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Another study (95) found that Ex-4 downregulated the level of hypoxia-inducible factor-1 (HIF-1) under hypoxic conditions in vivo (SH-SY5Y cells and primary cortical neurons) and ischemic state in vivo (transient ischemia model of gerbil) in vitro

It achieves this by suppressing SLC7A11 expression, leading to ferroptosis induction in various cancer cells [149, 150]

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Its proposed mechanisms are complex and multifaceted, involving interactions with the nitric oxide (NO) system, influence on growth factor expression (like Vascular Endothelial Growth Factor or VEGF), and modulation of cellular pathways related to tissue repair