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Dual targeting of the thioredoxin and glutathione systems in cancer and HIV
Moran Benhar, Iart Luca Shytaj, Jonathan S. Stamler, Andrea Savarino
Moran Benhar, Iart Luca Shytaj, Jonathan S. Stamler, Andrea Savarino
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Review

Dual targeting of the thioredoxin and glutathione systems in cancer and HIV

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Abstract

Although the use of antioxidants for the treatment of cancer and HIV/AIDS has been proposed for decades, new insights gained from redox research have suggested a very different scenario. These new data show that the major cellular antioxidant systems, the thioredoxin (Trx) and glutathione (GSH) systems, actually promote cancer growth and HIV infection, while suppressing an effective immune response. Mechanistically, these systems control both the redox- and NO-based pathways (nitroso-redox homeostasis), which subserve innate and cellular immune defenses. Dual inhibition of the Trx and GSH systems synergistically kills neoplastic cells in vitro and in mice and decreases resistance to anticancer therapy. Similarly, the population of HIV reservoir cells that constitutes the major barrier to a cure for AIDS is exquisitely redox sensitive and could be selectively targeted by Trx and GSH inhibitors. Trx and GSH inhibition may lead to a reprogramming of the immune response, tilting the balance between the immune system and cancer or HIV in favor of the former, allowing elimination of diseased cells. Thus, therapies based on silencing of the Trx and GSH pathways represent a promising approach for the cure of both cancer and AIDS and warrant further investigation.

Authors

Moran Benhar, Iart Luca Shytaj, Jonathan S. Stamler, Andrea Savarino

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Figure 2

Model of the anticancer and anti-HIV effects of targeting the Trx and GSH systems.

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Model of the anticancer and anti-HIV effects of targeting the Trx and GS...
Left: Many cancer cells generate large amounts of ROS and RNS but also have elevated antioxidant defenses, largely through upregulation of the Trx and GSH systems. Inhibition of TrxR by auranofin can lead to elevated ROS and RNS levels, apoptosis, and decreased cell proliferation. However, when TrxR is inhibited, the GSH redox system often becomes upregulated, eliminating ROS and RNS and acting as a backup system to reduce Trx. Exposure of cancer cells to auranofin and BSO disables both Trx and GSH systems, severely compromising antioxidant capacity and leading to marked elevation of ROS and SNOs, which suppress cell proliferation and promote cell death. Cell death is in part mediated by inhibition of ribonucleotide reductase (RNR) and through activation of the proapoptotic kinase ASK1. Right: HIV-infected cells are characterized by elevated levels of ROS, coupled with decreased intracellular levels of antioxidant defenses (Trx, TrxR, and GSH). ART blocks HIV replication and partially counteracts the effects of oxidative stress, but is unable to target the latently infected cells. Inhibition of TrxR by auranofin increases oxidative (and potentially nitrosative) stress and apoptosis. TrxR inhibition also leads to a prodifferentiation effect on the latently HIV-infected cells, driving them toward short-lived phenotypes (i.e., effector memory) and, ultimately, decreasing the viral reservoir. Auranofin and BSO impair lymphocyte activation and increase HIV-infected cell death. ROS variations are documented, whereas RNS variations are predicted. Arrows beside the names of the molecules indicate the variation over time. SH, thiol.

Copyright © 2026 American Society for Clinical Investigation
ISSN: 0021-9738 (print), 1558-8238 (online)

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