Bleomycin is a clinically potent anticancer
drug used for the treatment of
germ-cell tumors,
lymphomas and
squamous-cell carcinomas. Unfortunately, the therapeutic efficacy of
bleomycin is severely hampered by the development of
pulmonary fibrosis. However, the mechanisms underlying
bleomycin-induced
pulmonary fibrosis, particularly the molecular target of
bleomycin, remains unknown. Here, using a chemical proteomics approach, we identify ANXA2 (
annexin A2) as a direct binding target of
bleomycin. The interaction of
bleomycin with ANXA2 was corroborated both in vitro and in vivo. Genetic depletion of anxa2 in mice mitigates
bleomycin-induced
pulmonary fibrosis. We further demonstrate that Glu139 (E139) of ANXA2 is required for
bleomycin binding in lung epithelial cells. A CRISPR-Cas9-engineered ANXA2E139A mutation in lung epithelial cells ablates
bleomycin binding and activates TFEB (
transcription factor EB), a master regulator of macroautophagy/autophagy, resulting in substantial acceleration of autophagic flux. Pharmacological activation of TFEB elevates
bleomycin-initiated autophagic flux, inhibits apoptosis and proliferation of epithelial cells, and ameliorates
pulmonary fibrosis in bleomycin-treated mice. Notably, we observe lowered TFEB and LC3B levels in human
pulmonary fibrosis tissues compared to normal controls, suggesting a critical role of TFEB-mediated autophagy in
pulmonary fibrosis. Collectively, our data demonstrate that ANXA2 is a specific
bleomycin target, and
bleomycin binding with ANXA2 impedes TFEB-induced autophagic flux, leading to induction of
pulmonary fibrosis. Our findings provide insight into the mechanisms of
bleomycin-induced
fibrosis and may facilitate development of optimized
bleomycin therapeutics devoid of lung toxicity.