Due to the prevalence of viral hepatitis and non-alcoholic fatty liver disease (NAFLD), liver fibrosis has become a very common disease in Asia and other parts of the world, increasing the healthcare burden on society[14]. Hepatic fibrosis occurs when the endothelial cells of the hepatic sinusoids, which are the main responding cells, continue to lose their window apertures and form a large number of contiguous basement membranes, a process known as hepatic sinusoidal capillarisation[15]. At the same time, the HSEC phenotype was greatly altered, expressing the vascular endothelial markers cluster of differentiation 31(CD31) and von Willebrand factor(vWF)[16]. Studies have shown that hepatic sinusoidal capillarisation is the main form of microvascular neovascularisation in the liver[17]. Angiogenesis plays an important role in the pathological process of liver fibrosis characterised by collagen deposition and persistent inflammatory infiltration[18]. The intimate relationship between hepatic fibrosis and neovascularisation dictates that anti-neovascularisation can be an important strategy to halt and delay the progression of hepatic fibrosis.
Ferroptosis is an iron-dependent redox imbalance that leads to cell membrane phospholipid peroxidation damage[19]. Ferroptosis was manifested morphologically as a reduction in mitochondrial volume, an increase in membrane density, a decrease or disappearance of mitochondria, rupture of the outer membrane of some mitochondria, a significant decrease in mitochondrial cristae and rupture of the cell membrane[20]. The main biochemical characteristics of ferroptosis are the accumulation of iron and lipid peroxidation, which is manifested by the Fenton reaction between excess free Fe2+ and hydrogen peroxide, a product of mitochondrial oxidative respiration, resulting in a large increase in reactive oxygen species (ROS), inhibition of glutathione (GSH) synthesis and glutathione peroxidase 4 (GPX4) activity, leading to impaired antioxidant system, redox imbalance, toxic lipid peroxidation, and impairment of the antioxidant system. The inhibition of GSH synthesis and GPX4 activity led to the impairment of the antioxidant system, redox imbalance, and the massive deposition of toxic lipid peroxides[21–22].
Genetically, ferroptosis is regulated by a variety of genetic factors, focusing on both lipid peroxidation and iron homeostasis[23]. The cystathionine/glutamate reverse transporter protein solute carrier family 7 member 11 (SLC7A11) promotes cystathionine uptake and glutathione biosynthesis, and its up-regulation increases intracellular cystathionine levels and accelerates glutathione biosynthesis to enhance GPX4 activity, thereby preventing oxidative stress and ferroptosis[24]. Acyl-Co A synthetase long chain family member 4 (ACSL4) plays an important role in the synthesis of polyunsaturated fatty acids, which can modulate cellular resistance to ferroptosis[25]. Studies have shown that inducing ferroptosis in human venous endothelial cells can lead to inhibition of angiogenesis[26]. Further suggesting that ferroptosis is a key upstream signal for angiogenesis[27].
P53 is a transcription factor involved in the regulation of genome integrity, cell cycle arrest, apoptosis, autophagy, altered metabolism, cellular plasticity, and the promotion of iron-dependent cell death[27–28]. P53 can reduce cystine and glutamate exchange by inhibiting SLC7A11, leading to a decrease in cysteine, the cystine reduction product of cystine in the cell, and a decrease in downstream GSH synthesis, which in turn reduces GPX4 activity, leading to the accumulation of ROS and thus inducing ferroptosis[29]. Fe2+ from food or erythrocyte degradation is oxidised to Fe3+ by plasma ceruloplasmin (CP), which binds to transferrin (TF) on the cell membrane to form TF-Fe3+, which enters the cell in a complex with TFR1, and is then reduced to Fe2+ by prostate transmembrane epithelial antigen 3 (STEAP3)[30]. Intracellular iron ions can form a ferritin complex composition with ferritin heavy chains(FTH1)[31]. Nuclear receptor coactivator 4 (NCOA4) binds to FTH1 and subsequently transports the ferritin complex to autophagic vesicles for degradation and release of iron[32]. It has been shown that up-regulation of P53 expression, increase of TRF1 expression, and down-regulation of FTH1 expression lead to massive deposition of intracellular iron ions and induce the development of ferroptosis[33]. Taken together, targeting the P53-TFR1-TFH1 signalling axis is a key strategy to regulate ferroptosis.
In recent years, the study of natural active ingredients has gradually become an important direction in the development of drugs for the treatment of diseases. Curcuma comes from a variety of plants in the genus Curcuma of the ginger family. According to Chinese medicine theory, Curcuma is warm in nature, pungent and bitter in flavour, and belongs to the liver and spleen meridians. Modern phytochemical studies show that the chemical composition of Curcuma longa mainly includes volatile oil, curcumin, polysaccharides, sterols, phenolic acids and alkaloids[34]. The main components of the volatile oil of Curcuma are monoterpenes and sesquiterpenes such as curcumol, curcumin, curcuminone, β-elemene, and curcuminone. Sesquiterpenoids possess various pharmacological activities such as antioxidant, anti-inflammatory and cytotoxic activities due to their structural specificity[35]. Curcumol is a natural product that structurally belongs to the guaiacol sesquiterpene family and has a wide range of biological activities.The anti-inflammatory and anticancer effects of curcumol have been extensively studied, and other therapeutic effects are being revealed[36–37]. We have also recently found that curcumol has significant anti-hepatic fibrosis effects in vitro and in vivo[38–39]. The above observations guided us to investigate whether the regulation of hepatic angiogenesis is related to the action of curcumol.
In our study, we found that curcumol inhibited HSEC proliferation and migration. Meanwhile, curcumol can upregulate P53 and TFR1 expression, inhibit FTH1 expression, and induce HSEC to undergo ferroptosis, but the curcumol-induced ferroptosis of HSEC can be rescued by siP53, suggesting that P53 is a key target for curcumol to regulate HSEC. Further experiments revealed that curcumol had an inhibitory effect on angiogenesis, but this effect could be rescued by si P53 or ferroptosis inhibition, suggesting that the induction of ferroptosis is a key mechanism for curcumol to inhibit angiogenesis. However, it has now also been shown that inhibition of iron death inhibits angiogenesis, which is different from our reported results[40–41].The reason for this situation is related to the different drugs and cell types, but the most important thing is the degree of ferroptosis, because the degree of iron death occurs in different levels of ROS content, ROS in a certain dose range can promote angiogenesis, if ferroptosis continues to occur in large quantities of ROS deposition, will lead to apoptosis and inhibit angiogenesis[42]. Overall, the results suggest that curcumol inhibits angiogenesis by targeting P53-TFR1-FTH1 to mediate the deposition of large amounts of iron ions in HSEC and inducing the onset of ferroptosis in HSEC, as shown in Fig. 6. These results compel us to investigate the complex mechanism between ferroptosis and angiogenesis. Of course there are some limitations in this study, such as no in vivo experiments were carried out, as well as no further clarification of the mechanism by which curcumol regulates P53 protein expression and how the increase in iron ions mediates the decrease in FTH1 protein expression.