ASIV promoted H/R induced-H9c2 cells viability
In order to document the therapeutic activity of ASIV, CCK-8 analysis was employed to examine cell viability. In normoxia, compared to the control, although there was no obvious effect on the viability of H9c2 cells treated with ASIV at concentrations ranging from 5 μM to 50 μM, an increased cell viability could be detected at concentrations of 100 μM and 150 μM. However, it was worth noting that a negative effect was found when H9c2 cells were treated with 200 μM ASIV (Figure 1A). Then, the therapeutic potential of ASIV in the H9c2 H/R model was assessed. CCK-8 analysis revealed that cellular proliferation in the H/R groups was significantly decreased in comparison with the control. Additionally, ASIV treatment at concentrations of 50 μM, 100 μM, and 150 μM contributed to the increased cell viability (Figure 1B). Taken together, these studies suggested that ASIV could promote H/R induced H9c2 cell viability.
Anti-oxidative effects of ASIV on H/R induced H9c2 cells
According to previous reports, reactive oxygen species (ROS) induced oxidative stress plays a key role in the development of IRI. Therefore, the production of ROS was assessed in ASIV-treated H9c2 cells. First, propranolol, widely used to treat cardiovascular disorders, has been reported to suppress the production of ROS, thus used as a positive control16. As shown in Figure 2A, H/R treatment remarkably induced ROS levels in H9c2 cells, which could be relieved either by ASIV treatment or propranolol treatment, thus indicating that ASIV may play a vital role in protecting H9c2 cells against oxidative stress. Furthermore, SOD and MDA content have also been studied. Following exposure to H/R led to a reduced SOD activity, while the decreased SOD activity could be elevated by ASIV or propranolol in H9c2 cells (Figure 2B). Additionally, MDA content was remarkably increased in the H12/R16 group, which was alleviated by using ASIV or propranolol treatment (Figure 2C). As a result, it was documented that ASIV alleviated H/R induced oxidative stress via deregulation of ROS production, MDA content, and induction of SOD activity, thus contributing to promoting cell viability.
ASIV pretreatment altered apoptosis-related protein expression in H/R-treated H9c2 cells
To investigate the effects of ASIV on apoptosis-related molecular changes following H/R injury, the expression of Bcl-2, cleaved caspase-3, Bax, and cytochrome c was examined by Western blotting. Compared with the control group, H12/R16 exposure decreased Bcl-2 expression and increased cleaved caspase-3, Bax, and cytochrome c expression. ASIV pretreatment attenuated these H/R-induced changes, as evidenced by increased Bcl-2 expression and decreased cleaved caspase-3, Bax, and cytochrome c expression compared with the H12/R16 group (Figure 3). These findings indicate that ASIV pretreatment modulated H/R-induced changes in apoptosis-related protein expression in H9c2 cells.
Protective effects of ASIV on the function of mitochondria in H/R induced H9c2 cells
To determine whether the protective effect of ASIV on H/R induced H9c2 cells was associated with improved mitochondrial function, oxygen consumption rate (OCR) was assessed using an extracellular flux bioanalyzer. Four experimental groups were included: control, H12/R16, H12/R16 + ASIV, and H12/R16 + propranolol, with propranolol serving as a positive control.
Compared with the control group, H/R exposure decreased basal respiration, ATP-linked respiration, maximal respiration, and spare respiratory capacity, while increasing proton leak (Figure 4A-F). Pretreatment with ASIV attenuated these H/R induced alterations, as evidenced by increased basal respiration, ATP-linked respiration, maximal respiration, and spare respiratory capacity, together with decreased proton leak compared with the H12/R16 group. Propranolol pretreatment, used as a positive control, similarly ameliorated H/R induced mitochondrial respiratory dysfunction. Collectively, these findings indicate that ASIV pretreatment attenuated H/R induced impairment of mitochondrial respiratory function in H9c2 cells.
ASIV improved H/R induced impaired mitochondrial function
To further determine whether ASIV attenuated H/R induced mitochondrial dysfunction, mitochondrial membrane potential (ΔΨm) was assessed using JC-1 staining and quantified as the red/green fluorescence ratio. H/R exposure resulted in a decreased JC-1 red/green fluorescence ratio compared with the control group, indicating mitochondrial membrane depolarization. In contrast, ASIV pretreatment increased the red/green fluorescence ratio compared with the H/R group, indicating attenuation of the H/R induced loss of mitochondrial membrane potential (Figure 5).
ASIV alleviated H/R induced oxidative stress, accompanied by changes in Nrf2/HO-1 signaling
To further explore the molecular changes associated with the protective effects of ASIV, the expression of Keap1, Nrf2, and HO-1 was examined by Western blotting. H/R exposure was associated with increased Keap1 expression and decreased Nrf2 and HO-1 expression, whereas ASIV pretreatment attenuated these H/R-associated changes (Figure 6E). These findings suggest that the protective effects of ASIV in H/R-treated H9c2 cells are associated with changes in Keap1/Nrf2/HO-1 signaling.
Molecular docking was additionally performed as an exploratory computational analysis. Re-examination of the protein structure used in the original docking analysis confirmed that the receptor was the Keap1 Kelch domain (PDB ID: 2FLU), rather than Nrf2, as incorrectly described in the original manuscript. The predicted docking pose showed interactions between ASIV and residues within the Keap1 binding pocket (Figure 6A-D), with a calculated binding energy of -3.58 kcal/mol. Given the modest predicted binding energy and the absence of experimental target-binding validation, this docking result was interpreted cautiously and was not considered evidence of direct or functionally relevant binding.
DATA AVAILABILITY:
All raw data generated and analyzed during this study are provided in Supplementary File 1.

Figure 1: Effects of ASIV and H/R exposure on H9c2 cell viability. (A) Effects of different concentrations of ASIV (5 μM, 10 μM, 20 μM, 50 μM, 100 μM, 150, and 200 μM) on H9c2 cell viability under normoxic conditions. (B) Effects of ASIV pretreatment at the indicated concentrations (50 μM, 100 μM, and 150 μM) on the viability of H9c2 cells subjected to 12 h of hypoxia followed by 16 h of reoxygenation (H12/R16). Cell viability was assessed using the CCK-8 assay and expressed as a percentage of the control group. Data are presented as mean ± SD from three independent experiments (n = 3). Statistical comparisons were performed using one-way ANOVA followed by Dunnett's multiple-comparisons test. *P < 0.05 and **P < 0.01 versus the corresponding untreated group; ##P < 0.01 versus the control group. Please click here to view a larger version of this figure.

Figure 2: ASIV pretreatment attenuated H/R-induced oxidative stress in H9c2 cells. (A) Intracellular ROS levels were assessed using DCFH-DA, with representative fluorescence-intensity distributions shown for the control, H12/R16, H12/R16 + ASIV, and H12/R16 + propranolol groups; the corresponding quantitative analysis is shown on the right. (B) SOD activity. (C) MDA content. Data are presented as mean ± SD from three independent experiments (n = 3). Statistical comparisons were performed using one-way ANOVA followed by Dunnett's multiple-comparisons test. **P < 0.01 versus the control group; ##P < 0.01 versus the H12/R16 group. Please click here to view a larger version of this figure.

Figure 3: Effects of ASIV pretreatment on apoptosis-related protein expression in H/R-treated H9c2 cells. Representative Western blots and densitometric analyses of Bcl-2, cleaved caspase-3, Bax, and cytochrome c protein expression in the control, H12/R16, and H12/R16 + ASIV groups. GAPDH was used as the loading control, and protein expression was normalized to GAPDH. Data are presented as mean ± SD from three independent experiments (n = 3). Statistical comparisons were performed using one-way ANOVA followed by Dunnett's multiple-comparisons test. **P < 0.01 versus the control group; △P < 0.05 and △△P < 0.01 versus the H12/R16 group. Please click here to view a larger version of this figure.

Figure 4: ASIV pretreatment attenuated H/R-induced impairment of mitochondrial respiratory function in H9c2 cells. Mitochondrial respiration was assessed using the extracellular flux analyzer in the control (CTRL), H12/R16, H12/R16 + ASIV, and H12/R16 + propranolol groups. (A) Representative oxygen consumption rate (OCR) profiles during the mitochondrial stress test. (B) Basal respiration. (C) ATP-linked respiration. (D) Maximal respiration. (E) Spare respiratory capacity. (F) Proton leak. Data for the derived respiratory parameters are presented as mean ± SD from three independent experiments (n = 3). Statistical comparisons were performed using one-way ANOVA followed by Dunnett's multiple-comparisons test. *P < 0.05 and **P < 0.01 versus the control group; △P < 0.05 and △△P < 0.01 versus the H12/R16 group. Please click here to view a larger version of this figure.

Figure 5: Effects of ASIV pretreatment on JC-1 fluorescence in H/R-treated H9c2 cells. Mitochondrial membrane potential (ΔΨm) was assessed using the JC-1 assay and quantified as the red/green fluorescence intensity ratio in the control (CTRL), H12/R16, and H12/R16 + ASIV groups. H12/R16 exposure significantly decreased the JC-1 red/green fluorescence ratio compared with the control group, whereas ASIV pretreatment partially restored the ratio compared with the H12/R16 group. Data are presented as mean ± SD from three independent experiments (n = 3). Statistical comparisons were performed using one-way ANOVA followed by Dunnett's multiple-comparisons test. **P < 0.01 versus the control group; △P < 0.05 versus the H12/R16 group. Please click here to view a larger version of this figure.

Figure 6: ASIV pretreatment was associated with changes in Keap1/Nrf2/HO-1 signaling in H/R-treated H9c2 cells. (A-C) Molecular docking analysis illustrating the predicted interaction between ASIV and the Keap1 Kelch domain (PDB ID: 2FLU). (A) Overall molecular-surface representation of the predicted docking pose. (B) Enlarged view of ASIV within the predicted Keap1 binding pocket. (C) Ribbon representation of the Keap1 Kelch domain showing the predicted position of ASIV within the binding region. (D) Two-dimensional interaction map showing the predicted interactions between ASIV and residues within the Keap1 binding pocket. (E) Representative Western blots showing Keap1, Nrf2, and HO-1 protein expression in the control, H12/R16, and H12/R16 + ASIV groups. GAPDH was used as the loading control. Western blot experiments were independently repeated three times (n = 3), and representative blots are shown. Please click here to view a larger version of this figure.
Supplementary File 1: All raw data generated and analyzed during this study.Please click here to download this file.