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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 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]
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Nrf2 reduces allergic asthma in mice through enhanced airway epithelial cytoprotective function
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Role of Nrf2 in Host Defense against Influenza Virus in Cigarette Smoke-Exposed Mice
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Enhancer remodeling promotes tumor-initiating activity in NRF2-activated non-small cell lung cancers
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Nrf2 and SQSTM1/p62 jointly contribute to mesenchymal transition and invasion in glioblastoma
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Health Benefits of Coffee Consumption for Cancer and Other Diseases and Mechanisms of Action
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“The first CNS active non-covalent KEAP1-NRF2 inhibitor, the aniline-derivative 12 (NXPZ-2), was reported by Sun et al. to induce NRF2 activity in an AD mouse model, improve learning and memory functions, and lead to reduction in p-Tau and A β 1-42 serum levels [395].”
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Nrf2 gene promoter polymorphism is associated with ulcerative colitis in a Japanese population.
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Overlooked and valuable facts to know in the NRF2/KEAP1 field
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Microenvironmental Activation of Nrf2 Restricts the Progression of Nrf2-Activated Malignant Tumors
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Self-citationPhosphorylation of serine 349 of p62 in Alzheimer’s disease brain
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Self-citationThe Role of KEAP1-NRF2 System in Atopic Dermatitis and Psoriasis
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Development of Noncovalent Small-Molecule Keap1-Nrf2 Inhibitors by Fragment-Based Drug Discovery
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Yoon, S. J., Combs, J. A., Falzone, A., Prieto-Farigua, N., Caldwell, S., Ackerman, H. D., Flores, E. R., & DeNicola, G. M. (2023) · Cancer Research · doi:10.1158/0008-5472.can-22-3000 · Cited by 54
Self-citationSun, Y., Xu, L., Zheng, D., Wang, J., Liu, G., Mo, Z., Liu, C., Zhang, W., Yu, J., Xing, C., et al. (2023) · Redox Biology · doi:10.1016/j.redox.2023.102793 · Cited by 54
MASH clinical trials and drugs pipeline: An impending tsunami
Noureddin, M. (2024) · Hepatology · doi:10.1097/hep.0000000000000860 · Cited by 54
Association of Nrf2 with airway pathogenesis: lessons learned from genetic mouse models
Cho, H., & Kleeberger, S. R. (2015) · Archives of Toxicology · doi:10.1007/s00204-015-1557-y · Cited by 53
Oxidative Stress, Environmental Pollution, and Lifestyle as Determinants of Asthma in Children
Vincenzo, S. D., Ferrante, G., Ferraro, M., Cascio, C., Malizia, V., Licari, A., Grutta, S. L., & Pace, E. (2023) · Biology · doi:10.3390/biology12010133 · Cited by 53
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Self-citationDesign, synthesis and identification of novel, orally bioavailable non-covalent Nrf2 activators
Ma, B., Lucas, B. S., Capacci, A. G., Lin, E. Y.-S., Jones, J. H., Dechantsreiter, M. A., Enyedy, I. J., Marcotte, D. J., Xiao, G., Li, B., et al. (2019) · Bioorganic & Medicinal Chemistry Letters · doi:10.1016/j.bmcl.2019.126852 · Cited by 51
A pan-cancer analysis shows immunoevasive characteristics in NRF2 hyperactive squamous malignancies
Härkönen, J., Pölönen, P., Deen, A. J., Selvarajan, I., Teppo, H., Dimova, E. Y., Kietzmann, T., Ahtiainen, M., Väyrynen, J. P., Väyrynen, S. A., et al. (2023) · Redox Biology · doi:10.1016/j.redox.2023.102644 · Cited by 51
Self-citationOmaveloxolone (SkyclarysTM) for patients with Friedreich’s ataxia
Naidu, S. D., & Dinkova‐Kostova, A. T. (2023) · Trends in Pharmacological Sciences · doi:10.1016/j.tips.2023.03.005 · Cited by 51
Self-citationMining Natural Products for Macrocycles to Drug Difficult Targets
Begnini, F., Poongavanam, V., Over, B., Castaldo, M., Geschwindner, S., Johansson, P., Tyagi, M., Tyrchan, C., Wissler, L., Sjö, P., et al. (2020) · Journal of Medicinal Chemistry · doi:10.1021/acs.jmedchem.0c01569 · Cited by 50
Hamidi, S. H., Kadamboor Veethil, S., & Hamidi, S. H. (2021) · Pharmacological Reports · doi:10.1007/s43440-021-00255-x · Cited by 50
Begnini, F., Geschwindner, S., Johansson, P., Wissler, L., Lewis, R. J., Danelius, E., Luttens, A., Matricon, P. G., Carlsson, J., Lenders, S., et al. (2022) · Journal of Medicinal Chemistry · doi:10.1021/acs.jmedchem.1c01975 · Cited by 50
Hui, Q., Karlstetter, M., Xu, Z., Yang, J., Zhou, L., Eilken, H. M., Terjung, C., Cho, H., Gong, J., Lai, M. J., et al. (2019) · Free Radical Biology and Medicine · doi:10.1016/j.freeradbiomed.2019.10.414 · Cited by 49
Carling, P. J., Mortiboys, H., Green, C., Mihaylov, S. R., Sandor, C., Schwartzentruber, A., Taylor, R. N., Wei, W., Hastings, C., Wong, S. L., et al. (2020) · Progress in Neurobiology · doi:10.1016/j.pneurobio.2020.101772 · Cited by 49
Zhou, H.-S., Hu, L.-B., Zhang, H., Shan, W.-X., Wang, Y., Li, X., Liu, T., Zhao, J., You, Q., & Jiang, Z. (2020) · Journal of Medicinal Chemistry · doi:10.1021/acs.jmedchem.0c01116 · Cited by 49
Distinct Nrf2 Signaling Thresholds Mediate Lung Tumor Initiation and Progression
DeBlasi, J. M., Falzone, A., Caldwell, S., Prieto-Farigua, N., Prigge, J. R., Schmidt, E. E., Chio, I. I. C., Karreth, F. A., & DeNicola, G. M. (2023) · Cancer Research · doi:10.1158/0008-5472.can-22-3848 · Cited by 49 · cited 1×
“However, constitutive NRF2 activation is not always favorable and, in some models, does not promote tumor formation [294], antagonizes tumor progression [295], or impairs metastasis [296].”
Self-citationDeleterious effect of oltipraz on extrahepatic cholestasis in bile duct-ligated mice
Weerachayaphorn, J., Luo, Y., Mennone, A., Soroka, C. J., Harry, K., & Boyer, J. L. (2013) · Journal of Hepatology · doi:10.1016/j.jhep.2013.08.015 · Cited by 47
Jiménez‐Osorio, A. S., González-Reyes, S., García‐Niño, W. R., Moreno-Macías, H., Rodríguez-Arellano, M. E., Vargas‐Alarcón, G., Zúñiga, J., Barquera, R., & Pedraza‐Chaverrí, J. (2016) · Oxidative Medicine and Cellular Longevity · doi:10.1155/2016/7367641 · Cited by 47
Stigmasterol sensitizes endometrial cancer cells to chemotherapy by repressing Nrf2 signal pathway
Liao, H., Zhu, D., Bai, M., Chen, H., Yan, S., Yu, J. Q., Zhu, H., Zheng, W., & Fan, G. (2020) · Cancer Cell International · doi:10.1186/s12935-020-01470-x · Cited by 47
Association of NFE2L2 and KEAP1 haplotypes with amyotrophic lateral sclerosis
Bergström, P., von Otter, M., Nilsson, S., Nilsson, A.-C., Nilsson, M., Andersen, P. M., Hammarsten, O., & Zetterberg, H. (2013) · Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration · doi:10.3109/21678421.2013.839708 · Cited by 46
A Novel Nrf2 Pathway Inhibitor Sensitizes Keap1-Mutant Lung Cancer Cells to Chemotherapy
Zhang, D., Hou, Z., Aldrich, K. E., Lockwood, L. R., Odom, A. L., & Liby, K. T. (2021) · Molecular Cancer Therapeutics · doi:10.1158/1535-7163.mct-21-0210 · Cited by 46
Self-citationRuotsalainen, A., Lappalainen, J. P., Heiskanen, E., Merentie, M., Sihvola, V., Näpänkangas, J. P., Lottonen‐Raikaslehto, L., Kansanen, E., Adinolfi, S., Kaarniranta, K., et al. (2018) · Cardiovascular Research · doi:10.1093/cvr/cvy143 · Cited by 45
Self-citationRegulation of the Nrf2 Pathway by Glycogen Synthase Kinase-3β in MPP+-Induced Cell Damage
Armağan, G., Sevgili, E., Gürkan, F. T., Köse, F. A., Bilgiç, T., Dağcı, T., & Saso, L. (2019) · Molecules · doi:10.3390/molecules24071377 · Cited by 45
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22 of the 551 references couldn’t be matched to a known paper.
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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 222
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
NRF2 as a guardian of health: from an ancient survival pathway to a modern therapeutic target
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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
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Self-citation
Metadata
- 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
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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.
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