Ferroptosis-associated genes and compounds in renal cell carcinoma

Current trends and landscape of drug resistance in renal cell carcinoma: a bibliometric analysis

INTRODUCTION

Renal cell carcinoma (RCC) is a common type of kidney cancer, and the prognosis for patients with advanced-stage disease remains poor. One major obstacle is the development of drug resistance, which severely limits the effectiveness of therapeutic interventions. This bibliometric study aims to provide a comprehensive overview of current research trends on drug resistance in RCC.

METHODS

This study examines publications on drug resistance in RCC from 2000 to 2023, sourced from the Web of Science Core Collection (WoSCC). Detailed analyses were conducted to identify research hotspots, academic collaborations, and emerging trends. CiteSpace, SCImago Graphica, and VOSviewer were utilized to conduct these analyses comprehensively.

RESULTS

This study analyzed a total of 2,804 publications from the WoSCC database. The number of annual publications showed a consistent upward trend, with an average annual growth rate of 8.12%. The United States had the highest number of publications, followed by China and Japan. The most productive institutions were the University of Texas System, Harvard University, and the National Institutes of Health (NIH). Alfred H. Schinkel emerged as the most prolific author, also having the highest H-index. The three most frequent research categories were oncology, pharmacology and pharmacy, and biochemistry and molecular biology. The evolution of research topics was assessed in 5-year intervals, revealing that recent themes such as ferroptosis and immunotherapy have gained increasing attention. Keyword analysis indicated a shift in research focus toward cell lipid metabolism, androgen receptor and specific molecular signatures.

CONCLUSION

This study offers the first comprehensive bibliometric analysis specifically focused on drug resistance in RCC. It identifies current research trends, highlights emerging hotspots, and provides insights into key contributors and ongoing challenges in the field. Our study provides a theoretical reference and guidance to guide future research efforts to address drug resistance in RCC more effectively.

Molecular Mechanisms of Drug Resistance in Clear Cell Renal Cell Carcinoma

Renal cell carcinoma (RCC) accounts for about 3% of all human tumors. Alterations of oxygen, lipids, iron, and energy metabolism are involved in carcinogenesis, development, and expansion. Thirty percent of patients affected by clear cell renal cell carcinoma (ccRCC) will develop relapses or distance metastases (mRCC), dramatically reducing their life expectancy. Current first-line therapies for mRCC patients are based on treatment with immune checkpoint inhibitors (ICIs) alone and in combination with each other or with tyrosine kinase inhibitors (TKIs). However, only 20% of patients show a mild response because of innate or acquired drug resistance during long-term treatment; therefore, resistant patients need alternative first-line or second-line therapies. Pharmacological resistance represents a big problem that counteracts the efficacy of treatment by reducing overall survival (OS) in mRCC patients. Investigating the molecular mechanisms underlying drug resistance is crucial to overcoming drug insensitivity and enhancing therapeutic outcomes. In this review, we emphasize the latest and most significant studies on the molecular mechanisms that drive drug resistance in ccRCC carcinoma. Particular attention is given to the key signaling pathways involved in resistance, including those mediated by HIF, p53, Akt-mTOR, MEK-ERK cascades, Wnt signaling, autophagy, membrane transporters, ferroptosis, and non-coding RNAs. Understanding these resistance mechanisms is essential for developing new therapeutic strategies aimed to enhancing overall OS and improving the quality of life for mRCC patients. This review also discusses recent clinical trial findings on the use of specific inhibitors able to circumvent drug resistance. The data presented here could be valuable for clinicians in understanding the mechanisms of drug resistance, ultimately aiding in the management of ccRCC patients.

Programable Prodrug Nanomodulator Targets Tumor Redox Homeostasis Imbalance to Amplify Disulfidptosis and Immunogenic Pyroptosis for Breast Tumor Immunotherapy

Despite the great potential of photodynamic therapy (PDT), its success remains compromised by the abnormal redox homeostasis of tumor cells, which supports survival, growth, and resistance to oxidative therapeutic interventions by neutralizing reactive oxygen species (ROS). To overcome this barrier, a multifunctional prodrug nanomodulator (Pro@FLNC) is designed to induce disulfidptosis and immunogenic pyroptosis to trigger an antitumor immune response. Pro@FLNC features a prodrug core-shell structure where ursolic acid (UA) and Chlorin e6 (Ce6) are conjugated via a GSH-responsive linker and encapsulated in a DSPE-PEG-FA lipid shell for enhanced stability, biocompatibility, and tumor-specific targeting. Within the tumor microenvironment (TME), Pro@FLNC depletes intracellular GSH, disrupts redox homeostasis, and releases Ce6 and UA, triggering oxidative stress and mitochondrial dysfunction. These mechanisms amplify ROS production, promote lipid peroxidation, and initiate disulfidptosis, evidenced by increased SLC7A11 expression and F-actin collapse. Elevated ROS levels and metabolic imbalance-triggered disulfidptosis further activate immunogenic pyroptosis, releasing damage-associated molecular patterns (DAMPs) that stimulate dendritic cell maturation and cytotoxic T-cell activation. Together, Pro@FLNC reshapes the TME, reduces immunosuppressive cells, and promotes CD8+ T-cell infiltration, effectively suppressing primary tumors and metastases. This programmed prodrug nanomodulator offers a promising strategy to enhance PDT and immunotherapy for advanced breast cancer.