Iron Chelator Deferiprone Curbs Ferroptosis to Shield Liver from Parasite

A single oral drug already sitting on pharmacy shelves for blood disorders may offer a new way to protect the liver and immune cells from one of the most damaging parasitic infections in cattle, according to a new study published in Acta Parasitologica. Researchers from Foshan University and Southwest University in China report that deferiprone, a clinically approved iron chelator, shields macrophages and liver tissue from ferroptosis—a form of iron-driven cell death—during infection with Neospora caninum, an intracellular parasite responsible for abortion and stillbirth in livestock worldwide.

The study, led by Zhengkai Wei with co-first authors Zijun Zhu and Xi Jiang, is the first to establish ferroptosis as a critical pathogenic mechanism in N. caninum infection. The findings suggest that repurposing existing iron-targeted drugs could open a new front in the fight against intracellular parasites, though the work also reveals a surprising trade-off: while deferiprone protected tissues from oxidative destruction, it appeared to worsen weight loss in infected animals, hinting at complex metabolic consequences of dampening this cell death pathway.

N. caninum is an obligate intracellular apicomplexan parasite, a relative of Toxoplasma gondii and the malaria-causing Plasmodium species. It infects nucleated cells across a wide range of mammalian hosts, and its clinical impact is severe: reproductive failure marked by abortion and stillbirth, as well as neurological impairment in infected animals. Unlike some parasitic diseases, neosporosis has no effective widely available treatment, and the parasite places an enormous economic burden on the dairy and beef industries. Macrophages, the immune cells that engulf pathogens and coordinate inflammatory responses, are among the first lines of defense—and among the key battlegrounds where the parasite and host immune system collide.

Ferroptosis itself is a relatively recent addition to the catalog of regulated cell death pathways. First named in 2012, it is fundamentally different from apoptosis, the tidy, programmatic dismantling of a cell that leaves surrounding tissue unharmed. Ferroptosis is instead an iron-dependent process driven by runaway lipid peroxidation: free iron catalyzes the conversion of polyunsaturated fatty acids in cell membranes into destructive lipid radicals, which rupture the membrane and cause the cell to burst. The cell’s principal defense against this cascade is the enzyme glutathione peroxidase 4, or GPX4, which uses the antioxidant glutathione (GSH) to neutralize lipid peroxides before they accumulate. When GPX4 activity falters, or when the labile iron pool grows too large, ferroptosis proceeds unchecked.

In recent years, ferroptosis has been implicated in an expanding list of infectious diseases. Studies have shown that Mycobacterium tuberculosis, the bacterium responsible for tuberculosis, drives ferroptotic death in macrophages, contributing to tissue necrosis. Parasites have also been caught manipulating the pathway: Leishmania infantum exploits the anti-ferroptotic transcription factor Nrf2 to avoid being killed inside macrophages, while iron-overload-induced ferroptosis contributes to brain injury in cerebral toxoplasmosis, where deferiprone has already been shown to reduce damage. The new study extends this emerging picture to N. caninum, an organism whose interactions with host iron metabolism had remained largely unexplored.

To interrogate the role of ferroptosis in neosporosis, the research team built both in vitro and in vivo infection models. In the cell culture experiments, they infected RAW 264.7 macrophages—a standard murine macrophage cell line—with N. caninum tachyzoites, the rapidly dividing stage of the parasite responsible for disseminating infection through host tissues. Some infected cultures were then treated with deferiprone, allowing the team to dissect how the drug altered the redox environment of the infected cells. The researchers measured a battery of ferroptosis-related parameters: reactive oxygen species (ROS) production, intracellular glutathione concentrations, total cellular iron content, GPX4 gene expression, and parasite proliferation quantified by quantitative polymerase chain reaction (qPCR), a technique that amplifies and detects specific DNA sequences to estimate parasite burden.

The results were unambiguous in showing that N. caninum pushes macrophages toward the ferroptotic brink. Infection significantly elevated ROS production and drove intracellular iron accumulation, while simultaneously depleting GSH stores and suppressing GPX4 transcription. Each of these changes is a recognized hallmark of ferroptosis, and together they paint a mechanistic portrait of how the parasite damages its host cell: it floods the macrophage with catalytically reactive iron and strips away the enzymatic antioxidant machinery that would normally keep lipid peroxidation in check.

Remarkably, deferiprone treatment reversed this cascade. The drug, a bidentate iron chelator that binds ferric iron in a three-to-one complex and is orally bioavailable, restored redox balance in the infected macrophages and protected host tissue. Critically, however, the team found that the drug protected the host, not the host’s control of the infection—parasite proliferation was not curtailed by deferiprone, which means the drug’s benefit lies in preventing tissue destruction rather than in directly killing the parasite. This distinction matters, because it places deferiprone in the category of host-directed therapies, an increasingly discussed strategy in infectious disease research. Rather than targeting the pathogen directly, which drives drug resistance, host-directed approaches modulate the injured tissue environment to reduce pathology.

The in vivo arm of the study extended these findings to whole animals. C57BL/6 mice were intraperitoneally inoculated with 1 × 10^7 N. caninum tachyzoites and given deferiprone orally for seven consecutive days. Over the course of infection, the researchers monitored body weight, food intake, hepatic pathology, oxidative stress markers including GSH and malondialdehyde (MDA, a degradation product of lipid peroxides that serves as a standard readout of oxidative membrane damage), iron levels, and the expression of ferroptosis-related genes including GPX4, ferritin heavy chain 1 (FTH1, the iron-storage protein), and transferrin (TRF, the iron transport protein in blood).

The liver, an organ central to iron metabolism and a frequent casualty of systemic infection, showed clear signs of ferroptotic damage in infected animals. Deferiprone alleviated this hepatic ferroptosis: iron homeostasis normalized, GPX4 and ferritin expression were upregulated, and histopathological examination of liver sections revealed reduced tissue damage compared with untreated infected controls. In essence, the drug restored the liver’s antioxidant and iron-buffering capacity, preventing the membrane-peroxidizing spiral that otherwise destroys hepatocytes during infection.

But the study was not a simple story of a protective drug. Mice treated with deferiprone actually lost more weight than infected untreated animals, a finding the authors interpret as a potential trade-off between ferroptosis inhibition and metabolic adaptation. Ferroptosis, despite its destructive capacity, is a regulated process that the body may deploy as part of a coordinated response to infection; suppressing it wholesale may blunt not only tissue damage but also the metabolic restructuring that helps an animal survive acute illness. Alternatively, the weight loss may reflect deferiprone’s known side effects on appetite and gastrointestinal tolerance, which are documented in human patients. Either way, the result complicates any straightforward translation of iron chelation therapy to infected animals and underscores the need for careful dosing and timing studies.

The therapeutic concept behind the study has deep clinical roots. Deferiprone has been used for decades to treat iron overload in patients with β-thalassemia, where repeated transfusions flood the body with iron that the body cannot excrete. More recently, clinical trials have tested the drug in neurodegenerative contexts—iron accumulates in the brains of patients with Alzheimer’s and Parkinson’s disease, and randomized trials of deferiprone in both conditions have been reported. The drug’s antioxidant and anti-inflammatory properties, independent of its iron-binding activity, have also been documented in cell culture studies. This broad clinical track record means that a new indication in parasitic disease would not require developing a molecule from scratch, and its safety profile in humans is comparatively well characterized.

The work also fits into a growing appreciation of the macrophage as a ferroptosis-sensitive cell type. Macrophages are professional recyclers of iron, reclaiming the metal from senescent red blood cells and managing its release through transporters and storage proteins. This intimate relationship with iron metabolism makes macrophages intrinsically vulnerable to ferroptotic triggers, and pathogens that manipulate macrophage iron handling can tip these cells toward self-destruction while simultaneously liberating the iron that microbes need to grow. Understanding how N. caninum hijacks this system could illuminate fundamental aspects of host-pathogen iron competition.

The authors caution that their findings, while establishing ferroptosis as a pathogenic mechanism in neosporosis and validating deferiprone as a protective agent in experimental models, represent an early step. The drug did not reduce parasite burden, so any future therapeutic strategy would likely combine iron chelation with conventional antiparasitic agents or vaccines. Optimizing the timing, dose, and duration of chelation to capture tissue protection without exacerbating metabolic costs remains an open challenge. Still, the study provides a mechanistic foundation for host-directed antiparasitic interventions in a disease where current options are limited, and it adds N. caninum to the expanding roster of pathogens whose virulence depends, at least in part, on weaponizing the host’s own iron against it.