Abstract
RNA 5-methylcytosine (m5C), a prevalent epitranscriptomic modification that critically regulates gene expression and cellular homeostasis. While its roles in solid tumors have been increasingly recognized, the functional landscape of m5C in acute myeloid leukemia (AML) remains unexplored. Here, we identified NSUN2, the principal RNA m5C methyltransferase, as a key regulator of AML progression. NSUN2 was aberrantly upregulated in AML patient samples and correlated with poor prognosis. Functional studies demonstrated that NSUN2 promoted leukemic cell proliferation, enhanced tumor growth in xenograft models, and conferred resistance to ferroptosis-a regulated cell death process driven by lipid peroxidation. Mechanistically, NSUN2 catalyzed m&sup5;C deposition on the 3'UTR of FSP1 (ferroptosis suppressor protein 1) mRNA, facilitating its recognition and stabilization by the m5C reader protein YBX1. This NSUN2-YBX1-FSP1 axis protected AML cells from ferroptotic stress by suppressing lipid peroxidation and oxidative damage. Depletion of NSUN2 or FSP1 induced mitochondrial remodeling, which primed cells for ferroptosis. Reconstitution of wild-type NSUN2 or FSP1 rescued ferroptosis resistance, whereas catalytically inactive NSUN2 (C271A/C321A) or non-functional FSP1 mutants (G2A/E156A) failed to reverse this phenotype. Pharmacological inhibition of NSUN2 with MY-1B or targeting FSP1 with iFSP1 exhibited potent anti-leukemic effects, synergizing robustly with ferroptosis inducers, standard chemotherapy, and the BCL-2 inhibitor venetoclax. Our study unveils NSUN2 and FSP1 as prognostic biomarkers and therapeutic targets in AML. We highlight a novel epitranscriptomic mechanism linking RNA methylation to ferroptosis evasion, providing a dual-strategy approach to overcome AML treatment resistance.