Ferroptotic propagation: from single-cell execution to tissue-scale death programs

Ferroptosis has long been regarded as a cell-autonomous form of regulated cell death driven by iron-dependent lipid peroxidation. Recent work, however, suggests that ferroptotic commitment can extend beyond the initiating cell, spreading to neighboring cells and, in some contexts, across tissue-scale distances. Multiple, non-mutually exclusive modes of contagion have now been described, including reactive oxygen species-triggered death waves, direct membrane contact-dependent transfer, and extracellular vesicle-mediated paracrine signaling. These findings redefine ferroptosis from a single-cell execution pathway into a spatially coordinated, multicellular process. In this perspective, we integrate mechanistic insights with experimental evidence on ferroptotic contagion and propose a unifying, multiscale framework in which distinct modes of transmission operate over different spatial scales, from short-range membrane transfer to longer-range oxidative and extracellular relay mechanisms. We discuss how nonlinear redox amplification, membrane biophysics, and tissue architecture together determine the dynamics, limits, and patterning of ferroptotic injury in vivo. This emerging framework has important implications for developmental tissue remodeling, the progression of organ injury, and ferroptosis-based cancer therapy. More broadly, defining how ferroptotic contagion is initiated, constrained, and manipulated therapeutically may help establish ferroptosis as a fundamental organizing principle for understanding tissue-level regulation and pathological escalation.