Protective effect of resveratrol against colistin-induced nephrotoxicity through regulating Nrf2 pathway and inhibiting ferroptosis.

Resveratrol (Res), a natural polyphenol, is widely used as a functional food additive and food preservative due to its antioxidant and anti-inflammatory properties. However, its protective role against drug-induced organ damage, particularly colistin-induced nephrotoxicity (CIN), remains underexplored. This study investigated Res's protective effects and mechanisms against CIN in rat and NRK-52E cells. In vivo, Res (5-20 mg/kg) significantly improved renal function, alleviated histopathological damage, and restored antioxidant status. Mechanistically, Res modulated the Keap1/Nrf2 axis, suppressing excessive Nrf2 activation and its downstream enzymes. Concurrently, Res inhibited ferroptosis by reducing iron accumulation and modulating key ferroptosis markers (GPX4, ACSL4). In vitro, Res (20 μM) reversed CS- and RSL3-induced cytotoxicity, lipid peroxidation, and ferrous iron overload; Nrf2 siRNA abrogated these effects, confirming Nrf2's essential role. These findings highlight Res as a promising strategy to enhance colistin's clinical safety through precise Nrf2 modulation and ferroptosis inhibition, underscoring the therapeutic potential of natural food compounds.