Basic Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Stem Cells. Nov 26, 2020; 12(11): 1410-1428
Published online Nov 26, 2020. doi: 10.4252/wjsc.v12.i11.1410
Glutathione metabolism is essential for self-renewal and chemoresistance of pancreatic cancer stem cells
Petra Jagust, Sonia Alcalá, Bruno Sainz Jr, Christopher Heeschen, Patricia Sancho
Petra Jagust, Molecular Pathology Programme, Spanish National Cancer Research Centre (CNIO), Madrid 28029, Spain
Sonia Alcalá, Bruno Sainz Jr, Department of Biochemistry, Autónoma University of Madrid, Instituto de Investigaciones Biomédicas "Alberto Sols" CSIC-UAM, Madrid 28029, Spain
Christopher Heeschen, Center for Single-Cell Omics & Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
Patricia Sancho, Hospital Universitario Miguel Servet, IIS Aragon, Zaragoza 50009, Spain
Author contributions: Jagust P and Sancho P performed the experiments, acquired and analyzed data; Alcalá S and Sainz Jr B compiled and validated the samples for RNAseq analysis; Heeschen C and Sancho P interpreted data, designed the study and wrote the manuscript; all authors approved the final version of the manuscript.
Supported by ERC Advanced Investigator Grant, No. Pa-CSC 233460; European Community's Seventh Framework Programme, No. 602783; Instituto de Salud Carlos III and European Funds (FSE: “el FSE invierte en tu futuro” and FEDER: “una manera de hacer Europa”) Miguel Servet Fellowship, No. CP16/00121; and Fondo Investigaciones Sanitarias, No. PI17/00082.
Institutional review board statement: The study was reviewed and approved by the IIS Aragon Institutional Review Board.
Conflict-of-interest statement: Authors declare no conflict of interest.
Data sharing statement: RNAseq dataset E-MTAB-3808 is available at
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Patricia Sancho, PhD, Senior Scientist, Hospital Universitario Miguel Servet, IIS Aragon, Isabel la Católica 1-3, Zaragoza 50009, Spain.
Received: July 10, 2020
Peer-review started: July 10, 2020
First decision: August 9, 2020
Revised: August 19, 2020
Accepted: September 25, 2020
Article in press: September 25, 2020
Published online: November 26, 2020

Cellular metabolism regulates stemness in health and disease.  A reduced redox state is essential for self-renewal of normal and cancer stem cells (CSCs). However, while stem cells rely on glycolysis, different CSCs, including pancreatic CSCs, favor mitochondrial metabolism as their dominant energy-producing pathway. This suggests that powerful antioxidant networks must be in place to detoxify mitochondrial reactive oxygen species (ROS) and maintain stemness in oxidative CSCs. Since glutathione metabolism is critical for normal stem cell function and CSCs from breast, liver and gastric cancer show increased glutathione content, we hypothesized that pancreatic CSCs also rely on this pathway for ROS detoxification.


To investigate the role of glutathione metabolism in pancreatic CSCs.


Primary pancreatic cancer cells of patient-derived xenografts (PDXs) were cultured in adherent or CSC-enriching sphere conditions to determine the role of glutathione metabolism in stemness. Real-time polymerase chain reaction (PCR) was used to validate RNAseq results involving glutathione metabolism genes in adherent vs spheres, as well as the expression of pluripotency-related genes following treatment. Public TCGA and GTEx RNAseq data from pancreatic cancer vs normal tissue samples were analyzed using the webserver GEPIA2. The glutathione-sensitive fluorescent probe monochlorobimane was used to determine glutathione content by fluorimetry or flow cytometry. Pharmacological inhibitors of glutathione synthesis and recycling [buthionine-sulfoximine (BSO) and 6-Aminonicotinamide (6-AN), respectively] were used to investigate the impact of glutathione depletion on CSC-enriched cultures. Staining with propidium iodide (cell cycle), Annexin-V (apoptosis) and CD133 (CSC content) were determined by flow cytometry. Self-renewal was assessed by sphere formation assay and response to gemcitabine treatment was used as a readout for chemoresistance.


Analysis of our previously published RNAseq dataset E-MTAB-3808 revealed up-regulation of genes involved in the KEGG (Kyoto Encyclopedia of Genes and Genomes) Pathway Glutathione Metabolism in CSC-enriched cultures compared to their differentiated counterparts. Consistently, in pancreatic cancer patient samples the expression of most of these up-regulated genes positively correlated with a stemness signature defined by NANOG, KLF4, SOX2 and OCT4 expression (P < 10-5). Moreover, 3 of the upregulated genes (MGST1, GPX8, GCCT) were associated with reduced disease-free survival in patients [Hazard ratio (HR) 2.2-2.5; P = 0.03-0.0054], suggesting a critical role for this pathway in pancreatic cancer progression. CSC-enriched sphere cultures also showed increased expression of different glutathione metabolism-related genes, as well as enhanced glutathione content in its reduced form (GSH). Glutathione depletion with BSO induced cell cycle arrest and apoptosis in spheres, and diminished the expression of stemness genes. Moreover, treatment with either BSO or the glutathione recycling inhibitor 6-AN inhibited self-renewal and the expression of the CSC marker CD133. GSH content in spheres positively correlated with intrinsic resistance to gemcitabine treatment in different PDXs r = 0.96, P = 5.8 × 1011). Additionally, CD133+ cells accumulated GSH in response to gemcitabine, which was abrogated by BSO treatment (P < 0.05). Combined treatment with BSO and gemcitabine-induced apoptosis in CD133+ cells to levels comparable to CD133- cells and significantly diminished self-renewal (P < 0.05), suggesting that chemoresistance of CSCs is partially dependent on GSH metabolism.


Our data suggest that pancreatic CSCs depend on glutathione metabolism. Pharmacological targeting of this pathway showed that high GSH content is essential to maintain CSC functionality in terms of self-renewal and chemoresistance.

Keywords: Pancreatic cancer, Cancer stem cells, Glutathione, Self-renewal, Chemoresistance, Redox

Core Tip: Several glutathione metabolism genes are upregulated in pancreatic cancer stem cells (CSCs), and their expression correlates with a stemness signature and predicts survival in clinical samples. Increased glutathione concentration in CSCs promotes viability, cell cycle progression and pluripotency gene expression. Inhibition of glutathione synthesis or recycling impairs CSC functionalities such as self-renewal and chemoresistance. Our data demonstrate a targetable metabolic vulnerability of this aggressive subpopulation of cancer cells.