Cited by 2,638Antioxidant Activity and Oxidative StressRedox biology and oxidative stressExercise and Physiological Responses

The DOI matches its Crossref record; 672 of the 675 references it cites were found in a registry or an index; none of the 567 sources its claims cite is checked for support yet.

Reactive oxygen species, toxicity, oxidative stress, and antioxidants: chronic diseases and aging

Open access
Jomova, Klaudia, Raptova, Renata, Alomar, Suliman Y., Alwasel, Saleh H., Nepovimova, Eugenie, Kuca, Kamil, Valko, Marian·2023·Archives of Toxicology

Abstract

A physiological level of oxygen/nitrogen free radicals and non-radical reactive species (collectively known as ROS/RNS) is termed oxidative eustress or “good stress” and is characterized by low to mild levels of oxidants involved in the regulation of various biochemical transformations such as carboxylation, hydroxylation, peroxidation, or modulation of signal transduction pathways such as Nuclear factor-κB (NF-κB), Mitogen-activated protein kinase (MAPK) cascade, phosphoinositide-3-kinase, nuclear factor erythroid 2–related factor 2 (Nrf2) and other processes. Increased levels of ROS/RNS, generated from both endogenous (mitochondria, NADPH oxidases) and/or exogenous sources (radiation, certain drugs, foods, cigarette smoking, pollution) result in a harmful condition termed oxidative stress (“bad stress”). Although it is widely accepted, that many chronic diseases are multifactorial in origin, they share oxidative stress as a common denominator. Here we review the importance of oxidative stress and the mechanisms through which oxidative stress contributes to the pathological states of an organism. Attention is focused on the chemistry of ROS and RNS (e.g. superoxide radical, hydrogen peroxide, hydroxyl radicals, peroxyl radicals, nitric oxide, peroxynitrite), and their role in oxidative damage of DNA, proteins, and membrane lipids. Quantitative and qualitative assessment of oxidative stress biomarkers is also discussed. Oxidative stress contributes to the pathology of cancer, cardiovascular diseases, diabetes, neurological disorders (Alzheimer’s and Parkinson’s diseases, Down syndrome), psychiatric diseases (depression, schizophrenia, bipolar disorder), renal disease, lung disease (chronic pulmonary obstruction, lung cancer), and aging. The concerted action of antioxidants to ameliorate the harmful effect of oxidative stress is achieved by antioxidant enzymes (Superoxide dismutases-SODs, catalase, glutathione peroxidase-GPx), and small molecular weight antioxidants (vitamins C and E, flavonoids, carotenoids, melatonin, ergothioneine, and others). Perhaps one of the most effective low molecular weight antioxidants is vitamin E, the first line of defense against the peroxidation of lipids. A promising approach appears to be the use of certain antioxidants (e.g. flavonoids), showing weak prooxidant properties that may boost cellular antioxidant systems and thus act as preventive anticancer agents. Redox metal-based enzyme mimetic compounds as potential pharmaceutical interventions and sirtuins as promising therapeutic targets for age-related diseases and anti-aging strategies are discussed.

Overview

AI snapshot

Written from a shortened version of the paper’s full text (it is longer than we read).

TL;DR

This review argues that ROS/RNS at physiological levels support redox signaling (“oxidative eustress”), while excessive ROS/RNS cause oxidative stress (“distress”) that is a common denominator in chronic diseases and aging. It surveys ROS/RNS chemistry, antioxidant systems, oxidative-stress biomarkers, disease associations, and antioxidant interventions, concluding that antioxidant therapy has shown only limited and inconsistent clinical benefit.

Key findings

  • Oxidative stress is implicated as a shared feature of cancer, cardiovascular disease, diabetes, neurological disorders (Alzheimer’s and Parkinson’s diseases, Down syndrome), psychiatric disorders (depression, schizophrenia, bipolar disorder), renal disease, lung disease (COPD, lung cancer), and aging.
  • Antioxidant defense includes enzymes (SODs, catalase, GPx) and low-molecular-weight antioxidants (vitamins C and E, flavonoids, carotenoids, melatonin, ergothioneine, and others); vitamin E is described as “the first line of defense against the peroxidation of lipids.”
  • Clinical antioxidant results are mixed: in the ATBC trial, β-carotene supplementation (20 mg/day for 5–8 years) was associated with an 18% increased incidence of lung cancer; the CHAOS trial found α-tocopherol reduced myocardial infarction but not cardiovascular mortality, while the HOPE trial failed.
  • Some interventions showed benefit in specific contexts: CoQ10 at 1200 mg/day delayed progression in early Parkinson’s disease; NAC (50 mg/kg IV plus 500 mg orally twice daily for 3 months) improved dopamine transporter binding by about 3.5–8.3% in Parkinson’s patients.

Methods

  • Narrative review of ROS/RNS chemistry, endogenous and exogenous sources, ROS-mediated signaling pathways, antioxidant systems, oxidative-stress biomarkers, and disease/aging associations.
  • Discusses evidence from in vitro experiments, animal models, and clinical trials, including selected trial doses and outcomes.
  • No systematic review search strategy, inclusion criteria, or quantitative meta-analysis is stated in the paper.

Limitations

  • The paper states that many in vitro antioxidant results cannot be simply translated to in vivo conditions, and that some antioxidants switch to prooxidant behavior or lose activity in vivo.
  • It states that whether oxidative stress is a cause or consequence of disease is impossible to conclude, and that “total antioxidant capacity” has serious limitations.
  • Evident from the text: as a narrative review, it does not provide a systematic search, risk-of-bias assessment, or pooled effect estimates, so the strength of disease-specific conclusions varies.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1007/s00204-023-03562-9

Cites

672 of 672 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 567 cited sources checked · 0 supported · 0 flagged

Show all 306 claims

  • Probably not a substantial claim. 91
  • It may state two separate claims as one. 227
  • The quote only partly states this claim. 3
297 of 297
  • The paper relies on this without support.

    Many chronic diseases are multifactorial in origin.

    “Although it is widely accepted, that many chronic diseases are multifactorial in origin, they share oxidative stress as a common denominator.”
  • The paper relies on this without support.

    ROS are important players in cellular proliferation, differentiation, migration, apoptosis, and necrosis.

    “ROS are important players in cellular proliferation, differentiation, migration, apoptosis, and necrosis.”
  • The paper relies on this without support.

    Low to intermediate levels of ROS and RNS are necessary for the maintenance of many important physiological functions, redox homeostasis, and the regulation of key transcription factors.

    “Low to intermediate levels of ROS and RNS are necessary for the maintenance of many important physiological functions, redox homeostasis, and the regulation of key transcription factors.”
  • The paper relies on this without support.

    The level of oxidative stress, quantified by oxidative stress markers, is elevated in aging individuals or people with bad lifestyles, taking unhealthy food, smoking, drinking alcohol, lack of physical exercise, and genetic predisposition.

    “The level of oxidative stress, quantified by the oxidative stress markers, has been found elevated in aging individuals or people with bad lifestyles, taking unhealthy food, smoking, drinking alcohol, lack of physical exercise, and genetic predisposition.”
  • The paper relies on this without support.

    Superoxide does not react with DNA directly.

    “Since superoxide does not react with DNA directly, in the context of DNA damage is of important dismutation reaction of superoxide radical2”
  • The paper relies on this without support.

    Hydrogen peroxide plays an important role in growth factor-induced signal transduction, maintenance of thiol redox homeostasis, and mitochondrial functioning.

    “Hydrogen peroxide plays an important role in growth factor-induced signal transduction, maintenance of thiol redox homeostasis, and mitochondrial functioning.”
  • The paper relies on this without support.

    Peroxynitrite is a very powerful oxidant capable of causing damage to biomolecules including proteins and DNA.

    “Peroxynitrite is a very powerful oxidant capable of causing damage to biomolecules including proteins and DNA.”
  • The paper relies on this without support.

    Several chronic diseases and aging are characterized by oxidative stress as a common denominator.

    “In the next sections, we will discuss several chronic diseases and aging characterized by oxidative stress as a common denominator.”
  • The paper relies on this without support.

    Oxidative stress, cellular senescence, and SASP are involved in the incidence of chronic diseases involving cardiovascular diseases, cancer, metabolic, renal, lung, and neurological disorders, and other diseases.

    “Oxidative stress, cellular senescence, and SASP are involved in the incidence of chronic diseases involving cardiovascular diseases, cancer, metabolic, renal, lung, and neurological disorders (Alzheimer’s and Parkinson’s disease), and other diseases.”
  • The paper relies on this without support.

    ROS are known to interfere with various components of SASP.

    “ROS are known to interfere with various components of SASP.”
  • The paper relies on this without support.

    Hyperhomocysteinemia occurs approximately in about 5% of the population, and among patients with cardiovascular diseases this condition occurs in up to 45% of patients.

    “This condition occurs approximately in about 5% of the population, however, among patients with cardiovascular diseases this condition occurs in up to 45% of patients and represents a serious risk of heart attack, endothelial dysfunction, arterial diseases, extracranial carotid artery disease, a common cause of the transient ischemic attack, termed also “mini-stroke”.”
  • The paper relies on this without support.

    Hyperactivation of ERK plays an important role in cancer progression.

    “Hyperactivation of ERK plays an important role in cancer progression.”
  • The paper relies on this without support.

    Cancer cells produce significantly higher amounts of ROS than normal cells.

    “Cancer cells produce significantly higher amounts of ROS than normal cells”
  • The paper relies on this without support.

    The onset of PD is associated with severely decreased levels of reduced glutathione (GSH) in the substantia nigra.

    “The onset of PD is associated with severely decreased levels of reduced glutathione (GSH) in the substantia nigra.”
  • The paper relies on this without support.

    GSH depletion precedes the dysfunction of mitochondrial complex I and lowered dopamine levels.

    “GSH depletion has been confirmed to precede the dysfunction of mitochondrial complex I and lowered dopamine levels.”
  • The paper relies on this without support.

    Dopamine transport, utilization, and storage may be involved in increased ROS formation followed by cellular dysfunction.

    “Dopamine transport, utilization, and storage may be involved in increased ROS formation followed by cellular dysfunction.”
  • The paper relies on this without support.

    Calcium is an essential metal involved in the pathogenesis of PD.

    “Calcium is another essential metal involved in the pathogenesis of PD.”
  • The paper relies on this without support.

    The most important genes associated with familial PD involve α-synuclein, DJ-1, Parkin, PINK-1, and others.

    “The most important genes associated with familial PD involve α-synuclein (discussed above), DJ-1, Parkin, PINK-1, and others.”
  • The paper relies on this without support.

    Vitamin D supplementation did not improve symptoms in bipolar disorder patients with low levels of vitamin D.

    “Surprisingly, supplementation of patients with vitamin D did not improve the symptoms of bipolar disorder patients with low levels of vitamin D.”
  • The paper relies on this without support.

    Oxidative stress is a common denominator of kidney diseases and associated complications such as cardiovascular diseases and inflammation.

    “In fact, oxidative stress is a common denominator of kidney diseases and associated complications such as cardiovascular diseases and inflammation.”
  • The paper relies on this without support.

    About 85% of lung cancers are associated with smoking.

    “About 85% of lung cancers are associated with smoking, however, lung cancer occurs also among non-smokers and represents the seventh most common cause of cancer mortality which indicates that other factors such as genetic predisposition, diet, silica, asbestos, high energy radiation, concentration of radon and other factors play a role.”
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Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Singlet species is called a radical despite having no unpaired electrons

    Minor

    The paper defines a free radical as having at least one unpaired electron, but later calls a species with no unpaired electrons a "Singlet radical."

  • Ex-527 is described as both inhibiting and increasing SIRT1 activity

    Minor

    The paper calls Ex-527 a potent SIRT1 inhibitor, but also attributes its protective effect to an increase in SIRT1 activity without explaining how the two claims fit together.

  • 3-NT is given two different meanings

    Minor

    The paper first identifies 3-NT as 3-nitrotyrosine, then calls it "3 neurotrophic factor" in the bipolar-disorder section.

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Citations

Cites

1 retracted

Items 201–400 of 672

Flagged first, then by citations

3 of the 675 references couldn’t be matched to a known paper.

Research works printed but not linked: 11

  1. Aiken CA (2018) Common antioxidant shows promise in bipolar depression. Psychiatr times 35:20
  2. Bandyopadhyay U, Das D, Banerjee RK (1999) Reactive oxygen species: oxidative damage and pathogenesis. Curr Sci 77(5):658–666
  3. Bernardo VS (2021) Ergotionein as a therapeutic alternative: antioxidant and/or modulating effects on K562 erythroleukemic cells [Master thesis, Universidade Estadual Paulista]. UNESP Institutional Repository, M.Sc. Thesis. https://hdl.handle.net/11449/204323. Accessed 7 Aug 2023
  4. Kouser S, Kausar S, Khan S, Ghani M, Yousef N (2021) Role of antioxidants in the management of Schizophrenia: a randomized control trail. J Appl Mech Eng 10(3):1–4
  5. Krishnamurthy P, Wadhwani A (2012) Antioxidant enzymes and human health. Antioxidant enzyme. InTech
  6. Mandal A, Hossain U, Sil PC (2022) Antioxidants and cardiovascular diseases. In: Nabavi SM, Silva A (eds) Antioxidants in health, the bright and dark side, 1st edn. Elsevier, pp 613–640
  7. O-Uchi J, Jhun BS, Mishra J, Sheu SS (2018) Organellar ion channels and transporters in cardiac electrophysiology: from cell to bedside, 7th edn. Elsevier, pp 66–69
  8. Rahman I, Biswas SK (2006). In: Laurent GJ, Shapiro SD (eds) Oxidants and antioxidants, encyclopedia of respiratory medicine, 2006 258–266. Elsevier
  9. Sies H (1985) Oxidative stress: introductory remarks. In: Sies H (ed) Oxidative stress. Academic Press, London, pp 1–8
  10. Wang L, Azad N, Kongkaneramit L, Chen F, Lu Y, Jiang BH, Rojanasakul Y (2012) The Fas death signaling pathway connecting reactive oxygen species generation and FLICE inhibitory protein down-regulation. J Immunol 180(5):3072–3080. https://doi.org/10.4049/jimmunol.180.5.3072 · DOI · Paper page
  11. WHO (2001) Biomarkers in risk assessment: validity and validation. WHO, Geneva

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Metadata

Authors
Jomova, K., Raptova, R., Alomar, S. Y., Alwasel, S. H., Nepovimova, E., Kuca, K., & Valko, M.
Affiliations
King Saud University (SA)
Venue
Archives of Toxicology
Published
2023-08-19
Volume
97
Issue
10
Pages
2499-2574
ISSN
  • 0340-5761 (ISSN-L)
  • 1432-0738
OpenAlex
W4385999933
Cited by
2,638
References
675
Citations by year
2026: 852 · 2025: 1193 · 2024: 559 · 2023: 33
FWCI
52.53
Type
journal article
Language
en
Open access
Locations
  • Archives of Toxicology (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Funders
  • DSFP contract
  • Agentúra Ministerstva Školstva, Vedy, Výskumu a Športu SR (1/0482/20)
  • Czech Ministry of Health (NV19-09-00578)
  • Slovak Technical University
Topics
  • Health Sciences › Medicine › Biochemistry (medical) › Antioxidant Activity and Oxidative Stress
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Redox biology and oxidative stress
  • Health Sciences › Medicine › Physiology (medical) › Exercise and Physiological Responses
Keywords
reactive oxygen species, reactive nitrogen species, oxidative stress, antioxidants, chronic disease, aging, oxidative damage, oxidative stress biomarkers, superoxide, hydrogen peroxide, hydroxyl radicals, peroxynitrite, nitric oxide, lipid peroxidation, DNA damage, protein oxidation, antioxidant enzymes, superoxide dismutase, catalase, glutathione peroxidase, vitamin E, flavonoids, melatonin, ergothioneine, sirtuins
MeSH terms
Antioxidants, Chronic Disease, Humans, Reactive Oxygen Species, Oxidative Stress

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