Dihydroartemisinin-induced ferroptosis in acute myeloid leukemia: links to iron metabolism and metallothionein

Abstract

Abstract Artemisinin is an anti-malarial drug that has shown anticancer properties. Recently, ferroptosis was reported to be induced by dihydroartemisinin and linked to iron increase. In the current study, we determined the effect of artemisinin in leukemic cell lines on ferroptosis induction and iron metabolism and the cytoprotective effect triggered in leukemic cells. We found that treatment of artemisinin induces early ferroptosis by promoting ferritinophagy and subsequent iron increase. Furthermore, our study demonstrated that artemisinin activated zinc metabolism signaling, especially the upregulation of metallothionein. By inhibiting MT2A and MT1M isoforms, we showed that cytotoxic effect of artemisinin and ferroptosis induction were enhanced. Finally, we demonstrated that ferroptosis inducers effect acting on glutathione pool were highly dependent on MTs-driven antioxidant response. Taken together, our study indicated that DHA activates ferritinophagy and subsequent ferroptosis in AML and that MTs are involved in glutathione regenerating and antioxidant response.