Thismini-reviewpresentstheauthors'visiononthecurrentstatusandfuturetrendsinthedevelopmentofneuroprotectiveagentsworkingviaactivationofnuclearfactorerythroid2-relatedfactor2(Nrf2),andinparticular,viadisruptionofNrf2-Keaplinteraction.Therearetwoopposite'chemical'mechanismsunderlyingsuchactivation:thefirstoneisanon-specificcovalentmodificationofKeap1thiols,resultinginsideeffectsofvariedseverity,andthesecondoneistheshiftoftheNrf2-Kelch-likeECHassociatedprotein-1(Keap1)bindingequilibriuminthepresenceofacompetitiveandchemicallybenigndisplacementagent.Atthispoint,nodisplacementactivatorsexhibitsufficientbiologicalactivityincomparisonwithcommonNrf2activatorsworkingviaKeaplthiolmodification.Hence,thehopeintherapeuticsisnowlinkedtotheFDAapproveddimethylfumarate,whosederivative,monomethylfumarate,aswedemonstratedrecently,ismuchlesstoxicbutequallybiologicallypotentandanidealcandidateforclinicaltrialsrightnow.AnewlyemergingplayerisanuclearinhibitorofNrf2,BTBdomainandCNChomolog1(Bach1).ThecommerciallydevelopedBachlinhibitorsarecurrentlyunderinvestigationinourlaboratoryshowingpromisingresults.Inourviewpoint,theperfectfuturedrugwillpresentthecombinationofadisplacementactivatorandBachlinhibitortoinsuresafetyandefficiencyofNrf2activation.
