Heat stroke (HS), a perilous medical emergency marked by extreme hyperthermia, presents an ongoing challenge in clinical medicine due to its frequent association with multiorgan dysfunction and high mortality rates. Recent groundbreaking research published in Acta Pharmaceutica Sinica B unveils a novel pathogenic mechanism whereby palmitoylation of transferrin receptor 1 (Tfr1) potentiates platelet ferroptosis, significantly exacerbating liver injury during heat stroke. This study not only sheds light on the intricate molecular underpinnings of platelet dysfunction in HS but also proposes new avenues for therapeutic intervention.
A hallmark of heat stroke is the severe coagulative disturbance reflected in thrombocytopenia—a critical decline in platelet numbers—which correlates strongly with worsened organ damage and increased death risk. The investigators discovered that the ferroptotic death of platelets, induced by Tfr1 palmitoylation, represents the driving force behind this pathological thrombocytopenia. Ferroptosis, an iron-dependent regulated form of cell death characterized by lipid peroxidation and oxidative stress, is revealed here for the first time as central to HS-induced platelet demise.
Central to this pathogenic cascade is the post-translational modification of Tfr1, a pivotal iron importer on the platelet membrane, via palmitoylation. This lipid modification enhances Tfr1’s function, thereby increasing intracellular iron accumulation within platelets. Elevated intracellular iron triggers a surge in reactive lipid species, including lipid reactive oxygen species (ROS) and 4-hydroxynonenal (4-HNE), culminating in cell membrane damage and ferroptosis. The excessive ferroptotic loss of platelets worsens the systemic inflammatory milieu and propagates liver injury.
Using state-of-the-art murine models of heat stroke, researchers demonstrated that pharmacological blockade of Tfr1 palmitoylation with the inhibitor 2-bromopalmitate (2BP) effectively mitigated platelet ferroptosis. 2BP treatment not only reduced total iron and ferrous iron (Fe²⁺) accumulation in platelets but also diminished lipid ROS and 4-HNE levels, ultimately decreasing platelet cytotoxicity under thermal stress conditions. Accordingly, mice treated with 2BP exhibited markedly preserved platelet counts, decreased thrombocytopenia, and improved survival outcomes, underscoring the therapeutic potential of targeting this pathway.
Furthermore, ferroptotic platelets were shown to actively secrete the potent pro-inflammatory cytokine interleukin-1β (IL-1β), amplifying systemic inflammation and contributing to hepatic injury. Inhibition of platelet ferroptosis curtailed IL-1β secretion, which attenuated inflammatory damage in liver tissues. These findings underscore the multifactorial impact of Tfr1-driven platelet ferroptosis extending beyond cellular demise to modulation of systemic immune responses during heat stroke.
This study integrates multiple layers of molecular biology, pathology, and immunology to elucidate the pathological role of Tfr1 palmitoylation in iron-mediated oxidative stress within platelets. By delineating how this specific lipid modification modulates iron transport and instigates ferroptosis, it propels forward our understanding of platelet biology under stress conditions. The linkage between platelet ferroptosis and liver injury establishes a new paradigm in HS pathophysiology.
The implications of targeting Tfr1 palmitoylation-dependent ferroptosis extend beyond heat stroke, highlighting potential broader applications in diseases characterized by dysregulated iron metabolism, oxidative stress, and thrombocytopenia. Compounds such as 2BP exhibit promising pharmacological profiles, offering a novel class of interventions to preserve platelet viability and function under pathologic conditions involving iron-induced oxidative injury.
In the context of clinical translation, the identification of Tfr1 palmitoylation as a druggable modification paves the way for the development of precision therapies aimed at disrupting maladaptive iron uptake and ferroptotic signaling in platelets. Such targeted strategies could dramatically improve patient outcomes by simultaneously preventing thrombocytopenia and attenuating organ injury.
This research also advances the paradigm of ferroptosis beyond classical contexts like cancer and neurodegeneration by positioning it as a critical cellular process in acute systemic insults such as heat stroke. The discovery adds an important dimension to the understanding of platelet lifespan regulation and inflammatory signaling during critical illness.
Collectively, the insights garnered from this comprehensive study spotlight a previously unrecognized mechanism by which pathogenic platelet ferroptosis—via enhanced Tfr1 palmitoylation—drives liver injury in HS. These findings chart a promising course toward novel therapeutics that could revolutionize the management of this life-threatening condition and its complications.
Further investigation into the molecular regulators of Tfr1 palmitoylation and ferroptosis in diverse cell types may reveal conserved mechanisms applicable to a wide spectrum of oxidative stress-related diseases. Such efforts will be instrumental in translating these fundamental discoveries into clinical realities.
Ultimately, this study exemplifies how intricate biochemical modifications intersect with cellular death pathways to shape disease trajectories, offering a beacon of hope for improved precision medicine approaches in heat stroke and beyond.
Subject of Research: Heat stroke-induced liver injury mediated by platelet ferroptosis via Tfr1 palmitoylation
Article Title: Palmitoylation of Tfr1 Enhances Platelet Ferroptosis and Liver Injury in Heat Stroke
News Publication Date: Not specified (Article published in Volume 16, Issue 1, 2026)
Web References:
DOI link: http://dx.doi.org/10.1016/j.apsb.2025.10.027
Acta Pharmaceutica Sinica B: https://www.sciencedirect.com/journal/acta-pharmaceutica-sinica-b
Keywords: Heat stroke, liver injury, platelet, ferroptosis, transferrin receptor 1, palmitoylation, iron metabolism, oxidative stress, 2-bromopalmitate (2BP), lipid peroxidation, interleukin-1β
Tags: clinical implications of heat strokeheat stroke pathophysiologyiron-dependent cell death mechanismslipid peroxidation in plateletsliver damage exacerbationmolecular mechanisms of platelet dysfunctionoxidative stress and heat strokepalmitoylation of transferrin receptor 1platelet ferroptosis in heat strokepost-translational modifications in plateletstherapeutic interventions for heat strokethrombocytopenia and organ dysfunction
