COQ4 and hyperinsulinemic hypoglycemia, familial, 4: FSP1 overexpression or CoQ10 supplementation alone partially alleviates ferroptosis whereas combined intervention more effectively improves it.<h4>Discussion</h4>This study demonstrates that Coq4 deficiency induces endothelial ferroptosis via disrupting the FSP1-CoQ10 antioxidant axis, and may also provide new insights into the pathogenesis of pregnancy complications caused by placental dysfunction and iron-related vascular diseases, while offering novel approaches for exploring potential therapeutic targets.