Diabetic cardiomyopathy is one of the main causes of
heart failure and death in patients with
diabetes mellitus.
Reactive oxygen species produced excessively in
diabetes mellitus cause
necrosis, apoptosis, ferroptosis,
inflammation, and
fibrosis of the myocardium as well as impair the cardiac structure and function. It is increasingly clear that oxidative stress is a principal cause of
diabetic cardiomyopathy. The
transcription factor nuclear factor-erythroid 2 p45-related factor 2 (NRF2) activates the transcription of more than 200 genes in the human genome. Most of the
proteins translated from these genes possess
anti-oxidant, anti-inflammatory, anti-apoptotic, anti-ferroptotic, and anti-fibrotic actions. There is a growing body of evidence indicating that NRF2 and its target genes are crucial in preventing high
glucose-induced oxidative damage in
diabetic cardiomyopathy. Recently, many natural and synthetic activators of NRF2 are shown to possess promising
therapeutic effects on
diabetic cardiomyopathy in animal models of
diabetic cardiomyopathy. Targeting NRF2 signaling by pharmacological entities is a potential approach to ameliorating
diabetic cardiomyopathy. However, the persistent high expression of NRF2 in
cancer tissues also protects the growth of
cancer cells. This "dark side" of NRF2 increases the challenges of using NRF2 activators to treat
diabetic cardiomyopathy. In addition, some NRF2 activators were found to have off-target effects. In this review, we summarize the current status and challenges of NRF2 as a potential therapeutic target for
diabetic cardiomyopathy.