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Cao L, Wang Y, Liu J, Bai X, Chi X. Long non-coding RNA TPT1-AS1 inhibits ferroptosis in ovarian cancer by regulating GPX4 via CREB1 regulation. Am J Reprod Immunol 2024; 92:e13864. [PMID: 39141012 DOI: 10.1111/aji.13864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/08/2024] [Accepted: 05/03/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Long non-coding RNAs (lncRNAs) play crucial roles in cellular processes, with dysregulation implicated in various diseases, including cancers. The lncRNA TPT1-AS1 (TPT1 Antisense RNA 1) promotes tumor progression in several cancers, including ovarian cancer (OC), but its influence on ferroptosis and interaction with other proteins remains underexplored. METHODS In this study, we employed a multi-faceted approach to investigate the functional significance of TPT1-AS1 in OC. We assessed TPT1-AS1 expression in OC specimens and cell lines using RT-qPCR, in situ hybridization (ISH), and fluorescence in situ hybridization (FISH) assays. Functional assays included evaluating the impact of TPT1-AS1 knockdown on OC cell proliferation, migration, invasiveness, and cell cycle progression. Further, we explored and validated the interaction of TPT1-AS1 with other proteins using bioinformatics. Finally, we investigated TPT1-AS1 involvement in erastin-induced ferroptosis using Iron Assay, Malondialdehyde (MDA) assay, and reactive oxygen species (ROS) detection. RESULTS Our findings revealed that TPT1-AS1 overexpression in OC correlated with an unfavorable prognosis. TPT1-AS1 knockdown suppressed cell proliferation, migration, and invasiveness. Additionally, TPT1-AS1 inhibited erastin-induced ferroptosis, and in vivo experiments confirmed its oncogenic impact on tumor development. Mechanistically, TPT1-AS1 was found to regulate Glutathione Peroxidase 4 (GPX4) transcription via CREB1 (cAMP response element-binding protein 1) and interact with RNA-binding protein (RBP) KHDRBS3 (KH RNA Binding Domain Containing, Signal Transduction Associated 3) to regulate CREB1. CONCLUSION TPT1-AS1 promotes OC progression by inhibiting ferroptosis and upregulating CREB1, forming a regulatory axis with KHDRBS3. These findings highlight the regulatory network involving lncRNAs, RBPs, and transcription factors in cancer progression.
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Affiliation(s)
- Lei Cao
- Department of Gynecology, The Second Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China
| | - Yan Wang
- Department of Gynecology, The Second Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China
| | - Juanni Liu
- Department of Gynecology, The Second Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China
| | - Xiaoying Bai
- Department of Gynecology, The Second Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China
| | - Xiaohong Chi
- Department of Gynecology, The Second Affiliated Hospital of Shandong First Medical University, Tai'an, Shandong, China
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Luo Y, Bai XY, Zhang L, Hu QQ, Zhang N, Cheng JZ, Hou MZ, Liu XL. Ferroptosis in Cancer Therapy: Mechanisms, Small Molecule Inducers, and Novel Approaches. Drug Des Devel Ther 2024; 18:2485-2529. [PMID: 38919962 PMCID: PMC11198730 DOI: 10.2147/dddt.s472178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 06/13/2024] [Indexed: 06/27/2024] Open
Abstract
Ferroptosis, a unique form of programmed cell death, is initiated by an excess of iron accumulation and lipid peroxidation-induced damage. There is a growing body of evidence indicating that ferroptosis plays a critical role in the advancement of tumors. The increased metabolic activity and higher iron levels in tumor cells make them particularly vulnerable to ferroptosis. As a result, the targeted induction of ferroptosis is becoming an increasingly promising approach for cancer treatment. This review offers an overview of the regulatory mechanisms of ferroptosis, delves into the mechanism of action of traditional small molecule ferroptosis inducers and their effects on various tumors. In addition, the latest progress in inducing ferroptosis using new means such as proteolysis-targeting chimeras (PROTACs), photodynamic therapy (PDT), sonodynamic therapy (SDT) and nanomaterials is summarized. Finally, this review discusses the challenges and opportunities in the development of ferroptosis-inducing agents, focusing on discovering new targets, improving selectivity, and reducing toxic and side effects.
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Affiliation(s)
- YiLin Luo
- Yan ‘an Small Molecule Innovative Drug R&D Engineering Research Center, School of Medicine, Yan’an University, Yan’an, People’s Republic of China
| | - Xin Yue Bai
- Yan ‘an Small Molecule Innovative Drug R&D Engineering Research Center, School of Medicine, Yan’an University, Yan’an, People’s Republic of China
| | - Lei Zhang
- Yan ‘an Small Molecule Innovative Drug R&D Engineering Research Center, School of Medicine, Yan’an University, Yan’an, People’s Republic of China
| | - Qian Qian Hu
- Yan ‘an Small Molecule Innovative Drug R&D Engineering Research Center, School of Medicine, Yan’an University, Yan’an, People’s Republic of China
| | - Ning Zhang
- Yan ‘an Small Molecule Innovative Drug R&D Engineering Research Center, School of Medicine, Yan’an University, Yan’an, People’s Republic of China
| | - Jun Zhi Cheng
- Yan ‘an Small Molecule Innovative Drug R&D Engineering Research Center, School of Medicine, Yan’an University, Yan’an, People’s Republic of China
| | - Ming Zheng Hou
- Yan ‘an Small Molecule Innovative Drug R&D Engineering Research Center, School of Medicine, Yan’an University, Yan’an, People’s Republic of China
| | - Xiao Long Liu
- Yan ‘an Small Molecule Innovative Drug R&D Engineering Research Center, School of Medicine, Yan’an University, Yan’an, People’s Republic of China
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Mokhtarpour K, Razi S, Rezaei N. Ferroptosis as a promising targeted therapy for triple negative breast cancer. Breast Cancer Res Treat 2024:10.1007/s10549-024-07387-7. [PMID: 38874688 DOI: 10.1007/s10549-024-07387-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 05/22/2024] [Indexed: 06/15/2024]
Abstract
PURPOSE Triple negative breast cancer (TNBC) is a challenging subtype characterized by the absence of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) expression. Standard treatment options are limited, and approximately 45% of patients develop distant metastasis. Ferroptosis, a regulated form of cell death triggered by iron-dependent lipid peroxidation and oxidative stress, has emerged as a potential targeted therapy for TNBC. METHODS This study utilizes a multifaceted approach to investigate the induction of ferroptosis as a therapeutic strategy for TNBC. It explores metabolic alterations, redox imbalance, and oncogenic signaling pathways to understand their roles in inducing ferroptosis, characterized by lipid peroxidation, reactive oxygen species (ROS) generation, and altered cellular morphology. Critical pathways such as Xc-/GSH/GPX4, ACSL4/LPCAT3, and nuclear factor erythroid 2-related factor 2 (NRF2) are examined for their regulatory roles in ferroptosis and their potential dysregulation contributing to cancer cell survival and resistance. RESULTS Inducing ferroptosis has been shown to inhibit tumor growth, enhance the efficacy of conventional therapies, and overcome drug resistance in TNBC. Lipophilic antioxidants, GPX4 inhibitors, and inhibitors of the Xc- system have been demonstrated to be potential ferroptosis inducers. Additionally, targeting the NRF2 pathway and exploring other ferroptosis regulators, such as ferroptosis suppressor protein 1 (FSP1), and the PERK-eIF2α-ATF4-CHOP pathway, may offer novel therapeutic avenues. CONCLUSION Further research is needed to understand the mechanisms, optimize therapeutic strategies, and evaluate the safety and efficacy of ferroptosis-targeted therapies in TNBC treatment. Overall, targeting ferroptosis represents a promising approach to improving treatment outcomes and overcoming the challenges posed by TNBC.
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Affiliation(s)
- Kasra Mokhtarpour
- Faculty of Veterinary Medicine, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran
- Cancer Immunology Project (CIP), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Sepideh Razi
- Cancer Immunology Project (CIP), Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Research Center for Imunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Dr Qarib St, Keshavarz Blvd, Tehran, 14194, Iran
| | - Nima Rezaei
- Research Center for Imunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Dr Qarib St, Keshavarz Blvd, Tehran, 14194, Iran.
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Cancer Immunology Project (CIP), Universal Scientific Education and Research Network (USERN), Stockholm, Sweden.
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Vinik Y, Lev S. A snapshot into the transcriptomic landscape of apoptosis and ferroptosis in cancer. Cell Death Dis 2024; 15:371. [PMID: 38811541 PMCID: PMC11137012 DOI: 10.1038/s41419-024-06766-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 05/31/2024]
Affiliation(s)
- Yaron Vinik
- Molecular Cell Biology Department, Weizmann Institute of Science, Rehovot, Israel
| | - Sima Lev
- Molecular Cell Biology Department, Weizmann Institute of Science, Rehovot, Israel.
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Katkova SA, Bunev AS, Gasanov RE, Khochenkov DA, Kulsha AV, Ivashkevich OA, Serebryanskaya TV, Kinzhalov MA. Metal-(Acyclic Diaminocarbene) Complexes Demonstrate Nanomolar Antiproliferative Activity against Triple-Negative Breast Cancer. Chemistry 2024; 30:e202400101. [PMID: 38363795 DOI: 10.1002/chem.202400101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 02/18/2024]
Abstract
Hydrolytically stable PdII and PtII complexes supported by acyclic diaminocarbene ligands represent a novel class of structural organometallic anticancer agents exhibiting nanomolar antiproliferative activity in a panel of cancer cell lines (IC50 0.07-0.81 μM) and up to 300-fold selectivity for cancer cells over normal primary fibroblasts. The lead drug candidate was 300 times more potent than cisplatin in vitro and showed higher efficacy in reducing the growth of aggressive MDA-MB-231 xenograft tumors in mice.
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Affiliation(s)
- Svetlana A Katkova
- Saint Petersburg State University, 7/9 Universitetskaya Nab., St. Petersburg, 199034, Russian Federation
| | - Alexander S Bunev
- Medicinal Chemistry Center, Togliatti State University, Belorusskaya 14, Togliatti, 445020, Russian Federation
| | - Rovshan E Gasanov
- Medicinal Chemistry Center, Togliatti State University, Belorusskaya 14, Togliatti, 445020, Russian Federation
| | - Dmitry A Khochenkov
- Medicinal Chemistry Center, Togliatti State University, Belorusskaya 14, Togliatti, 445020, Russian Federation
- Blokhin National Medical Research Center of Oncology, Kashirskoe Shosse 24, 115478, Moscow, Russian Federation
| | - Andrey V Kulsha
- Department of Chemistry, Belarusian State University, Leningradskaya 14, 220006, Minsk, Belarus
| | - Oleg A Ivashkevich
- Research Institute for Physical Chemical Problems, Belarusian State University, Leningradskaya 14, 220006, Minsk, Belarus
| | - Tatiyana V Serebryanskaya
- Research Institute for Physical Chemical Problems, Belarusian State University, Leningradskaya 14, 220006, Minsk, Belarus
| | - Mikhail A Kinzhalov
- Saint Petersburg State University, 7/9 Universitetskaya Nab., St. Petersburg, 199034, Russian Federation
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Liang Q, Wang Y, Li Y, Wang J, Liu C, Li Y. Ferroptosis: emerging roles in lung cancer and potential implications in biological compounds. Front Pharmacol 2024; 15:1374182. [PMID: 38783959 PMCID: PMC11111967 DOI: 10.3389/fphar.2024.1374182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Lung cancer has high metastasis and drug resistance. The prognosis of lung cancer patients is poor and the patients' survival chances are easily neglected. Ferroptosis is a programmed cell death proposed in 2012, which differs from apoptosis, necrosis and autophagy. Ferroptosis is a novel type of regulated cell death which is driven by iron-dependent lipid peroxidation and subsequent plasma membrane ruptures. It has broad prospects in the field of tumor disease treatment. At present, multiple studies have shown that biological compounds can induce ferroptosis in lung cancer cells, which exhibits significant anti-cancer effects, and they have the advantages in high safety, minimal side effects, and less possibility to drug resistance. In this review, we summarize the biological compounds used for the treatment of lung cancer by focusing on ferroptosis and its mechanism. In addition, we systematically review the current research status of combining nanotechnology with biological compounds for tumor treatment, shed new light for targeting ferroptosis pathways and applying biological compounds-based therapies.
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Affiliation(s)
- Qiuran Liang
- The Second Clinical Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Yuehui Wang
- The Second Clinical Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Yili Li
- The Second Clinical Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Jinyan Wang
- The Second Clinical Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Chuanbo Liu
- Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Yicong Li
- Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
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Guo M, Liu M, Li W, Wang C, Zhang L, Zhang H. Osteopontin promotes tumor growth and metastasis and GPX4-mediated anti-lipid peroxidation in triple-negative breast cancer by activating the PI3k/Akt/mTOR pathway. J Cancer Res Clin Oncol 2024; 150:155. [PMID: 38526702 PMCID: PMC10963528 DOI: 10.1007/s00432-024-05658-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/20/2024] [Indexed: 03/27/2024]
Abstract
PURPOSE Triple-negative breast cancer (TNBC) features high aggressiveness, metastasis rate, drug resistance as well as poor prognosis. Osteopontin (OPN) is a key protein in the process of osteogenesis and has emerged as a new tumor marker in recent years. METHODS Cell viability was tested with the CCK-8 kit. Transwell and wound healing were adopted to test cell invasive and migratory abilities. Tumor sphere formation was detected by tumor sphere formation assay. Human umbilical vein endothelial cell (HUVEC) tube formation assay was used to measure the angiogenesis of tumor cells. Western blot was applied for the estimation of the expression of cancer stem cell markers, angiogenesis-, signaling pathway-related proteins as well as OPN. Bioinformatics tools predicted OPN expression in breast cancer tissues. The levels of oxidative stress-related markers were assessed with ELISA. Following the overexpression of OPN in MD-MB-436 cells and the addition of the PI3K/AKT/mTOR pathway inhibitor LY294002, the aforementioned functional experiments were implemented again to investigate the mechanism. Finally, in vivo experiments of tumor-bearing mice were performed for further verification. RESULTS The proliferative, invasive, migratory and tumor sphere formation capabilities as well as angiogenesis of TNBC cells were conspicuously increased in contrast to non-TNBC cell lines. OPN expression in TNBC tissues and cells was dramatically enhanced. OPN upregulation significantly elevated cell proliferative, invasive and migratory capabilities as well as tumor sphere formation and angiogenesis. The mechanism might be achieved by activating PI3K/AKT/mTOR signaling to regulate glutathione peroxidase 4 (GPX4)-mediated anti-lipid peroxidation. CONCLUSION OPN promoted tumor sphere formation and angiogenesis in TNBC by activating the PI3K/AKT/mTOR pathway to regulate GPX4-mediated anti-lipid peroxidation levels.
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Affiliation(s)
- Man Guo
- Department of Thyroid and Breast Surgery, Nanyang Central Hospital, No. 312 Gongnong Road, Wancheng District, Nanyang City, 473005, Henan Province, China
| | - Mengyue Liu
- Xinxiang Medical University, Xinxiang City, 453003, Henan Province, China
| | - Weihan Li
- Department of Thyroid and Breast Surgery, Nanyang Central Hospital, No. 312 Gongnong Road, Wancheng District, Nanyang City, 473005, Henan Province, China
| | - Cao Wang
- Department of Thyroid and Breast Surgery, Nanyang Central Hospital, No. 312 Gongnong Road, Wancheng District, Nanyang City, 473005, Henan Province, China
| | - Lu Zhang
- Department of Thyroid and Breast Surgery, Nanyang Central Hospital, No. 312 Gongnong Road, Wancheng District, Nanyang City, 473005, Henan Province, China
| | - Hao Zhang
- Department of Thyroid and Breast Surgery, Nanyang Central Hospital, No. 312 Gongnong Road, Wancheng District, Nanyang City, 473005, Henan Province, China.
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Siquara da Rocha LDO, de Morais EF, de Oliveira LQR, Barbosa AV, Lambert DW, Gurgel Rocha CA, Coletta RD. Exploring beyond Common Cell Death Pathways in Oral Cancer: A Systematic Review. BIOLOGY 2024; 13:103. [PMID: 38392321 PMCID: PMC10886582 DOI: 10.3390/biology13020103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/17/2024] [Accepted: 02/01/2024] [Indexed: 02/24/2024]
Abstract
Oral squamous cell carcinoma (OSCC) is the most common and lethal type of head and neck cancer in the world. Variable response and acquisition of resistance to traditional therapies show that it is essential to develop novel strategies that can provide better outcomes for the patient. Understanding of cellular and molecular mechanisms of cell death control has increased rapidly in recent years. Activation of cell death pathways, such as the emerging forms of non-apoptotic programmed cell death, including ferroptosis, pyroptosis, necroptosis, NETosis, parthanatos, mitoptosis and paraptosis, may represent clinically relevant novel therapeutic opportunities. This systematic review summarizes the recently described forms of cell death in OSCC, highlighting their potential for informing diagnosis, prognosis and treatment. Original studies that explored any of the selected cell deaths in OSCC were included. Electronic search, study selection, data collection and risk of bias assessment tools were realized. The literature search was carried out in four databases, and the extracted data from 79 articles were categorized and grouped by type of cell death. Ferroptosis, pyroptosis, and necroptosis represented the main forms of cell death in the selected studies, with links to cancer immunity and inflammatory responses, progression and prognosis of OSCC. Harnessing the potential of these pathways may be useful in patient-specific prognosis and individualized therapy. We provide perspectives on how these different cell death types can be integrated to develop decision tools for diagnosis, prognosis, and treatment of OSCC.
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Affiliation(s)
- Leonardo de Oliveira Siquara da Rocha
- Department of Pathology and Forensic Medicine, School of Medicine, Federal University of Bahia, Salvador 40110-100, BA, Brazil
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation (IGM-FIOCRUZ/BA), Salvador 40296-710, BA, Brazil
| | - Everton Freitas de Morais
- Graduate Program in Oral Biology and Department of Oral Diagnosis, School of Dentistry, University of Campinas, Piracicaba 13414-018, SP, Brazil
| | - Lilianny Querino Rocha de Oliveira
- Graduate Program in Oral Biology and Department of Oral Diagnosis, School of Dentistry, University of Campinas, Piracicaba 13414-018, SP, Brazil
| | - Andressa Vollono Barbosa
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation (IGM-FIOCRUZ/BA), Salvador 40296-710, BA, Brazil
| | - Daniel W Lambert
- School of Clinical Dentistry, The University of Sheffield, Sheffield S10 2TA, UK
| | - Clarissa A Gurgel Rocha
- Department of Pathology and Forensic Medicine, School of Medicine, Federal University of Bahia, Salvador 40110-100, BA, Brazil
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation (IGM-FIOCRUZ/BA), Salvador 40296-710, BA, Brazil
- Department of Propaedeutics, School of Dentistry, Federal University of Bahia, Salvador 40110-909, BA, Brazil
- D'Or Institute for Research and Education (IDOR), Salvador 41253-190, BA, Brazil
| | - Ricardo D Coletta
- Graduate Program in Oral Biology and Department of Oral Diagnosis, School of Dentistry, University of Campinas, Piracicaba 13414-018, SP, Brazil
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Khan M, Sunkara V, Yadav M, Bokhari SFH, Rehman A, Maheen A, Shehryar A, Chilla SP, Nasir M, Niaz H, Choudhari J, Anika NN, Amir M. Ferroptosis and Triple-Negative Breast Cancer: A Systematic Overview of Prognostic Insights and Therapeutic Potential. Cureus 2024; 16:e51719. [PMID: 38318597 PMCID: PMC10838809 DOI: 10.7759/cureus.51719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2024] [Indexed: 02/07/2024] Open
Abstract
In the realm of oncology, the prognosis and treatment of triple-negative breast cancer (TNBC) have long been challenges for researchers and clinicians. Characterized by its aggressive nature and limited therapeutic options, TNBC demands innovative approaches to understanding its underlying mechanisms and improving patient outcomes. One such avenue of exploration that has emerged in recent years is the study of ferroptosis, a form of regulated cell death driven by iron-dependent lipid peroxidation. Ferroptosis has garnered increasing attention due to its potential relevance in the context of TNBC. This systematic review aims to shed light on the intricate interplay between ferroptosis and the prognosis of TNBC. The article delves into a comprehensive examination of the existing literature to provide a holistic understanding of the subject. By investigating ferroptosis as both an intervention and a prognostic factor in TNBC, this article seeks to unravel its potential as a therapeutic target and prognostic marker. The emerging evidence and heterogeneity of ferroptosis in TNBC underscore the need for a systematic approach to assess its impact on patient outcomes. This review will serve as a valuable resource for researchers, clinicians, and healthcare professionals striving to enhance our knowledge of TNBC and explore novel avenues for prognosis and treatment.
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Affiliation(s)
- Mohsin Khan
- Interventional Radiology, Musgrove Park Hospital, Taunton, GBR
| | | | - Mansi Yadav
- Internal Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | | | | | - Azka Maheen
- Medicine, Gomal Medical College, Dera Ismail Khan, PAK
| | | | - Srikar P Chilla
- Medicine, Care Hospitals, Hyderabad, IND
- School of Health Sciences, University of East London, London, GBR
| | - Maheen Nasir
- Anesthesiology, National University of Medical Sciences, Lahore, PAK
| | - Humaira Niaz
- Internal Medicine, Peshawar Medical College, Peshawar, PAK
| | - Jinal Choudhari
- Research & Academic Affairs, Larkin Community Hospital, Miami, USA
| | - Nabila N Anika
- Medicine, Holy Family Red Crescent Medical College and Hospital, Dhaka, BGD
| | - Maaz Amir
- Internal Medicine, King Edward Medical University, Lahore, PAK
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