Cellular and molecular mechanisms of hepatic ischemia-reperfusion injury: The role of oxidative stress and therapeutic approaches

Off-label use of treprostinil in adult patients in clinical cases

Treprostinil is a relatively new tricyclic prostacyclin analog with a stable structure, extended half-life and improved potency. Currently, treprostinil is indicated by the Food and Drug Administration in the United States for the treatment of pulmonary arterial hypertension (group 1 in the pulmonary hypertension classification of the World Health Organization). It has a potent vasodilating effect along with the inhibition of platelet aggregation and the attenuation of the inflammatory response in pulmonary and systemic circulation. It is available in the following formulations: Subcutaneous, intravenous, inhaled and oral. Although unknown to many clinicians, several encouraging reports of off-label treprostinil use in the adult population suggest its potential effectiveness in other clinical conditions. Currently under investigation are digital ischemia secondary to systemic sclerosis, chronic limb ischemia, hepatic ischemia-reperfusion injury and group 3 and 4 pulmonary hypertension. Based on review and analysis of the available literature, this article provides a thorough update on the off-label use of treprostinil in adult patients.

m6A reader YTHDC1 mediates MAFF nuclear export to induce VMP1 transcription and alleviate I/R-induced oxidative stress injury in hepatocytes

Hepatic ischemia/reperfusion (I/R) injury occurs after liver resection surgery, trauma, shock, and transplantation. This study aimed to identify and characterize the role of the YTH domain-containing protein 1 (YTHDC1)/MAFF/vacuole membrane protein 1 (VMP1) axis in hepatic I/R injury. YTHDC1, MAFF, and VMP1 were significantly overexpressed in the hepatic tissues of mice with I/R and hepatocytes exposed to hypoxia-reoxygenation (H/R). Knockdown of MAFF exacerbated oxidative stress and inflammatory injury in mice induced with hepatic I/R, which were reversed by overexpression of VMP1. Similarly, I/R-associated injury mitigated by YTHDC1 overexpression was reversed by MAFF knockdown. Mechanistically, YTHDC1 mediated the nuclear export and stability of MAFF mRNA and promoted MAFF translation. Collectively, the findings establish that YTHDC1-mediated m6A-dependent MAFF expression determines hepatocyte oxidative stress via VMP1, providing valuable insights into the potential mechanisms underlying hepatic I/R injury and offering potential therapeutic strategies for its treatment.

A hemicyanine-based dual-modal probe for fluorescence and mass spectrometry imaging of peroxynitrite in biosamples

Peroxynitrite (ONOO-) is a highly reactive oxidant formed by the reaction of nitric oxide with superoxide. Excessive ONOO- can be produced by the body in response to multiple diseases, resulting in cell death through oxidation and nitration processes. However, technical challenges arise in detection due to its high reactivity and very short lifespan. In this work, we rationally designed and synthesized a novel tetrazine-hemicyanine-based probe (TZN-HCY). This probe demonstrates the ability to capture ONOO- with high selectivity and sensitivity, enabling the detection and imaging of ONOO- in biological samples with both fluorescence and matrix-assisted laser desorption/ionization (MALDI) mass spectrometry (MS). The 3,6-disubstituted tetrazine moiety could react with ONOO-, and the hemicyanine skeleton with a permanent positive charge could enhance MALDI MS detection. The responsive performances of the TZN-HCY probe were verified on cell models and livers of hepatic ischemia-reperfusion injury (HIRI) model mice. Due to the applicability to dual-mode imaging, the formation of ONOO- and its content change in the liver of living mice were visualized by fluorescence imaging, while the fine-scale spatial distribution of ONOO- in liver tissues was revealed by MALDI MS imaging. This dual-modal probe could serve as a powerful tool for elucidating the diverse and complex roles of biogenic ONOO- in ischemia-reperfusion injury.

Niacin attenuates hepatic ischemia-reperfusion injury via suppression of 15-HETE mediated inflammation

Hepatic ischemia-reperfusion injury (HIRI) remains a critical clinical challenge in liver surgery and transplantation. Niacin has been demonstrated to participate in hypoxic regulation, while its role in HIRI remains unclear. In this study, we constructed a mouse HIRI model and demonstrated that Niacin significantly alleviated HIRI by reducing pathological damage, inflammatory cell infiltration and inflammatory cytokine release. Mechanistically, Transcriptome analysis identified Niacin-regulated differentially expressed genes, which significant enrichment in lipid metabolism-related pathways, and further confirmed that Niacin participate in regulating lipid metabolites 15-HETE. Rescue experiments demonstrated that exogenous 15-HETE supplementation reversed the Niacin-mediated inhibition of inflammation and protective effects against HIRI. In vitro experiments have also confirmed that Niacin can reduce inflammation and cell damage caused by hypoxia reoxygenation through 15-HETE. These findings highlight Niacin as a promising therapeutic agent for HIRI, acting via regulation of 15-HETE metabolism and inflammation. The study provides novel insights into the interplay between lipid homeostasis and ischemia-reperfusion injury, offering a rationale for clinical translation of Niacin-based interventions.

Patho-physiological effects of environmental relevant concentrations of lufenuron in male Japanese quails

The widespread utilization of synthetic chemicals contaminates the land and water environments. The present investigation determined the effects of sub-lethal concentrations of lufenuron in the male Japanese quail. The birds exposed to lufenuron showed the clinical signs of behavioral, digestive, nervous and reproductive upsets. The drug significantly (p < 0.05) decreased the feed intake, body weight, absolute and relative weights of visceral organs (kidneys, liver, brain, heart, testes), RBCs count, HCT, Hg concentration, serum proteins and anti-oxidants enzymes (SOD, CAT, LPO, GSH) while concentrations of hepatic, cardiac and renal biomarkers were significantly (p < 0.05) increased in the birds treated with higher doses (15 mg/kg and 20 mg/kg) of lufenuron, in a time and dose dependent manner. Comet assay revealed significantly (p < 0.05) increased frequency of DNA damage in the isolated cells of liver, kidneys and intestine along with a significant (p < 0.05) increased frequency of micronucleus in the erythrocytes. The visceral organs showed prominent histo-pathological ailments in the birds exposed to higher doses of lufenuron. Our study is the first comprehensive report that demonstrates the significant physio-biochemical health effects of lufenuron on complete clinico-hematological parameters of free ranging fauna (quail) of the natural ecosystem, even at sub-lethal environment relevant concentrations.

A biomimetic nanomedicine alleviates liver transplant-related biliary injury by sequentially inhibiting oxidative stress and regulating macrophage polarization via Nrf-2/HO-1 and JNK pathways

Liver transplantation is an effective method for treating end-stage liver disease. However, 10-20 % of liver transplantation patients develop biliary injury, the main cause of which is ischemia-reperfusion injury (IRI), which consists of oxidative stress injury in the early stage and inflammatory injury in the advanced stage. Biliary injury seriously affects patient outcomes and even leads to mortality, and there are few effective treatments for IRI. Herein, nanoparticles containing quercetin (QR) and rapamycin (RP) coated with poly (lactic-co-glycolic acid) (PLGA) and encapsulated by platelet membrane (PM) were designed to treat IRI in the liver transplantation. The specific binding of ICAM-1 expressed on the PM to integrins (e.g., LFA-1 and Mac-1) in damaged vascular endothelial cells, as well as the interaction between P-selectin on the platelet surface and PSGL-1 on the macrophage surface, allows the accumulation of these biomimetic cell membrane-encapsulated nanoparticles, and subsequently, the delivery of both drugs, to ischemia-reperfusion sites in the liver. The encapsulated QR alleviated oxidative stress injury by activating the Nrf-2/HO-1 signaling pathway in the early stage in model rats with IRI and liver transplantation models. Moreover, RP alleviated inflammatory damage in the advanced stage by suppressing the JNK signaling pathway in M1 macrophages. Thus, these biomimetic nanoparticles that intervene in IRI to alleviate both the early oxidative stress and the advanced inflammatory response constitute a novel delivery system for managing biliary injury after liver transplantation.

Ceramide(d18:1/18:1)-NDUFA6 interaction inactivates respiratory complex I to attenuate oxidative-stress-driven pathogenesis in liver ischemia/reperfusion injury

Oxidative stress driven by malfunctioning respiratory complex I (RC-I) is a crucial pathogenic factor in liver ischemia/reperfusion (I/R) injury. This study investigated the role of alkaline ceramidase 3 (ACER3) and its unsaturated long-chain ceramide (CER) substrates in regulating liver I/R injury through RC-I. Our findings demonstrated that I/R upregulated ACER3 and decreased unsaturated long-chain CER levels in human and mouse livers. Both global and hepatocyte-specific Acer3 ablation, as well as treatment with CER(d18:1/18:1), led to a significant increase in CER(d18:1/18:1) levels in the liver, which mitigated the I/R-induced hepatocyte damage and inflammation in mice. Mechanistically, ACER3 modulated CER(d18:1/18:1) levels in mitochondria-associated membranes and the endoplasmic reticulum (ER), thereby influencing the transport of CER(d18:1/18:1) from the ER to mitochondria. Acer3 ablation and CER(d18:1/18:1) treatment elevated CER(d18:1/18:1) in mitochondria, where CER(d18:1/18:1) bound to the RC-I subunit NDUFA6 to inactivate RC-I and reduced reactive oxygen species production in the I/R-injured mouse liver. These findings underscore the role of the CER(d18:1/18:1)-NDUFA6 interaction in suppressing RC-I-mediated oxidative-stress-driven pathogenesis in liver I/R injury.

HDAC inhibitors: Cardiotoxicity and paradoxical cardioprotective effect in ischemia-reperfusion myocardiocyte injury

Histone deacetylase inhibitors (HDACIs) are epigenetic drugs that regulate the acetylation status of histones and non-histone proteins, thereby leading to chromatin remodeling and transcriptional regulation of key apoptotic and cell cycle regulatory genes. There are currently five HDACIs clinically approved by the major regulatory authorities for treating hematological cancers, primarily as monotherapy. While HDACIs have been particularly effective in T-cell lymphomas, their clinical efficacies have not yet extended to solid tumors. The development of HDACIs continues, including for the treatment of a non-malignant conditions, with givinostat recently approved by the US FDA. However, the early development of HDACIs was limited by concerns about cardiotoxicity including QT interval prolongation. Yet, paradoxically, the latest research suggests some cardioprotective effect of HDACIs in ischemic heart disease or heart failure. This review presents the latest update about the cardiotoxicity of the clinically approved HDACIs. The mechanisms leading to HDACI-induced cardiotoxic adverse events and clinical strategies for their management are discussed. We will also deliberate the potential repurposing use of HDACIs and their HDAC isoform selectivity for treating ischemia-reperfusion cardiac muscle injury, cardiac hypertrophy, and fibrosis.

Dual-color reversible fluorescent carbon dots designed for dynamic monitoring of cellular superoxide anion radicals

The superoxide anion radical (O2˙-) represents the primary reactive oxygen species generated in biological systems. Real-time monitoring of its dynamic fluctuations provides valuable insights into disease progression and enables early diagnosis of hepatic ischemia-reperfusion injury (HIRI). In this work, we developed a novel dual-color fluorescent carbon dot (CD) probe through a one-step hydrothermal synthesis for reversible O2˙- detection. The CDs demonstrated excellent sensitivity, dynamically detecting O2˙- concentrations ranging from 0 to 60 μM with a detection limit of 0.56 μM. The probe exhibited remarkable reversibility, maintaining stable performance through at least three complete oxidation-reduction cycles following glutathione (GSH) treatment. In practical applications, the CDs achieved 95.2-104% recovery rates when detecting O2˙- in serum samples. Cellular imaging experiments confirmed the probe's effectiveness in normal hepatocytes (LO2), showing clear reversible responses to O2˙- fluctuations. Application in a HIRI cell model revealed significant elevation of O2˙- levels and provided new evidence for its role in HIRI-related signaling pathways. This study not only presents an effective dual-color fluorescent probe for dynamic O2˙- monitoring but also establishes a versatile synthetic strategy that could be adapted for imaging other biologically relevant molecules in living cells.

Mesenchymal stem cell-derived exosomes: an emerging therapeutic strategy for hepatic ischemia-reperfusion injury

Hepatic ischemia-reperfusion injury (HIRI) severely threatens the success rates of liver surgery and transplantation. Its complex pathological process involves multiple factors such as oxidative stress, inflammatory responses, and ferroptosis, creating an urgent need for new therapeutic strategies. Exosomes derived from mesenchymal stem cells (MSCs) are emerging as a next-generation acellular therapeutic approach. With their outstanding immune-regulatory capabilities, significant reparative functions, and good biocompatibility, they are leading innovations in the field of HIRI treatment. This article provides a systematic comparison of the therapeutic characteristics of MSC-derived exosomes(MSC-EXOs) from four different sources: adipose tissue, bone marrow, umbilical cord, and induced pluripotent stem cells. Although the clinical translation of MSC-EXOs still faces challenges such as variations in isolation methods, large-scale production, and safety assessments, their remarkable therapeutic effects and vast application potential signal the arrival of a new era of precision treatment for HIRI. This review not only provides a comprehensive theoretical foundation to promote the clinical application of MSC-EXOs but also opens up innovative research directions in the field of regenerative medicine.

Lentinan enhances microbiota-derived isoursodeoxycholic acid levels to alleviate hepatic ischemia-reperfusion injury in mice

Hepatic ischemia-reperfusion injury (HIRI) is an essential clinical concern caused by liver transplantation, resection, trauma, and shock that must be addressed immediately. Although the mechanisms underlying HIRI are well-documented, effective prevention and treatment strategies are still lacking. Inflammation is a central mechanism of HIRI, with macrophages playing a crucial role in initiating and amplifying the inflammatory response. Numerous plant polysaccharides exhibit substantial anti-inflammatory and hepatoprotective properties. However, the function of Lentinan (LNT) in HIRI has not been fully explored. Thus, this study aims to investigate the preventive potential of LNT in HIRI. Here, we reveal that oral administration of LNT considerably reduces hepatic inflammation and improves liver pathology in mice with HIRI by modulating gut microbiota. Specifically, LNT considerably increased microbiota-derived isoursodeoxycholic acid (IsoUDCA). Further experiments showed that IsoUDCA alleviates hepatic injury by suppressing macrophage inflammation. Mechanistically, IsoUDCA directly binds to and activates the neuron-derived clone 77 (Nur77) transcription factor, inhibiting the NF-κB signaling pathway in macrophages. Our findings shed light on the significant role of the LNT-microbiota-IsoUDCA-Nur77 axis in attenuating macrophage inflammation during HIRI, offering novel insights into potential therapeutic targets and avenues for preventing HIRI.

Targeting the sigma-1 receptor with pridopidine induces functional neurorestoration in spinal cord ischemia-reperfusion injury

Spinal cord ischemia reperfusion injury (IRI) occurs with an incidence of 1-32%, often leading to paraplegia with limited prevention options. Pridopidine (Prdpn), a highly selective sigma-1 receptor (Sig-1R) agonist, serves as a protein chaperone that is engaged in neuroplasticity and cellular defense. This research aimed to assess the neuroprotective properties of Prdpn in spinal cord IRI in rats and investigate the underlying mechanisms. Forty male Wistar albino rats were randomly allocated into 4 groups: control, sham, IRI, and IRI + Prdpn. Tarlov's test was used to examine behavioral performance, as well as withdrawal from agonizing stimuli and the placing/stepping reflex (SPR). Biochemical markers, including spinal malondialdehyde (MDA), AOPP, antioxidant GPX, TNF-α and IL-1β, and apoptotic caspase-3, were measured, along with BDNF, GDNF, and Sig-1R gene expression. Histopathological changes in spinal cord tissue were also evaluated. Spinal cord IRI significantly caused neurological deficits, evidenced by lower scores in Tarlov's test, withdrawal from agonizing stimuli, and SPR. Biochemically, spinal cord IRI led to decreased GPX and increased MDA, AOPP, TNF-α, IL-1β, caspase-3, and GDNF levels, along with downregulated BDNF and Sig-1R gene expression. Histopathologically, spinal cord IRI resulted in greater spinal neuronal degeneration, apoptosis, and demyelination. However, treatment with Prdpn significantly improved behavioral outcomes and partially reversed the biochemical and histopathological alterations. Prdpn improved spinal cord IRI-induced behavioral deficits through its antioxidant, anti-inflammatory, anti-apoptotic, and neurotrophic properties. It suggests promise as a potential treatment option to stop spinal cord IRI.

Molecular mechanisms in liver repair and regeneration: from physiology to therapeutics

Liver repair and regeneration are crucial physiological responses to hepatic injury and are orchestrated through intricate cellular and molecular networks. This review systematically delineates advancements in the field, emphasizing the essential roles played by diverse liver cell types. Their coordinated actions, supported by complex crosstalk within the liver microenvironment, are pivotal to enhancing regenerative outcomes. Recent molecular investigations have elucidated key signaling pathways involved in liver injury and regeneration. Viewed through the lens of metabolic reprogramming, these pathways highlight how shifts in glucose, lipid, and amino acid metabolism support the cellular functions essential for liver repair and regeneration. An analysis of regenerative variability across pathological states reveals how disease conditions influence these dynamics, guiding the development of novel therapeutic strategies and advanced techniques to enhance liver repair and regeneration. Bridging laboratory findings with practical applications, recent clinical trials highlight the potential of optimizing liver regeneration strategies. These trials offer valuable insights into the effectiveness of novel therapies and underscore significant progress in translational research. In conclusion, this review intricately links molecular insights to therapeutic frontiers, systematically charting the trajectory from fundamental physiological mechanisms to innovative clinical applications in liver repair and regeneration.

The interplay of senescence and MMPs in myocardial infarction: implications for cardiac aging and therapeutics

Aging is associated with a marked increase in cardiovascular diseases, such as myocardial infarction (MI). Cellular senescence is also a crucial factor in the development of age-related MI. Matrix metalloproteinases (MMPs) interaction with cellular senescence is a critical determinant of MI development and outcomes, most notably in the aged heart. After experiencing a heart attack, senescent cells exhibit a Senescence-Associated Secretory Phenotype (SASP) and are involved in tissue regeneration and chronic inflammation. MMPs are necessary for extracellular matrix proteolysis and have a biphasic effect, promoting early heart healing and detrimental change if overexpressed shortly. This review analyses the complex connection between senescence and MMPs in MI and how it influences elderly cardiac performance. Critical findings suggest that increasing cellular senescence in aged hearts elevates MMP activity and aggravates extended ventricular remodeling and dysfunction. Additionally, we explore potential therapeutics that address MMPs and senescence to enhance old MI patient myocardial performance and regeneration.

Pathophysiology of cerebral ischemia-reperfusion injury: An overview of oxidative stress and plant-based therapeutic approaches

Stroke is a debilitating neurological disorder that causes substantial morbidity and mortality on a global scale. Ischemic stroke, the most common type, occurs when the brain's blood supply is interrupted. Oxidative stress is a key factor in stroke pathology, contributing to inflammation and neuronal cell death. As a result, there is increasing interest in the potential of plant extracts, which have been used in traditional medicine for centuries and are generally considered safe, to serve as alternative or complementary treatments for stroke. The plant extracts can target multiple pathological processes, including oxidative stress, offering neuroprotective effects. The development of highly efficient, low-toxicity, and cost-effective natural products is crucial for enhancing stroke treatment options. In this review, we examine 60 plant extracts that have been focused on the studies published from year 2000 to 2024 along with the studies' experimental models, dosages, and results. The plant extracts hold promise in modulating cerebral ischemia-reperfusion injury through counteraction of relevant pathophysiologic processes such as oxidative stress.

[Ferroptosis and liver diseases]

As the central organ of metabolism, the liver plays a pivotal role in the regulation of the synthesis and metabolism of various nutrients within the body. Ferroptosis, as a newly discovered type of programmed cell death caused by the accumulation of iron-dependent lipid peroxides, is involved in the physiological and pathological processes of a variety of acute and chronic liver diseases. Ferroptosis can accelerate the pathogenetic process of acute liver injury, metabolic associated fatty liver disease, alcoholic liver disease, viral hepatitis, and autoimmune hepatitis; while it can slower disease progression in advanced liver fibrosis and hepatocellular carcinoma. This suggests that targeted regulation of ferroptosis may impact the occurrence and development of various liver diseases. This article reviews the latest research progress of ferroptosis in various liver diseases, including acute liver injury, metabolic associated fatty liver disease, alcoholic liver disease, viral hepatitis, autoimmune hepatitis, liver fibrosis and hepatocellular carcinoma. It aims to provide insights for the prevention and treatment of acute and chronic liver diseases through targeting ferroptosis.

Synergistic Protection of Vitamin B Complex and Alpha-Lipoic Acid Against Hepatic Ischemia-Reperfusion Injury: Boosting Antioxidant Defenses in Rats

This study aimed to investigate the protective effects of vitamin B complex and alpha-lipoic acid (ALA) pre-treatments on hepatic ischemia-reperfusion injury (IRI) in rats, focusing on their potential to enhance antioxidant defense mechanisms and reduce post-ischemic liver damage. Thirty male Wistar albino rats were divided into four groups: sham group (n = 10), IRI group (n = 10), vitamin B group (n = 10), vitamin B + ALA group (n = 10). In the IRI, vitamin B, and vitamin B + ALA groups, the rats underwent 45 min of hepatic ischemia followed by 60 min of reperfusion. Serum levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea, creatinine, and lactate dehydrogenase (LDH) were measured. Additionally, serum total antioxidant status (TAS) and total oxidant status (TOS) were assessed, and the oxidative stress index (OSI) was calculated. Liver tissue samples were collected for morphological evaluation. In the vitamin B and vitamin B + ALA groups, ALT, AST, urea, creatinine and LDH levels were better compared with the IRI group but the difference was statistically significant for only LDH levels in the vitamin B group and ALT, urea, and LDH levels in the vitamin B + ALA group (p < 0.05). The lowest TOS and OSI levels were reported in the vitamin B and vitamin B + ALA groups and these groups had statistically significantly higher TAS compared with the sham and IRI groups (p < 0.05). Our findings suggest that a vitamin B complex alone or a vitamin B complex + ALA combination reduces post-ischemic hepatic injury by enhancing the anti-oxidative status. The low dose of ALA may be a co-factor in these results and studies with larger doses of ALA are required to determine its effects on IRI of the liver.

Current status and perspective on molecular targets and therapeutic intervention strategy in hepatic ischemia-reperfusion injury

Hepatic ischemia‒reperfusion injury (HIRI) is a common and inevitable complication of hepatic trauma, liver resection, or liver transplantation. It contributes to postoperative organ failure or tissue rejection, eventually affecting patient prognosis and overall survival. The pathological mechanism of HIRI is highly complex and has not yet been fully elucidated. The proposed underlying mechanisms include mitochondrial damage, oxidative stress imbalance, abnormal cell death, immune cell hyperactivation, intracellular inflammatory disorders and other complex events. In addition to serious clinical limitations, available antagonistic drugs and specific treatment regimens are still lacking. Therefore, there is an urgent need to not only clarify the exact etiology of HIRI but also reveal the possible reactions and bottlenecks of existing drugs, helping to reduce morbidity and shorten hospitalizations. We analyzed the possible underlying mechanism of HIRI, discussed various outcomes among different animal models and explored neglected potential therapeutic strategies for HIRI treatment. By thoroughly reviewing and analyzing the literature on HIRI, we gained a comprehensive understanding of the current research status in related fields and identified valuable references for future clinical and scientific investigations.

Nuclear receptor subfamily 4 group A member 1 promotes myocardial ischemia/reperfusion injury through inducing mitochondrial fission factor-mediated mitochondrial fragmentation and inhibiting FUN14 domain containing 1-depedent mitophagy

This study investigated the mechanism by which NR4A1 regulates mitochondrial fission factor (Mff)-related mitochondrial fission and FUN14 domain 1 (FUNDC1)-mediated mitophagy following cardiac ischemia-reperfusion injury(I/R). Our findings showed that the damage regulation was positively correlated with the pathological fission and pan-apoptosis of myocardial cell mitochondria. Compared with wild-type mice (WT), NR4A1-knockout mice exhibited resistance to myocardial ischemia-reperfusion injury and mitochondrial pathological fission, characterized by mitophagy activation. Results showed that ischemia-reperfusion injury increased NR4A1 expression level, activating mitochondrial fission mediated by Mff and restoring the mitophagy phenotype mediated by FUNDC1. The inactivation of FUNDC1 phosphorylation could not mediate the normalization of mitophagy in a timely manner, leading to an excessive stress response of unfolded mitochondrial proteins and an imbalance in mitochondrial homeostasis. This process disrupted the normalization of the mitochondrial quality control network, leading to accumulation of damaged mitochondria and the activation of pan-apoptotic programs. Our data indicate that NR4A1 is a novel and critical target in myocardial I/R injury that exertsand negative regulatory effects by activating Mff-mediated mito-fission and inhibiting FUNDC1-mediated mitophagy. Targeting the crosstalk balance between NR4A1-Mff-FUNDC1 is a potential approach for treating I/R.