FERROGAST · Mechanisms of Neuronal Degeneration in Diabetic Gastroparesis: The Role of Ferroptosis and Macrophages

Diabetes mellitus is one of the fastest growing health problems worldwide, and its complications have a major impact on patients’ quality of life. One of the most debilitating is diabetic gastroparesis, defined by delayed gastric emptying, causing nausea, vomiting and abdominal pain. Despite its prevalence, especially among women, effective treatments are lacking.The hallmark of diabetic gastroparesis is the progressive loss of enteric neurons, which we also observed in preliminary data, but the mechanisms behind this degeneration remain unclear. Building on our previous results showing that type I interferons (IFN-I) drive ferroptosis in neurons in colitis, I propose that a similar pathway contributes to neuronal death in diabetic gastroparesis. Ferroptosis is an iron-dependent form of regulated cell death driven by lipid peroxidation and oxidative stress, and is emerging as a key contributor to tissue pathology. An additional central focus of the project is the role of muscularis macrophages, long-lived tissue-resident immune cells that closely interact with enteric neurons. These macrophages control oxidative stress, iron metabolism and inflammatory responses in the gut, and are therefore ideally positioned to regulate ferroptosis. I will investigate how their crosstalk with neurons and IFN-I signaling shapes neuronal vulnerability in diabetes.To address these questions, I will use single-nucleus sequencing, diabetic mouse models, co-culture experiments with primary cells and patient biopsies. This will allow me to map ferroptosis and IFN pathways in neurons, define macrophage–neuron interactions, and test interventions such as ferroptosis inhibitors, iron chelators and IFN blockade.