Redox Regulation in Glioblastoma: Mechanisms, Biomarkers, and Therapeutic Implications

Glioblastoma is the most aggressive primary tumor of the central nervous system, characterized by high invasiveness, rapid progression, and a poor prognosis despite the current treatment modalities. Molecular stratification, using biomarkers such as IDH1, TERT, and MGMT, is a crucial step in the 2021 WHO classification for improving diagnosis and prognosis. Oxidative stress, a feature of GB, has been identified as an important factor in the initiation, progression, and resistance to treatment. It occurs due to an imbalance between reactive oxygen species generated by mitochondrial metabolism, NADPH oxidases, and exogenous sources such as ionizing radiation and xenobiotics and antioxidant defense. This imbalance leads to DNA damage, genomic instability, and deregulation of signaling pathways involved in cell proliferation, apoptosis, and tumor progression. This review provides an overview of key oxidative stress biomarkers and their dual roles in tumor suppression and progression. It highlights how oxidative stress contributes to treatment responses and resistance to current GB treatments, including redox-adaptive mechanisms such as the Nrf2-Keap1 pathway, which promotes radioresistance. Finally, it discusses the potential of understanding these mechanisms to develop therapeutic strategies that target redox balance and homeostasis, aiming to overcome resistance and improve survival outcomes for glioblastoma patients.