52 Ferroptosis Suppressor Protein 1 is a Potent and Targetable Inhibitor of Ferroptosis in Chromophobe Renal Cell

Abstract Background There are currently no proven therapies for metastatic or unresectable Chromophobe renal cell carcinoma (ChRCC). Ferroptosis is an iron-dependent form of cell death characterized by the peroxidation of membrane polyunsaturated fatty acids, leading to membrane damage and cell death. Glutathione, a potent cellular antioxidant, counters lipid peroxidation to prevent ferroptosis. Both reduced and oxidized glutathione are markedly elevated in ChRCC (PNAS, 2018). We have previously discovered that ChRCC is hypersensitive to ferroptotic cell death induced by the pharmacologic disruption of glutathione homeostasis via the cysteine transporter SLC7A11 or glutathione peroxidase (GPX4) inhibition (PNAS, 2022). Ferroptosis suppressor protein (FSP1) is a glutathione-independent suppressor of ferroptosis. FSP1’s role in ChRCC is unexplored. Methods Transcriptional data from DepMap (484 cell lines) and Cancer Therapeutics Response Portal (CTRP) (860 cell lines) were used to study genetic or pharmacologic inhibition of GPX4 and SLC7A11. Statistical analysis was performed in PRISM 10 using Mann-Whitney U and ANOVA tests. Statistical significance was defined as p 0.05. Results DepMap data revealed that FSP1 is the top upregulated gene in cells resistant to RNAi inhibition of GPX4 (Achilles, DEMETER2) (Panel A). In CTRP data, FSP1 was the top upregulated gene in cells resistant to the GPX4 inhibitor RSL3 and the 19th most upregulated gene in cells resistant to the SCL7A11 inhibitor, Erastin (Panel B). In The Cancer Genomic Atlas (TCGA) KICH (ChRCC) dataset, FSP1 was 2-fold higher in ChRCC compared to normal kidney (mean RSEM = 818.9 vs 445.9, p-value 0.0001) (Panel C). In vitro studies of two ChRCC cell lines, UOK276 and RCJ-T2, revealed that while siRNA-mediated inhibition of GPX4 or FSP1 individually did not induce substantial cell death, their combination was synergistic and resulted in almost complete cell death (UOK276 mean viability 8% of siCTRL, p0.0001; RCJ-T2 mean viability 13% of siCTRL, p0.0001). Cell viability was completely rescued by the ferroptosis inhibitor ferrostatin-1 but not by the necroptosis inhibitor necrostatin-1 or the apoptosis inhibitor Z-Vad-FMK (Panel D). siRNA-mediated GPX4 knockdown combined with FSP1 pharmacologic inhibition (icFSP1 or FSEN1) induced extensive cell death (mean viability of siGPX4 + icFSP1 group = 21% of siCTRL + DMSO group, p0.0001; mean viability of siGPX4 + FSEN1 group = 29% of siCTRL + DMSO group, p0.0001) (Panel E). Combining RSL3 with FSEN1, or IKE with icFSP1, also demonstrated synergy, with the ChRCC cell lines showing increased overall sensitivity to these drug combinations compared to 786-0 cells (ccRCC-derived) and HeLa cells (Panel F). Snapshots from these experiments taken at IKE = 177nM and/or icFSP1 = 20 mM for UOK276, and RSL3 = 39.4 nM and/or FSEN1 = 20 mM for RCJ-T2, show almost complete cell death when pharmacologic inhibitors of glutathione-dependent and -independent ferroptosis suppressors are combined, but no substantial cell death when each is used individually (7% and 10% viability in combination group compared to DMSO group for UOK276 and RCJ-T2 respectively, p0.0001) (Panel G). Conclusions We show that in vitro genetic or pharmacologic inhibition of FSP1, a glutathione-independent inhibitor of ferroptosis, leads to ferroptosis in ChRCC-derived cells when combined with genetic or pharmacologic inhibition of the glutathione-dependent suppressors of ferroptosis GPX4 or SLC7A11.