Insight into Iron, Oxidative Stress and Ferroptosis: Therapy Targets for Approaching Anticancer Strategies

Simple Summary In this manuscript, we review the progress in knowledge made over the last decade, which, thanks to the commitment of many academics and researchers, has clarified many aspects relating to ferroptosis and its connections with cancer. Ferroptosis is currently regarded as a distinct type of regulated cell death (RCD), characterized by iron-dependent oxidative stress and the accumulation of lethal oxidized lipids. With a focus on the recent literature, the connection between iron homeostasis, oxidative stress and lipid metabolism is highlighted, which overall regulates ferroptotic cellular death. Moreover, special attention is devoted to the possible activation of this RCD pathway as a mechanism of tumor suppression. Its in-depth understanding from a regulatory and molecular perspective could provide important information for the development of new candidate drugs for the treatment of tumors resistant to conventional therapies.Abstract Based on the multifaceted molecular machinery that tightly controls iron cellular homeostasis, this review delves into its paradoxical, potentially dangerous role in biological systems, with a special focus on double-edged sword correlations with cancer. Indeed, though iron is a vital micronutrient and a required cofactor participating in several essential cell functions, its tendency to cause oxidative stress can be related both to cancer risk and to the activation of cancer cell death pathways. In this scenario, ferroptosis refers to an iron-dependent form of regulated cell death (RCD) powered by an overload of lethal peroxides sharing distinctive oxidized phospholipid profiles. As a unique cell death pathway, ferroptosis is both morphologically and mechanistically different from other types of programmed cell death involving executioner family proteins. The accumulation of cytotoxic lipid peroxides encompasses a cellular antagonism between ferroptosis execution and defense systems, with iron-dependent death occurring when ferroptosis-promoting activities significantly exceed the cellular antioxidant defenses. The most recent molecular breakthroughs in the execution of ferroptosis have aroused great consideration in tumor biology, as targeting ferroptosis can provide new tools for exploring therapeutic strategies for tumor suppression. Mutations and death/survival pathway alterations, as well as distinctive metabolic regulations of cancer cells, including the propensity to generate ROS, are seen as features that can render cancer cells unprotected to ferroptosis, thereby exposing vulnerabilities which deserve further attention to be regarded as targetable for cancers with limited therapeutic options.