Can monomethyl fumarate and nifedipine reduce ischemia reperfusion injury in rat ovary, and what is the share of oxidative stress-sensitive transcription factors HIF-1α, NF-κB, and Nrf2?

Objectives: This study aimed to investigate the potential protective roles of monomethyl fumarate (MMF) and nifedipine (NF) against ovarian ischemia-reperfusion (I/R) injury in rats, with a particular focus on the contribution of oxidative stress-sensitive transcription factors HIF-1α, NF-κB, and Nrf2. Materials and Methods: A rat model of ovarian I/R injury was established using 3-hr ischemia followed by 24-hour reperfusion. Ovarian hormone secretion capacity, oxidative stress-related biomolecular alterations, and apoptosis activation were analyzed using ELISA. Histopathological damage and apoptotic cell status were evaluated by hematoxylin-eosin (H&E) and immunohistochemical (IHC) staining. Expression levels of HIF-1α, NF-κB, Nrf2, and related downstream genes were determined using RT-qPCR. Combined administration of MMF and NF restored serum AMH and E2 levels toward control values and reduced tissue oxidative stress markers (TOS and MDA). Gene expression of pro-apoptotic (BAX, BECLIN-1) and stress-related (HIF-1α, NF-κB, Nrf2) molecules improved under MMF and NF treatments. The combined therapy showed the most effective reduction in oxidative stress-induced molecular and histological alterations. Conclusion: MMF and NF exerted protective effects against ovarian I/R injury by modulating oxidative stress and apoptosis. These findings suggest that the coordinated regulation of HIF-1α, NF-κB, and Nrf2 pathways may play a pivotal role in reducing reperfusion-related ovarian tissue damage.