Ferroptosis is an iron-dependent form of regulated cell
death linking
iron, lipid, and glutathione levels to degenerative processes and
tumor suppression. By performing a genome-wide activation screen,
we identified a cohort of genes antagonizing ferroptotic cell death,
including GTP cyclohydrolase-1 (GCH1) and its metabolic derivatives
tetrahydrobiopterin/dihydrobiopterin (BH4/BH2). Synthesis of BH4/BH2 by GCH1-expressing
cells caused lipid remodeling, suppressing ferroptosis by selectively
preventing depletion of phospholipids with two polyunsaturated fatty
acyl tails. GCH1 expression level in cancer cell lines stratified
susceptibility to ferroptosis, in accordance with its expression in
human tumor samples. The GCH1-BH4-phospholipid axis acts
as a master regulator of ferroptosis resistance, controlling endogenous
production of the antioxidant BH4, abundance of CoQ10, and peroxidation of unusual phospholipids with two polyunsaturated
fatty acyl tails. This demonstrates a unique mechanism of ferroptosis
protection that is independent of the GPX4/glutathione system.