (Endosomal Sorting Complex Required for Transport) mediated plasma Membrane repair and LC-3 Associated Macropinocytosis (LAM) to survive persistent membrane damage inflicted by immune attack, mechanical stress especially during metastasis and chemotherapy induction. These processes rapidly restore membrane integrity, maintaining cellular homeostasis and conferring survival advantages during metastasis and immune evasion. Notably, key repair proteins such as ANXs, synaptotagmin VII (Syt VII), ESCRT components, and autophagy-related factors (ATGs, rubicon and LC-3) are often upregulated in various cancers including breast, pancreatic, bladder, liver, and aggressive solid tumors, highlighting their clinical relevance and potential as therapeutic targets. Moreover, an understanding of the mechanistic interplay among different pathways unveils a new therapeutic window to selectively disrupt these repair pathways, sensitizing cancer cells to persistent damage while sparing normal tissues. This review elucidates the mechanisms of plasma membrane repair in cancer, highlights the differential regulation of their key mediators across multiple tumor types, and briefly explores their therapeutic potential.