Advanced glycation end products exacerbate lipopolysaccharide-induced acute lung injury with diabetes by promoting ferroptosis via AMP-activated protein kinase/acetyl-CoA carboxylase signaling

Diabetes increases susceptibility to acute lung injury (ALI), yet the mechanisms linking hyperglycemia to pulmonary damage remain incompletely understood. Here, we demonstrate advanced glycation end products (AGEs)-metabolic byproducts elevated in diabetes-as promoters of ferroptosis that contribute to ALI pathogenesis. Clinical analysis of 170 patients with sepsis-related ALI showed that diabetic individuals had heightened inflammation and reduced PaO₂/FiO₂ ratios. Bioinformatic analysis revealed overlapping ferroptosis-related gene signatures between DM and ALI. In lipopolysaccharide (LPS)-induced ALI mice with diabetes mellitus (DM), reducing AGEs levels attenuated inflammatory cell infiltration and pro-inflammatory cytokine production, decreased Fe²⁺ accumulation and malondialdehyde (MDA) levels, and increased the expression of glutathione peroxidase 4 (GPX4) and solute carrier family 7 member 11 (SLC7A11). In vitro experiments suggested that AGEs exacerbate ferroptotic injury in LPS-treated bronchial epithelial (BEAS-2B) cells partly by suppressing AMP-activated protein kinase (AMPK)/acetyl-CoA carboxylase (ACC) signaling, an effect mitigated by pharmacological AMPK activation. These findings support a potential mechanistic link between DM and ALI through AGEs-driven ferroptosis and raise the possibility that targeting the AMPK/ACC pathway could offer therapeutic benefit.