Abstract 2873: Radiation therapy promotes polyunsaturated fatty acid mediated ferroptosis in cervical cancer: Role of AMPK/xCT/GPX4 axis
Authors: Muhammad Naoshad , Gabriel Nishanth , Bengtsson Louise M. , McKinnish Tyler , Msengi Naomi , Cho Kevin , Patti Gary , Schwarz Julie K. 
Published: March 2024

Abstract
Purpose: Previously, we found that mono-and di-unsaturated fatty acids can sensitize cervical cancer to radiotherapy (RT) through a p53 dependent apoptotic mechanism that is distinct from ferroptosis (Muhammad et al., Cancer Res. 2022; 82: 4515-27). Polyunsaturated fatty acids (PUFAs) enhance therapeutic response in preclinical tumor models by increasing lipid peroxidation (L-ROS) and induction of ferroptosis. Ferroptosis is a form of cell death that requires abundant cytosolic labile iron to promote membrane lipid peroxidation. The objective of the present study is to test whether the combination of RT + PUFAs promotes cell death via increased membrane lipid peroxidation and ferroptosis in cervical cancer, and to determine the impact of RT + PUFAs on cervix tumor cell metabolism and mitochondrial function.
Experimental Procedures: Cell viability and clonogenic cell survival assays were performed using 8 human cervical cancer cell lines including normal cervix epithelial controls incubated with PUFAs (EPA, DHA and AA), before and after RT. Western blotting, siRNA-mediated knockdown, pharmacologic inhibition and activation were performed to determine whether ferroptosis dependent signals were mediating PUFA-induced RT sensitivity. Oxidative stress parameters were quantified using mass spectrometry and fluorometric dyes. Flow cytometry was used to quantify total cell ROS, lipid ROS, mitochondrial ROS and labile iron pool. Mitochondrial morphology and function were characterized using microscopy and the Seahorse assay.
Summary: PUFAs + RT increased total ROS and LROS accumulation followed by a ferroptotic tumor cell death, which was iron-dependent and could be prevented by the addition of iron chelator and lipophilic antioxidants, Ferrostatin-1 and Liproxstatin-1. GPX4, a thiol dependent enzyme that eliminates lipid peroxides, and the cystine-glutamate antiporter (xCT) a key source of cystine for reduced glutathione (GSH) synthesis, were downregulated in response to PUFAs + RT. PUFAs + RT induced increased mitochondrial ROS and subsequent metabolic dysfunction. Mechanistically, the expression of AMPK, a key regulator of metabolic/energy homeostasis and mitochondrial biogenesis, was upregulated by PUFAs + RT. Pharmacological activation and inhibition of AMPK further enhanced and abrogated the effect of PUFA + RT, respectively.
Conclusions: PUFAs modify the RT sensitivity of cervical cancer cells by inducing cell death through ferroptosis and mitochondrial dysfunction via AMPK activation. In vivo experiments are ongoing in immunocompromised and immunodeficient mouse tumor models to confirm this finding and determine the impact of PUFAs on RT induced tumor cell death and anti-tumor immunity.
Citation Format: Naoshad Muhammad, Nishanth Gabriel, Louise M. Bengtsson, Tyler McKinnish, Naomi Msengi, Kevin Cho, Gary Patti, Julie K. Schwarz. Radiation therapy promotes polyunsaturated fatty acid mediated ferroptosis in cervical cancer: Role of AMPK/xCT/GPX4 axis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2873.