Disulfiram’s anti-cancer activity reflects targeting NPL4, not inhibition of aldehyde dehydrogenase
Abstract
Aldehyde dehydrogenase (ALDH) is a proposed biomarker and possible target to eradicate cancer stem cells. ALDH inhibition as a treatment approach is supported by anti-cancer effects of the alcohol-abuse drug disulfiram (DSF, Antabuse). Given that metabolic products of DSF, rather than DSF itself inhibit ALDH in vivo, and that DSF's anti-cancer activity is potentiated by copper led us to investigate the relevance of ALDH as the suggested molecular cancer-relevant target of DSF. Here we show that DSF does not directly inhibit ALDH activity in diverse human cell types, while DSF's in vivo metabolite, S-methyl-N,N-diethylthiocarbamate-sulfoxide inhibits ALDH activity yet does not impair cancer cell viability. Our data indicate that the anti-cancer activity of DSF does not involve ALDH inhibition, and rather reflects the impact of DSF's copper-containing metabolite (CuET), that forms spontaneously in vivo and in cell culture media, and kills cells through aggregation of NPL4, a subunit of the p97/VCP segregase. We also show that the CuET-mediated, rather than any ALDH-inhibitory activity of DSF underlies the preferential cytotoxicity of DSF towards BRCA1- and BRCA2-deficient cells. These findings provide evidence clarifying the confusing literature about the anti-cancer mechanism of DSF, a drug currently tested in clinical trials for repositioning in oncology.
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DIS anticancer effects arise from its copper-containing metabolite, which forms spontaneously in vitro and in vivo, induces NPL4 aggregation, and disrupts the p97/valosin-containing protein segregase.
“DIS anticancer effects instead arise from its copper-containing metabolite, which forms spontaneously in vitro and in vivo, that induces nuclear protein localization 4 (NPL4) aggregation, disrupting the p97/valosin-containing protein (VCP) segregase.81”
From Off-label and repurposed use of disulfiram beyond alcohol dependence: A systematic review of clinical and preclinical evidence (2026) · cites this paper as [81]
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- Authors
- Skrott, Z., Majera, D., Gursky, J., Buchtova, T., Hajduch, M., Mistrik, M., & Bartek, J.
- Venue
- Oncogene
- Published
- 2019-08-07
- Volume
- 38
- Issue
- 40
- Pages
- 6711-6722
- ISSN
- 0950-9232 (ISSN-L)
- 1476-5594
- OpenAlex
- W2965238366
- Cited by
- 115
- References
- 43
- Citations by year
- 2026: 7 · 2025: 18 · 2024: 18 · 2023: 17 · 2022: 23 · 2021: 16 · 2020: 13 · 2019: 2 · 2017: 1
- FWCI
- 10.18
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Oncogene (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Novo Nordisk Fonden (NNF15OC0016584)
- Topics
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Bioactive Compounds and Antitumor Agents
- Health Sciences › Medicine › Oncology › Cancer Cells and Metastasis
- Health Sciences › Medicine › Oncology › Cancer-related Molecular Pathways
- Keywords
- disulfiram, aldehyde dehydrogenase, Npl4, cancer stem cells, BRCA1 deficiency, BRCA2 deficiency, drug repurposing, anticancer mechanism, protein aggregation
- MeSH terms
- A549 Cells, Aldehyde Dehydrogenase, Antineoplastic Agents, Culture Media, Disulfiram, Humans, Nuclear Proteins, K562 Cells, Acetaldehyde Dehydrogenase Inhibitors
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