Abbreviations: AA, arachidonic acid; Abhd5, abhydrolase domain containing 5; Ace, angiotensin I converting enzyme; Acsl4, Long-chain fatty-acid-CoA ligase 4; AdA, adrenic acid;Alox5ap, arachidonate 5-lipoxygenase-activating protein; ALT, alanine aminotransferase; AST, aspartate aminotransferase; ATCC, American Type Culture Collection; CoQ, coenzyme Q; Cyp, cytochrome P450; DFO, deferoxamine; Elovl6, elongation of very long chain fatty acids protein 6; Fer-1, Ferrostatin-1; FSP1, ferroptosis suppressor protein 1; GPX4, glutathione peroxidase 4; HCC, hepatocellular carcinoma; HE, hematoxylin and eosin; Hmox1, heme oxygenase-1; Hsl, hormone-sensitive lipase; IRPs, iron regulatory proteins; KEGG, Kyoto Encyclopedia of Genes; LDs, lipid droplets; Lip-1, Liprostatin-1; Lpcat2, lysophosphatidylcholine acyltransferase 2; MCD, methionine-and choline-deficient; MCDM, methionine-and choline-deficient medium; Mcp-1, monocyte chemoattractant protein-1; NAFLD, nonalcoholic fatty liver disease; NAS score, non-alcoholic steatohepatitis score; NASH, nonalcoholic steatohepatitis; Nox2, NADPH oxidase 2; PBS, phosphate buffer solution; PE, phosphatidylethanolamine; PI, propidium iodide; Pla2g4a, phospholipase A2, group IVA; Pnpla2, patatin like phospholipase domain containing 2; PPAR, peroxisome proliferator-activator receptor; Ptgs1/2, prostaglandin-endoperoxide synthase 1/2; PUFAs, polyunsaturated fatty acids;RNA-seq, RNA-sequencing; ROS, reactive oxygen species; RTA, radical trapping agent; RT-PCR, real-time polymerase chain reaction; shRNA, short hairpin RNA; Srebp1c, sterol regulatory element-binding protein 1c; TEM, transmission electron microscopy; Tgfβ, transforming growth factor-β; Tnf-α, tumor necrosis factor-α; VLDL, very-low-density lipoprotein. Abstract Background: NASH is one of the fastest growing liver diseases that leads to severe steatosis, inflammation and ultimately liver injury. However, the pathophysiological mechanisms of NASH remain unclear and pharmacological treatment against the disease is unavailable currently. Ferroptosis is a non-apoptotic form of cell death induced by iron-dependent lipid peroxidation. Since NASH progression is accompanied by massive lipid accumulation, which generates lipotoxic species, we investigated the role of ferroptosis in NASH progression. Method: Mice were fed on MCD-diet to mimic NASH progression and gene expression in liver was analysed by RNA-seq. The occurrence of hepatic ferroptosis was measured by lipid ROS level, electron microscopy and in vivo PI staining. The beneficial effects of ferroptosis inhibitors on NASH was evaluated by liver pathology analysis. The mechanism of lipid ROS induced lipid droplets accumulation was investigated by in vitro cell culture. Results: RNA-seq analysis suggested that elevated arachidonic acid metabolism promotes ferroptosis in MCD-diet fed mouse livers, which was further demonstrated by lipid ROS accumulation, morphological change of mitochondria and increased cell death. Iron accumulation was detected in the liver and the serum of MCD-f...