The technical centerpiece of the work is a family of fluorescent biosensors called iNap, which fluoresce in proportion to NADPH concentration and can be targeted to specific cellular compartments. When the researchers expressed these sensors in adult mouse cardiomyocytes, they observed that swimming and running exercise elevated the NADPH signal in the cytosol while leaving the mitochondrial pool untouched. This compartmental specificity matters, because cytosolic and mitochondrial NADPH fluxes are known to be independently regulated, and it points the finger away from mitochondrial transhydrogenase and toward cytosolic sources. Among those sources, the pentose phosphate pathway, or PPP, stood out: a glucose-shunting branch of metabolism whose rate-limiting enzyme, glucose-6-phosphate dehydrogenase (G6PD), strips electrons from glucose-6-phosphate and deposits them onto NADP+ to make NADPH.

The causal chain was established through a series of loss-of-function experiments. When the team inhibited PPP activity or depleted cytosolic NADPH in mice, the heart’s response to exercise was blunted: the characteristic enlargement of cardiomyocytes that normally accompanies training failed to materialize. Conversely, the study showed that NADPH itself is a driver of cardiomyocyte growth, acting by inhibiting the HDAC3/C/EBPβ pathway—a signaling axis previously implicated in the control of exercise-induced cardiac growth. In other words, the reducing equivalents manufactured by the PPP do more than keep reactive oxygen species in check; they directly tune an epigenetic and transcriptional program that tells heart cells to grow in a coordinated, physiological manner rather than in the maladaptive fashion seen in disease.

The protective side of the story emerged from mouse models of acute ischemia–reperfusion injury, a scenario that unfolds in millions of patients each year when a blocked coronary artery is reopened and the sudden return of oxygen floods the tissue with reactive oxygen species. Mice with an exercise-activated PPP/NADPH pathway suffered measurably less injury from a subsequent ischemia–reperfusion challenge, and this protection persisted: four weeks after the insult, heart function remained significantly preserved compared with sedentary controls. The mechanism appears to be twofold. First, abundant NADPH sustains the glutathione and thioredoxin antioxidant systems that neutralize the oxidative burst of reperfusion. Second, by suppressing HDAC3 activity, NADPH restrains the transcriptional changes that push stressed cardiomyocytes toward death and maladaptive remodeling.

What makes the study more than an elegant piece of mechanistic cardiology is its drug-discovery angle. The researchers screened 310 Tibetan medicinal compounds for the ability to raise intracellular NADPH, and one molecule rose to the top: lyciumspermidine-0527, a spermidine derivative derived from a plant used in traditional Tibetan medicine. Biochemical and structural analyses showed that this compound directly activates G6PD, the rate-limiting enzyme of the pentose phosphate pathway, stabilizing the enzyme’s active dimeric form. In cultured cardiomyocytes and in living mice, lyciumspermidine-0527 elevated cytosolic NADPH, promoted cardiomyocyte growth, and—most strikingly—alleviated ischemia–reperfusion injury to a degree that rivaled exercise itself.

Safety data accompanying the compound were encouraging. Across a range of doses in vitro and in vivo, lyciumspermidine-0527 did not significantly induce cell death in the heart, and histological examination of heart, liver, lung, kidney, and brain tissue showed no overt toxicity. The compound also maintained redox homeostasis in cardiomyocytes, consistent with its proposed mechanism of boosting, rather than overwhelming, the cell’s antioxidant buffering capacity. Genetic confirmation followed: when G6PD was knocked down, the protective effects of the compound vanished, placing G6PD squarely upstream of the observed benefit and ruling out major off-target explanations for the phenotype.

Conceptually, the findings reframe physiological cardiac hypertrophy as a metabolic checkpoint phenomenon. The healthy heart’s enlargement in response to exercise has long been distinguished from the pathological hypertrophy of hypertension or heart failure by its reversibility and preserved function, but the molecular gatekeepers separating the two states have been only partially mapped. By demonstrating that PPP-derived NADPH is required for exercise-induced growth and simultaneously protective against injury, the study positions a single metabolite as a checkpoint that integrates the demand for biosynthesis (NADPH feeds fatty acid and nucleotide production), antioxidant defense (NADPH powers glutathione reductase), and epigenetic regulation (NADPH inhibits the HDAC3–Ncor complex). Exercise, in this view, is a metabolic intervention, and its cardiac benefits can be recapitulated—at least in mice—by pharmacologically opening a single metabolic valve.

The translational horizon is tantalizing but cautious. Lyciumspermidine-0527 is not yet a drug, and the leap from mouse models of surgically induced ischemia–reperfusion to human myocardial infarction is considerable. G6PD activity is a double-edged sword: the same pathway that supports antioxidant defense in cardiomyocytes also supports nucleotide synthesis and growth in cancer cells, raising questions about systemic effects that would need careful evaluation in longer-term studies. Nonetheless, the identification of a small molecule that directly activates G6PD offers a starting point for medicinal chemistry, and the iNap biosensor toolkit the team deployed provides a template for screening compounds by their ability to raise NADPH in specific subcellular compartments rather than by crude proxies.

For now, the study’s most immediate contribution is conceptual clarity. It explains, in mechanistic terms, why the exercising heart grows well and withstands injury better, connecting the dots from a transcription factor (SP1-driven G6PD expression), through a metabolic flux (the pentose phosphate pathway), to a redox cofactor (cytosolic NADPH), and finally to an epigenetic effector (HDAC3/C/EBPβ) and a clinical phenotype (preserved function after reperfusion). It also validates a natural-product-inspired approach to finding exercise mimetics for the heart. If the PPP/NADPH axis holds up in larger preclinical models, the prospect of a pill that trains the heart’s metabolism—conferring some of exercise’s cardioprotection on patients who cannot exercise—moves from metaphor to plausible pipeline.

Subject of Research: Pentose phosphate pathway-derived NADPH as a metabolic checkpoint regulating exercise-induced physiological cardiac hypertrophy and protection against ischemia–reperfusion injury

Article Title: Pentose phosphate pathway-derived NADPH facilitates physiological hypertrophy and alleviates ischemia–reperfusion injury in the heart

Article References: Wu, D., Chen, T., Dong, X., Li, H., Cheng, Z., Li, H., Chao, Y., Li, F., Yin, Y., Guo, F., Xu, X., Zhang, Y., Ning, K., Fu, X., Bian, Y., Ma, F., Ritterhoff, J., Wang, W., & Hu, Q. (2026). Pentose phosphate pathway-derived NADPH facilitates physiological hypertrophy and alleviates ischemia–reperfusion injury in the heart. Nature Metabolism. https://doi.org/10.1038/s42255-026-01587-9

Image Credits: AI Generated

DOI: 10.1038/s42255-026-01587-9

Keywords: NADPH, pentose phosphate pathway, cardiac hypertrophy, exercise, ischemia-reperfusion injury, glucose-6-phosphate dehydrogenase, cardiomyocytes, HDAC3, lyciumspermidine-0527, redox homeostasis, cardiac metabolism, Nature Metabolism