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(4) Furthermore, the oxidative stress imbalance, caused by excessive ROS production, impairs the antioxidant defense system by directly damaging antioxidant enzymes (such as SOD and GPx) and depleting key antioxidant molecules like glutathione, leading to fragmentation of hyaluronic acid in the extracellular matrix and abnormal collagen cross-linking, thereby reducing the mechanical properties of cartilage (6, 22, 23)

Aggregation produces particles large enough to scatter light, creating visible turbidity

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The activity of NRF2 is primarily regulated post-translationally through its interaction with Kelch-like ECH-associated protein 1 (KEAP1), a crucial regulator of NRF2 under basal redox conditions

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