The Nrf2-ARE signaling pathway: An update on its regulation and possible role in cancer prevention and treatment.

Nrf2 acts as a sensor of oxidative or electrophilic stress and prevents genome instability. The activation of Nrf2 signaling induces ARE-dependent expression of detoxifying and antioxidant defense proteins. Nrf2-ARE signaling has become an attractive target for cancer chemoprevention. On the other hand, constitutive over-activation of Nrf2 in cancer cells has been implicated in cancer progression as well as in resistance to cancer chemotherapeutics. Two basic Nrf2 activation pathways were described. The canonical pathway is the primary mechanism of Nrf2 activation and is based on dissociation of Nrf2 from its inactive complex with the repressor protein Keap1 and the subsequent translocation of Nrf2 into the nucleus. Numerous proteins which compete with Nrf2 for Keap1 binding stabilize Nrf2 and are involved in non-canonical pathways of Nrf2 activation. However, growing evidence indicates that the regulation of Keap1-Nrf2-ARE is more complex than was previously thought and that other molecular mechanisms are also involved. Among them is epigenetic regulation of Nrf2 and Keap1, which seems to be a particularly interesting subject for future studies. Nrf2 has become an important chemopreventive and therapeutic target, and many natural and synthetic chemicals have been described as its modulators. However, most small molecules which are either inducers or inhibitors of Nrf2 may provoke "off-target" toxic effects because of their electrophilic character. This review highlights Nrf2-ARE activation pathways and their role in cancer prevention and therapy. A critical evaluation of currently available Nrf2 inducers and inhibitors is also presented.