Nuclear factor erythroid 2-related factor 2 (NRF2), also known as nuclear factor erythroid-derived 2-like 2, is a transcription factor that in humans is encoded by the NFE2L2 gene. [5] NRF2 is a basic leucine zipper (bZIP) protein that may regulate the expression of antioxidant proteins that protect against oxidative damage triggered by injury and inflammation, according to preliminary research. [6] In vitro , NRF2 binds to antioxidant response elements (AREs) in the promoter regions of genes encoding cytoprotective proteins. [7] NRF2 induces the expression of heme oxygenase 1 in vitro leading to an increase in phase II enzymes. [8] NRF2 also inhibits the NLRP3 inflammasome. [9]
NRF2 appears to participate in a complex regulatory network and performs a pleiotropic role in the regulation of metabolism, inflammation, autophagy, proteostasis, mitochondrial physiology, and immune responses. [10] Several drugs that stimulate the NFE2L2 pathway are being studied for treatment of diseases that are caused by oxidative stress. [6] [11]
NFE2L2 and other genes, such as NFE2 , NFE2L1 and NFE2L3 , encode basic leucine zipper (bZIP) transcription factors. They share highly conserved regions that are distinct from other bZIP families, such as JUN and FOS, although remaining regions have diverged considerably from each other. [12] [13]
NRF2 is a basic leucine zipper (bZip) transcription factor with a Cap “n” Collar (CNC) structure. [5] NRF2 possesses seven highly conserved domains called NRF2-ECH homology (Neh) domains. From the N-terminus to the C-terminus, they are:
The "domains" of Nrf2 are regions of conservation, not protein domains in the structual sense. Neh2, Neh7 and Neh1 are partially unstructured. Neh3 and Nah6 is predicted to be mainly unstructured. Neh4 and Neh5 are disordered, meaning they do not fold into a fixed shape. [19] Neh4 and Neh5 have been predicted as structured, but experimental data show otherwise. [20] The methods employed by InterPro, from curated domain patterns to AlphaFold, cover less than half of human Nrf2. [21]
NRF2 is ubiquitously expressed with the highest concentrations (in descending order) in the kidney, muscle, lung, heart, liver, and brain. [5]
Under normal or unstressed conditions, NRF2 is kept in the cytoplasm by a cluster of proteins that degrade it quickly. Under oxidative stress, NRF2 is not degraded, but instead travels to the nucleus where it binds to a DNA promoter and initiates transcription of antioxidative genes and their proteins.
NRF2 is kept in the cytoplasm by Kelch like-ECH-associated protein 1 (KEAP1) and Cullin 3, which degrade NRF2 by ubiquitination. [22] Cullin 3 ubiquitinates NRF2, while Keap1 is a substrate adaptor protein that facilitates the reaction. Once NRF2 is ubiquitinated, it is transported to the proteasome, where it is degraded and its components recycled. Under normal conditions, NRF2 has a half-life of only 20 minutes. [23] Oxidative stress or electrophilic stress disrupts critical cysteine residues in Keap1, disrupting the Keap1-Cul3 ubiquitination system. When NRF2 is not ubiquitinated, it builds up in the cytoplasm, [24] [25] and translocates into the nucleus. In the nucleus, it combines (forms a heterodimer) with one of small Maf proteins (MAFF, MAFG, MAFK) and binds to the antioxidant response element (ARE) in the upstream promoter region of many antioxidative genes, and initiates their transcription. [26]
Activation of NRF2 induces the transcription of genes encoding cytoprotective proteins. These include:
Genetic activation of NRF2 has been implicated in the development of de novo tumors, [40] [41] as well as in the progression of atherosclerosis by increasing plasma cholesterol levels and hepatic cholesterol content. [42] It has been suggested that these pro-atherogenic effects may outweigh the protective benefits of NRF2-mediated antioxidant induction. [43]
Activation of the NRF2 (nuclear factor erythroid 2–related factor 2) pathway has been explored as a therapeutic strategy due to its role in regulating antioxidant and cytoprotective responses. One of the most clinically advanced NRF2 activators is dimethyl fumarate, marketed as Tecfidera by Biogen Idec. It was approved by the Food and Drug Administration in March 2013 following a successful Phase III clinical trial that demonstrated reduced relapse rates and delayed progression of disability in individuals with multiple sclerosis. [6]
Although the precise mechanism of action of dimethyl fumarate is not fully understood, it is known to activate the NRF2 signaling pathway. Both dimethyl fumarate and its active metabolite, monomethyl fumarate, promote NRF2 nuclear translocation and the subsequent transcription of antioxidant response element (ARE)-driven genes. In addition, they have been shown to act as nicotinic acid receptor agonists in vitro. [44]
Despite its clinical efficacy, dimethyl fumarate is associated with several adverse effects, including anaphylaxis, angioedema, progressive multifocal leukoencephalopathy (PML), lymphopenia, and liver damage. Common side effects include flushing and gastrointestinal symptoms such as diarrhea, nausea, and upper abdominal pain. [44]
Other NRF2 activators have also been investigated. The dithiolethiones are a class of organosulfur compounds known to induce NRF2 activity. Among them, oltipraz is the most extensively studied. [45] Oltipraz has been shown to suppress tumor formation in multiple rodent tissues, including the bladder, colon, liver, lung, and pancreas, by upregulating NRF2-dependent detoxification pathways. [46]
However, clinical trials of oltipraz have failed to demonstrate clear therapeutic benefit and have reported significant toxicities, including neurotoxicity and gastrointestinal disturbances. Additionally, oltipraz has been found to generate superoxide radicals, which may offset its NRF2-mediated protective effects. [46] [47]
NFE2L2 has been shown to interact with MAFF, MAFG, MAFK, C-jun, [48] CREBBP, [49] EIF2AK3, [50] KEAP1, [51] [50] [52] [53] and UBC. [52] [54]
This article incorporates text from the United States National Library of Medicine, which is in the public domain.