Drugging the ferroptotic landscape of Friedreich’s Ataxia: Current paradigms and future directions

Drugging the ferroptotic landscape of Friedreich’s Ataxia: Current paradigms and future directions

Giovanni Cravin
1
,
Giorgio Cozza
1,2,*
*Correspondence to: Giorgio Cozza, Department of Molecular Medicine, University of Padua, Padua 35131, Italy. E-mail: giorgio.cozza@unipd.it
Ferroptosis Oxid Stress. 2026;2:202618. 10.70401/fos.2026.0032
Received: April 29, 2026Accepted: June 16, 2026Published: June 16, 2026
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This manuscript is made available in its unedited form to allow early access to the reported findings. Further editing will be completed before final publication. As such, the content may include errors, and standard legal disclaimers are applicable.

Abstract

Friedreich’s Ataxia (FRDA) is a rare neurodegenerative condition driven by a severe deficiency of the mitochondrial protein frataxin. This depletion impairs mitochondrial iron-sulfur cluster biogenesis and disrupts intracellular iron homeostasis, ultimately promoting oxidative stress. Driven by localized iron overload and the continuous generation of reactive oxygen species, the resulting metabolic dysfunction renders vulnerable tissues highly susceptible to ferroptosis. This iron-dependent form of regulated cell death, executed through excessive lipid peroxidation, is now widely acknowledged as an important contributor to the neurodegeneration and hypertrophic cardiomyopathy that characterize FRDA. In the present review, we explore how frataxin loss undermines cellular defenses against oxidative damage, placing a specific focus on the regulation of the lipid redox landscape. We detail the breakdown of glutathione (GSH)-dependent mechanisms, specifically highlighting the blunted Nrf2 antioxidant response and the subsequent reduced capacity of glutathione peroxidase 4. Alongside these deficits, we investigate the compensatory roles of GSH-independent rescue networks, namely ferroptosis suppressor protein 1 and mitochondrial dihydroorotate dehydrogenase. Looking toward clinical translation, we critically assess emerging pharmacological interventions designed to target these ferroptotic nodes. The potential of mitochondria-targeted iron chelators, lipoxygenase inhibitors, lipophilic radical-trapping antioxidants, and novel Nrf2 activators is evaluated to determine whether inhibiting ferroptosis can serve as a viable disease-modifying strategy. Moving forward, combinatorial “protect and restore” approaches will likely prove essential for maximizing therapeutic efficacy in FRDA.

Keywords

Friedreich’s ataxia, ferroptosis, Nrf2, antioxidants, glutathione peroxidase 4, reactive oxygen species

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Cravin G, Cozza G. Drugging the ferroptotic landscape of Friedreich’s Ataxia: Current paradigms and future directions. Ferroptosis Oxid Stress. 2026;2:202618. https://doi.org/10.70401/fos.2026.0032

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