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Tzeng TT, Chen CC, Lee LY, et al

The intrinsic pathways of apoptosis are activated by melatonin by impacting the membrane potential of mitochondria and cytochrome c release via increasing the expression of pro-apoptotic genes belonging to Bcl-2 family like Bax, Bak, Bid these proteins from pores in the mitochondrial membrane and facilitating the release of cytochrome c (138)

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Their coordinated activation determines whether the heart maintains resilience under physiological demand and pathological stress or undergoes progressive failure

This also poses a challenge to the timing and extent of intervention with ferroptosis treatment options