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. 2022 Apr 14;29(6):1094–1106. doi: 10.1038/s41418-022-00998-x

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© The Author(s) 2022

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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Fig. 1 — Ferroptosis can be initiated by non-enzymatic and enzymatic processes. The non-enzymatic process includes Fenton reaction, where iron and hydrogen peroxide react and form free radicals. Various enzymes and proteins drive ferroptosis via increasing iron availability and enhancing free radical formation (CYP450, HO-1, HIFs), and performing important roles in biosynthesis and oxidation of PUFAs (ACSL4, LPCAT3, ALOX). In contrast, ferroptosis is suppressed by several enzymes and cofactors with antioxidant functions (GPX4, GSH, FSP1, CoQ10, BH4) and system x_c^- cystine/glutamate antiporter (SLC7A11 and SLC3A2) that import cystine which is necessary for the biosynthesis of antioxidant enzymes. Consequences of ferroptosis are various harmful breakdown products (e.g., MDA and 4-HNE), modified and oxidized proteins (e.g., reparatory ESCRT-III), damaged mitochondria and eventual disruption of membrane integrity. MDA, malondialdehyde; 4-HNE, 4-hydroxy-2-nonenal; TfR1, transferrin receptor 1; PUFAs-OOH, polyunsaturated fatty acid peroxides; ROS, reactive oxygen species; PROM2, prominin 2; system xc-, cystine/glutamate antiporter; SLC7A11, solute carrier family 7 member 11; SLC3A2, solute carrier family 3 member 2; ESCRT-III, endosomal sorting complexes required for transport-III; Fe, ferrum (iron); ACSL4, acyl-CoA synthetase long-chain family member 4; LPCAT3, lysophosphatidylcholine acyltransferase 3; ALOX, lipoxygenase; CYP450, cytochrome P450; GPX4, glutathione peroxidase 4; GSH, glutathione; BH4, tetrahydrobiopterin; CoQ10, coenzyme Q10; FSP1, ferroptosis suppressor protein 1; FTH1, ferritin heavy chain 1; FTL, ferritin light chain; NRF2, nuclear factor E2-related factor 2; IREB2, iron-responsive element binding protein 2; HIFs, hypoxia-inducible factors; HO-1, heme oxygenase-1. Created with BioRender.