Metabolic adaptations of inflammatory macrophages govern ferroptosis susceptibility via the GCH1–BH4–iNOS axis

J Julia Sauer (Boehringer Ingelheim Pharma GmbH & Co. KG , Biberach an der Riß,) P Patricia P Ogger (Department of Immunoregulation, Max Planck Institute of Biochemistry , Martinsried,) J Jasmina Dukic (Boehringer Ingelheim Pharma GmbH & Co. KG , Biberach an der Riß,) A Alina Nessensohn (Boehringer Ingelheim Pharma GmbH & Co. KG , Biberach an der Riß,) S Svenja Gabler (Boehringer Ingelheim Pharma GmbH & Co. KG , Biberach an der Riß,) A Ann-Katrin Schwenzer (Boehringer Ingelheim Pharma GmbH & Co. KG , Biberach an der Riß,) J Julia Kirstin Unsöld (Boehringer Ingelheim Pharma GmbH & Co. KG , Biberach an der Riß,) B Birgit Maria Cortès (Boehringer Ingelheim Pharma GmbH & Co. KG , Biberach an der Riß,) B Barbara Steigenberger N Nuria Fernandez Perez (Department of Immunoregulation, Max Planck Institute of Biochemistry , Martinsried,) A Alexander Strasser (Department of Immunoregulation, Max Planck Institute of Biochemistry , Martinsried,) R Rodrigo Dias Requiao (Department of Immunoregulation, Max Planck Institute of Biochemistry , Martinsried,) U Ulrike Schleicher (Mikrobiologisches Institut—Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität Erlangen-Nürnberg , Erlangen,) E Eva Griesser (Boehringer Ingelheim Pharma GmbH & Co. KG , Biberach an der Riß,) T Tom Bretschneider (Boehringer Ingelheim Pharma GmbH & Co. KG , Biberach an der Riß,) F Florian Gantner M Matthew James Thomas (Boehringer Ingelheim Pharma GmbH & Co. KG , Biberach an der Riß,) C Carolin Kirstin Watson (Boehringer Ingelheim Pharma GmbH & Co. KG , Biberach an der Riß,) K Karim Christian El Kasmi (Boehringer Ingelheim Pharma , Ridgefield, CT,) P Peter J Murray (Department of Biology, Graduate School of Biological Sciences, University of Konstanz , Konstanz,)

Abstract

Abstract In inflammatory tissue niches, macrophages encounter intense oxidative stress due to their own production of reactive oxygen and nitrogen species as part of antimicrobial defense. Our findings reveal that inflammatory macrophages deploy distinct, context-dependent redox-protective mechanisms to survive this self-inflicted stress, thereby avoiding ferroptotic cell death. Specifically, LPS-activated macrophages, M(LPS), rely on the GTP cyclohydrolase 1 (GCH1)–tetrahydrobiopterin (BH4) pathway for ferroptosis resistance, whereas LPS + IFN-γ–activated macrophages, M(LPS–IFN-γ), depend primarily on nitric oxide produced by inducible nitric oxide synthase (iNOS)—with the BH4 pathway suppressing cell death in the absence of nitric oxide. These distinct adaptations highlight a novel GCH1–BH4–iNOS axis that governs macrophage ferroptosis susceptibility. In both the LPS or the LPS + IFN-γ–activated settings, the redox-protective phenotype is reversible: Removal of inflammatory stimuli abolishes the protection, indicating that this metabolic programming requires continuous stimulation and is not a permanently fixed state. These findings uncover redox metabolism-guided metabolic distinctions between inflammatory macrophages and reveal how they preserve viability over prolonged inflammatory activation. Ultimately, our findings establish the GCH1–BH4–iNOS axis as a central, targetable mechanism to manipulate macrophage ferroptosis resistance for therapeutic purposes.

Article Details

Volume / Issue Vol. 215, Issue 6
Published June 07, 2026
ISSN 0022-1767
Publisher American Association of Immunologists

Authors (20)

J

Julia Sauer

Boehringer Ingelheim Pharma GmbH & Co. KG , Biberach an der Riß,

P

Patricia P Ogger

Department of Immunoregulation, Max Planck Institute of Biochemistry , Martinsried,

J

Jasmina Dukic

Boehringer Ingelheim Pharma GmbH & Co. KG , Biberach an der Riß,

A

Alina Nessensohn

Boehringer Ingelheim Pharma GmbH & Co. KG , Biberach an der Riß,

S

Svenja Gabler

Boehringer Ingelheim Pharma GmbH & Co. KG , Biberach an der Riß,

A

Ann-Katrin Schwenzer

Boehringer Ingelheim Pharma GmbH & Co. KG , Biberach an der Riß,

J

Julia Kirstin Unsöld

Boehringer Ingelheim Pharma GmbH & Co. KG , Biberach an der Riß,

B

Birgit Maria Cortès

Boehringer Ingelheim Pharma GmbH & Co. KG , Biberach an der Riß,

B

Barbara Steigenberger

N

Nuria Fernandez Perez

Department of Immunoregulation, Max Planck Institute of Biochemistry , Martinsried,

A

Alexander Strasser

Department of Immunoregulation, Max Planck Institute of Biochemistry , Martinsried,

R

Rodrigo Dias Requiao

Department of Immunoregulation, Max Planck Institute of Biochemistry , Martinsried,

U

Ulrike Schleicher

Mikrobiologisches Institut—Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität Erlangen-Nürnberg , Erlangen,

E

Eva Griesser

Boehringer Ingelheim Pharma GmbH & Co. KG , Biberach an der Riß,

T

Tom Bretschneider

Boehringer Ingelheim Pharma GmbH & Co. KG , Biberach an der Riß,

F

Florian Gantner

M

Matthew James Thomas

Boehringer Ingelheim Pharma GmbH & Co. KG , Biberach an der Riß,

C

Carolin Kirstin Watson

Boehringer Ingelheim Pharma GmbH & Co. KG , Biberach an der Riß,

K

Karim Christian El Kasmi

Boehringer Ingelheim Pharma , Ridgefield, CT,

P

Peter J Murray

Department of Biology, Graduate School of Biological Sciences, University of Konstanz , Konstanz,