VAMP7 governs ferroptosis suppression and cisplatin resistance in esophageal cancer: a dual-targeting therapeutic paradigm

Chemoresistance in esophageal cancer (EC) continues to impose formidable clinical challenges, driving disease recurrence and adverse outcomes. While vesicle-associated membrane protein 7 (VAMP7), a SNARE family regulator, has emerged as an oncogenic participant in tumor evolution, its mechanistic role in EC chemoresistance remains uncharted. Clinico-pathological analyses reveal pronounced VAMP7 overexpression in EC specimens, correlating with unfavorable prognosis, metastatic dissemination, advanced tumor staging, and cisplatin-refractory phenotypes. Functional interrogation demonstrates that VAMP7 silencing attenuates malignant hallmarks-proliferation, migratory capacity, and epithelial-mesenchymal transition (EMT)-while potentiating apoptotic cascades. Mechanistically, VAMP7 exhibits robust positive correlation with ferroptosis regulators GPX4 and NRF2, establishing its role as a ferroptosis checkpoint inhibitor that sustains cisplatin resistance. Combinatorial VAMP7 depletion and cisplatin treatment synergistically diminished neoplastic viability through dual mechanisms: amplification of ferroptosis biomarkers (lipid peroxidation, iron dysregulation) and induction of mitochondrial ultrastructural derangements. Conversely, ectopic VAMP7 expression in resistant clones upregulated GPX4/NRF2 axis activity and reinstated chemotolerance. Therapeutically, co-administration of ferroptosis agonists (RSL3/Erastin) with cisplatin abrogated VAMP7-mediated resistance, evidenced by suppressed xenograft growth and amplified mitochondrial pathology in preclinical models. This work identifies VAMP7 as a novel ferroptosis-chemoresistance nexus in EC, offering a translational framework for overcoming cisplatin refractoriness through coordinated inhibition of VAMP7 signaling and ferroptosis potentiation.