A dysregulated hepcidin-iron axis impairs antiviral immunity and induces lethal liver pathology in neonates

Yanhui Xu1, Xixi Chen2, Rongli Fang2

  • 1Department of Pediatric Surgery, Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Clinical Research Center for Pediatric Infection and Immunity, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, China.

Immunity
|December 9, 2025
PubMed

Insights

Rotavirus infection in newborns causes liver damage by disrupting iron regulation via type I interferon (IFN-I) and hepcidin. Folic acid supplementation showed promise in reducing liver injury and complications in infants with biliary atresia.

Area of Science:

  • Immunology
  • Hepatology
  • Neonatal Medicine

Background:

  • Systemic rotavirus (RV) infection presents a significant health risk to neonates, with its pathogenesis poorly understood.
  • Biliary atresia (BA) is a serious neonatal liver condition where RV infection may exacerbate outcomes.
  • Iron dysregulation is increasingly recognized as a factor in various inflammatory and infectious diseases.

Purpose of the Study:

  • To elucidate the pathogenesis of RV infection in neonatal liver disease.
  • To investigate the role of type I interferon (IFN-I) and hepcidin in RV-induced liver injury.
  • To explore the therapeutic potential of targeting the IFN-I-hepcidin-iron axis and folic acid supplementation in neonatal liver disease.

Main Methods:

  • Utilized RV-infected neonatal mouse models and analyzed samples from infants with biliary atresia (BA).
  • Assessed the expression of hepcidin, IFN-I signaling components, and iron-related proteins (e.g., SLC40A1).
  • Investigated the effects of blocking IFN-I-hepcidin signaling, iron chelation, and folic acid administration in vivo and in a clinical trial.

Main Results:

  • Persistent IFN-I signaling upregulated hepcidin in hepatocytes and macrophages, impairing iron excretion (SLC40A1) and causing ferroptosis.
  • Iron accumulation in myeloid cells (Kupffer cells) exacerbated RV replication and IFN-I activation.
  • Blocking IFN-I-hepcidin signaling and iron chelation mitigated RV-induced liver damage in mice.
  • Folic acid suppressed the IFN-I-hepcidin-iron axis and, in a clinical trial, reduced cholangitis and liver transplantation rates in infants with BA.

Conclusions:

  • Hepcidin-iron dysregulation is a critical mechanism in neonatal RV infection and associated liver damage.
  • Targeting the IFN-I-hepcidin-iron pathway offers a potential therapeutic strategy for neonatal RV diseases.
  • Folic acid supplementation demonstrates therapeutic efficacy in infants with BA, suggesting a role in managing RV-related neonatal liver conditions.

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