Targeting ferroptosis in sepsis-induced cardiomyopathy: mechanisms and therapeutic potential of traditional Chinese Medicine

Abstract

Sepsis-induced cardiomyopathy (SIC), a severe complication of sepsis, is strongly associated with significantly increased patient mortality, yet targeted therapeutic strategies remain lacking. Emerging evidence has established ferroptosis, an iron-dependent, lipid peroxidation-mediated regulated cell death pathway, as a critical pathogenic mechanism underlying SIC. Iron metabolism dysregulation plays a central role in SIC. Although sepsis reduces circulating iron levels, iron paradoxically accumulates in myocardial tissues. This abnormal redistribution of iron leads to uncontrollable lipid peroxidation in cardiac tissue, ultimately aggravating myocardial injury. In recent years, the application of traditional Chinese medicine (TCM) in the treatment of sepsis has become increasingly widespread. Moreover, due to its multi-target and multi-pathway advantages, TCM has shown considerable potential in the intervention of ferroptosis. However, due to the lack of understanding of the precise molecular mechanism, the therapeutic potential of TCM and its active components in SIC has not been fully explored. This review summarizes the mechanism of ferroptosis in the pathogenesis of SIC, and comprehensively synthesizes the mechanism and application potential of TCM targeting ferroptosis for SIC intervention, aiming to provide a theoretical basis for the development of innovative treatment strategies and the improvement of prognosis of SIC.