Overburdened Ferroptotic Stress Impairs Tooth Morphogenesis

Reviewer #1 (Public Review):

Cell death plays a critical role on regulating organogenesis. During tooth morphogenesis, apoptosis of embryonic dental tissue plays critical roles on regulating tooth germ development. The current study focused on ferroptosis, another way of cell death which has rarely been investigated in tooth development, and showed it may also play an important role on regulating the tooth dimension. The topic is novel and interesting, but the experimental design has many flaws which significantly compromised the study.

1. The entire study was based on ex vivo tooth germ explant culture. Mandibular tooth germs of E15.5 (bell stage) were isolated for ex vivo culture. Most tooth germ explant culture experiments were actually using tooth germ of much earlier stages (E11.5-E13.5) for organ culture. After E16.5, both the large size and initially formed enamel/dentin could prevent nutrition from penetrating inside. Also, using tooth germ of earlier stage will help identify impact of ferroptosis upon early tooth development.
2. Due to limited penetration, the ex vivo culture in the study lasted for no more than 5 days. I would recommend the authors to perform kidney capsule transplantation as an alternative approach, which can support tooth germ development much longer even into root formation.
3. The major justification of using tooth germ ex vivo culture as the model in the study was to "conduct high-throughput analysis". However, the study could hardly be qualified as a high-throughput analysis. I would recommend the authors perform RNA sequencing for comparing tooth germs before/after erastin treatment. Such experiments won't take too much time or resource.
4. Although the study mostly used molars as the model, the in vivo iron concentration was only demonstrated on incisors, but not molars (Figure 1).
5. Phenotype analysis in Figure 2 is too superficial. Only dimensional information was provided. Cusps number, cusps distribution pattern and rooth/furcation formation were not evaluated. Differentiation of amelobast/odontoblast was not evaluated. The proliferation rate in the dental epithelium/mesenchyme was not analyzed.
6. Low magnification images should be included in Figure 3 to display the entire tooth germs.
7. In Figure 4, does ferroptotic inhibitor eliminate the iron accumulation in the tooth germ? How about the expression level of several target genes shown in Figure 3?
8. The manuscript has many typos and grammar mistakes. All "submandibular" should be simply "mandibular". "eastin" should be "erastin" (line 92). "partly" should be "partially" (line 611).

Reviewer #2 (Public Review):

The present study by Ye et al. characterizes some of the major effects of ferroptotic stress on tooth morphogenesis.

The strengths of this study are its innovative nature and beautiful histology. Mechanistic data are convincing Overall, the study is well done.

Reviewer #3 (Public Review):

This is an interesting work reporting ferroptosis that is involved in the tooth morphogenesis. The authors showed that Gpx4, the core anti-lipid peroxidation enzyme in ferroptosis, is upregulated in tooth development using ex vivo culture system.