Research Article 2026-04-22 in-revision v1

β3-adrenergic blockade targets fatty acid oxidation to induce ferroptotic vulnerability in pediatric T-ALL

C
Cristina Banella Meyer Children’s Hospital IRCCS
S
Serena Travaglini University of Rome Tor Vergata
F
Francesco Carrozzo Meyer Children’s Hospital IRCCS
A
Agnese Roveta Meyer Children’s Hospital IRCCS
F
Francesco Pegoraro Meyer Children’s Hospital IRCCS
G
Gianluca Mattei Meyer Children's Hospital
R
Rachele Amato Meyer Children's Hospital
M
Maria Ascone Meyer Children’s Hospital IRCCS
F
Federica De Luca Meyer Children’s Hospital IRCCS
A
Aurora Chinnici Meyer Children’s Hospital IRCCS
C
Cinzia Marchi Meyer Children's Hospital
E
Elena Chiocca Meyer Children’s Hospital IRCCS
A
Annalisa Tondo Meyer Children’s Hospital IRCCS
M
Marinella Veltroni Meyer Children’s Hospital IRCCS
M
Maura Calvani Meyer Children’s Hospital IRCCS

Abstract

Pediatric T-cell acute lymphoblastic leukemia (T-ALL) accounts for approximately 15% of childhood ALL and is associated with a high risk of relapse, with ~ 25% of patients failing conventional therapy. Resistance is driven by pro-survival signaling, impaired apoptosis, and metabolic adaptations that sustain leukemic proliferation under stress. Herein, we investigate the role of β3-adrenergic receptor (β3-AR) antagonist SR59230A signaling in the metabolic reprogramming and therapeutic vulnerability of pediatric T-ALL. β3-AR expression and transcriptomic profiling following SR59230A exposure were assessed in T-ALL cell lines by RNA sequencing, followed by gene set enrichment analysis of Gene Ontology and Hallmark pathways. Metabolic alterations were validated by Seahorse analyses of mitochondrial respiration, glycolysis, fatty acid oxidation (FAO), and fuel dependency. Systemic iron metabolism was evaluated by ferritin and free iron quantification using COBAS8000. β3-AR was markedly upregulated in T-ALL cells compared with normal hematopoietic counterparts, identifying a selective metabolic vulnerability. Pharmacologic inhibition of β3-AR with SR59230A affected mitochondrial oxidative phosphorylation, with a predominant effect on complex I activity, and suppressed FAO. This metabolic collapse disrupted bioenergetic flexibility and triggered ferroptotic cell death, accompanied by modulation of ferritin and transferrin levels, suggesting their potential role as biomarkers of metabolic response. Importantly, β3-AR blockade sensitized T-ALL cells to oxidative phosphorylation inhibition, resulting in synergistic cytotoxicity in refractory models. Collectively, these findings identify β3-AR as a central regulator of metabolic plasticity in pediatric T-ALL and uncover a basis to explore combined strategies targeting metabolic and iron-dependent vulnerabilities in high-risk disease.

Citation Information

@article{cristinabanella2026,
  title={β3-adrenergic blockade targets fatty acid oxidation to induce ferroptotic vulnerability in pediatric T-ALL},
  author={Cristina Banella and Serena Travaglini and Francesco Carrozzo and Agnese Roveta and Francesco Pegoraro and Gianluca Mattei and Rachele Amato and Maria Ascone and Federica De Luca and Aurora Chinnici and Cinzia Marchi and Elena Chiocca and Annalisa Tondo and Marinella Veltroni and Maura Calvani},
  journal={Biology Direct},
  year={2026},
  doi={https://doi.org/10.21203/rs.3.rs-9392453/v1}
}
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