The predictive, preventive, and personalized medicine of multiple sclerosis: ferroptosis and circulating proteins.

Based on the principles of Predictive, Preventive, and Personalized Medicine (PPPM), this study aimed to identify ferroptosis-related genes associated with multiple sclerosis (MS) and to explore the underlying mechanisms through genetic approaches. Summary statistics of circulating proteins were obtained from the UK Biobank Pharma Proteomics Project (UKB-PPP), ferroptosis-related genes were curated from the FerrDb database, and MS genome-wide association study (GWAS) data were sourced from the International Multiple Sclerosis Genetics Consortium (IMSGC). Two-sample Mendelian randomization (MR) analyses were performed to assess the causal relationships between proteins, ferroptosis-related genes, and MS risk. Mediation MR analysis was conducted to explore the potential mediating role of ferroptosis-related genes. The primary analytical method was inverse variance weighting (IVW), supplemented by MR-Egger and weighted median approaches. After Bonferroni correction, one ferroptosis-related gene (Ferritin Mitochondrial, FTMT) and 21 circulating proteins were significantly associated with MS. Eleven protein-gene pairs were identified. Mediation analysis further revealed that FTMT mediated the effects of several proteins on MS risk, including CD8A (17.6%), CFB (9.0%), ENPP6 (9.5%), GZMA (22.9%), KIR2DL2 (17.4%), KIR2DL3 (16.9%), and TNXB (13.2%). This study highlights the critical role of FTMT in linking circulating proteins to MS pathogenesis through ferroptosis regulation, providing novel insights into predictive, preventive, and personalized medicine strategies for MS management.