AccScience Publishing / ITPS / Online First / DOI: 10.36922/ITPS025130016
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REVIEW ARTICLE

Therapeutic role of Nrf2/ARE pathway activation in chronic atrophic gastritis: Mechanisms, progress, and future perspectives

Weiyan Wu1,2 ,  Siyu Chen1 ,  Yan Su1 ,  Yuting Chen2 ,  Tiandong Lin1,2* ,  Yangyang Liu1,3*
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1 Department of Li Ethnic Medicine Industry College, College of Traditional Chinese Medicine, Hainan Medical University, Haikou, Hainan, China
2 Innovation Studio of Wu Weiyan, Chengmai County Hospital of Traditional Chinese Medicine, Chengmai, Hainan, China
3 International Joint Research Center for Traditional Chinese Medicine Quality, Hainan Branch of the Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences, Haikou, Hainan, China
INNOSC Theranostics and Pharmacological Sciences, 025130016 https://doi.org/10.36922/ITPS025130016
Received: 30 March 2025 | Revised: 15 September 2025 | Accepted: 19 September 2025 | Published online: 22 October 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Chronic atrophic gastritis (CAG) is a prevalent and progressive gastric disorder that can lead to significant gastric dysfunction and an increased risk of gastric cancer. Oxidative stress plays a central role in the pathogenesis of CAG, contributing to cellular damage and inflammation. The nuclear factor erythroid 2-related factor 2 (Nrf2)/antioxidant response element (ARE) pathway is crucial in cellular defense against oxidative stress by regulating the expression of antioxidant and cytoprotective genes. Activation of this pathway has shown promise in mitigating oxidative damage and promoting mucosal healing in CAG. This review aims to explore the therapeutic potential of Nrf2/ARE pathway activation in the context of CAG. We discuss the mechanisms underlying the activation of Nrf2, its role in regulating antioxidant genes, and its impact on oxidative stress management in the gastric mucosa. Recent advancements in pharmacological agents that activate the Nrf2 pathway, such as rhein and certain traditional Chinese medicines, are also highlighted. These interventions have demonstrated protective effects against oxidative stress, reduced inflammation, and promoted gastric mucosal healing. We, further, explore the potential clinical applications of Nrf2 activators in CAG treatment and the challenges in translating these findings into clinical practice. In addition, we outline future research directions aimed at optimizing Nrf2 activation strategies and exploring combination therapies to enhance therapeutic outcomes in CAG patients. The findings underscore the importance of targeting the Nrf2/ARE pathway as a promising strategy for managing oxidative stress-related gastric diseases.

Keywords
Nrf2/ARE pathway
Chronic atrophic gastritis
Antioxidant genes
Oxidative stress
Funding
This study was funded by the Nanhai Xinxing Medical and Health Talent Platform Project of Hainan Province (NHXX-WJW-2023030) and the Hainan Province Science and Technology Special Fund of China (ZDYF2022SHFZ304).
Conflict of interest
The authors declare that they have no competing interests.
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INNOSC Theranostics and Pharmacological Sciences, Electronic ISSN: 2705-0823 Print ISSN: 2705-0734, Published by AccScience Publishing
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