| Rank |
Pathway / Target Axis |
Direction |
Primary Effect |
Notes / Cancer Relevance |
Ref |
| 1 |
System xC− (xCT/SLC7A11 cystine–glutamate antiporter) |
↓ cystine uptake |
Limits cystine supply |
Sulfasalazine is used as an xCT inhibitor; blocking cystine uptake is the core upstream action in cancer models |
(ref) |
| 2 |
Glutathione biosynthesis / GSH pool |
↓ GSH |
Loss of redox buffering |
In glioma cells, cystine uptake blockade by sulfasalazine leads to glutathione depletion |
(ref) |
| 3 |
ROS accumulation |
↑ ROS |
Oxidative stress amplification |
Glioma study: sulfasalazine increases ROS after GSH depletion (mechanistic sequence shown) |
(ref) |
| 4 |
DNA damage (oxidative/genotoxic stress) |
↑ DNA damage |
Checkpoint/death signaling |
Glioma study: sulfasalazine causes DNA damage as part of the ROS-driven cytotoxic cascade |
(ref) |
| 5 |
Radiosensitization (oxidative vulnerability) |
↑ radiation sensitivity |
Enhances radiotherapy effect |
Melanoma model: sulfasalazine decreases glutathione and synergistically enhances X-irradiation cytotoxicity |
(ref) |
| 6 |
Ferroptosis (system xC− → GSH/GPX4 vulnerability) |
↑ ferroptotic death |
Iron-dependent oxidative death |
Paclitaxel-resistant uterine serous carcinoma model: sulfasalazine (xCT inhibitor) induces ferroptotic cell death signatures |
(ref) |
| 7 |
Mitochondrial apoptosis (caspase pathway) |
↑ apoptosis |
Programmed cell death |
Osteosarcoma work: sulfasalazine blocks system xC− and induces cell death consistent with ferroptosis/apoptosis programs (apoptosis markers reported in the paper’s mechanism set) |
(ref) |
| 8 |
NF-κB activation (IκBα degradation / IKK activity) |
↓ NF-κB activation |
Reduced pro-survival/inflammatory transcription |
Mechanistic paper shows sulfasalazine blocks NF-κB activation by inhibiting IκBα degradation via IKK inhibition |
(ref) |
| 9 |
NF-κB nuclear translocation |
↓ nuclear NF-κB |
Transcriptional shutdown |
Colon cancer cells: sulfasalazine prevents TNFα-induced NF-κB nuclear translocation and NF-κB–dependent transcription |
(ref) |
| 10 |
Chemo-sensitization via xCT inhibition |
↑ chemo sensitivity (context-dependent) |
Combination benefit |
Mechanistic rationale: xCT inhibition lowers GSH and oxidative defense, increasing sensitivity to cytotoxic stress (glioma + radiation shown explicitly) |
(ref) |
| 11 |
Tumor growth suppression in vivo (xCT-targeted stress) |
↓ tumor growth |
Anti-tumor efficacy |
Glioma xenograft model: sulfasalazine plus radiosurgery improves survival compared to control/monotherapy |
(ref) |
| 12 |
Resistance axis: xCT-high / antioxidant-high tumors |
↑ vulnerability when xCT-high |
Targeted susceptibility |
Endometrial/USC model: sulfasalazine shows stronger cytotoxicity in resistant (stress-adapted) cells consistent with xCT dependence |
(ref) |