Bo Sun,1,* Li Wang,2,* Tianqing Zhang1 

1Department of Critical Care Medicine, Cixi People Hospital Medical Health Group (Cixi People Hospital), Cixi, 315300, People’s Republic of China; 2Department of Emergency Medicine, Second Affiliated Hospital of School of Medicine, Zhejiang University, Hangzhou, 310052, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Tianqing Zhang, Cixi People Hospital Medical Health Group (Cixi People Hospital), No. 999 South Second Ring Road, Hu Shan Street, Cixi City, Zhejiang Province, 315300, People’s Republic of China, Tel +86-0574-63929064, Email cryicu@163.com

Abstract: Acute respiratory distress syndrome (ARDS) is a life-threatening condition characterized by the rapid onset of respiratory failure resulting from extensive inflammation and damage to the alveolar‒capillary barrier. ARDS can be triggered by various factors, including pneumonia, sepsis, trauma, and aspiration, emphasizing its relevance in the field of critical care medicine. Ferroptosis is a novel form of regulated cell death that plays a crucial role in the pathophysiology of ARDS. Unlike apoptosis and necrosis, ferroptosis is characterized by the lethal accumulation of lipid peroxides (LPOs), which is driven primarily by dysregulated iron metabolism and oxidative stress. Alveolar epithelial cells (AECs), pivotal in maintaining pulmonary homeostasis and gas exchange, exhibit heightened vulnerability to ferroptosis in ARDS. The inflammatory microenvironment associated with this syndrome further highlights the potential impact of ferroptosis on lung injury and repair processes. This review elucidates the multifaceted relationships among ferroptosis, inflammation, and oxidative stress in AECs, providing insights into the pathological mechanisms through which ferroptosis contributes to lung injury and the disruption of the alveolar‒capillary barrier. Furthermore, the therapeutic implications of targeting ferroptosis in ARDS management, including the roles of antioxidants and intracellular nutrients in mitigating oxidative damage and preserving lung function, are discussed. These mechanistic insights underscore ferroptosis as a tractable therapeutic node in ARDS pathobiology.

Keywords: acute respiratory distress syndrome, ferroptosis, alveolar epithelial cells, oxidative stress, inflammation, immune cells, antioxidants