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Tetrahydroberberrubine (THBru) is a small molecule derivative of berberrubine being investigated for its potential to treat atherosclerosis. It functions by inhibiting endothelial ferroptosis, an iron-dependent form of regulated cell death that contributes to vascular dysfunction and plaque formation. Mechanistically, THBru activates the adenosine monophosphate-activated protein kinase (AMPK) pathway, which subsequently downregulates the transcription factor BTB and CNC homology 1 (BACH1). This suppression leads to the inhibition of the super-enhancer activity of the ATP-binding cassette subfamily C member 1 (ABCC1) gene, thereby enhancing glutathione homeostasis and reducing the accumulation of reactive oxygen species (ROS) in vascular endothelial cells.
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