Biosacetalin (1,1-Diethoxyethane) Prolongs Survival and Alleviates Cachexia in the NSG Mice Bearing Neuroblastoma SH-SY5Y Cells

Neuroblastoma remains a formidable pediatric malignancy characterized by profound metabolic plasticity and limited therapeutic responsiveness in high-risk disease. Emerging evidence positions the interplay between Reactive Oxygen Species (ROS) and the metabolic sentinel AMP-activated protein kinase (AMPK) as a critical regulator of tumor metabolic stress and apoptotic susceptibility, with additional implications in the systemic pathology of Cancer Cachexia. Building on our previous work demonstrating that 1,1-Diethoxyethane (1,1-DEE; Biosacetalin), a volatile aroma compound inhibits mitochondrial complex I, induces ROS production, and activates AMPK-PGC1α-mediated mitochondrial biogenesis accompanying enhancement of aerobic respiration, leading to anti-Warburg effect. We identify 1,1-DEE as a previously unrecognized metabolic modulator with potent antitumor activity. 1,1-DEE triggers ROS-induced AMPK activation, leading to apoptotic elimination of neuroblastoma cells (SH-SY5Y), robust suppression of tumor growth, and significant prolongation of survival (median survival 77 days) in tumor-bearing NSG mice. Strikingly, 1,1-DEE simultaneously alleviates cancer-associated cachexia by preserving body weight. Mechanistically, our findings reveal a ROS-AMPK-centered signaling axis through which 1,1-DEE integrates tumor-selective cytotoxicity with systemic metabolic protection, highlighting a unified therapeutic strategy for targeting both tumor progression and cachexia in neuroblastoma.