Abstract:Objective: To identify shared key genes associated with manganese (Mn) metabolism and ferroptosis in intracerebral hemorrhage (ICH), and to explore potential mechanisms underlying the onset and progression of ICH. Methods: Differentially expressed genes derived from acute ICH-related GEO datasets were intersected with module genes identified by weighted gene co-expression network analysis, as well as with ferroptosis-related genes and Mn metabolism-related genes, to identify overlapping candidates. Functional enrichment analyses and protein-protein interaction network construction were performed for the overlapping genes. LASSO regression and random forest algorithms were applied to identify key genes. Based on these genes, a nomogram model was established to evaluate ICH risk. Subsequently, cell type identification, trajectory analysis, and immune infiltration analysis were conducted. Protein expression of the key genes in rats was validated using western blot analysis. Results: A total of 16 overlapping genes were identified. Among them, Ftl1, Gdf15, and Hmox1 were recognized as key genes by both LASSO regression and random forest analysis. The nomogram constructed based on these genes demonstrated high accuracy in risk prediction. These genes were enriched in immune- and inflammation-related pathways and were significantly upregulated in ICH samples at both the bulk and single-cell levels. Notably, macrophage proportions were markedly increased in ICH, and all three genes exhibited pronounced macrophage-specific expression patterns, suggesting that macrophages may represent a critical cell type through which these genes jointly contribute to ICH pathology. Furthermore, trajectory analysis revealed that the expression of these genes increased over time during the transition toward pro-inflammatory (M1) macrophages. Immune infiltration analysis indicated that Gdf15 and Hmox1 were significantly associated with T-cell and natural killer cell subpopulations. Western blot experiments confirmed elevated protein expression levels of Ftl1, Gdf15, and Hmox1 in the ICH model. Conclusion: Ftl1, Gdf15, and Hmox1 were identified as shared key genes involved in Mn metabolism and ferroptosis in ICH. These findings suggest a potential direct molecular link between Mn metabolic dysregulation and ferroptosis, providing candidate molecular targets for further mechanistic investigations.