Fig. 7: Schematic representation of the proposed hypothesis: elevated AZIN1-driven polyamine production promotes osteosarcoma proliferation and impairs immunotherapy efficacy.

In osteosarcoma cells, increased levels of arginine and AZIN1 upregulate the metabolism of arginine into polyamines through AZIN1-mediated activation of ornithine decarboxylase 1 (ODC1). This enhancement in polyamine production supports tumor cell proliferation and impedes the efficacy of immunotherapy. Conversely, when polyamine synthesis is inhibited—either by AZIN1 knockdown or through difluoromethylornithine (DFMO)-mediated inhibition of ODC1-polyamine levels decrease, leading to cell cycle arrest and the upregulation of human leukocyte antigen (HLA) expression and T cell-activating cytokines. These changes augment the cytotoxic efficacy of TCR-engineered T cells against osteosarcoma cells.