# Ferroptosis in diabetic retinopathy: from pathogenic mechanisms to translational prospects

**Authors:** Jieyu Jiang, Zhimin Liu, Xiangdong Chen

PMC · DOI: 10.3389/fendo.2026.1765089 · 2026-02-03

## TL;DR

This review explores how a type of cell death called ferroptosis contributes to diabetic retinopathy and suggests possible new treatments.

## Contribution

The paper provides a comprehensive overview of ferroptosis mechanisms and its role in diabetic retinopathy, highlighting potential therapeutic strategies.

## Key findings

- Ferroptosis is increasingly recognized as a key player in the progression of diabetic retinopathy.
- Abnormal iron metabolism and related signaling pathways are linked to ferroptosis in DR.
- Potential ferroptosis inhibitors may offer new treatment options for diabetic retinopathy.

## Abstract

Diabetic retinopathy (DR) is a common microvascular complication of diabetes. Despite ongoing revisions in the prevention and treatment of DR, optimal treatment strategies have yet to be established. Revealing the pathological changes and molecular mechanisms of DR is the cornerstone for exploring new therapeutic strategies. Ferroptosis, a new type of programmed cell death proposed in recent years, is characterized mainly by reactive oxygen species and iron-mediated lipid peroxidation. As studies progress, growing evidence has highlighted the involvement of ferroptosis, a newly identified programmed cell death pathway, in the development and pathological mechanisms of DR. The purpose of this review is to discuss the known underlying mechanisms of ferroptosis and elucidate its role in the pathogenesis of DR. Additionally, it explores the abnormal manifestations of iron metabolism and related signaling pathways in DR. Finally, we also summarize the potential compounds that may act as ferroptosis inhibitors in DR in the future. By synthesizing these aspects, this review aims to provide insights for a deeper understanding of the relationship between ferroptosis and DR, as well as potential prevention and treatment strategies.

## Linked entities

- **Diseases:** diabetic retinopathy (MONDO:0005266), diabetes (MONDO:0005015)

## Full-text entities

- **Genes:** PPARG (peroxisome proliferator activated receptor gamma) [NCBI Gene 5468] {aka CIMT1, FPLD3, GLM1, NR1C3, PPARG1, PPARG2}, RELA (RELA proto-oncogene, NF-kB subunit) [NCBI Gene 5970] {aka AIF3BL3, CMCU, NFKB3, p65}, Slc40a1 (solute carrier family 40 (iron-regulated transporter), member 1) [NCBI Gene 53945] {aka Dusg, Fpn1, IREG1, MTP, MTP1, Ol5}, SUCNR1 (succinate receptor 1) [NCBI Gene 56670] {aka GPR91}, DHODH (dihydroorotate dehydrogenase (quinone)) [NCBI Gene 1723] {aka DHOdehase, POADS, URA1}, HMOX1 (heme oxygenase 1) [NCBI Gene 3162] {aka HMOX1D, HO-1, HSP32, bK286B10}, BECN1 (beclin 1) [NCBI Gene 8678] {aka ATG6, VPS30, beclin1}, GPX4 (glutathione peroxidase 4) [NCBI Gene 2879] {aka GPx-4, GSHPx-4, MCSP, PHGPx, SMDS, snGPx}, Acsl4 (acyl-CoA synthetase long-chain family member 4) [NCBI Gene 113976] {aka Acs4, Facl4}, MYD88 (MYD88 innate immune signal transduction adaptor) [NCBI Gene 4615] {aka IMD68, MYD88D, WM1}, ALOX15 (arachidonate 15-lipoxygenase) [NCBI Gene 246] {aka 12-LOX, 15-LOX, 15-LOX-1, LOG15}, G6PD (glucose-6-phosphate dehydrogenase) [NCBI Gene 2539] {aka CNSHA1, G6PD1}, EPAS1 (endothelial PAS domain protein 1) [NCBI Gene 2034] {aka ECYT4, HIF2A, HLF, MOP2, PASD2, bHLHe73}, LPCAT3 (lysophosphatidylcholine acyltransferase 3) [NCBI Gene 10162] {aka C3F, LPCAT, LPLAT 5, LPLAT12, LPSAT, MBOAT5}, HAMP (hepcidin antimicrobial peptide) [NCBI Gene 57817] {aka HEPC, HFE2B, LEAP1, PLTR}, HIF1A (hypoxia inducible factor 1 subunit alpha) [NCBI Gene 3091] {aka HIF-1-alpha, HIF-1A, HIF-1alpha, HIF1, HIF1-ALPHA, MOP1}, ROBO1 (roundabout guidance receptor 1) [NCBI Gene 6091] {aka CPHD8, DUTT1, NORS, NYS8, SAX3}, LOX (lysyl oxidase) [NCBI Gene 4015] {aka AAT10}, SLC1A5 (solute carrier family 1 member 5) [NCBI Gene 6510] {aka AAAT, ASCT2, ATBO, M7V1, M7VS1, R16}, HSPB1 (heat shock protein family B (small) member 1) [NCBI Gene 3315] {aka CMT2F, HEL-S-102, HMN2B, HMND3, HS.76067, HSP27}, NFKBIA (NFKB inhibitor alpha) [NCBI Gene 4792] {aka EDAID2, IKBA, MAD-3, NFKBI}, PTK2B (protein tyrosine kinase 2 beta) [NCBI Gene 2185] {aka CADTK, CAKB, FADK2, FAK2, PKB, PTK}, MIR9-3 (microRNA 9-3) [NCBI Gene 407051] {aka MIRN9-3, hsa-mir-9-3, miRNA9-3, mir-9-3}, TJP1 (tight junction protein 1) [NCBI Gene 7082] {aka ZO-1}, TFRC (transferrin receptor) [NCBI Gene 7037] {aka CD71, IMD46, T9, TFR, TFR1, TR}, PCBP1 (poly(rC) binding protein 1) [NCBI Gene 5093] {aka HEL-S-85, HNRPE1, HNRPX, hnRNP-E1, hnRNP-X}, MAPK8 (mitogen-activated protein kinase 8) [NCBI Gene 5599] {aka JNK, JNK-46, JNK1, JNK1A2, JNK21B1/2, PRKM8}, GLS2 (glutaminase 2) [NCBI Gene 27165] {aka GA, GLS, LGA, hLGA}, SLC3A2 (solute carrier family 3 member 2) [NCBI Gene 6520] {aka 4F2, 4F2HC, 4T2HC, CD98, CD98HC, MDU1}, ACO1 (aconitase 1) [NCBI Gene 48] {aka ACONS, HEL60, IREB1, IREBP, IREBP1, IRP1}, KEAP1 (kelch like ECH associated protein 1) [NCBI Gene 9817] {aka INrf2, KLHL19}, NOX1 (NADPH oxidase 1) [NCBI Gene 27035] {aka GP91-2, MOX1, NOH-1, NOH-1L, NOH1}, SP1 (Sp1 transcription factor) [NCBI Gene 6667], MTOR (mechanistic target of rapamycin kinase) [NCBI Gene 2475] {aka FRAP, FRAP1, FRAP2, RAFT1, RAPT1, SKS}, Alox15 (arachidonate 15-lipoxygenase) [NCBI Gene 81639] {aka 12-LOX, 15-LOX, Alox12, Alox12l}, SAT1 (spermidine/spermine N1-acetyltransferase 1) [NCBI Gene 6303] {aka DC21, KFSD, KFSDX, SAT, SSAT, SSAT-1}, F3 (coagulation factor III, tissue factor) [NCBI Gene 2152] {aka CD142, TF, TFA}, TF (transferrin) [NCBI Gene 7018] {aka HEL-S-71p, PRO1557, PRO2086, TFQTL1}, CLDN1 (claudin 1) [NCBI Gene 9076] {aka CLD1, ILVASC, SEMP1}, PRKAA1 (protein kinase AMP-activated catalytic subunit alpha 1) [NCBI Gene 5562] {aka AMPK, AMPK alpha 1, AMPKa1}, Trpv4 (transient receptor potential cation channel, subfamily V, member 4) [NCBI Gene 66026] {aka Otrpc4, Vroac}, DPP4 (dipeptidyl peptidase 4) [NCBI Gene 1803] {aka ADABP, ADCP2, CD26, DPPIV, TP103}, CAT (catalase) [NCBI Gene 847], Arg1 (arginase, liver) [NCBI Gene 11846] {aka AI, Arg-1, PGIF}, USP48 (ubiquitin specific peptidase 48) [NCBI Gene 84196] {aka DFNA85, RAP1GA1, USP31}, NFE2L2 (NFE2 like bZIP transcription factor 2) [NCBI Gene 4780] {aka IMDDHH, NRF2, Nrf-2}, ACSL4 (acyl-CoA synthetase long chain family member 4) [NCBI Gene 2182] {aka ACS4, FACL4, LACS4, MRX63, MRX68, XLID63}, Gpx4 (glutathione peroxidase 4) [NCBI Gene 625249] {aka GPx-4, GSHPx-4, PHGPx, mtPHGPx, snGPx}, SOD1 (superoxide dismutase 1) [NCBI Gene 6647] {aka ALS, ALS1, HEL-S-44, IPOA, SOD, STAHP}, PRRT2 (proline rich transmembrane protein 2) [NCBI Gene 112476] {aka BFIC2, BFIS2, DSPB3, DYT10, EKD1, FICCA}, Slc7a11 (solute carrier family 7 (cationic amino acid transporter, y+ system), member 11) [NCBI Gene 26570] {aka 9930009M05Rik, sut, xCT}, NFKB1 (nuclear factor kappa B subunit 1) [NCBI Gene 4790] {aka CVID12, EBP-1, KBF1, NF-kB, NF-kB1, NF-kappa-B1}, GCLC (glutamate-cysteine ligase catalytic subunit) [NCBI Gene 2729] {aka CNSHA7, GCL, GCS, GLCL, GLCLC}, TXNIP (thioredoxin interacting protein) [NCBI Gene 10628] {aka ARRDC6, EST01027, HHCPA78, THIF, VDUP1}, Atl1 (atlastin GTPase 1) [NCBI Gene 73991] {aka 4930435M24Rik, Adfsp, Fsp1, Spg3, Spg3a}, VDAC2 (voltage dependent anion channel 2) [NCBI Gene 7417], PPARGC1A (PPARG coactivator 1 alpha) [NCBI Gene 10891] {aka LEM6, PGC-1(alpha), PGC-1alpha, PGC-1v, PGC1, PGC1A}, MALAT1 (metastasis associated lung adenocarcinoma transcript 1) [NCBI Gene 378938] {aka HCN, LINC00047, NCRNA00047, NEAT2, PRO2853, miPEP-52}, Slc6a6 (solute carrier family 6 (neurotransmitter transporter, taurine), member 6) [NCBI Gene 21366] {aka Taut}, YAP1 (Yes1 associated transcriptional regulator) [NCBI Gene 10413] {aka COB1, YAP, YAP-1, YAP2, YAP65, YKI}
- **Diseases:** type 2 diabetes (MESH:D003924), neuronal damage (MESH:D009410), retinal damage (MESH:D012164), ERG dysfunction (MESH:D006331), ocular diseases (MESH:D005128), necrosis (MESH:D009336), endothelial (MESH:D005642), fundus diseases (MESH:C535828), iron homeostasis disorders (MESH:D019189), metastasis (MESH:D009362), endothelial abnormalities (MESH:D000014), methemoglobinemia (MESH:D008708), lipid metabolism disorders (MESH:D052439), hyperglycemic (MESH:D006944), capillary occlusion (MESH:D001157), PDR (OMIM:603933), DR (MESH:D003930), hyperglycaemic retinal injury (MESH:D012173), neurovascular disorder (MESH:D013901), cytotoxic (MESH:D064420), retinal degeneration (MESH:D012162), hypoxic (MESH:D002534), ocular pathologies (MESH:D009759), diabetic endothelial dysfunction (MESH:D003925), metabolic diseases (MESH:D008659), ischemia (MESH:D007511), blindness (MESH:D001766), hypoxia (MESH:D000860), iron (MESH:D000090463), inflammation (MESH:D007249), PCD (MESH:D007619), retinal edema (MESH:D010211), Ferroptotic injury (MESH:D014947), neurodegeneration (MESH:D019636), Hyperglycemia (MESH:D006943), intraretinal and subretinal neovascularization (MESH:D006949), RGCs loss (MESH:D016388), iron overload (MESH:D019190), vision impairment (MESH:D014786), Mitochondrial (MESH:D028361), ocular neovascular diseases (MESH:D016510), tumor (MESH:D009369), endothelial dysfunction (MESH:D014652), Diabetic (MESH:D003920), atrophy (MESH:D001284), Neuroinflammation (MESH:D000090862)
- **Chemicals:** ATP (MESH:D000255), polyphenols (MESH:D059808), Glutamine (MESH:D005973), GSH (MESH:D005978), Lipid (MESH:D008055), cysteine (MESH:D003545), DHA (MESH:D004281), sterol (MESH:D013261), astragaloside IV (MESH:C052064), Coenzyme Q (MESH:D014451), sphingolipid (MESH:D013107), OA (MESH:D019301), pyrimidine nucleotide (MESH:D011742), lysine (MESH:D008239), N-acetylcysteine (MESH:D000111), tryptophan (MESH:D014364), flavonoids (MESH:D005419), amygdalin (MESH:D000678), manganese (MESH:D008345), glucose (MESH:D005947), selenocysteine (MESH:D017279), ROS (MESH:D017382), berberine (MESH:D001599), hexosamine (MESH:D006595), H2O2 (MESH:D006861), superoxide anions (MESH:D013481), 25 (OH) D3 (-), PA (MESH:D010168), lipofuscin (MESH:D008062), PUFA (MESH:D005231), cystine (MESH:D003553), Erastin (MESH:C477224), peroxides (MESH:D010545), sulfhydryl (MESH:D013438), Amino acid (MESH:D000596), BH4 (MESH:C003402), NADPH (MESH:D009249), Isoquercetin (MESH:C016527), cholesteryl esters (MESH:D002788), serine (MESH:D012694), phenylalanine (MESH:D010649), GSSG (MESH:D019803), fatty acid (MESH:D005227), arginine (MESH:D001120), MDA (MESH:D008315), EPA (MESH:D015118), AGEs (MESH:D017127), phospholipid (MESH:D010743), water (MESH:D014867), valine (MESH:D014633), Iron (MESH:D007501), FFA (MESH:D005230), STZ (MESH:D013311), squalene (MESH:D013185), resveratrol (MESH:D000077185), retinal (MESH:D012172), BCAA (MESH:D000597), glutamate (MESH:D018698), 4-HNE (MESH:C027576), oxysterols (MESH:D000072376)
- **Species:** Portulaca oleracea (species) [taxon 46147], Asarum heterotropoides (species) [taxon 366663], Rattus norvegicus (brown rat, species) [taxon 10116], Homo sapiens (human, species) [taxon 9606], Mus musculus (house mouse, species) [taxon 10090]
- **Mutations:** glutamine/glutamate
- **Cell lines:** HRMECs — Homo sapiens (Human), Transformed cell line (CVCL_0307), 661W — Mus musculus (Mouse), Transformed cell line (CVCL_6240), C57BL/6J — Mus musculus (Mouse), Transformed cell line (CVCL_C0MW), RPE — Homo sapiens (Human), Spontaneously immortalized cell line (CVCL_IQ82), ARPE — Homo sapiens (Human), Spontaneously immortalized cell line (CVCL_0145)

## Figures

3 figures with captions in the complete paper: https://tomesphere.com/paper/PMC12909233/full.md

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Source: https://tomesphere.com/paper/PMC12909233