RUNX2 isoform II suppresses ferroptosis. (A, B) CAL 27 and SCC-9 cells were treated with anti-isoform II siRNAs (si-II-1 and si-II-2) or negative control siRNA (NC). (A) The levels of total ROS were detected with DCFH-DA using flow cytometry. The histograms below summarized the levels of mean fluorescent intensity (MFI). Data are means ± SD, n = 4. (B) The lipid peroxidation of cells was analyzed with C11 BODIPY 581/591 reagent using flow cytometry. The histograms below summarized the levels of MFI. Data are means ± SD, n = 4 for CAL 27, n = 3 for SCC-9. (C, D) CAL 27 or SCC-9 cells were stably transfected by isoform II-expression or vector control lentivirus. The levels of ROS (C) or lipid peroxidation (D) were detected by flow cytometry. The histograms below summarized the levels of MFI. Data are means ± SD, n = 4. (E) Transmission electron microscopy images of CAL 27 cells transfected with si-II-1, si-II-2 or NC. RSL3 (a ferroptosis activator) served as a positive control. (F) CAL 27 cells transfected with anti-isoform II siRNAs were also treated with ferrostatin-1 (Fer-1, 10 μM), a ferroptosis inhibitor. Negative control siRNA and DMSO were used as controls. Cells were divided into six groups: NC+DMSO, si-II-1+DMSO, si-II-2+DMSO, NC+Fer-1, si-II-1+Fer-1 and si-II-2+Fer-1. To display clear diagrams, the proliferation curves of si-II-1-treated cells or si-II-2-treated cells were shown separately. Data are means ± SD, n = 3. (G) CAL 27 cells transfected with anti-isoform II siRNAs were also treated with Z-VAD (20 μM, an apoptosis inhibitor) or necrostatin-1 (Nec-1, 20 μM, a necroptosis inhibitor). Negative control siRNA and DMSO were used as controls. Cells were divided into nine groups: NC+DMSO, si-II-1+DMSO, si-II-2+DMSO, NC+Z-VAD, si-II-1+Z-VAD, si-II-2+Z-VAD, NC+Nec-1, si-II-1+Nec-1, si-II-2+Nec-1. To display clear diagrams, the proliferation curves of si-II-1-transfected cells or si-II-2-transfected cells were shown separately. Data are means ± SD, n = 3. (H, I) The total ROS levels (H) or lipid peroxidation (I) of cells simultaneously transfected with anti-isoform II siRNAs or NC and treated with Fer-1 or DMSO were detected with DCFH-DA (H) or BODIPY 581/591 reagent (I) by flow cytometry. The histogram on the right summarized the levels of MFI. Data are means ± SD, n = 3. (J, K) The total ROS levels (J) or lipid peroxidation (K) of isoform II-overexpressed cells treated with RSL3 (2 μM, a ferroptosis activator) or DMSO were detected with DCFH-DA (J) or BODIPY 581/591 reagent (K) by flow cytometry. The histogram on the right summarized the levels of MFI. Data are means ± SD, n = 4 for J, n = 5 for K. (L) Representative images of immunohistochemical staining of 4-HNE in tumors with or without isoform II-knockdown (shisoform II vs shNC) in Figure 2G. The histogram below summarized the H score of 4-HNE staining in tumors. * P < 0.05, ** P < 0.01, *** P < 0.001.