Abstract Non-ablative pulsed focused ultrasound (pFUS) has shown promise as an immunomodulatory anti-cancer therapeutic. While largely nondestructive to tissues compared ablative ultrasound, pFUS can generate anti-tumor molecular microenvironments and enhance migration of anti-tumor immune cells into B16 and 4T1 flank tumors in immune-competent mice. pFUS also increases the number of dsDNA breaks in nuclear DNA of tumor cells by TUNEL reactions. DNA damage can elicit immune responses by causing cells to express ligands for immune cells and thus may be a critical component of generating observed immune responses in flank tumors following pFUS treatment. Here we investigate potential phyisological mechanisms underlying pFUS-associated DNA damage. B16 melanoma, 4T1 or MBA-MD-231 breast tumors, or C6 glioma cells were cultured and treated with pFUS in vitro (1 MHz, 6 MPa peak negative pressure, 10% duty cycle, 100 pulses). Cells were analyzed for DNA damage by TUNEL, reactive oxygen species (ROS) production by DCFDA, and intracellular Ca2+ by fluo-4. pFUS increased TUNEL reactivity and ROS concentrations in all cell types 2-6 hr after pFUS. Increased TUNEL reactivity was not observed when cells were incubated with the ROS scavenger Trolox (need concentration) following pFUS. pFUS generated Ca2+ transients in all cell types during pFUS treatment. Ca2+ dysregulation can increase cellular ROS production and when cytosolic Ca2+ transients were blocked by BAPTA-AM, both ROS production and TUNEL reactivity was reduced in all cell types. Further investigating mechanisms of Ca2+ transients, application of verapamil (10 uM) during pFUS to inhibit voltage-gated Ca2+ channels (VGCC) also suppressed Ca2+ transients, ROS production, and TUNEL reactivity. Lastly, the magnitudes of Ca2+ transients, ROS production, and TUNEL reactivity induced by pFUS were nonetheless different for different cell types (C6 glioma exhibited the smallest changes after pFUS, while MBA-MD-231 exhibited the largest). This suggested different sensitivities for each cell type to pFUS-induced DNA damage. As Ca2+ homeostasis can be disrupted in tumor cells, we measured resting cytosolic Ca2+ concentrations in each cell type following plasma membrane disruption with digitonin (20 uM). Resting cytosolic Ca2+ concentrations inversely correlated with increased magnitudes of ROS production or TUNEL reactivity following pFUS treatment. In conclusion, pFUS causes DNA damage in tumor cells by initiating cytosolic Ca2+ transients, in part, through VGCC that increase cellular ROS production and lead to dsDNA breaks. The effectiveness of pFUS to stimulate this physiological pathway is related to resting cytosolic Ca2+ concentrations, which different tumor cells could display varying levels of disrupted homeostasis and, thus differing magnitudes of response to pFUS. Future directions will assess potential involvement of mitochondrial dynamics in Ca2+-induced ROS production and in vivo experiments to further understand these dynamics in solid tumor models. Citation Format: Robert B. Rosenblatt, Joseph A. Frank, Scott R. Burks. Pulsed focused ultrasound induces cytosolic calcium transients that increase free radical production and dsDNA breaks in tumor cells [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 3577.