APR-246 induces early cell death by ferroptosis in acute myeloid leukemia
Open accessAbstract
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.
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Inhibiting cystine uptake with erastin or sulfasalazine synergizes with eprenetapopt both in vitro and in vivo.
“This model is in keeping with our prior work, and confirmed by others (7, 8, 20), demonstrating that inhibiting cystine uptake with erastin or sulfasalazine synergizes with eprenetapopt both in vitro and in vivo.”
From Eprenetapopt triggers ferroptosis, inhibits NFS1 cysteine desulfurase, and synergizes with serine and glycine dietary restriction (2022) · cites this paper as [20]
The Results section on cystine uptake reports that erastin synergized with APR-246 in AML cell lines and primary samples in vitro. The in vivo Results section reports enhanced activity from combining APR-246 with genetic SLC7A11 knockdown, not erastin or sulfasalazine. Our copy does not report sulfasalazine synergy. (LLM, conf=0.89)
Experimental — accuracy not yet measuredA critical mechanism of APR-246 for cell death in AML models is via ferroptosis, where mTP53 mutant cells may be preferentially sensitive.
“More recently, a critical mechanism of APR‐246 for cell death in AML models is via ferroptosis, where mTP53 mutant cells may be preferentially sensitive.”
From Long‐term follow‐up and combined Phase 2 results of eprenetapopt and azacitidine in patients with <i>TP53</i> mutant MDS/AML (2025) · cites this paper as [24]
The Results section reports that APR-246 induces ferroptosis in AML cells, supporting the mechanism attributed to this paper. But the same section reports sensitivity independently of TP53 mutational status, and the Discussion says APR-246 induced cell death irrespective of that status. The proposed preferential sensitivity of mutant-TP53 cells is therefore not supported by this study's AML findings. (LLM, conf=0.90)
Experimental — accuracy not yet measuredEprenetapopt induces ferroptosis in AML models.
“This is in keeping with recent findings suggesting that eprenetapopt induces ferroptosis in AML models (20).”
From Eprenetapopt triggers ferroptosis, inhibits NFS1 cysteine desulfurase, and synergizes with serine and glycine dietary restriction (2022) · cites this paper as [20]
Eprenetapopt has p53-independent anticancer activity.
“preclinical evidence demonstrated that eprenetapopt has p53-independent anticancer activity (20)”
From Eprenetapopt triggers ferroptosis, inhibits NFS1 cysteine desulfurase, and synergizes with serine and glycine dietary restriction (2022) · cites this paper as [20]
Eprenetapopt is a ferroptosis inducer, contrary to reports that it induces apoptosis through mut-p53 reactivation.
“our findings are contrary to reports concluding that eprenetapopt induces apoptosis through mut-p53 reactivation (5, 24) and instead supports eprenetapopt as a ferroptosis inducer (20).”
From Eprenetapopt triggers ferroptosis, inhibits NFS1 cysteine desulfurase, and synergizes with serine and glycine dietary restriction (2022) · cites this paper as [20]
Ferroptosis induction can induce p53-independent cell death preferentially in AML cells that lack the ability to prevent lipid peroxide accumulation.
“As ferroptosis induction can induce p53‐independent cell death preferentially in AML cells that lack the ability to prevent lipid peroxide accumulation”
From Long‐term follow‐up and combined Phase 2 results of eprenetapopt and azacitidine in patients with <i>TP53</i> mutant MDS/AML (2025) · cites this paper as [24]
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- Authors
- Birsen, R., Larrue, C., Decroocq, J., Johnson, N., Guiraud, N., Gotanegre, M., Cantero-Aguilar, L., Grignano, E., Huynh, T., Fontenay, M., Kosmider, O., Mayeux, P., Chapuis, N., Sarry, J. E., Tamburini, J., & Bouscary, D.
- Affiliations
- Centre National de la Recherche Scientifique (FR)
- Inserm (FR)
- Corresponding author
- Birsen, Rudy
- Bouscary, Didier
- ORCID
- Venue
- Haematologica
- Published
- 2021-01-07
- Volume
- 107
- Issue
- 2
- Pages
- 403-416
- ISSN
- 0390-6078 (ISSN-L)
- 1592-8721
- PMC
- PMC8804578
- OpenAlex
- W3120795654
- Cited by
- 182
- References
- 48
- Citations by year
- 2026: 21 · 2025: 30 · 2024: 32 · 2023: 42 · 2022: 42 · 2021: 14
- FWCI
- 21.10
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Haematologica (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Institut National Du Cancer
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Ferroptosis and cancer prognosis
- Health Sciences › Medicine › Hematology › Acute Myeloid Leukemia Research
- Health Sciences › Medicine › Oncology › Cancer-related Molecular Pathways
- Keywords
- APR-246, ferroptosis, acute myeloid leukemia, TP53 mutation, lipid peroxidation, iron chelators, cystine uptake, glutathione synthesis, SLC7A11, GPX4, lipophilic antioxidants, drug sensitivity, synergistic cell death
- MeSH terms
- Ferroptosis, Humans, Quinuclidines, Leukemia, Myeloid, Acute, Cell Death
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