Abstract
Exertional heat stroke (EHS) poses a significant public health challenge because of its elevated rates of mortality and disability. Sex differences in incidence have been noted, and estrogen may be a contributing factor. The innovative G protein-coupled estrogen receptor (GPER) is recognized for its protective function in various diseases via the rapid non-genomic pathway associated with estrogen. The neuroprotective effects of the GPER agonist G1 are well known, but its potential to improve EHS-related brain injury has not been explored. We investigated whether G1 can improve EHS-related brain injury and clarified the mechanisms underlying its protective effects. Twenty-four hours after injury, transcriptome sequencing was conducted, disclosing varying gene expression patterns within the mouse hippocampus. Increased expression of stress-related genes within the endoplasmic reticulum (ER) of EHS mice was noted. The activation of GPER through G1 led to reduction in the levels of ER stress-related proteins, including CHOP, GRP78, and caspase-12. This, in turn, diminished neuronal apoptosis caused by ER stress and enhanced both the survival rate and cognitive abilities of EHS mice. Notably, the protective effects of G1 were diminished by the GPER blocker G15. GPER may represent a potential therapeutic target for brain injury associated with EHS.
Data availability
The transcriptome sequencing data generated and analyzed during the current study are available in the National Center for Biotechnology Information (NCBI) under the BioProject number PRJNA1224851. All other data supporting the findings of this study are available from the corresponding author upon reasonable request.
References
Bouchama, A. et al. Classic and exertional heatstroke. Nat. Rev. Dis. Primers 8, 8 (2022).
Bouchama, A. & Knochel, J. P. Heat stroke. N. Engl. J. Med. 346, 1978–1988 (2002).
Wang, C. et al. Association of D-dimer and acute kidney injury associated with rhabdomyolysis in patients with exertional heatstroke: An over 10-year intensive care survey. Ren. Fail. 43, 1561–1568 (2021).
DeGroot, D. W., Litchfield, A. C., Blodgett, C. A., Rhodehouse, B. B. & Hudson, K. P. Chain of survival for a severe exertional heat stroke casualty. J. Appl. Physiol. 138, 699–705 (2025).
Chao, C. M. et al. Myocardial structure and functional alterations in a preclinical model of exertional heat stroke. Life Sci. 323, 121640 (2023).
Lorenz, E., Herold, J., Lodes, U. & Meyer, F. Fatal heat stroke based on foudroyant irreversible multiple organ dysfunction in German summer. Innov. Surg. Sci. 8, 129–134 (2023).
Garcia, C. K., Renteria, L. I., Leite-Santos, G., Leon, L. R. & Laitano, O. Exertional heat stroke: Pathophysiology and risk factors. BMJ Med. 1, e000239 (2022).
Xie, J. et al. Exertional heat stroke-induced changes in gut microbiota cause cognitive impairment in mice. BMC Microbiol. 24, 134 (2024).
Goodwin, K. C., Giersch, G. E. W., Murray, T. A., DeGroot, D. W. & Charkoudian, N. Sex differences in biomarkers of end-organ damage following exertional heat stroke in humans. J. Appl. Physiol. 137(5), 1434–1445 (2024).
Giersch, G. E. W., Garcia, C. K., Stachenfeld, N. S. & Charkoudian, N. Are there sex differences in risk for exertional heat stroke? A translational approach. Exp. Physiol. 107, 1136–1143 (2022).
Garcia, C. K. et al. Sex-dependent responses to exertional heat stroke in mice. J. Appl. Physiol. 125, 841–849 (2018).
Shen, B. et al. Estrogen-induced extracellular calcium influx promotes endometrial cancer progress by regulating lysosomal activity and mitochondrial ROS. Front. Med. 9, 835700 (2022).
Xi, Y., Zheng, P., Xi, W. & Fu, T. Exploring the impact of estrogenic endocrine disruptors on cervical cancer progression: A transcriptome analysis and prognostic model development. Ecotoxicol. Environ. Saf. 285, 117025 (2024).
Diaz-Zegarra, L. A. et al. Electrophysiological changes induced by G1, the selective agonist of the G-protein coupled estrogen receptor (GPER), in the clip-TAC mice model. A new potential cardioprotective mechanism. Life Sci. 379, 123873 (2025).
Xu, S., Yu, S., Dong, D. & Lee, L. T. O. G protein-coupled estrogen receptor: A potential therapeutic target in cancer. Front. Endocrinol. 10, 725 (2019).
Kutuk, O. & Kaplan, A. Phytoestrogen signal pathways and estrogen signaling in ovarian cancer: A narrative review. Phytother. Res. 39, 3601–3612 (2025).
Kilanowski-Doroh, I. M. et al. Ovariectomy-induced arterial stiffening differs from vascular aging and is reversed by GPER activation. Hypertension 81, e51–e62 (2024).
Karamali, N. et al. Pathophysiology of endoplasmic reticulum stress and the potential role of dexmedetomidine as a modulator. BioFactors 51, e70022 (2025).
Lee, J. et al. Roridin E and satratoxin H, macrocyclic trichothecene mycotoxins, induce endoplasmic reticulum stress-dependent apoptosis through ribosome interaction in B16 mouse melanoma cells. Bioorg. Chem. 164, 108842 (2025).
Zhang, B. Y. et al. L-carnitine ameliorates myocardial injury by alleviating endoplasmic reticulum stress via inhibition of PERK pathway in exertional heatstroke rats. Heliyon 10, e40502 (2024).
Song, R. et al. A mouse model of exertional heatstroke-related acute kidney injury. Ann. Transl. Med. 10, 276 (2022).
Sharma, G. et al. Preclinical efficacy of the GPER-selective agonist G-1 in mouse models of obesity and diabetes. Sci. Transl Med. 12, eaau5956 (2020).
Qian, Y. et al. SRGN amplifies microglia-mediated neuroinflammation and exacerbates ischemic brain injury. J. Neuroinflammation 21, 35 (2024).
Li, J. et al. Heat acclimation defense against exertional heat stroke by improving the function of preopticTRPV1 neurons. Theranostics 15, 1376–1398 (2025).
Waters, E. M. et al. G-protein-coupled estrogen receptor 1 is anatomically positioned to modulate synaptic plasticity in the mouse hippocampus. J. Neurosci. 35, 2384–2397 (2015).
Peng, J., He, J., Hu, X. & Xia, Y. GPR30 alleviated subarachnoid hemorrhage-induced blood-brain barrier dysfunction by activating the PI3K/Akt and Nrf2/HO-1 pathways. Am. J. Physiol. Cell. Physiol. 327, C65–C73 (2024).
Larson, P. S. et al. Long-term exposure to extreme heat and cold and cognitive decline in older adults: Results from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. Environ. Res. 283, 121984 (2025).
Fu, Z. et al. GPER agonist G-1 activates YAP to induce apoptosis in breast cancer cells. J. Steroid Biochem. Mol. Biol. 248, 106693 (2025).
Mohammad-Sadeghipour, M. et al. G protein-coupled estrogen receptor reduces the breast cancer cell survival by regulating the IRE1α/miR-17-5p/TXNIP pathway. J. Steroid Biochem. Mol. Biol. 252, 106770 (2025).
Wowui, P. I. et al. Estrogen via GPER downregulated HIF-1a and MIF expression, attenuated cardiac arrhythmias, and myocardial inflammation during hypobaric hypoxia. Mol. Med. 31, 107 (2025).
Kozler, P., Marešová, D. & Pokorný, J. Determination of brain water content by dry/wet weight measurement for the detection of experimental brain edema. Physiol. Res. 71, S277–S283 (2022).
Alsbrook, D. L. et al. Neuroinflammation in acute ischemic and hemorrhagic stroke. Curr. Neurol. Neurosci. Rep. 23, 407–431 (2023).
Chou, Y. S. et al. G-protein-coupled estrogen receptor-1 facilitates chondrocyte proliferation in pubertal epiphyseal growth plate via PTHrP/Ihh regulation. Bone Joint Res. 14, 589–600 (2025).
Langdon, S. P., Herrington, C. S., Hollis, R. L. & Gourley, C. Estrogen signaling and its potential as a target for therapy in ovarian cancer. Cancers 12, 1647 (2020).
Chang, Y. et al. G protein-coupled estrogen receptor activation improves contractile and diastolic functions in rat renal interlobular artery to protect against renal ischemia reperfusion injury. Biomed. Pharmacother. 112, 108666 (2019).
Han, Z. W. et al. GPER agonist G1 suppresses neuronal apoptosis mediated by endoplasmic reticulum stress after cerebral ischemia/reperfusion injury. Neural Regen. Res. 14, 1221–1229 (2019).
Cirillo, F. et al. GPER deletion triggers inhibitory effects in triple negative breast cancer (TNBC) cells through the JNK/c-Jun/p53/Noxa transduction pathway. Cell Death Discov. 9, 353 (2023).
Wang, S. et al. Neuronal GPER participates in genistein-mediated neuroprotection in ischemic stroke by inhibiting NLRP3 inflammasome activation in ovariectomized female mice. Mol. Neurobiol. 59, 5024–5040 (2022).
Yu, Z. et al. Icaritin inhibits neuroinflammation in a rat cerebral ischemia model by regulating microglial polarization through the GPER-ERK-NF-κB signaling pathway. Mol. Med. 28, 142 (2022).
Lu, D. et al. Activation of G protein-coupled estrogen receptor 1 (GPER-1) ameliorates blood-brain barrier permeability after global cerebral ischemia in ovariectomized rats. Biochem. Biophys. Res. Commun. 477, 209–214 (2016).
Upadhayay, S. et al. Involvement of the G-protein-coupled estrogen receptor-1 (GPER) signaling pathway in neurodegenerative disorders: A review. Cell. Mol. Neurobiol. 43, 1833–1847 (2023).
Acknowledgements
The authors extend their sincere thanks to Zhi Dai, Dongxu Qian, and non-author contributors for their assistance with data collection, technical support, and critical feedback.
Funding
The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.
Author information
Authors and Affiliations
Contributions
Conceptualization: Feihu Zhou Ziwei Han; Data curation: Xiaochen Wang; Formal analysis: Jiansong Guo; Investigation: Chao Liu; Methodology: Jie Hu; Project administration: Zhi Mao; Resources: Feihu Zhou: Supervision: Feihu Zhou; Validation: Yan Shen; Visualization: Baisheng Sun; Writing – original draft: Ziwei Han; Writing – review & editing: Feihu Zhou.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Ethics approval
All animal procedures adhered to the guidelines of the Animal Welfare Ethics Committee of the Chinese PLA General Hospital (2023-X19-15).
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
About this article
Cite this article
Han, Z., Wang, X., Guo, J. et al. GPER agonist G1 suppresses neuronal apoptosis mediated by endoplasmic reticulum stress after exertional heat stroke injury. Sci Rep (2026). https://doi.org/10.1038/s41598-026-44173-5
Received:
Accepted:
Published:
DOI: https://doi.org/10.1038/s41598-026-44173-5