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  3. Fasting enhances the efficacy of Sorafenib in breast cancer via mitophagy mediated ROS-driven p53 pathway

Fasting enhances the efficacy of Sorafenib in breast cancer via mitophagy mediated ROS-driven p53 pathway

  • Free Radic Biol Med. 2025 Mar 1:229:350-363. doi: 10.1016/j.freeradbiomed.2025.01.047.
Ru Li 1,  Yimei Ma 2,  Anqi He 3,  Yamin Pu 4,  Xuanting Wan 5,  Hongbao Sun 6,  Ningyu Wang 5,  Min Luo 7,  Guan Wang 8,  Yong Xia 9
Affiliations

Affiliations

  • 1 Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, Rehabilitation Medicine Center, West China Hospital, Sichuan University /West China School of Nursing, Sichuan University, Chengdu, 610041, China.
  • 2 Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.
  • 3 Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, Rehabilitation Medicine Center, West China Hospital, Sichuan University /West China School of Nursing, Sichuan University, Chengdu, 610041, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, 610041, China.
  • 4 Department of Biotherapy, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China.
  • 5 School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, China.
  • 6 Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, China.
  • 7 Department of Biotherapy, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, China. Electronic address: minluo_scu@163.com.
  • 8 Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, Rehabilitation Medicine Center, West China Hospital, Sichuan University /West China School of Nursing, Sichuan University, Chengdu, 610041, China. Electronic address: guan8079@163.com.
  • 9 Innovation Center of Nursing Research, Nursing Key Laboratory of Sichuan Province, Rehabilitation Medicine Center, West China Hospital, Sichuan University /West China School of Nursing, Sichuan University, Chengdu, 610041, China; Key Laboratory of Rehabilitation Medicine in Sichuan Province, West China Hospital, Sichuan University, Chengdu, 610041, China. Electronic address: yxia4@scu.edu.cn.
PMID: 39864757 DOI: 10.1016/j.freeradbiomed.2025.01.047
Abstract

The multi-kinase inhibitor sorafenib has shown potential to inhibit tumor cell growth and intra-tumoral angiogenesis by targeting several kinases, including VEGFR2/KDR/Flk-1 and Raf. Abnormal activation of the Ras/Raf/MAPK/ERK kinase cascade and the VEGF pathway is a common feature in breast Cancer. However, the efficacy of sorafenib in breast Cancer treatment remains limited. Recently, fasting has emerged as a promising non-pharmacological approach to modulate Cancer metabolism and enhance the effectiveness of Cancer therapies. In this study, we found that fasting significantly enhances the anti-cancer effects of sorafenib monotherapy and its combination with immunotherapy in breast Cancer models without causing obvious side effects. This combined treatment effectively inhibits tumor cell proliferation and intra-tumoral angiogenesis. The fasting-induced reduction in peripheral blood glucose levels strongly correlated with enhanced sensitivity to sorafenib. Mechanistically, the combined treatment induced Mitophagy, characterized by mitochondrial dysfunction and activation of the PINK1-Parkin pathway. Consequently, increased mitochondrial ROS levels promoted p53 expression, amplifying cell cycle arrest and Apoptosis in breast Cancer cells. Furthermore, fasting reduced lactate levels within the tumor, and the consequent glucose limitation synergized with sorafenib to activate AMPK, which in turn elevated PD-L1 expression in tumor cells, potentially enhancing their sensitivity to immunotherapy. In summary, our findings demonstrate that fasting and sorafenib, as a rational combination therapy, induce Mitophagy, thereby enhancing sorafenib's efficacy in treating breast Cancer through the ROS-driven p53 pathway. This study underscores the potential of fasting in breast Cancer therapy and provides a foundation for optimizing the clinical application of sorafenib.

Keywords

Breast cancer; Fasting; Mitophagy; ROS; mtROS; p53.

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