Lim Tina Si Ting, Ng Kar Hui, Zhang Yaochun
Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117549, Singapore.
Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore 119074, Singapore.
Int J Mol Sci. 2025 Aug 2;26(15):7471. doi: 10.3390/ijms26157471.
Chronic kidney disease (CKD) remains a global health burden, with limited therapeutic options that effectively target the underlying pathophysiology. Nuclear factor erythroid 2-related factor 2 (NRF2), a key regulator of oxidative stress and inflammation, has garnered significant attention as a potential therapeutic target in CKD. Despite encouraging preclinical results, no NRF2-targeted agents have achieved clinical approval for CKD treatment. This review synthesizes emerging evidence showing substantial heterogeneity in NRF2 activity across CKD subtypes, influenced by disease etiology, CKD stage, and rate of disease progression. We elucidate the key therapeutic implications across diverse CKD etiologies and highlight that the therapeutic efficacy of NRF2 activation depends on precise modulation tailored to disease context. Although NRF2 overactivation and the need for stage-dependent modulation are increasingly recognized, this review further delineates the consequences of indiscriminate NRF2 activation, demonstrating that its effects diverge across CKD etiologies and cellular contexts. These insights support a nuanced, context-specific approach to NRF2-targeted strategies and provide a framework to guide future drug development in CKD.
慢性肾脏病(CKD)仍然是一项全球性的健康负担,针对其潜在病理生理学的有效治疗选择有限。核因子红细胞2相关因子2(NRF2)是氧化应激和炎症的关键调节因子,作为CKD的潜在治疗靶点已受到广泛关注。尽管临床前研究结果令人鼓舞,但尚无NRF2靶向药物获批用于CKD治疗。本综述综合了新出现的证据,表明受疾病病因、CKD分期和疾病进展速度影响,CKD各亚型的NRF2活性存在显著异质性。我们阐明了不同CKD病因的关键治疗意义,并强调NRF2激活的治疗效果取决于针对疾病背景的精确调节。尽管NRF2过度激活以及分期依赖性调节的必要性越来越受到认可,但本综述进一步阐述了不加区分地激活NRF2的后果,表明其作用在不同的CKD病因和细胞环境中存在差异。这些见解支持针对NRF2靶向策略采取细致入微、因地制宜的方法,并为指导未来CKD药物研发提供了一个框架。
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