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This study delves into the emerging role of ferroptosis in Myelodysplastic Neoplasms (MDS) and aims to identify a prognostic ferroptosis-related gene signature for MDS. Utilizing RNA-seq data and clinical information from the Gene Expression Omnibus database, the researchers extracted ferroptosis-related genes from the FerrDb website and conducted differential expression analysis using the 'limma' package in R. Hub ferroptosis-related genes in MDS were screened using the “RandomForest” and “carat” R packages. Kaplan -Meier and Cox regression analyses were employed to assess the prognostic role of three identified hub genes ( BNIP3, MDM2, and RRM2 ). Receiver operator characteristic curve analysis confirmed the diagnostic efficacy of these genes. The study delved further into immune infiltration correlations, ncRNA-transcription factor coregulatory network analysis, and the identification of potential therapeutic drugs targeting hub ferroptosis-related genes in MDS. The researchers constructed a 3-gene signature-based risk score using datasets GSE58831 and GSE19429, demonstrating high accuracy (AUC &gt; 0.75) in both datasets for survival prediction in MDS. A nomogram analysis reinforced the prognostic value of the risk-scoring model. Immunological analysis revealed an association between the risk score and immune infiltration. Quantitative reverse transcription polymerase chain reaction (qPCR) data indicated significant expression differences in  MDM2, RRM2 , and  BNIP3  between MDS and healthy bone marrow samples. Notably, MDM2 and RRM2 showed decreased expression, while  BNIP3  exhibited increased expression in MDS samples. This comprehensive study concludes that  BNIP3, MDM2 , and  RRM2  hold diagnostic and prognostic significance in MDS and provide valuable insights into immune cell landscapes and potential therapeutic avenues for this condition.

Diagnostic and prognostic value of ferroptosis-related genes in patients with Myelodysplastic neoplasms