Redox imbalance,
mitochondrial dysfunction, and
inflammation play a major role in the pathophysiology of
X-linked adrenoleukodystrophy (
X-ALD), an inherited
neurodegenerative disease caused by mutations in the ABCD1 gene, encoding the
protein responsible for peroxisomal import and degradation of very long chain
fatty acids (VLCFAs). Therefore, VLCFAs accumulate in tissues and plasma, constituting a pathognomonic
biomarker for diagnosis. However, the precise role of VLCFA accumulation on the diverse clinical phenotypes of
X-ALD and the pathogenic link between VLCFAs and oxidative stress remain currently unclear. This study proposes ferroptosis as a crucial contributor to the disease development and progression. The expression profiles of "GPX4-
glutathione" and "NQO1-
CoQ10" ferroptosis pathways have been analyzed in fibroblasts of one patient with AMN, the late onset and slowly progressive form of
X-ALD, and in two patients with cALD, the cerebral inflammatory demyelinating form of early childhood. Furthermore, as no effective treatments are currently available, especially for the rapidly progressing form of
X-ALD (cALD), the efficacy of NAC treatment has also been evaluated to open the way toward novel combined
therapies. Our findings demonstrate that
lipid peroxides accumulate in
X-ALD fibroblasts and ferroptosis-counteracting
enzymes are dysregulated, highlighting a different
antioxidant response in patients with AMN and cALD.