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Ferroptosis (also known as oxytosis) is a type of programmed cell death dependent on iron and characterized by the accumulation of lipid peroxides. Ferroptosis is biochemically, genetically, and morphologically distinct from other forms of regulated cell death such as apoptosis and necroptosis. Oxytosis/ferroptosis can be initiated by the failure of the glutathione-dependent antioxidant defenses, resulting in unchecked lipid peroxidation and eventual cell death. Lipophilic antioxidants and iron chelators can prevent ferroptotic cell death.
Researchers have identified roles in which oxytosis/ferroptosis can contribute to the medical field, such as the development of cancer therapies. Ferroptosis activation plays a regulatory role on growth of tumor cells in the human body. However, the positive effects of oxytosis/ferroptosis could be potentially neutralized by its disruption of metabolic pathways and disruption of homeostasis in the human body. Since oxytosis/ferroptosis is a form of regulated cell death, some of the molecules that regulate oxytosis/ferroptosis are involved in metabolic pathways that regulate cysteine exploitation, glutathione state, nicotinamide adenine dinucleotide phosphate (NADP) function, lipid peroxidation, and iron homeostasis.
Other early studies regarding the connection between iron and lipid peroxidation, cystine deprivation and oxidative cell death, the activity and importance of glutathione peroxidase 4 (GPX4), and the identification of small molecules that induce ferroptosis were key to the eventual characterization of ferroptosis.
The primary cellular mechanism of protection against oxytosis/ferroptosis is mediated by the selenoprotein GPX4, a glutathione-dependent hydroperoxidase that converts lipid peroxides into non-toxic lipid alcohols. Recently, a second parallel protective pathway was independently discovered by two labs that involves the oxidoreductase FSP1 (also known as AIFM2). FSP1 enzymatically reduces non-mitochondrial coenzyme Q10 (CoQ10), thereby generating a potent lipophilic antioxidant that suppresses the propagation of lipid peroxides. Vitamin K is also reduced by FSP1 to a hydroquinone species that also acts as a radical-trapping antoxidant and suppressor of ferroptosis. A similar mechanism for a cofactor moonlighting as a diffusable antioxidant was discovered in the same year for tetrahydrobiopterin (BH4), a product of the rate-limiting enzyme GTP cyclohdrolase 1 (GCH1).
Replacing natural polyunsaturated fatty acids (PUFA) with deuterated PUFA (dPUFA), which have deuterium in place of the bis-allylic hydrogens, can prevent cell death induced by erastin or RSL3. These deuterated PUFAs effectively inhibit ferroptosis and various chronic degenerative diseases associated with ferroptosis.
Live-cell imaging has been used to observe the morphological changes that cells undergo during oxytosis/ferroptosis. Initially the cell contracts and then begins to swell. Perinuclear lipid assembly is observed immediately before oxytosis/ferroptosis occurs. After the process is complete, lipid droplets are redistributed throughout the cell (see GIF on right side).
Unlike other forms of cell death, ferroptosis has been shown to propagate between cells in a wave-like manner. This phenomenon is promoted by secretion of galectin-13 during ferroptosis. Mechanistically, galectin-13 binds to CD44, inhibiting CD44-mediated membrane localization of SLC7A11.
Oxytosis/ferroptosis has been implicated in several types of cancer, including:
These forms of cancer have been hypothesized to be highly sensitive to oxytosis/ferroptosis induction. An upregulation of iron levels has also been seen to induce oxytosis/ferroptosis in certain types of cancer, such as breast cancer. Breast cancer cells have exhibited vulnerability to oxytosis/ferroptosis via a combination of siramesine and lapatinib. These cells also exhibited an autophagic cycle independent of ferroptotic activity, indicating that the two different forms of cell death could be controlled to activate at specific times following treatment. Furthermore, intratumor bacteria may scavenge iron by producing iron siderophores, which indirectly protect tumor cells from ferroptosis, emphasizing the need for ferroptosis inducers (thiostrepton) for cancer treatment.
In various contexts, resistance to cancer therapy is associated with a mesenchymal state. A pair of studies in 2017 found that these cancer cells in this therapy-induced drug-resistant state exhibit a greater dependence on GPX4 to suppress ferroptosis. Consequently, GPX4 inhibition represents a possible therapeutic strategy to mitigate acquired drug resistance.
Recent studies have suggested that oxytosis/ferroptosis contributes to neuronal cell death after traumatic brain injury.
During chemotherapy treatment, ferroptosis contributes to acute kidney injury. Reagents to image ferroptosis have been developed to monitor anticancer drug-induced acute kidney injury in mouse models.
Initial studies characterized the mitochondrial VDAC2 and VDAC3 as the targets of erastin, though it was later found that the mechanistic target of erastin is the cystine/glutamate transporter system xc−. Erastin inhibits system xc−, lowering intracellular GSH levels. Consequently, the GSH-dependent GPX4 is unable to detoxify lipid hydroperoxide species, leading to ferroptotic cell death. Derivatives of erastin have been prepared to improve aqueous solubility, potency, and metabolic stability, with imidazole ketone erastin (IKE) being the most extensively studied.
RSL3 and ML162 contain chloroacetamide moieties that can covalently react with nucleophilic residues. RSL3 and ML162 are able to bind to and inhibit GPX4 enzymatic activity or degrade GPX4 in lysate-based assays, though it has been found that RSL3 and ML162 do not inhibit purified GPX4 in vitro and target other selenoproteins such as thioredoxin reductase 1 (TXNRD1). However, other TXNRD1 inhibitors do not trigger ferroptosis, suggesting that TXNRD1 inhibition is not sufficient to trigger ferroptosis. The GPX4-inhibiting activity of RSL3 has also been suggested to be regulated by other factors such as 14-3-3ε or through broad targeting of the selenoproteome.
ML210 contains a nitroisoxazole group that acts as a masked nitrile-oxide electrophile. Specifically, in cellular and lysate contexts, ML210 undergoes ring-opening hydrolysis followed by a retro-Claisen-like condensation and ring-closing hydration to yield an unstable furoxan. Through a ring-opening tautomerization, this furoxan then yields a nitrile oxide that selectively reacts with selenocysteine residue 46 of GPX4.
Upstream of GPX4, depletion of GSH by inhibiting GSH biosynthesis also induces ferroptosis. Work from Kojin Therapeutics and Ono Pharmaceutical has demonstrated that inhibition of glutamate-cysteine ligase (GCL), the rate-limiting enzyme in GSH biosynthesis, induces ferroptosis in cancer cell lines. GCL also suppresses ferroptosis through a GSH-independent mechanisms such as limiting glutamate accumulation. Buthionine sulfoximine (BSO) has been commonly used as a tool compound to inhibit GCL, though BSO is relatively low potency. Accordingly, analogues have been reported that show improved potency and pharmacological properties that may be used in in vivo studies. FSP1 inhibition is generally not sufficient to induce ferroptosis but FSP1 inhibitors such as iFSP1 (targeting the CoQ10 binding site) and viFSP1 (versatile inhibitor of FSP1; targeting the NAD(P)H binding pocket) have been explored as ferroptosis sensitizers. iFSP1 is not usable in rodent models, though viFSP1 is species-independent. FSEN1 is an uncompetitive inhibitor of FSP1 that binds to the FSP1–NADH–CoQ complex. 3-Phenylquinazolines (represented by icFSP1) do not competitively inhibit FSP1 enzymatic activity but rather trigger phase separation of FSP1 followed by induction of ferroptosis. Notably, FSP1 activity can compensate for GPX4 loss and suppress ferroptosis in certain contexts.
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