Ferritinophagy is a Druggable Vulnerability of Quiescent Leukemic Stem Cells

Acute myeloid leukemia (AML) remains a challenging hematological malignancy with poor prognosis and limited treatment options. Leukemic stem cells (LSCs) contributes to therapeutic failure, post-therapy relapse and adverse outcome. Here, we investigated the role of quiescence and its associated molecular mechanisms in AML pathogenesis and LSCs functions, and identified potential vulnerabilities for therapeutic intervention. We found that LSC-enriched quiescent cell population exhibited a distinct gene set of prognostic significance in AML patients. Furthermore, this quiescent cells subset displayed heightened autophagic activity with a reliance on ferritinophagy, a selective form of autophagy mediated by Nuclear Receptor Coactivator 4 (NCOA4) regulating iron bioavailability. Inhibition of NCOA4 genetically or chemically showed potent anti-leukemic effects, particularly targeting the LSC compartment. These findings uncover that ferritinophagy inhibition may represent a promising therapeutic strategy for patients with AML. One Sentence SummaryTargeting quiescent leukemic stem cells via NCOA4-dependent ferritinophagy inhibition may improve therapeutic outcomes in acute myeloid leukemia.