Reactive
oxygen species (ROS) are chemically reactive species that
are produced in cellular aerobic metabolism. They mainly include superoxide
anion, hydrogen peroxide, hydroxyl radicals, singlet oxygen, ozone,
and nitric oxide and are implicated in many physiological and pathological
processes. Bilirubin, a cardinal pigment in the bile, has been increasingly
investigated to treat cancer, diabetes, ischemia–reperfusion
injury, asthma, and inflammatory bowel diseases (IBD). Indeed, bilirubin
has been shown to eliminate ROS production, so it is now considered
as a promising therapeutic agent for ROS-mediated diseases and can
be used for the development of antioxidative nanomedicines. This review
summarizes the current knowledge of the physiological mechanisms of
ROS production and its role in pathological changes and focuses on
discussing the antioxidative effects of bilirubin and its application
in the experimental studies of nanomedicines. Previous studies have
shown that bilirubin was mainly used as a responsive molecule in the
microenvironment of ROS overproduction in neoplastic tissues for the
development of anticancer nanodrugs; however, it could also exert
powerful ROS scavenging activity in chronic inflammation and ischemia–reperfusion
injury. Therefore, bilirubin, as an inartificial ROS scavenger, is
expected to be used for the development of nanomedicines against more
diseases due to the universality of ROS involvement in human pathological
conditions.