The RAGE-Ferroptosis Axis Drives Oxidative Stress-Associated Inflammatory Lung Injury in Viral Infection

The receptor for advanced glycation end-products (RAGE) is a lung-enriched pattern recognition receptor implicated in inflammatory responses. Its role in ferroptosis-mediated lung injury during viral infection, however, remains unclear. Here, we combined bioinformatics analysis with in vitro and in vivo experimental validation to investigate the RAGE-ferroptosis axis in influenza virus infection. Cross-analysis of RAGE- and ferroptosis-related genes identified overlapping candidates, suggesting functional crosstalk. Influenza-infected A549 cells exhibited ferroptotic cell death, characterized by Fe²⁺ accumulation, reactive oxygen species (ROS) elevation, and lipid peroxidation, which was markedly attenuated by the RAGE inhibitor FPS-ZM1. In A/PR/8/34 (H1N1)-infected female C57BL/6J mice, FPS-ZM1 treatment improved survival, reduced lung injury, restored redox balance, and modulated key ferroptosis regulators ACSL4, POR, and GPX4. Moreover, RAGE inhibition decreased M1 macrophage and neutrophil infiltration and reduced pro-inflammatory cytokines. Collectively, these findings reveal that RAGE activation drives ferroptosis and amplifies oxidative stress-associated lung injury, whereas RAGE inhibition mitigates tissue damage via the ACSL4/POR/GPX4 pathway and immunomodulation. This study identifies the RAGE-ferroptosis axis as a potential therapeutic target for severe pulmonary inflammation.