Health position paper and redox perspectives – Bench to bedside transition for pharmacological regulation of NRF2 in noncommunicable diseases
Open accessAbstract
Nuclear factor erythroid 2-related factor 2 (NRF2) is a redox-activated transcription factor regulating cellular defense against oxidative stress, thereby playing a pivotal role in maintaining cellular homeostasis. Its dysregulation is implicated in the progression of a wide array of human diseases, making NRF2 a compelling target for therapeutic interventions. However, challenges persist in drug discovery and safe targeting of NRF2, as unresolved questions remain especially regarding its context-specific role in diseases and off-target effects. This comprehensive review discusses the dualistic role of NRF2 in disease pathophysiology, covering its protective and/or destructive roles in autoimmune, respiratory, cardiovascular, and metabolic diseases, as well as diseases of the digestive system and cancer. Additionally, we also review the development of drugs that either activate or inhibit NRF2, discuss main barriers in translating NRF2-based therapies from bench to bedside, and consider the ways to monitor NRF2 activation in vivo.
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Compared to systemic administration of Nrf2 agonists, the localized activation strategy provided by TA-GelMA circumvents potential side effects related to systemic Nrf2 activation.
“Compared to the systemic administration of Nrf2 agonists, the localized activation strategy provided by TA-GelMA circumvents potential side effects related to systemic Nrf2 activation58,59, thereby enhancing clinical application safety.”
From Intelligence-responsive wettability switch coating on magnesium implants for treating osteoporotic fracture (2026) · cites this paper as [59]
The Conclusions and future perspective section (page unavailable) reports unwanted effects in patients taking NRF2 activators, supporting the concern about potential side effects. It explicitly says further research is needed to determine whether those effects arise from NRF2 activation or off-target activity. It does not establish that localized TA-GelMA activation avoids them; that comparison is the citing authors’ inference. (LLM, conf=0.84)
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Self-citationKensler, T. W., Egner, P. A., Dolan, P. M., Groopman, J. D., & Roebuck, B. D. (1987) · PubMed · Cited by 240 · see citing works
Self-citationCan Activation of NRF2 Be a Strategy against COVID-19?
Cuadrado, A., Pajares, M., Benito, C., Jiménez-Villegas, J., Escoll, M., Fernández-Ginés, R., García‐Yagüe, Á. J., Lastra, D., Manda, G., Rojo, A. I., et al. (2020) · Trends in Pharmacological Sciences · doi:10.1016/j.tips.2020.07.003 · Cited by 239 · see citing works
Self-citationNrf2 protects against airway disorders
Cho, H., & Kleeberger, S. R. (2009) · Toxicology and Applied Pharmacology · doi:10.1016/j.taap.2009.07.024 · Cited by 237 · see citing works
Hong, D. S., Kurzrock, R., Supko, J. G., He, X., Naing, A., Wheler, J., Lawrence, D., Eder, J. P., Meyer, C. J., Ferguson, D. A., et al. (2012) · Clinical Cancer Research · doi:10.1158/1078-0432.ccr-11-2703 · Cited by 236 · see citing works
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Non-Alcoholic Steatohepatitis: A Review of Its Mechanism, Models and Medical Treatments
Peng, C. Y., Stewart, A. G., Woodman, O. L., Ritchie, R. H., & Qin, C. X. (2020) · Frontiers in Pharmacology · doi:10.3389/fphar.2020.603926 · Cited by 230 · see citing works
Meakin, P. J., Chowdhry, S., Sharma, R. S., Ashford, F. B., Walsh, S. V., McCrimmon, R. J., Dinkova‐Kostova, A. T., Dillon, J. F., Hayes, J. D., & Ashford, M. L. J. (2014) · Molecular and Cellular Biology · doi:10.1128/mcb.00677-14 · Cited by 229 · see citing works
Self-citationOvercoming the legal and regulatory barriers to drug repurposing
Breckenridge, A. M., & Jacob, R. (2018) · Nature Reviews Drug Discovery · doi:10.1038/nrd.2018.92 · Cited by 228 · see citing works
Rojo, A. I., Pajares, M., Rada, P., Núñez, Á., Nevado‐Holgado, A. J., Killick, R., LEUVEN, F. V., Ribé, E. M., Lovestone, S., Yamamoto, M. P., et al. (2017) · Redox Biology · doi:10.1016/j.redox.2017.07.006 · Cited by 216 · see citing works
Self-citationFox, D. B., Garcia, N. M. G., McKinney, B. J., Lupo, R., Noteware, L. C., Newcomb, R., Liu, J., Locasale, J. W., Hirschey, M. D., & Alvarez, J. V. (2020) · Nature Metabolism · doi:10.1038/s42255-020-0191-z · Cited by 214 · see citing works
Neymotin, A., Calingasan, N. Y., Wille, E. J., Naseri, N., Petri, S., Damiano, M. G., Liby, K. T., Risingsong, R., Sporn, M. B., Beal, M. F., et al. (2011) · Free Radical Biology and Medicine · doi:10.1016/j.freeradbiomed.2011.03.027 · Cited by 212 · see citing works
Self-citationNRF2 plays a protective role in diabetic retinopathy in mice
Xu, Z., Wei, Y., Gong, J., Cho, H., Park, J. K., Sung, E.-R., Hu, H., Wu, L., Eberhart, C. G., Handa, J. T., et al. (2013) · Diabetologia · doi:10.1007/s00125-013-3093-8 · Cited by 211 · see citing works
Electrophilic nitro-fatty acids activate NRF2 by a KEAP1 cysteine 151-independent mechanism
Kansanen, E., Bonacci, G., Schopfer, F. J., Kuosmanen, S. M., Tong, K. I., Leinonen, H., Woodcock, S. R., Yamamoto, M., Carlberg, C., Ylä-Herttuala, S., et al. (2011) · Journal of Biological Chemistry · doi:10.1074/jbc.m110.190710 · Cited by 208 · see citing works
Self-citationSulforaphane mobilizes cellular defenses that protect skin against damage by UV radiation
Talalay, P., Fahey, J. W., Healy, Z. R., Wehage, S. L., Benedict, A. L., Min, C., & Dinkova‐Kostova, A. T. (2007) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.0708710104 · Cited by 208 · see citing works
Self-citationDiscovery of a small-molecule inhibitor and cellular probe of Keap1–Nrf2 protein–protein interaction
Hu, L., Magesh, S., Chen, L., Wang, L., Lewis, T. A., Chen, Y., Khodier, C., Inoyama, D., Beamer, L. J., Emge, T. J., et al. (2013) · Bioorganic & Medicinal Chemistry Letters · doi:10.1016/j.bmcl.2013.03.013 · Cited by 206 · see citing works
Quiroz, J. A. (2004) · Molecular Interventions · doi:10.1124/mi.4.5.6 · Cited by 206 · see citing works
Comutations and KRASG12C Inhibitor Efficacy in Advanced NSCLC
Negrao, M. V., Araujo, H. A., Lamberti, G., Cooper, A. J., Akhave, N. S., Zhou, T., Delasos, L., Hicks, J. K., Aldea, M., Minuti, G., et al. (2023) · Cancer Discovery · doi:10.1158/2159-8290.cd-22-1420 · Cited by 203 · see citing works
Glial heme oxygenase-1 expression in Alzheimer disease and mild cognitive impairment
Schipper, H. M., BENNETT, D., Liberman, A., Bienias, J. L., Schneider, J. A., Kelly, J. W., & Arvanitakis, Z. (2005) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2005.01.016 · Cited by 199 · see citing works
Nrf2-deficiency creates a responsive microenvironment for metastasis to the lung
Satoh, H., Moriguchi, T., Taguchi, K., Takai, J., Maher, J. M., Suzuki, T., Winnard, P. T., Raman, V., Ebina, M., Nukiwa, T., et al. (2010) · Carcinogenesis · doi:10.1093/carcin/bgq105 · Cited by 197 · see citing works
Self-citationAltered Nrf2/Keap1-Bach1 equilibrium in pulmonary emphysema
Goven, D., Boutten, A., Leçon-Malas, V., Marchal-Sommé, J., Amara, N., Crestani, B., Fournier, M., Lesèche, G., Soler, P., Boczkowski, J., et al. (2008) · Thorax · doi:10.1136/thx.2007.091181 · Cited by 196 · see citing works
Rojo, A. I., Medina‐Campos, O. N., Rada, P., Zúñiga-Toalá, A., López-Gazcón, A., Espada, S., Pedraza‐Chaverrí, J., & Cuadrado, A. (2011) · Free Radical Biology and Medicine · doi:10.1016/j.freeradbiomed.2011.11.003 · Cited by 195 · see citing works
Self-citationNrf2: Molecular and epigenetic regulation during aging
Silva‐Palacios, A., Ostolga-Chavarría, M., Zazueta, C., & Königsberg, M. (2018) · Ageing Research Reviews · doi:10.1016/j.arr.2018.06.003 · Cited by 195 · see citing works
Molecular basis for the disruption of Keap1–Nrf2 interaction via Hinge & Latch mechanism
Horie, Y., Suzuki, T., Inoue, J., Iso, T., Wells, G., Moore, T. W., Mizushima, T., Dinkova‐Kostova, A. T., Kasai, T., Kamei, T., et al. (2021) · Communications Biology · doi:10.1038/s42003-021-02100-6 · Cited by 195 · see citing works
Self-citationBell, K. F. S., Al-Mubarak, B., Martel, M.-A., McKay, S., Wheelan, N., Hasel, P., Márkus, N. M., Baxter, P., Deighton, R. F., Serio, A., et al. (2015) · Nature Communications · doi:10.1038/ncomms8066 · Cited by 191 · see citing works
Self-citationNRF2: KEAPing Tumors Protected
Pillai, R., Hayashi, M., Zavitsanou, A.-M., & Papagiannakopoulos, T. Y. (2022) · Cancer Discovery · doi:10.1158/2159-8290.cd-21-0922 · Cited by 187 · see citing works
Nrf2 Represses FGF21 During Long-Term High-Fat Diet–Induced Obesity in Mice
Chartoumpekis, D. V., Ziros, P. G., Psyrogiannis, A. I., Papavassiliou, A. G., Kyriazopoulou, V. E., Sykiotis, G. P., & Habeos, I. G. (2011) · Diabetes · doi:10.2337/db11-0112 · Cited by 184 · see citing works
Self-citationGlutaminase inhibition impairs CD8 T cell activation in STK11-/Lkb1-deficient lung cancer
Best, S. A., Gubser, P. M., Sethumadhavan, S., Kersbergen, A. J., Abril, Y. L. N., Goldford, J. E., Sellers, K., Abeysekera, W., Garnham, A. L., McDonald, J. A., et al. (2022) · Cell Metabolism · doi:10.1016/j.cmet.2022.04.003 · Cited by 184 · see citing works
Binding Mode and Structure–Activity Relationships around Direct Inhibitors of the Nrf2–Keap1 Complex
Jnoff, E., Albrecht, C., Barker, J. J., Barker, O., Beaumont, E., Bromidge, S. M., Brookfield, F. A., Brooks, M., Bubert, C., Ceska, T., et al. (2014) · ChemMedChem · doi:10.1002/cmdc.201300525 · Cited by 180 · see citing works
Flagged first, then by citations
22 of the 551 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Redox Imbalance in Inflammation: The Interplay of Oxidative and Reductive Stress
Bellanti, F., Coda, A. R. D., Trecca, M. I., Buglio, A. L., Serviddio, G., & Vendemiale, G. (2025) · Antioxidants · doi:10.3390/antiox14060656 · Cited by 212 · see citing works
Sulforaphane and Brain Health: From Pathways of Action to Effects on Specific Disorders
Fahey, J. W., Liu, H., Batt, H., Panjwani, A. A., & Tsuji, P. A. (2025) · Nutrients · doi:10.3390/nu17081353 · Cited by 22 · see citing works
NRF2 as a guardian of health: from an ancient survival pathway to a modern therapeutic target
Tenreiro, S., Falcão, A. S., Bender, N., Bernátová, I., Berry, A., Cuadrado, A., Eppenberger, P., Giona, L., Grochot‐Przeczek, A., Heiß, E. H., et al. (2026) · Redox Biology · doi:10.1016/j.redox.2026.104217 · Cited by 8 · see citing works
Self-citationLithium Augmentation in Treatment‐Resistant Depression: A Qualitative Review of the Literature
González, Á. R. A., Guzmán, Y., Proaños, N. J., Bustos, R., Aconcha, M., Guerrero, I. M., Calderon, L. A. M., Berk, M., & Dodd, S. (2025) · Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy · doi:10.1002/phar.70063 · Cited by 5 · see citing works
Ozleyen, A., Kulabas, S. S., Novak, M. J., Cichoń, M., Heras, C. M. D. L., Honda, T., Doveston, R. G., Dinkova‐Kostova, A. T., Grochot‐Przeczek, A., & Tumer, T. B. (2026) · Archives of Biochemistry and Biophysics · doi:10.1016/j.abb.2026.110847 · Cited by 5 · see citing works
Self-citationSeno, A., Bi, Z., Polin, L., Liu, Z., Qiu, Y., Zhang, W., Pawar, A. S., Thakur, C., Seno, M., Wang, Z., et al. (2025) · Redox Biology · doi:10.1016/j.redox.2025.103773 · Cited by 7 · see citing works
Dual targeting of Keap1 and Gsk-3 by hexaraphane in the regulation of transcription factor Nrf2
García‐Yagüe, Á. J., Cueto-Diaz, E. J., Escoll, M., Okunishi, I., Hayes, J. D., Rodrı́guez-Franco, M. I., Rojo, A. I., & Cuadrado, A. (2025) · Free Radical Biology and Medicine · doi:10.1016/j.freeradbiomed.2025.07.051 · Cited by 4 · see citing works
Self-citationPang, Y., Tu, J., Zhang, H., Ma, J., Zhang, L., Xue, C., Liu, Y., Hong, W., An, Q., Hui, M., et al. (2026) · Food & Function · doi:10.1039/d5fo03526k · Cited by 1 · see citing works
Sulforaphane Synergies with Phytochemicals and Pharmaceuticals: Implications for Healthspan
Fahey, J. W., & Liu, H. (2026) · Medicines · doi:10.3390/medicines13020016 · Cited by 2 · see citing works
Qi, G., Ma, T., Wang, Y., Chen, K., Yan, Y., Li, Z., Deng, N., Tseng, C., Li, B., Zheng, Y., et al. (2026) · Nature Communications · doi:10.1038/s41467-026-72683-3 · Cited by 2 · see citing works
“Compared to the systemic administration of Nrf2 agonists, the localized activation strategy provided by TA-GelMA circumvents potential side effects related to systemic Nrf2 activation 58,59 , thereby enhancing clinical application safety.”
Bozkurt, A., Kluknavský, M., Balis, P., Mičurová, A., A, Kopincová, J., & Bernátová, I. (2025) · Physiological Research · doi:10.33549/physiolres.935717 · Cited by 1 · see citing works
Zuo, M., Li, H., Chen, N., Guo, Z., & Wan, Z. (2026) · Frontiers in Immunology · doi:10.3389/fimmu.2026.1737569 · Cited by 1 · see citing works
Xing, Z., Yang, J., Zhang, H., Xie, Y., Yang, Q., Wu, M., Wang, W., Gao, S., & Hua, C. (2026) · Free Radical Biology and Medicine · doi:10.1016/j.freeradbiomed.2026.04.024 · Cited by 1 · see citing works
Zhao, Z., Lu, H., Zhang, J. Y., Zhao, J., Wang, J., Zhu, T., Xu, S., You, Q., Lu, M., & Jiang, Z. (2026) · Journal of Medicinal Chemistry · doi:10.1021/acs.jmedchem.6c00096 · Cited by 1 · see citing works
Vukobratovic, M., Jevtic, J., Zakić, T., Pekovic‐Vaughan, V., Korać, A., Korać, B., & Janković, A. (2026) · Redox Biology · doi:10.1016/j.redox.2026.104345 · Cited by 1 · see citing works
Cantu, A. E., Rasa, C. G., Mito, S., Cantu, D., López-Alvarenga, J. C., Rivera-López, L. L., Rios, I., Abrego-Gonzalez, A., & Reyna, S. M. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms26125485
Зигрій, Н. В., & Shevchuk, O. O. (2025) · Здобутки клінічної і експериментальної медицини · doi:10.11603/1811-2471.2025.v.i3.15557
Can’t KEEP Up: UXS1 Dependency Exposes a Pyrimidine Vulnerability in KEAP1 -Mutant Lung Cancer
Yasseen, B. A., & DeNicola, G. M. (2025) · Cancer Research · doi:10.1158/0008-5472.can-25-3547
Self-citationChai, S., Zhang, Y., Guo, Y., Cao, D., Wang, J., Yan, Y., Shi, Y., Yuan, Z., Wang, X., Tong, T., et al. (2026) · Phytomedicine · doi:10.1016/j.phymed.2026.158178
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Estrogen receptors and the NRF2 pathway: bridging hormonal regulation and stress response in the gut
Kopacz, A., Tomaszewska, Z., & Piechota-Polańczyk, A. (2026) · Frontiers in Endocrinology · doi:10.3389/fendo.2026.1861565
The utility of FRET/FLIM-based bioassays for monitoring Nrf2 activation in single live cells
Dikovskaya, D., & Dinkova‐Kostova, A. T. (2026) · Free Radical Biology and Medicine · doi:10.1016/j.freeradbiomed.2026.08.005
Self-citationDimova, E. Y., & Kietzmann, T. (2026) · Redox Biology · doi:10.1016/j.redox.2026.104348
Olazabal-Chias, M., Kratochvil, M., & Rojo, A. I. (2026) · Neurochemistry International · doi:10.1016/j.neuint.2026.106258
Dual promoter architecture of NFE2L2 underlies isoform-specific translational control of NRF2
Sznarkowska, A., Urban-Wójciuk, Z., Dziadosz-Brzezińska, A., Cieśla, M., Kusiński, S., Wakimian, K., Szabelska-Beręsewicz, A., Chruściel, E., Papak, I., Marek-Trzonkowska, N., et al. (2026) · Redox Biology · doi:10.1016/j.redox.2026.104405
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Sastre, J., Simmons, A. J., Miranda‐Vizuete, A., Arnér, E. S. J., Nagy, P., Martı́nez-Ruiz, A., & Schmidt, E. E. (2026) · Free Radical Biology and Medicine · doi:10.1016/j.freeradbiomed.2026.10.033
Guo, X., Wang, C., 张舒岩, Li, M., & Chen, C. (2026) · Frontiers in Medicine · doi:10.3389/fmed.2026.1976117
- Authors
- Cuadrado, A., Cazalla, E., Bach, A., Bathish, B., Naidu, S. D., DeNicola, G. M., Dinkova-Kostova, A. T., Fernández-Ginés, R., Grochot-Przeczek, A., Hayes, J. D., Kensler, T. W., León, R., Liby, K. T., López, M. G., Manda, G., Shivakumar, A. K., Hakomäki, H., Moerland, J. A., Motohashi, H., Rojo, A. I., Sykiotis, G. P., Taguchi, K., Valverde, Á. M., Yamamoto, M., & Levonen, A.-L.
- Affiliations
- Biomedical Research Networking Center on Neurodegenerative Diseases (ES)
- Consejo Superior de Investigaciones Científicas (ES)
- University of Copenhagen (DK)
- University of Dundee (GB)
- Moffitt Cancer Center (US)
- Fred Hutch Cancer Center (US)
- Indiana University School of Medicine (US)
- Hospital Universitario de La Princesa (ES)
- Institutul National Victor Babes (RO)
- University of Eastern Finland (FI)
- Tohoku University (JP)
- Corresponding author
- Cuadrado, Antonio
- ORCID
- Cuadrado, Antonio
- Cazalla, Eduardo
- Bach, Anders
- Bathish, Boushra
- Naidu, Sharadha Dayalan
- DeNicola, Gina M.
- Fernández-Ginés, Raquel
- Hayes, John D.
- Kensler, Thomas W.
- Liby, Karen T.
- López, Manuela G.
- Manda, Gina
- Hakomäki, Henriikka
- Moerland, Jessica A.
- Motohashi, Hozumi
- Rojo, Ana I.
- Sykiotis, Gerasimos P.
- Taguchi, Keiko
- Valverde, Ángela M.
- Yamamoto, Masayuki
- Levonen, Anna-Liisa
- Venue
- Redox Biology
- Publisher
- Elsevier BV
- Published
- 2025-04
- Volume
- 81
- Pages
- 103569
- ISSN
- 2213-2317 (ISSN-L)
- PMC
- PMC11970334
- OpenAlex
- W4408102298
- Cited by
- 28
- References
- 551
- Citations by year
- 2026: 19 · 2025: 9
- FWCI
- 8.37
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Redox Biology (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Discovery Research Portal (University of Dundee) (publishedVersion, cc-by-nc-nd)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by-nc-nd)
- SERVAL (Université de Lausanne) (publishedVersion, cc-by-nc-nd)
- DIGITAL.CSIC (Spanish National Research Council (CSIC)) (submittedVersion, cc-by-nc-nd)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- IRIS (submittedVersion, cc-by-nc-nd)
- Biblos-e Archivo (Universidad Autónoma de Madrid) (submittedVersion, public-domain)
- IUScholarWorks (Indiana University) (submittedVersion, cc-by-nc-nd)
- Funders
- Instituto de Salud Carlos III (CB06/05/0010)
- Biotechnology and Biological Sciences Research Council (BB/X00029X/1, BB/T508111/1)
- Lundbeck Foundation (R366-2021-270)
- Comunidad de Madrid (P2022/BMD-7230, P2022/BMD-7230-CAM-22)
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas
- Syöpäsäätiö
- Ministerio de Ciencia e Innovación
- Foundation for the National Institutes of Health
- Ministerio de Universidades (FPU21/02505, FPU2021)
- Biogen (415,416, S217879)
- National Institutes of Health (PID-2021-122766OB-1363 100, MICIU/AEI/10.13039/501100011033, F31 CA275239)
- National Cancer Center
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (IZCOZ0_205415, 310030_212558)
- Tenovus (T22-08)
- European Cooperation in Science and Technology (CA20121)
- Narodowe Centrum Nauki (2021/43/B/NZ4/02130)
- Medical Research Council (MR/W023806/1, MR/T014644/1)
- Sigrid Juséliuksen Säätiö
- Ministerio de Ciencia, Innovación y Universidades (PID-2021-122766OB-100, PID2021-123481OB-I00, PDC2021-121 421-I00, PDC2022-133 765-I00)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Genomics, phytochemicals, and oxidative stress
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Redox biology and oxidative stress
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cancer Research › NF-κB Signaling Pathways
- Keywords
- Nrf2, redox signaling, oxidative stress, non-communicable diseases, Nrf2 activators, Nrf2 inhibitors, drug development, translational medicine, autoimmune disease, respiratory diseases, cardiovascular disease, metabolic disorders, gastrointestinal diseases, cancer, off-target effects
- MeSH terms
- Noncommunicable Diseases, Animals, Humans, Neoplasms, Oxidation-Reduction, Oxidative Stress, NF-E2-Related Factor 2
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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