GPX4 at the Crossroads of Lipid Homeostasis and Ferroptosis

Oxygen is necessary for aerobic metabolism but can cause the harmful oxidation of lipids and other macromolecules. Oxidation of cholesterol and phospholipids containing polyunsaturated fatty acyl chains can lead to lipid peroxidation, membrane damage, and cell death. Lipid hydroperoxides are key intermediates in the process of lipid peroxidation. The lipid hydroperoxidase glutathione peroxidase 4 (GPX4) converts lipid hydroperoxides to lipid alcohols, and this process prevents the iron (Fe²⁺)‐dependent formation of toxic lipid reactive oxygen species (ROS). Inhibition of GPX4 function leads to lipid peroxidation and can result in the induction of ferroptosis, an iron‐dependent, non‐apoptotic form of cell death. This review describes the formation of reactive lipid species, the function of GPX4 in preventing oxidative lipid damage, and the link between GPX4 dysfunction, lipid oxidation, and the induction of ferroptosis.     

Ferroptotic pores induce Ca2+ fluxes and ESCRT-III activation to modulate cell death kinetics

Ferroptosis is an iron-dependent form of regulated necrosis associated with lipid peroxidation. Despite its key role in the inflammatory outcome of ferroptosis, little is known about the molecular events leading to the disruption of the plasma membrane during this type of cell death. Here we show that a sustained increase in cytosolic Ca²⁺ is a hallmark of ferroptosis that precedes complete bursting of the cell. We report that plasma membrane damage leading to ferroptosis is associated with membrane nanopores of a few nanometers in radius and that ferroptosis, but not lipid peroxidation, can be delayed by osmoprotectants. Importantly, Ca²⁺ fluxes during ferroptosis induce the activation of the ESCRT-III-dependent membrane repair machinery, which counterbalances the kinetics of cell death and modulates the immunological signature of ferroptosis. Our findings with ferroptosis provide a unifying concept that sustained increase of cytosolic Ca²⁺ prior to plasma membrane rupture is a common feature of regulated types of necrosis and position ESCRT-III activation as a general protective mechanism in these lytic cell death pathways.Subject terms: Cell biology, Molecular biology     

A tale of two lipids: Lipid unsaturation commands ferroptosis sensitivity

Membrane lipids play important roles in the regulation of cell fate, including the execution of ferroptosis. Ferroptosis is a non-apoptotic cell death mechanism defined by iron-dependent membrane lipid peroxidation. Phospholipids containing polyunsaturated fatty acids (PUFAs) are highly vulnerable to peroxidation and are essential for ferroptosis execution. By contrast, the incorporation of less oxidizable monounsaturated fatty acids (MUFAs) in membrane phospholipids protects cells from ferroptosis. The enzymes and pathways that govern PUFA and MUFA metabolism therefore play a critical role in determining cellular sensitivity to ferroptosis. Here, we review three lipid metabolic processes—fatty acid biosynthesis, ether lipid biosynthesis, and phospholipid remodeling—that can govern ferroptosis sensitivity by regulating the balance of PUFAs and MUFAs in membrane phospholipids.     

Compartmentalized regulation of lipid signaling in oxidative stress and inflammation: Plasmalogens,oxidized lipids and ferroptosis as new paradigms of bioactive lipid research

Perturbations in lipid homeostasis combined with conditions favoring oxidative stress constitute a hallmark of the inflammatory response. In this review we focus on the most recent results concerning lipid signaling in various oxidative stress-mediated responses and inflammation. These include phagocytosis and ferroptosis. The best characterized event, common to these responses, is the synthesis of oxygenated metabolites of arachidonic acid and other polyunsaturated fatty acids. Major developments in this area have highlighted the importance of compartmentalization of the enzymes and lipid substrates in shaping the appropriate response. In parallel, other relevant lipid metabolic pathways are also activated and, until recently, there has been a general lack of knowledge on the enzyme regulation and molecular mechanisms operating in these pathways. Specifically, data accumulated in recent years on the regulation and biological significance of plasmalogens and oxidized phospholipids have expanded our knowledge on the involvement of lipid metabolism in the progression of disease and the return to homeostasis. These recent major developments have helped to establish the concept of membrane phospholipids as cellular repositories for the compartmentalized production of bioactive lipids involved in cellular regulation. Importantly, an enzyme classically described as being involved in regulating the homeostatic turnover of phospholipids, namely the group VIA Ca²⁺-independent phospholipase A₂ (iPLA₂β), has taken center stage in oxidative stress and inflammation research owing to its key involvement in regulating metabolic and ferroptotic signals arising from membrane phospholipids. Understanding the role of iPLA₂β in ferroptosis and metabolism not only broadens our knowledge of disease but also opens possible new horizons for this enzyme as a target for therapeutic intervention.     

Lipid storage and lipophagy regulates ferroptosis

The synthesis, storage, and degradation of lipids are highly regulated processes. Impaired lipid metabolism is implicated in inflammation and cell death. Although ferroptosis is a recently described form of regulated cell death driven by lipid peroxidation, the impact of lipid droplets on ferroptosis remains unidentified. Here, we demonstrate that lipophagy, the autophagic degradation of intracellular lipid droplets, promotes RSL3-induced ferroptotic cell death in hepatocytes. Lipid droplet accumulation is increased at the early stage but decreased at the late stage of ferroptosis in mouse or human hepatocytes. Importantly, either genetically enhancing TPD52-dependent lipid storage or blocking ATG5-and RAB7A-dependent lipid degradation prevents RSL3-induced lipid peroxidation and subsequent ferroptosis in vitro and in vivo. These studies support an antioxidant role for lipid droplets in cell death and suggest novel strategies for the inhibition of ferroptosis by targeting the lipophagy pathway.     

The mitochondrial Ca2+ uptake regulator,MICU1, is involved in cold stress‐induced ferroptosis

Ferroptosis has recently attracted much interest because of its relevance to human diseases such as cancer and ischemia‐reperfusion injury. We have reported that prolonged severe cold stress induces lipid peroxidation‐dependent ferroptosis, but the upstream mechanism remains unknown. Here, using genome‐wide CRISPR screening, we found that a mitochondrial Ca²⁺ uptake regulator, mitochondrial calcium uptake 1 (MICU1), is required for generating lipid peroxide and subsequent ferroptosis under cold stress. Furthermore, the gatekeeping activity of MICU1 through mitochondrial calcium uniporter (MCU) is suggested to be indispensable for cold stress‐induced ferroptosis. MICU1 is required for mitochondrial Ca²⁺ increase, hyperpolarization of the mitochondrial membrane potential (MMP), and subsequent lipid peroxidation under cold stress. Collectively, these findings suggest that the MICU1‐dependent mitochondrial Ca²⁺ homeostasis‐MMP hyperpolarization axis is involved in cold stress‐induced lipid peroxidation and ferroptosis.     

The Groovy TMEM16 Family: Molecular Mechanisms of Lipid Scrambling and Ion Conduction

The TMEM16 family of membrane proteins displays a remarkable functional dichotomy – while some family members function as Ca²⁺-activated anion channels, the majority of characterized TMEM16 homologs are Ca²⁺-activated lipid scramblases, which catalyze the exchange of phospholipids between the two membrane leaflets. Furthermore, some TMEM16 scramblases can also function as channels. Due to their involvement in important physiological processes, the family has been actively studied ever since their molecular identity was unraveled. In this review, we will summarize the recent advances in the field and how they influenced our view of TMEM16 family function and evolution. Structural, functional and computational studies reveal how relatively small rearrangements in the permeation pathway are responsible for the observed functional duality: while TMEM16 scramblases can adopt both ion- and lipid conductive conformations, TMEM16 channels can only populate the former. Recent data further provides the molecular details of a stepwise activation mechanism, which is initiated by Ca²⁺ binding and modulated by various cellular factors, including lipids. TMEM16 function and the surrounding membrane properties are inextricably intertwined, with the protein inducing bilayer deformations associated with scrambling, while the surrounding lipids modulate TMEM16 conformation and activity.     

Redox regulation of calcium ion channels: chemical and physiological aspects

Reactive oxygen species (ROS) are increasingly recognized as second messengers in many cellular processes. While high concentrations of oxidants damage proteins, lipids and DNA, ultimately resulting in cell death, selective and reversible oxidation of key residues in proteins is a physiological mechanism that can transiently alter their activity and function. Defects in ROS producing enzymes cause disturbed immune response and disease.Changes in the intracellular free Ca²⁺ concentration are key triggers for diverse cellular functions. Ca²⁺ homeostasis thus needs to be precisely tuned by channels, pumps, transporters and cellular buffering systems. Alterations of these key regulatory proteins by reversible or irreversible oxidation alter the physiological outcome following cell stimulation. It is therefore necessary to understand which proteins are regulated and if this regulation is relevant in a physiological- and/or pathophysiological context. Because ROS are inherently difficult to identify and to measure, we first review basic oxygen redox chemistry and methods of ROS detection with special emphasis on electron paramagnetic resonance (EPR) spectroscopy. We then focus on the present knowledge of redox regulation of Ca²⁺ permeable ion channels such as voltage-gated (CaV) Ca²⁺ channels, transient receptor potential (TRP) channels and Orai channels.     

Phospholipase C delta 4 (PLCδ4) is a nuclear protein involved in cell proliferation and senescence in mesenchymal stromal stem cells

Ca²⁺ is an important second messenger, and it is involved in many cellular processes such as cell death and proliferation. The rise in intracellular Ca²⁺ levels can be due to the generation of inositol 1,4,5-trisphosphate (InsP₃), which is a product of phosphatidylinositol 4,5-bisphosphate (PIP₂) hydrolysis by phospholipases C (PLCs), that leads to Ca²⁺ release from endoplasmic reticulum by InsP₃ receptors (InsP₃R). Ca²⁺ signaling patterns can vary in different regions of the cell and increases in nuclear Ca²⁺ levels have specific biological effects that differ from those of Ca²⁺ increase in the cytoplasm. There are PLCs in the cytoplasm and nucleus, but little is known about the functions of nuclear PLCs. This work aimed to characterize phenotypically the human PLCδ4 (hPLCδ4) in mesenchymal stem cells. This nuclear isoform of PLC is present in different cell types and has a possible role in proliferative processes. In this work, hPLCδ4 was found to be mainly nuclear in human adipose-derived mesenchymal stem cells (hASC). PLCδ4 knockdown demonstrated that it is essential for hASC proliferation, without inducing cell death. An increase of cells in G1, and a reduction of cells on interphase and G2/M in knockdown cells were seen. Furthermore, PLCδ4 knockdown increased the percentage of senescent cells, p16^INK4A+ and p21^Cip1 mRNAs expression, which could explain the impaired cell proliferation. The results show that hPLCδ4 is in involved in cellular proliferation and senescence in hASC.     

A fluorescence polarization study of calcium and phase behaviour in synaptosomal lipids

Steady-state fluorescence polarization of the fluorescent probe 1,6-diphenyl-1,3,5-hexatriene reported temperature-dependent lipid order in l-α-dimyristoylphosphatidylcholine, egg phosphatidylcholine and synaptosomal membranes. No change in lipid order was detected after depolarization of synaptosomes by veratridine (150 μM) even in the presence of 2 mM CaCl₂. However, Ca²⁺ reduced the mobility of a second probe, dansylated dipalmitoylphosphatidylethanolamine, in dispersions of synaptosomal lipids. This effect, which was seen at a Ca²⁺/total phospholipid ratio as low as 0.1, may represent an interaction between the cation and negatively-charged phospholipids. It is suggested that Ca²⁺ promotes a phase separation in synaptosomal lipids which may be relevant to the process of neurotransmitter release.     

S-glutathionylation activates STIM1 and alters mitochondrial homeostasis

Oxidant stress influences many cellular processes, including cell growth, differentiation, and cell death. A well-recognized link between these processes and oxidant stress is via alterations in Ca²⁺ signaling. However, precisely how oxidants influence Ca²⁺ signaling remains unclear. Oxidant stress led to a phenotypic shift in Ca²⁺ mobilization from an oscillatory to a sustained elevated pattern via calcium release–activated calcium (CRAC)–mediated capacitive Ca²⁺ entry, and stromal interaction molecule 1 (STIM1)– and Orai1-deficient cells are resistant to oxidant stress. Functionally, oxidant-induced Ca²⁺ entry alters mitochondrial Ca²⁺ handling and bioenergetics and triggers cell death. STIM1 is S-glutathionylated at cysteine 56 in response to oxidant stress and evokes constitutive Ca²⁺ entry independent of intracellular Ca²⁺ stores. These experiments reveal that cysteine 56 is a sensor for oxidant-dependent activation of STIM1 and demonstrate a molecular link between oxidant stress and Ca²⁺ signaling via the CRAC channel.     

Ca(2+) signaling mechanisms of cell survival and cell death: an introduction

Ca²⁺ regulates many steps in cell death mechanisms, and is potentially involved in all types of cell death. Moreover, virtually all elements of the cellular Ca²⁺ toolbox seem to contribute to remodeling of the Ca²⁺ signaling machinery during cell death processes. As expected from the ubiquitous nature of Ca²⁺ signaling, these mechanisms are operative in all cell types, and their malfunction may lead to a wide diversity of pathological implications. The contributions in this Special Issue deal with many different aspects of the relation between Ca²⁺ signaling and cell death. They illustrate the complexity of this relation, and importantly they give an outlook on potential new therapeutic targets for treatment of diseases connected to defects in cell death pathways.     

Cytochrome P450 reductase (POR)as a ferroptosis fuel

Oxygen,iron,and polyunsaturated fatty acids (PUFAs;fatty acids containing more than one double bond) are all bene-ficial to our cellular lives.Incorporation of these components into cellular processes,however,comes at a cost:the bis-allylic structure of PUFAs and the enrichment of cellular environments with iron and oxygen render PUFA-containing phospholipids (PUFA-PLs) particularly susceptible to per-oxidation (Yang and Stockwell,2016).Accumulation of lethal amounts of lipid peroxides in cell membranes leads to a form of cell death known as ferroptosis (Dixon et al.,2012;Stockwell et al.,2017;Stockwell and Jiang,2020).Conse-quently,cells are equipped with strong antioxidant defense systems that constantly dissipate toxic lipid peroxides gen-erated in cellular membranes,thereby maintaining cell via-bility and homeostasis (Zheng and Conrad,2020).The most powerful anti-ferroptosis defense system is believed to be mediated by glutathione peroxidase 4 (GPX4),a glutathione peroxidase that uses glutathione as its cofactor to reduce lipid hydroperoxides to non-toxic lipid alcohols (Fig.1)(Zheng and Conrad,2020).A variety of ferroptosis inducers(FINs) act to inactivate GPX4 or deplete glutathione,causing an imbalance between the production and detoxification of lipid peroxides that subsequently induces ferroptotic cell death (Yang et al.,2014).Genetic ablation of GPX4 can have the same effect (Friedmann Angeli et al.,2014).     

NMN recruits GSH to enhance GPX4-mediated ferroptosis defense in UV irradiation induced skin injury

Oxidative stress and lipid peroxidation are major causes of skin injury induced by ultraviolet (UV) irradiation. Ferroptosis is a form of regulated necrosis driven by iron-dependent peroxidation of phospholipids and contributes to kinds of tissue injuries. However, it remains unclear whether the accumulation of lipid peroxides in UV irradiation-induced skin injury could lead to ferroptosis. We generated UV irradiation-induced skin injury mice model to examine the accumulation of the lipid peroxides and iron. Lipid peroxides 4-HNE, the oxidative enzyme COX2, the oxidative DNA damage biomarker 8-OHdG, and the iron level were increased in UV irradiation-induced skin. The accumulation of iron and lipid peroxidation was also observed in UVB-irradiated epidermal keratinocytes without actual ongoing ferroptotic cell death. Ferroptosis was triggered in UV-irradiated keratinocytes stimulated with ferric ammonium citrate (FAC) to mimic the iron overload. Although GPX4 protected UVB-injured keratinocytes against ferroptotic cell death resulted from dysregulation of iron metabolism and the subsequent increase of lipid ROS, keratinocytes enduring constant UVB treatment were markedly sensitized to ferroptosis. Nicotinamide mononucleotide (NMN) which is a direct and potent NAD⁺ precursor supplement, rescued the imbalanced NAD⁺/NADH ratio, recruited the production of GSH and promoted resistance to lipid peroxidation in a GPX4-dependent manner. Taken together, our data suggest that NMN recruits GSH to enhance GPX4-mediated ferroptosis defense in UV irradiation-induced skin injury and inhibits oxidative skin damage. NMN or ferroptosis inhibitor might become promising therapeutic approaches for treating oxidative stress-induced skin diseases or disorders.     

Ferroptosis: Role of lipid peroxidation,iron and ferritinophagy

Ferroptosis is a form of regulated cell death that is dependent on iron and reactive oxygen species (ROS) and is characterized by lipid peroxidation. It is morphologically and biochemically distinct and disparate from other processes of cell death. As ferroptosis is induced by inhibition of cysteine uptake or inactivation of the lipid repair enzyme glutathione peroxidase 4 (GPX4), the process is favored by chemical or mutational inhibition of the cystine/glutamate antiporter and culminates in the accumulation of reactive oxygen species (ROS) in the form of lipid hydroperoxides. Excessive lipid peroxidation leads to death by ferroptosis and the phenotype is accentuated respectively by the repletion and depletion of iron and glutathione in cells. Furthermore, oxidized phosphatidylethanolamines (PE) harbouring arachidonoyl (AA) and adrenoyl moieties (AdA) have been shown as proximate executioners of ferroptosis. Induction of ferroptosis due to cysteine depletion leads to the degradation of ferritin (i.e. ferritinophagy), which releases iron via the NCOA4-mediated autophagy pathway. Evidence of the manifestation of ferroptosis in vivo in iron overload mice mutants is emerging. Thus, a concerted synchronization of iron availability, ROS generation, glutamate excess and cysteine deficit leads to ferroptosis. A number of questions on the molecular mechanisms of some features of ferroptosis are highlighted as subjects for future investigations.     

Reaction of Local Anesthetics with Phospholipids : A possible chemical basis for anesthesia

Local anesthetics (LA) have been found to interact with phospholipids and lipids extracted from nerve and muscle. This reaction is demonstrated by: (a) Inhibition by LA of phospholipid (and tissue lipid) facilitated transport of calcium from a methanol: water phase into chloroform. This action is dependent upon the cationic form of the LA. (b) LA increase the electrical resistance of "membranes" prepared by impregnating Millipore filters with cephalin:cholesterol or tissue lipid extracts and bathed with NaCl or KCl solutions. (c) LA coagulate aqueous dispersions of cephalin, phosphatidyl serine, phosphatidyl ethanolamine, and inositide, an action shared by calcium. The order of potency in coagulating cephalin sols is tetracaine > calcium > butacaine > procaine. Na⁺ and K⁺ do not coagulate phospholipid dispersions at 0.1 M concentration and antagonize the effect of Ca²⁺. (d) LA produce a marked fall in the pH of cephalin sols equivalent to that produced by calcium, (e) Ca²⁺ and LA form 1:2 molar complexes with phospholipids probably by ion-ion and ion-induced polar type of binding at the phosphate groups of the lipid. It is suggested that such reactions with cell membrane phospholipids may underlie inhibitory effects of LA on cellular ion fluxes and provide a chemical basis for anesthetic action.     

Loss of cysteinyl-tRNA synthetase (CARS) induces the transsulfuration pathway and inhibits ferroptosis induced by cystine deprivation

Ferroptosis is a form of regulated non-apoptotic cell death that has been implicated in several disease contexts. A better understanding of the ferroptotic death mechanism could lead to the development of new therapeutics for degenerative diseases, and a better understanding of how to induce ferroptosis in specific tumor contexts. We performed an unbiased genome-wide siRNA screen to find genetic suppressors of ferroptosis. We determined that loss of CARS, the cysteinyl-tRNA synthetase, suppresses ferroptosis induced by erastin, which inhibits the cystine–glutamate antiporter known as system x_c⁻. Knockdown of CARS inhibited erastin-induced death by preventing the induction of lipid reactive oxygen species, without altering iron homeostasis. Knockdown of CARS led to the accumulation of cystathionine, a metabolite on the transsulfuration pathway, and upregulated genes associated with serine biosynthesis and transsulfuration. In addition, inhibition of the transsulfuration pathway resensitized cells to erastin, even after CARS knockdown. These studies demonstrate a new mechanism of resistance to ferroptosis and may lead to strategies for inducing and suppressing ferroptosis in diverse contexts.Precise regulation of cell death is essential for tissue homeostasis. Dysregulation of cell death processes is implicated in a variety of pathological conditions, such as ischemia and neurodegenerative diseases, providing a rationale for exploring cell-death-modulating compounds as potential therapeutics.¹ However, an incomplete understanding of cell death mechanisms in specific disease contexts has hindered efforts to develop therapeutics. Mechanistic analyses of cell death processes in disease contexts may uncover new strategies for drug discovery. Ferroptosis, a form of oxidative, non-apoptotic cell death, has recently been described and implicated in several pathological conditions, including Huntington''s disease (HD), periventricular leukomalacia (PVL) and kidney dysfunction.^{2, 3, 4} Ferroptotic cell death can be induced through perturbation of redox homeostasis maintained by glutathione, a key regulator of the intracellular redox state.Glutathione (GSH) is a tripeptide, the synthesis of which is dependent on the availability of the amino acid cysteine. A substantial fraction of extracellular cysteine exists as its oxidized disulfide form, cystine, because of the oxidative extracellular environment.⁵ Some cells primarily obtain cysteine by importing extracellular cystine through system x_c⁻, the cystine–glutamate antiporter. Cystine is then reduced to cysteine inside cells, fueling GSH synthesis. GSH maintains redox homeostasis by acting as a reductive substrate for reactive oxygen species (ROS)-detoxifying enzymes. As one example, glutathione peroxidase 4 (GPX4) uses GSH to reduce lipid hydroperoxides and organic hydroperoxides to alcohols, serving a critical role in lipid repair and detoxification. GPX4 was recently shown to be a central regulator of ferroptosis.⁶Ferroptosis can be induced by two classes of compounds, exemplified by erastin and (1 S, 3 R)-RSL3.^{6, 7, 8, 9} These two compounds target different parts of the ferroptotic pathway. Erastin inhibits system x_c⁻ to deplete GSH, which effectively inactivates all cellular glutathione peroxidases, including GPX4. RSL3, on the other hand, acts downstream, inhibiting GPX4 directly. In both cases, the loss of GPX4 activity causes accumulation of lipid peroxides, and ultimately, cell death. Recently, the FDA-approved drugs sorafenib and sulfasalazine were also found to induce ferroptosis through inhibition of system x_c⁻ activity,^{10, 11} although these lower-potency compounds may also activate other competing processes at similar or slightly higher concentrations. A specific inhibitor of ferroptosis, ferrostatin-1, and its analogs have been shown to suppress cell death in several degenerative disease models, including HD, PVL and kidney dysfunction, as well as in a model of glutamate toxicity, suggesting the involvement of ferroptosis in these conditions.^{4, 12} Collectively, these findings suggest that modulation of ferroptosis is of potential therapeutic relevance in several pathological conditions.Given the involvement of ferroptosis in these different contexts, we sought to identify specific features and regulators of ferroptosis. Ferroptosis is biochemically and morphologically distinct from necrosis and apoptosis.¹² Genetic analysis of ferroptosis has been performed using a limited set of genes related to mitochondrial function.¹² This previous analysis revealed that ferroptosis requires a distinct set of genes compared with apoptosis. However, this analysis cast a relatively narrow net; therefore, we sought to extend our understanding of the genetic regulation of ferroptosis further to identify essential genes and pathways using a genome-wide siRNA screen. Such genes may illuminate novel targets whose inhibition could be therapeutic in disease conditions involving aberrant activation of ferroptosis, or suggest strategies for inducing ferroptosis in specific tumor contexts.