Enhanced Chemodynamic Therapy Mediated by a Tumor-Specific Catalyst in Synergy with Mitophagy Inhibition Improves the Efficacy for Endometrial Cancer

Chemodynamic therapy (CDT) relies on the tumor microenvironment (e.g., high H₂ O₂ level) responsive Fenton-like reactions to produce hydroxyl radicals (·OH) against tumors. However, endogenous H₂ O₂ is insufficient for effective chemodynamic responses. An NAD(P)H: quinone oxidoreductase 1 (NQO1)^high catalase (CAT)^low therapeutic window for the use of NQO1 bioactive drug β-lapachone (β-Lap) is first identified in endometrial Cancer (EC). Accompanied by NADH depletion, NQO1 catalyzes β-Lap to produce excess H₂ O₂ and initiate oxidative stress, which selectively suppress NQO1^high EC cell proliferation, induce DNA double-strand breaks, and promote Apoptosis. Moreover, shRNA-mediated NQO1 knockdown or dicoumarol rescues NQO1^high EC cells from β-Lap-induced cytotoxicity. Arginine-glycine-aspartic acid (RGD)-functionalized iron-based metal-organic frameworks (MOF(Fe)) further promote the conversion of the accumulated H₂ O₂ into highly oxidative ·OH, which in turn, exacerbates the oxidative damage to RGD-positive target cells. Furthermore, Mitophagy inhibition by Mdivi-1 blocks a powerful antioxidant defense approach, ultimately ensuring the anti-tumor efficacy of stepwise-amplified Reactive Oxygen Species signals. The tumor growth inhibition rate (TGI) is about 85.92%. However, the TGI of MOF(Fe)-based synergistic antitumor therapy decreases to only 50.46% in NQO1-deficient KLE tumors. Tumor-specific chemotherapy and CDT-triggered therapeutic modality present unprecedented therapeutic benefits in treating NQO1^high EC.