Ferroptosis resistance in cancer: recent advances and future perspectives

Ferroptosis is an iron-dependent, non-apoptotic form of regulated cell death and has been implicated in the occurrence and development of various diseases, including heart disease, nervous system diseases and cancer. Ferroptosis induction recently emerged as an attractive strategy for cancer therapy. Ferroptosis has become a potential target for intervention in these diseases or injuries in relevant preclinical models. This review summarizes recent progress on the mechanisms of ferroptosis resistance in cancer, highlights redox status and metabolism's role in it. Combination therapy for ferroptosis has great potential in cancer treatment, especially malignant tumors that are resistant to conventional therapies. This review will lead us to have a comprehensive understanding of the future exploration of ferroptosis and cancer therapy. A deeper understanding of the relationship between ferroptosis resistance and metabolism reprogramming may provide new strategies for tumor treatment and drug development based on ferroptosis.

Understanding sorafenib-induced ferroptosis and resistance mechanisms: Implications for cancer therapy

Sorafenib is an important first-line treatment option for liver cancer due to its well-characterized safety profile. While novel first-line drugs may have better efficacy than Sorafenib, they also have limitations such as worse safety and cost-effectiveness. In addition to inducing apoptosis, Sorafenib can also trigger ferroptosis, which has recently been recognized as an immunogenic cell death, unleashing new possibilities for cancer treatment. However, resistance to Sorafenib-induced ferroptosis remains a major challenge. To overcome this resistance and augment the efficacy of Sorafenib, a wide range of nanomedicines has been developed to amplify its pro-ferroptotic effects. This review highlights the mechanisms underlying Sorafenib-triggered ferroptosis and its resistance, and outlines innovative strategies, particularly nanomedicines, to overcome ferroptosis resistance. Moreover, we summarize molecular biomarkers that signify resistance to Sorafenib-mediated ferroptosis, which can assist in predicting therapeutic outcomes.

Ferroptosis resistance mechanisms in endometriosis for diagnostic model establishment

RESEARCH QUESTION

Does ferroptosis resistance occur in patients with endometriosis, and can it be used as an indicator for diagnosis?

DESIGN

Six datasets including 164 expression arrays from endometriosis studies were selected from the National Center for Biotechnology Information Gene Expression Omnibus. Surrogate variable analysis was used for data integration after RobustRankAggreg to determine ferroptosis-associated gene expression trends. Differential genes between eutopic and normal endometrium, as well as between ectopic and eutopic endometrium, were determined. Ferroptosis resistance mechanisms during the development of endometriosis were determined by intergenic co-expression and the Kyoto Encyclopedia of Genes and Genomes pathway. Independent factors were then screened by least absolute shrinkage and selection operator regression to build a nomogram diagnostic model. The Hosmer-Lemeshow test and receiver operating characteristic (ROC) curve were used to verify model consistency and diagnostic efficacy, respectively.

RESULTS

Differential analysis revealed a progressive increase in changes of ferroptosis-related genes in endometriosis patients during the process of endometrium development from eutopic to ectopic. In the subsequent regression selection, nine ferroptosis-associated genes in the eutopic endometrium could, in most cases, distinguish endometriosis patients from healthy patients. Therefore, these genes can be used as independent factors for endometriosis diagnosis. The nomogram model established by these molecular markers had an area under the ROC curve of 0.979.

CONCLUSIONS

The eutopic and ectopic endometrium of patients with endometriosis is associated with ferroptosis resistance genetic alterations. Ferroptosis-associated genes have excellent clinical value in endometriosis diagnosis, achieved by the nomogram model.