Review Article

Potential Protective and Therapeutic Roles of the Nrf2 Pathway in Ocular Diseases: An Update

Table 1

Nrf2 regulative function of exogenous compounds.

NameExperimental subjectsFunctions and mechanisms

EdaravoneCECsAugments the expression of Nrf2 and its target genes, such as HO-1, GPX-1, and GCLC [23]
SERPINA3K (SA3K)CECsProtects against oxidative stress by targeting the ROS generation/degradation system and modulating the Keap1-Nrf2 signaling pathway [189]
Cultured pterygial epithelial cells (PECs)Inhibits NADPH oxidase 4 (NOX4) and elevates Nrf2, NQO1, and SOD2 [190]
Rosmarinic acid (RA)PECsReduces the cell viability of PECs. Increases Nrf2, HO-1, and NQO1 expression and activates SOD and CAT [191]
Chondrocyte-derived extracellular matrix (CDECM)Human conjunctival epithelial cells (ConECs) and PECsInhibits NF-κB activation and improves Nrf2 induction by blocking the p38 MAPK and PKC signaling pathways [192]
4-HNECECsElevates the ROS generation enzyme NOX4 and induces Nrf2 and its downstream effectors [193]
RPEsIncreases Nrf2 activity and GSH synthesis in a dose-dependent manner [194]
Trichostatin A (TSA)Corneal fibroblastsInhibits TGF-β-induced ROS accumulation and myofibroblast differentiation via enhanced Nrf2-ARE signaling [195]
DL-3-n-butylphthalide (NBP)Rat diabetic cataract modelDelays the onset and progression of diabetic cataract by enhancing the expressions of Nrf2, TRX, and CAT [95]
Acetyl-L-carnitineLECsPrevents homocysteine-induced suppression of Nrf2/Keap1-mediated antioxidation [91]
PuerarinRat diabetic cataract modelPrevents cataract development and progression in diabetic rats through Nrf2/HO-1 signaling [88]
RPEsActivates Nrf2/HO-1 antioxidant signaling pathway [196]
Rosmarinic acidSprague-Dawley rat pup selenite-inducedcataractogenesis modelIncreases the protein expressions of filensin, calpain 2, Nrf2, SOD, HO-1, and NQO1; the antioxidant enzyme activities; and the GSH level [94]
MorinLECsInduces HO-1 via the ERK-Nrf2 signaling pathway [92]
Calcium dobesilateRat D-galactose-induced cataract modelIncreases Nrf2 and HO-1 levels and inhibits the Keap1 level [197]
Rosa laevigata Michx.LECsInhibits ROS production and elevates mitochondrial membrane potential, through the induction of HO-1 expression mediated by the PI3K/Akt and Nrf2/ARE pathways [89]
HyperosideLECsIncreased Nrf2 level and the binding activity of its antioxidant components, increased the expression of HO-1, and restored cell vitality through ERK [90]
QuercetinTMCsUpregulates antioxidant peroxiredoxins through the activation of the Nrf2/Nrf1 transcription pathway [198]
RPEsProtects RPEs from H2O2-induced cytotoxicity by activating the Nrf2 pathway [199]
Sodium butyrateMouse experimental autoimmune uveitis (EAU) modelRegulates Th17/Treg cell balance to ameliorate uveitis via the Nrf2/HO-1 pathway [122]
LuteinRPEsReverses hyperglycemia-mediated blockage of Nrf2 translocation by modulating the activation of intracellular protein kinases [200]
Dh404Müller cellsReduces Müller cell gliosis and vascular leakage as well as the hypoxia-induced increase in ROS and angiogenic factors with a concomitant increase in Nrf2-responsive antioxidants [134, 201]
Myricetin derivatives (F2)RPEsProtects RPE cells against OS by the activation of Nrf2 and SOD2 [202]
FenofibrateMice diabetic retinasIncreases the expression of Nrf2, NQO1, and HO-1 [203]
ProbucolMüller cellsActivates the Keap1/Nrf2/ARE pathway [204]
HomocysteineMüller cellsIncreases the expression of Nrf2, NQO1, and HO-1 [205]
EbselenMüller cellsReduces the ROS levels and increases the expression of Nrf2, HO-1, glutathione peroxidase-1, NQO1, and glutamate-cysteine ligase [206]
DL-3-n-butylphthalideMüller cellsIncreases the expression level of HO-1 in a time-dependent manner [207]
3H-1,2-dithiole-3-thioneRPEsInduces Nrf2 phosphorylation, causing Nrf2 disassociation with Keap1 and its subsequent nuclear accumulation [208]
CurcuminRPEsPrevents high glucose damage through ERK1/2-mediated activation of the Nrf2/HO-1 pathway [135]
GlycyrrhizinRPEsProtects against sodium iodate-induced RPE and retinal injury through activation of the Akt and Nrf2/HO-1 pathway [209]
EscinRPEsActivates Akt-Nrf2 signaling [210]
Ginsenoside Rh3RPEs and mice retinasRh3 induces miRNA-141 expression causing the downregulation of Keap1 and activating Nrf2 [211]
HesperetinRPEsUpregulates the Keap1-Nrf2/HO-1 signal pathway [212]
LycopeneRPEsInhibits ICAM-1 expression and NF-κB activation by Nrf2-regulated cell redox state [213]
4-AcetoxyphenolRPEsBlocks the increase of cellular ROS and upregulates NQO1 and HO-1 genes by stabilizing and inducing the nuclear translocation of Nrf2 [214]
TaxifolinRPEsEnhances the nuclear accumulation of Nrf2 and increases the expression of HO-1, GCLC, GCLM, and NQO1 [215]
GenipinRPEsReverses the inhibitory effects of H2O2 by promoting cell viability, attenuating ROS accumulation and cell apoptosis, and increasing the expression of Nrf2, HO-1, and NQO1 [216]
α-TocopherolRPEsActivates the Keap1/Nrf2 pathway by increasing Nrf2 expression and inducing its translocation to the nucleus, and increases HO-1 as well as NQO1 [217]
AstaxanthinRPEsActivates the Nrf2-ARE pathway by inducing Nrf2 nuclear localization and increasing NQO1, HO-1, GCLM, and GCLC [218]
Salvianolic acid ARPEsCauses Nrf2 phosphorylation, accumulation, and nuclear translocation and increases the expression of HO-1 [219]
Salvianolic acid BRPEsProtects cells from OS-induced cell death by activating glutaredoxin 1 [220]
LipoamideRPEsInduces the expression of Nrf2 and its translocation to the nucleus, leading to an increase in the expression or activity of NQO1, GST, GCL, catalase, and Cu/Zn SOD [221]
ThymoquinoneRPEsEnhances the activation of the Nrf2/HO-1 signaling pathway [222]
Blueberry anthocyaninsDiabetes rat retinasIncreases the mRNA levels of Nrf2 and HO-1, and the nuclear location of Nrf2 and protein levels of HO-1 [223]
Grape seed proanthocyanidin extractDiabetes rat retinasIncreases the expression of Nrf2 and HO-1 [224]
Carbamyl erythropoietinDiabetes rat retinasIncreases the expression of Nrf2, HO-1, and NQO1 [225]
Ginsenoside Rb1Diabetes rat retinasIncreases the expression of Nrf2, GCLC, and GCLM [226]
PyridoxamineRetinal photoreceptor cellsPartly protects cells against light damage by Nrf2 expression [227]
Scutellarin (SC)RECs and RPEsEnhances nuclear Nrf2 accumulation and the SC-provided alleviation on BRB breakdown in STZ-induced diabetic mice was diminished in Nrf2 knockout mice [228]
Delphinidin (2-(3,4,5-trihydroxyphenyl) chromenylium-3,5,7-triol)RPEsReverses the decreased activities of SOD, CAT, and GSH-PX and the elevated MDA level via increasing nuclear Nrf2 protein expression [229]
4-Hydroxy-7-oxo-5-heptanoate (HOHA) lactoneRPEsInduces upregulation of Nrf2, GCLM, HO-1, and NQO1 [230]
MelatoninThe retina of diabetic ratsSignificantly upregulates glutamate-cysteine ligase by retaining Nrf2 in the nucleus and stimulating Akt phosphorylation [231]
GalanginRECs and RPEsAlleviates DR by reversing TNFα-induced blood-retinal barrier dysfunction by abrogating oxidative stress injury via activating Nrf2 [232]
Nonsteroidal anti-inflammatory drugs (NSAIDs)Laser-induced CNV model in rat; RPEsInhibits neovascularization of choroid through the HO-1-dependent pathway [233]
RS9Retinal microvascular endothelial cells (RMECs)Decreases retinal neovascularization through suppressing VEGF expression and increasing Nrf2, HO-1, and NQO1 [234]
661W cells and Müller glia cellsEnhances the expression of Nrf2 and increases the expression of HO-1, GCLC, GCLM, and NQO1 [235]
Acetaldehyde dehydrogenase 2 (ALDH2)Diabetic rats’ retinasIncreases the expression of Nrf2 [236]
Lipoic acidRGCsInduces the expression of HO-1 by promoting the translocation of Nrf2 to the nucleus [237, 238]
SulforaphaneFECD corneal specimensEnhances cell viability by decreasing ROS. Enhances nuclear translocation of Nrf2, DJ-1, HO-1, and NQO1 and decreases p53 [52]
Müller cellsEnhances the nuclear accumulation of Nrf2 and increases the expression of HO-1 and NQO1 [136]
Rabbit KC corneasProtects corneas against oxidative stress injury through activation of the Nrf2/HO-1 antioxidant pathway [37]
LECsIncludes the expression of NQO1 and TXNRD1 and the Nrf2 translocation to the nucleus [87, 239]
TMCs
RGCs
Attenuates H2O2-induced oxidative stress via PI3K/Akt-mediated Nrf2 signaling activation [240, 241]
CDDO-Im661WInhibits ROS, increases OS, and increases neuronal cell survival after I/R injury [107]
Nrf2 KO miceIncreases expressions of Nrf2, HO-1, NQO1, and GCLM in the retina, reduces inflammatory mediator expression, and reduces leukocyte adherence to retinal vasculature [121]
RTA 408RPEsActivates Nrf2 and increases the expression of its downstream genes, such as HO-1, NQO1, SOD2, catalase, Grx1, and Trx1 [242]
Soluble P-selectinRGCsIncreases NQO1 and HO-1 expression levels, along with increased transcription factor Nrf2 [243]
EriodictyolRGCsEnhances the nuclear translocation of Nrf2 and elevates the expression of HO-1 [244]
RPEsInduces the nuclear translocation of Nrf2, enhances the expression of HO-1 and NQO1, and increases the levels of intracellular glutathione [245]
Neuroligin-3RGCs and RPEsActivates Nrf2 signaling and enables Nrf2 protein stabilization, nuclear translocation, and expression of HO-1, NOQ1, and GCLC [246]
Long-acting (1R)-isopropyloxygenipin (IPRG001)RGCsThe protective action depends on NO induction and the Nrf2/HO-1 antioxidant response element pathway by S-nitrosylation [247]
ResveratrolRGCsUpregulates the expression of Nrf2, HO-1, and NQO1 [248, 249]
L-carnitine (LC)RGCsIncreases levels of Nrf2, HO-1, and γ-GCS and decreases expression of Keap1 protein [3]
SNJ-1945 (an exogenous calpain inhibitor)RGCsProtects RGCs against OS induced by high glucose [250]
Monomethyl fumarateGanglion cell layerFumaric acid esters exert a neuronal protective function in the retinal I/R model via Nrf2 modulation [251]
TrimetazidineRGCsConfers protection against RGC apoptosis via Nrf2/HO-1 signaling [252]
LECsReduces ROS production, inhibits Keap1 demethylation, and rescues Nrf2 expression level [93]
Hydrogen sulfide gas (H2S) donor drugsRGCsIncreases the levels of Nrf2 and HO-1 and inhibits OS-induced cell death [253]
5α-Androst-3β, 5α, 6β-triol (TRIOL)RGCsActivates and upregulates Nrf2 and HO-1 by negative regulation of Keap1 [254]
NipradilolRGCsProtects RGCs through S-nitrosylation of Keap1 and HO-1 induction [255]
FlavonoidsRGCsInduces Nrf2 and HO-1 [256]
RPEsInduces the expression of Nrf2 and HO-1 [257]
SulbutiamineRGCsStimulates CAT and significantly increased Nrf2 and HO-1 levels [258]
Chalcone analog L2H17RGCsExhibits its antioxidative effects by activating the Nrf2 pathway [259]
Chlorogenic acidRGCsRelieves oxidative stress injury in retinal ganglion cells through lncRNA-TUG1/Nrf2 [260]