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Artemisinin compounds sensitize cancer cells to ferroptosis by regulating iron homeostasis


The antimalarial drug artemisinin and its derivatives have been explored as potential anticancer agents, but their underlying mechanisms are controversial. In this study, we found that artemisinin compounds can sensitize cancer cells to ferroptosis, a new form of programmed cell death driven by iron-dependent lipid peroxidation. Mechanistically, dihydroartemisinin (DAT) can induce lysosomal degradation of ferritin in an autophagy-independent manner, increasing the cellular free iron level and causing cells to become more sensitive to ferroptosis. Further, by associating with cellular free iron and thus stimulating the binding of iron-regulatory proteins (IRPs) with mRNA molecules containing iron-responsive element (IRE) sequences, DAT impinges on IRP/IRE-controlled iron homeostasis to further increase cellular free iron. Importantly, in both in vitro and a mouse xenograft model in which ferroptosis was triggered in cancer cells by the inducible knockout of GPX4, we found that DAT can augment GPX4 inhibition-induced ferroptosis in a cohort of cancer cells that are otherwise highly resistant to ferroptosis. Collectively, artemisinin compounds can sensitize cells to ferroptosis by regulating cellular iron homeostasis. Our findings can be exploited clinically to enhance the effect of future ferroptosis-inducing cancer therapies.

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The authors thank members of the Jiang and Bian labs for advice, technical assistance and for critically reading the manuscript. This work is supported by NIH grants R01CA204232 & R01GM113013 (X.J.), Geoffrey Beene Cancer Research fund (X.J.), NCI Cancer Center Core Grant P30CA008748 for Memorial Sloan-Kettering Cancer Center, China Scholarship Council Fellowship 201603170375 (J.W.), and HKRGC GRF grant 12104415 (Z-X.B.).

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The authors declare that they have no conflict of interest.

Correspondence to Zhao-Xiang Bian or Xuejun Jiang.

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