In the absence of impaired kidney function, an elevated MMA level in conjunction with elevated homocysteine suggests either a vitamin B 12 deficiency or a combined vitamin B 12 and folate deficiency (32)
H 2 O 2 signaling leads to the release of Nrf2 from complexes with Kelch-like ECH-associated protein 1 (Keap1) and ubiquitin ligase Cullin 3 and into the nucleus, where it binds to antioxidant response elements (ARE) and activates the expression of its target gene GPX8, which in turn regulates the expression of ER calcium by regulating SERCA ( 2 O 2 signaling and inhibiting Nrf2 translocation to the nucleus, resulting in a decrease in GPX8, resulting in increased ER calcium content and signaling ( via GPX8, in the same study, after silencing Nrf2 in HeLa cells, GPX8 mRNA and protein levels also decreased, resulting in elevated ER and cytosolic calcium levels at rest and increased histamine-induced ER calcium release ( FIGURE 7 In summary, the antioxidant stress of GPX8 is not only related to the oxidative folding of endoplasmic reticulum proteins, but also may play a vital role in regulating endoplasmic reticulum Ca 2+
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