In HF, Nrf2 expression is regulated by multiple mechanisms, including transcriptional repression mediated by microRNAs (e.g., miR-27a, miR-28a, and miR-34a) (119, 120), direct inhibition by glycogen synthase kinase-3 (GSK-3) (118), and modulation of the Keap1-Nrf2 signaling axis by phosphoglycerate mutase family member 5 (PGAM5) (121). Here, PGAM5 is linked to hydrops fetalis.