Endothelial ferroptosis in blood-brain barrier dysfunction and neuroinflammation: mechanisms and immune-vascular...

Ferroptosis is an iron-dependent form of regulated cell death driven by phospholipid peroxidation. In the central nervous system (CNS), most ferroptosis research has focused on neurons and glial cells, whereas the vulnerability of brain microvascular endothelial cells (BMECs) and its consequences for blood-brain barrier (BBB) integrity remain less clearly defined. Because BMECs form the vascular interface between the circulation and the brain parenchyma, ferroptotic injury in this cell population may represent an immunovascular mechanism through which endothelial redox stress is translated into barrier dysfunction and neuroinflammatory amplification. In this review, we summarize molecular pathways that may promote or restrain BMEC ferroptosis, including iron handling, antioxidant defense mediated by the solute carrier family 7 member 11 (SLC7A11)-glutathione peroxidase 4 (GPX4) axis and nuclear factor erythroid 2-related factor 2 (Nrf2) signaling, lipid peroxidation, and junctional remodeling. We then discuss how ferroptosis-associated endothelial injury may contribute to BBB leakage, damage-associated molecular pattern release, innate immune sensing, leukocyte recruitment, glial activation, and self-amplifying inflammatory feedback at the neurovascular interface. We organize the available literature according to the strength and cellular specificity of evidence, separating BMEC-specific findings, BBB-focused in vivo studies, indirect CNS evidence, and mechanistic analogies from non-CNS endothelial systems. Finally, we evaluate disease-specific evidence in ischemic stroke and selected neurodegenerative or inflammatory conditions, together with therapeutic strategies, BMEC-targeting considerations, candidate clinical biomarkers, and translational barriers for modulating endothelial ferroptosis. This review frames endothelial ferroptosis as a promising but incompletely established immunovascular link between BBB dysfunction and neuroinflammation, and highlights the need for BMEC-specific models, human BBB systems, endothelial ferroptosis biomarkers, biomarker-guided monitoring, BMEC-targeted delivery approaches, and careful evaluation of the physiological risks of systemic or prolonged ferroptosis blockade.