Impairing Ferroptosis Through the PI3K/Akt/Nrf2 Pathway: The Way for Nerve Growth Factor to Mitigate Hypoxia-induced Cardiomyocyte Damage.

Myocardial infarction (MI) is an acute cardiovascular diseases, distinguished primarily by cardiomyocyte damage due to ischemia and hypoxia. Nerve growth factor (NGF) is paramount in ischemic heart disease, it contributes to maintaining heart function and protecting the heart. Nonetheless, the effects of NGF on cardiomyocyte damage induced by hypoxia and the precise mechanisms involved are still to be elucidated. Utilizing western blot and immunofluorescence methods to quantify the NGF levels in cardiomyocytes (H9C2) of rats after hypoxia. Cell Counting Kit-8 (CCK-8) assay was employed to monitor the dynamic changes in cells vitality. The lactate dehydrogenase (LDH), Fe²⁺, malondialdehyde (MDA), superoxide dismutase (SOD) and reactive oxygen species (ROS) levels were evaluated by different kits. Moreover, the PI3K/Akt/Nrf2 pathway and ferroptosis-linked protein levels were analyzed using western blotting. In H9C2 cells, exposure to hypoxia for 24 h led to weakened NGF level, as well as lowered cell vitality and SOD activity, but elevated levels of LDH, Fe²⁺, MDA, and ROS, triggering ferroptosis. Overexpression NGF alleviated the ferroptosis in H9C2 cells caused by hypoxia, while NGF knockdown intensified this process. Additionally, overexpression NGF reinforced heme oxygenase-1 (HO-1) and Nrf2 levels, and Akt and PI3K phosphorylation, whereas NGF silencing produced contrary outcomes. Furthermore, the PI3K/Akt pathway inhibitor negated the elevation in HO-1 and Nrf2 levels mediated by NGF amplification. In contrast, the pathway activator reversed the lowering in Nrf2 and HO-1 levels caused by silencing NGF. This suggested that NGF mediates the activation of Nrf2 through the PI3K/Akt axis. Overall, by mediating the activation of Nrf2 through the PI3K/Akt axis, NGF reduced the damage to H9C2 cells caused by hypoxia and thus hindered ferroptosis.