APR-246 induces early cell death by ferroptosis in acute myeloid leukemia

Haematologica. 2022 Feb 1;107(2):403-416. doi: 10.3324/haematol.2020.259531.

Abstract

APR-246 is a promising new therapeutic agent that targets p53 mutated proteins in myelodysplastic syndromes and in acute myeloid leukemia (AML). APR-246 reactivates the transcriptional activity of p53 mutants by facilitating their binding to DNA target sites. Recent studies in solid cancers have found that APR-246 can also induce p53-independent cell death. In this study, we demonstrate that AML cell death occurring early after APR-246 exposure is suppressed by iron chelators, lipophilic antioxidants and inhibitors of lipid peroxidation, and correlates with the accumulation of markers of lipid peroxidation, thus fulfilling the definition of ferroptosis, a recently described cell death process. The capacity of AML cells to detoxify lipid peroxides by increasing their cystine uptake to maintain major antioxidant molecule glutathione biosynthesis after exposure to APR-246 may be a key determinant of sensitivity to this compound. The association of APR-246 with induction of ferroptosis (either by pharmacological compounds, or genetic inactivation of SLC7A11 or GPX4) had a synergistic effect on the promotion of cell death, both in vivo and ex vivo.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cell Death
  • Ferroptosis*
  • Humans
  • Leukemia, Myeloid, Acute* / drug therapy
  • Leukemia, Myeloid, Acute* / genetics
  • Leukemia, Myeloid, Acute* / metabolism
  • Quinuclidines / therapeutic use

Substances

  • Quinuclidines
  • eprenetapopt

Grants and funding

Funding: This work was supported by grants from the Association de Recherche Contre le Cancer (ARC; aides doctorales RB, grant n°DOC20170505807 and DOC20190508975; aides jeune chercheur TH, grant n°M2R20180507379), from the Institut National du Cancer (JD, grant n° ASC16046KSA), from the Ligue Nationale Contre le Cancer (LNCC; DB, Equipe Labellisée EL2017. N° Projet: ELFUZ17337; NG, grant n° IP/SCG/JD-16129) and from association Laurette Fugain (grant n°ALF2018/02).