Figure 3.

The mechanism of ІМА formation driven by oxidative stress. Tissue hypoxia and activation of anaerobic glycolysis induce acidosis and release Cu²⁺ ions from copper-containing proteins, such as ceruloplasmin (1). In the presence of reducing agents, e.g., ascorbic acid, Cu²⁺ is reduced to Cu⁺ (2), followed by the formation of superoxide anion O⁻₂ (3-4). Superoxide dismutase (SOD) catalyzes the dismutation of superoxide O⁻₂ to hydrogen peroxide H₂O₂ (5), which, in the presence of Cu²⁺, undergoes the Fenton reaction with the formation of hydroxyl radicals ^·OH (6). These radicals contribute to the degradation of NTS (7) and IMA formation (8), which cannot bind Cu²⁺ and other metal ions.