Abstract

Objective: Primary intracerebral hemorrhage (ICH) is a severe stroke subtype characterized by high mortality and disability rates, largely attributable to secondary brain injury (SBI). While programmed cell death (PCD) pathways contribute to SBI, their mechanisms remain incompletely understood. This research investigated PANoptosis, a newly defined integrated PCD pathway, and its interactions with immune responses in ICH.Methods: The transcriptomic dataset GSE24265 was analyzed to identify differentially expressed genes (DEGs), which were intersected with a PANoptosis-related gene set. PANoptosis-related DEGs were analyzed through protein-protein interaction (PPI) networks, functional enrichment, and machine learning (LASSO and Random Forest) to identify signature genes. The diagnostic utility was evaluated using nomograms and receiver operating characteristic (ROC) curves. Immune interactions were assessed using CIBERSORT. Key findings were validated in clinical specimens using qRT-PCR and Western blot.Results: We identified 50 PANoptosis-related DEGs in ICH and derived five signature genes (AKR1C2, SLC2A14, FTL, TNFRSF12A, and SLC2A3) that were significantly upregulated and had high diagnostic accuracy. These genes were implicated in an inflammatory cell death hub, as their expression correlated with altered proportions of T follicular helper and T gamma delta cells, linking PANoptosis to immune dysregulation. Experimental validation confirmed the upregulation of mRNA levels of SLC2A3, SLC2A14, and TNFRSF12A in perihematomal tissues, along with increased protein levels of SLC2A3 and SLC2A14. Functional enrichment analysis linked these genes to HIF-1, NF-κB, and TNF signaling pathways in ICH PANoptosis.Conclusion: Our study identifies PANoptosis as a pathological hub connecting SBI and neuroinflammation in ICH, with five signature genes serving as key diagnostic biomarkers. Notably, SLC2A3 was significantly elevated in peripheral blood, highlighting its potential