Western diet induces iron-dependent enteric neurodegeneration via ferroptosis
Arun Balasubramaniam, Dmitrii Pavlov, Yunpeng Du, Jeremy Reeves, Alan Harzman, Yunshan Liu, Francesca Cingolani, Xinxu Yuan, Jay M. Patel, Simon Musyoka Mwangi, Peijian He, C. Michael Hart, Wenhui Hu, Fievos L. Christofi, Shanthi Srinivasan
Arun Balasubramaniam, Dmitrii Pavlov, Yunpeng Du, Jeremy Reeves, Alan Harzman, Yunshan Liu, Francesca Cingolani, Xinxu Yuan, Jay M. Patel, Simon Musyoka Mwangi, Peijian He, C. Michael Hart, Wenhui Hu, Fievos L. Christofi, Shanthi Srinivasan
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Research Article Gastroenterology Neuroscience

Western diet induces iron-dependent enteric neurodegeneration via ferroptosis

Abstract

The Western diets (WD), high in saturated fats such as palmitic acid (PA), promotes enteric neurodegeneration and motility disorders. Using murine models, in vitro systems, and human myenteric ganglia, we investigated whether a WD and PA drive iron-dependent ferroptotic injury in the enteric nervous system (ENS). Mice were fed a control diet (CD) or a WD for 12 weeks, with or without systemic AAV9-MaCPNS2 delivery of Nfe2l2 to enteric neurons. Colonic motility was assessed by a bead expulsion assay. We assessed ferroptosis using convergent readouts including iron dysregulation (transferrin receptor 1 [TfR1], ferritin heavy chain 1 [FTH1], labile and mitochondrial iron [Fe2+]), lipid peroxidation (C11-BODIPY and 4-hydroxynonenal [4-HNE]), glutathione peroxidase 4 (GPX4) suppression, and pharmacologic inhibition by ferrostatin 1 (Fer-1) in primary enteric neurons, murine myenteric plexuses, and human networks of myenteric ganglia (nhMPG). WD-fed mice exhibited delayed colonic transit, increased TfR1 and FTH1, and vulnerability of nNOS neurons; these changes were reversed by nuclear factor erythroid 2–related factor 2; (Nfe2l2, also known as Nrf2) overexpression. RNA-seq of PA-treated immortalized murine fetal enteric neurons (IM-FENs) revealed disrupted neurotransmitter signaling, reduced mitochondrial and antioxidant programs, and increased iron import and lipid peroxidation signatures. PA increased labile Fe2+, mitochondrial ROS, membrane depolarization, Ca2+ dysregulation, 4-HNE, and mitoferrin 2 (Mfrn2), whereas Fer-1 preserved mitochondrial integrity, viability, and ENS function. In human nhMPG, PA induced enteric neuronal iron loading and ferroptosis, supporting the translational relevance to diet-associated enteric neuropathy.

Authors

Arun Balasubramaniam, Dmitrii Pavlov, Yunpeng Du, Jeremy Reeves, Alan Harzman, Yunshan Liu, Francesca Cingolani, Xinxu Yuan, Jay M. Patel, Simon Musyoka Mwangi, Peijian He, C. Michael Hart, Wenhui Hu, Fievos L. Christofi, Shanthi Srinivasan

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Figure 10

PA induces ferroptotic enteric neurodegeneration through iron accumulation, oxidative stress, and mitochondrial dysfunction in murine and human models.

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PA induces ferroptotic enteric neurodegeneration through iron accumulati...
Schematic summary of the proposed mechanism by which chronic PA, a major dietary SFA, drives ferroptotic injury in enteric neurons, integrating findings from murine models and nhMPG. Steps: (i) Chronic PA exposure. (ii) Increased iron uptake and trafficking through upregulation of TfR1, DMT1, and ZIP14, expanding the intracellular labile Fe2+ pool and promoting iron retention. (iii) Impaired antioxidant defense via suppression of cystine transport and the GSH/GPX4 axis, which further sensitizes neurons to oxidative injury. (iv) Functional ENS impairment, shown as suppressed neuronal activity and excitability [blunted intracellular free calcium ([Ca2+]i) response to electrical stimulation]. (v) Convergent iron-driven oxidative stress and lipid peroxidation culminate in enteric neuronal ferroptosis and cell death, leading to neuronal loss and motility dysfunction. Fer-1 inhibits lipid peroxidation and preserves neuronal activity and excitability, mitigating ferroptotic cell death. Created with BioRender (2025).