Mol Cancer. 2026 Jul 23. pii: 248. [Epub ahead of print]25(1):
Adriana Celesia,
Filippo Piccoli,
Tian Wang,
Yushu Hu,
Federica Danzi,
Antonino Aparo,
Barbara Cisterna,
Raffaella Pacchiana,
Maria Poles,
Maria Teresa Scupoli,
Claudio Luchini,
Stefano Ugel,
Massimo Donadelli,
Alessandra Fiore.
BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy characterized by late diagnosis, rapid progression, and resistance to conventional therapies. Mutations in the tumor suppressor gene TP53 are prevalent in this cancer and have been associated with gain-of-function activities that promote tumor survival. Ferroptosis, an iron-dependent form of regulated cell death driven by lipid peroxidation, represents a potential therapeutic vulnerability. However, the influence of mutant p53 on ferroptosis susceptibility remains poorly understood.
METHODS: We employed isogenic pancreatic cancer cell models, including CRISPR-Cas9-mediated TP53 Knockout (TP53-KO) and transient overexpression of common mutant TP53 variants, to examine ferroptosis sensitivity. Cell viability, reactive oxygen species accumulation, lipid peroxidation, mitochondrial integrity, and metabolic profiling were assessed following treatment with ferroptosis inducers. Transcriptional changes were analysed by RNA sequencing, and functional contributions of glycolysis and mitochondrial respiration were evaluated using metabolic flux assays. Pharmacological reactivation of wild-type p53 was tested in combination with ferroptosis inducers in vitro and in orthotopic murine models.
RESULTS: Deletion of mutant TP53 sensitized pancreatic cancer cells to ferroptosis, accompanied by increased oxidative stress, lipid peroxidation and mitochondrial dysfunction. Mutant TP53 expression preserved mitochondrial integrity and sustained bioenergetic flexibility under ferroptotic stress. Transcriptomic analyses revealed a multi-layered adaptive program, including upregulation of antioxidant and metabolic genes, and activation of PI3K-AKT signaling, which is associated to a selective glycolytic shift to maintain ATP levels. Functional modulation confirmed that glucose supplementation enhanced, whereas glycolytic inhibition impaired, survival under ferroptotic conditions in mutant TP53-expressing cells, but not in TP53-KO cells. Pharmacological reactivation of wild-type p53 disrupted this adaptive network, abrogating glycolytic reprogramming and significantly increasing ferroptotic cell death both in vitro and in vivo.
CONCLUSIONS: Mutant p53 orchestrates transcriptional and metabolic plasticity that confers ferroptosis resistance in pancreatic cancer. Reactivating wild-type p53 in combination with ferroptosis induction overcomes this resistance, highlighting a therapeutically actionable vulnerability and supporting the development of combinatorial strategies for this aggressive malignancy.
Keywords: Ferroptosis; Glycolysis; Mitochondria; Mutant p53; PDAC