Current landscape of NRF2 biomarkers in clinical trials

Yoko Yagishita, Tonibelle N. Gatbonton‐schwager, Melissa L. McCallum, Thomas W. Kensler

Research output: Contribution to journalReview articlepeer-review

6 Scopus citations


The transcription factor NF‐E2 p45‐related factor 2 (NRF2; encoded by NFE2L2) plays a critical role in the maintenance of cellular redox and metabolic homeostasis, as well as the regulation of inflammation and cellular detoxication pathways. The contribution of the NRF2 pathway to organismal homeostasis is seen in many studies using cell lines and animal models, raising intense attention towards targeting its clinical promise. Over the last three decades, an expanding number of clinical studies have examined NRF2 inducers targeting an ever‐widening range of diseases. Full understanding of the pharmacokinetic and pharmacodynamic properties of drug candidates rely partly on the identification, validation, and use of biomarkers to optimize clinical applications. This review focuses on results from clinical trials with four agents known to target NRF2 signaling in preclinical studies (dimethyl fumarate, bardoxolone methyl, oltipraz, and sulforaphane), and evaluates the successes and limitations of biomarkers focused on expression of NRF2 target genes and others, inflammation and oxidative stress biomarkers, carcinogen metabolism and adduct biomarkers in unavoidably exposed populations, and targeted and untargeted metabolomics. While no biomarkers excel at defining pharmacodynamic actions in this setting, it is clear that these four lead clinical compounds do touch the NRF2 pathway in humans.

Original languageEnglish (US)
Article number716
Pages (from-to)1-36
Number of pages36
Issue number8
StatePublished - Aug 2020
Externally publishedYes


  • Bardoxolone methyl
  • Biomarkers
  • Carcinogenesis
  • Dimethyl fumarate
  • Gene expression
  • Inflammation
  • NRF2 (nuclear factor erythroid 2 related factor 2)
  • Oltipraz
  • Oxidative stress
  • Sulforaphane

ASJC Scopus subject areas

  • Food Science
  • Molecular Biology
  • Physiology
  • Biochemistry
  • Clinical Biochemistry
  • Cell Biology


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