Arterial iron regulates vasodilation during anemia via endothelial holo α-globin

Iron deficiency is a highly prevalent nutrient deficiency and the most common cause of anemia. Although iron deficiency exacerbates cardiovascular disease, the direct impact of iron deficiency on the vasculature remains unstudied. We assessed iron levels across the vascular endothelium in mouse and human endothelial cells and found resistance artery endothelial cells have the lowest iron stores, suggesting they may be especially impacted by iron deficiency. Anemia has previously been shown to increase arterial NO signaling in patients, and we have previously shown endothelial a-globin scavenges nitric oxide (NO) in the resistance artery endothelium. We hypothesized iron regulates vascular function through regulation of endothelial a-globin. To test this, we used a mouse model of iron deficiency anemia (IDA). In female mice, IDA increased NO signaling, which was rescued to control levels by repletion of vascular iron with iron dextran. Despite being similarly anemic and having a similar reduction in a-globin protein, there were no changes in NO signaling across groups in male mice. We further measured whether a-globin was in its heme-bound (holo a-globin) or heme-free (apo a-globin) state and found males did not fully lose its functional, heme-bound a-globin. Using endothelial specific a-globin knockout mice, we show loss of endothelial a-globin is necessary for increased NO signaling in IDA and for the rescue of NO signaling by iron dextran in female mice. Altogether, the data presented here demonstrate iron is a determinant of endothelial identity and modulates endothelial NO signaling through the regulation of a-globin.