Pancreatic ductal adenocarcinoma (PDA) is the third-leading cause of cancer mortality in the US and is highly resistant to classical, targeted, and immune therapies. We show that human PDA cells are dependent on the provision of exogenous cystine to avert a catastrophic accumulation of lipid reactive oxygen species (ROS) that, left unchecked, leads to ferroptotic cell death, both in vitro and in vivo. Using a dual-recombinase genetically engineered model, we found that acute deletion of Slc7a11 led to tumorselective ferroptosis, tumor stabilizations/regressions, and extended overall survival. The mechanism of ferroptosis induction in PDA cells required the concerted depletion of both glutathione and coenzyme A, highlighting a novel branch of ferroptosis-relevant metabolism. Finally, we found that cystine depletion in vivo using the pre-IND agent cyst(e)inase phenocopied Slc7a11 deletion, inducing tumor-selective ferroptosis and disease stabilizations/regressions in the well-validated KPC model of PDA.One Sentence Summary: Genetic and pharmacological targeting of cystine import induces pancreatic cancer-selective ferroptosis in vivo.
Main Body:The cancer-selective induction of apoptosis through cytotoxic chemotherapy is a foundation of modern oncology. However, some cancers, such as PDA, have proven highly resistant to traditional therapeutic strategies (1). In addition to proliferative signals, activating mutations in KRAS (found in >90% of human pancreatic tumors) induce both an increase in the generation of ROS as well as compensatory antioxidant programs (2-4). We hypothesize that in this state of elevated ROS flux, ROS detoxification programs become a critical metabolic dependency.Cellular ROS are neutralized primarily by thiols derived from the semi-essential amino acid cysteine (5-10). Antioxidant molecules such as glutathione and thioredoxin serve to position the uniquelyreactive sulfhydryl group of cysteine to catalyze ROS detoxification reactions. As cysteine is ultimately derived from extracellular sources, we examined the effects of culturing PDA cell lines in the absence of
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