1. PRDX3
2. Ferroptosis
3. Clear Cell Renal Cell Carcinoma
4. Tumor Immune Microenvironment
5. Prognosis in Cancer


In a groundbreaking study published in the Asian Journal of Surgery, a team led by Dr. Hongquan Liu has identified peroxiredoxin 3 (PRDX3) as a novel and specific marker of ferroptosis in clear cell renal cell carcinoma (ccRCC), raising questions about its potential role as either a therapeutic target or a prognostic biomarker. The publication, which has gathered immense interest within the oncological community, carries significant implications for understanding the intricate biological mechanisms underpinning ccRCC.

Clear cell renal cell carcinoma is the most common subtype of kidney cancer, known for its resistance to conventional chemotherapy and radiotherapy. As a result, there is a pressing need for new therapeutic targets and biomarkers that can improve patient outcomes. The study by Liu et al., identifying PRDX3’s role in the ferroptotic cell death pathway and in the tumor immune microenvironment, represents a significant advance in this quest.

A team of medical researchers from the Department of Urology at The Affiliated Yantai Yuhuangding Hospital of Qingdao University, led by Dr. Hongquan Liu and co-authored by Dr. Gonglin Tang, Dr. Xiaofei Zhang, and Dr. Jitao Wu, has made a significant discovery that could alter the therapeutic landscape of clear cell renal cell carcinoma (ccRCC). Their recent publication in the Asian Journal of Surgery focuses on the identification of peroxiredoxin 3 (PRDX3) as a novel biomarker specifically associated with ferroptosis in ccRCC. The study, which offers a dual perspective of PRDX3 as both a hero and a villain in carcinogenesis, has shed new light on the diverse roles of ferroptosis inducers and suppressors and their respective impact on the tumor immune microenvironment.

The DOI for this innovative publication is 10.1016/j.asjsur.2024.01.008, and it has garnered attention for offering a promising step towards personalized medicine for patients grappling with ccRCC.

Understanding PRDX3 and Ferroptosis

Ferroptosis, a form of non-apoptotic cell death, is driven by the iron-dependent accumulation of lipid peroxides to lethal levels, leading to cellular damage and death. It is distinguished by a unique set of morphological, biochemical, and genetic characteristics that are distinct from other forms of cell death like necrosis and apoptosis. PRDX3, the newfound marker of this study, is an antioxidant enzyme localized in the mitochondria, and its involvement in cellular oxidative stress responses makes it a potential player in cancer progression and treatment resistance.

The Asian Journal of Surgery has published numerous influential articles that have shaped the understanding of various medical concepts, and the presence of such a study on PRDX3 under its auspices underscores the journal’s stature in the academic sphere.

The Dual Nature of PRDX3

The study by Liu and his colleagues reveals that PRDX3 can exert opposing effects on tumor progression. Research shows that PRDX3 may serve as a protective enzyme, preventing the onslaught of oxidative stress and maintaining cellular homeostasis. This protective role might be a factor in its association with an increase in overall survival rates among ccRCC patients exhibiting higher PRDX3 expression.

However, the study also delineates PRDX3’s potential to act as a villain by enabling tumor cells to evade ferroptosis, a form of cell death that cancer often resists. By restricting ferroptotic cell death, PRDX3 might provide cancer cells with an edge to survive under conditions of oxidative stress, thereby contributing to the malignant phenotype and a potential worsening of the patient’s prognosis.

The Tumor Immune Microenvironment

A particularly noteworthy aspect of the study is the identification of a robust link between PRDX3 expression and the tumor immune microenvironment (TIME). The TIME comprises a complex network of immune cells, signaling molecules, and other factors that can both suppress and promote tumor growth and spread. PRDX3 levels have been associated with the infiltration of specific immune cells within the TIME, indicating that PRDX3 could influence the immunogenicity of the tumor and, as a result, the effectiveness of immune-based therapies.

Implications for Treatment Strategies

This newly identified role of PRDX3 may guide clinicians in tailoring treatments for ccRCC patients. The findings suggest that therapies aimed at modulating PRDX3 expression or function could enhance the susceptibility of the cancer cells to ferroptosis. In light of the current interest in leveraging ferroptosis for cancer therapy, the detailed exploration of PRDX3’s interaction with this cell death pathway could yield novel therapeutic strategies.

Moreover, the potential impact of PRDX3 on the TIME also paves the way for more research into how it could be manipulated to bolster the immune response against cancer cells. Immunotherapy, which strives to empower the immune system to combat cancer, could become more effective with a deeper understanding of the interplay between PRDX3 and the TIME.

Future Research Directions

The study underscores an urgent need for further research. Future investigations are warranted to ascertain the exact mechanisms through which PRDX3 modulates ferroptosis and immune cell infiltration. In-depth research is required to delineate the complex interplay between PRDX3 and other known regulators of ferroptosis, with the aim of uncovering potential therapeutic interventions that could potentiate ferroptosis in treatment-resistant cancer cells.

Additionally, clinical trials are necessary to validate the role of PRDX3 as a prognostic biomarker and to ascertain whether modulating its expression could optimize the effectiveness of existing treatments or contribute to the development of novel therapeutic regimens.


The discovery of PRDX3 as a novel and specific marker of ferroptosis in ccRCC has opened new avenues for understanding and treating this stubborn form of cancer. The work by Liu and colleagues embodies the relentless pursuit of medical science to uncover the hidden intricacies of cancer’s biology. Their work stands as a testament to the power of investigative research and its potential to reshape clinical practices.

The full impact of this discovery on patient care remains to be seen. As the scientific community eagerly awaits further research, the potential benefits of targeting PRDX3 in the context of TIME and ferroptosis herald a new chapter in the campaign against clear cell renal cell carcinoma.

Prospects of personalized medicine, refined prognostic tools, and enhanced therapeutic strategies seem more vivid than ever with the illumination of PRDX3’s paradoxical role in cancer biology. The journey from bench to bedside is laden with challenges, but with such insights, the path towards overcoming clear cell renal cell carcinoma appears less daunting.

The authors declare no potential financial and non-financial conflicts of interest associated with this manuscript.


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