| Rank |
Pathway / Axis |
Cancer / Tumor Context |
Normal Tissue Context |
TSF |
Primary Effect |
Notes / Interpretation |
| 1 |
DNA crosslink formation (intrastrand adducts) |
DNA adducts ↑; replication block ↑ |
Normal dividing cells also affected |
P, R, G |
Direct DNA cytotoxicity |
Cisplatin forms covalent intrastrand crosslinks (primarily at adjacent guanines), distorting DNA and blocking replication and transcription. |
| 2 |
DNA damage response (ATM / ATR → p53) |
Checkpoint activation ↑; p53 signaling ↑ |
↔ (toxicity in proliferating tissues) |
R, G |
Damage signaling cascade |
DNA distortion activates ATM/ATR pathways leading to p53-mediated cell-cycle arrest and apoptosis. |
| 3 |
Intrinsic apoptosis (mitochondrial pathway) |
Bax ↑; Bcl-2 ↓; caspase-9/3 ↑ |
Nephrotoxicity & ototoxicity risk |
G |
Execution of cell death |
Persistent DNA damage triggers mitochondrial outer membrane permeabilization and caspase activation. |
| 4 |
Cell-cycle arrest (G2/M emphasis) |
G2/M arrest ↑ |
↔ |
G |
Cytostasis → apoptosis |
Cells accumulate in G2/M phase due to unrepaired DNA lesions. |
| 5 |
ROS generation / oxidative stress |
ROS ↑ (secondary mechanism) |
Oxidative injury ↑ (kidney, cochlea) |
R, G |
Stress amplification |
Cisplatin increases mitochondrial ROS and oxidative stress, contributing to cytotoxicity and organ toxicity. |
| 6 |
MAPK signaling (JNK / p38 activation) |
Stress MAPK activation ↑ |
↔ |
R, G |
Stress-response signaling |
JNK and p38 activation contribute to apoptosis and stress signaling. |
| 7 |
NF-κB activation (resistance axis) |
NF-κB ↑ may promote survival |
↔ |
R, G |
Resistance modulation |
NF-κB activation can reduce sensitivity; inhibition enhances cytotoxicity in some models. |
| 8 |
DNA repair pathways (NER / ERCC1) |
NER ↑ → resistance |
— |
G |
Resistance determinant |
Nucleotide excision repair (ERCC1) removes platinum adducts; high ERCC1 correlates with resistance. |
| 9 |
Drug transport (CTR1 uptake; ATP7A/B efflux) |
CTR1 ↓ or ATP7A/B ↑ → resistance |
— |
G |
Exposure constraint |
Copper transporters influence intracellular cisplatin accumulation and resistance. |
| 10 |
Clinical toxicity profile |
— |
Nephrotoxicity, ototoxicity, neurotoxicity |
— |
Translation constraint |
Major dose-limiting toxicities arise from DNA damage and oxidative stress in normal tissues. |