中药改善心肌梗死促血管新生机制的研究进展

Research progress on the mechanism of traditional Chinese medicine promoting angiogenesis in myocardial infarction

心肌梗死是临床常见病,属中医“胸痹”“心痛”范畴,血管新生、血运重建是治疗心肌梗死的有效途径。中药在促血管新生、改善心肌缺血方面具有独特优势和潜力,研究表明中药复方、单体及有效成分可通过不同靶点、不同途径介导心肌梗死后促血管新生的作用机制。本文通过梳理文献总结出中药具有增强干细胞血管修复与新生能力,可以调控促血管生成因子分泌及其受体表达,并且靶向调控外泌体传递与血管新生相关的miRNA,激活下游信号,增加内皮细胞存活、迁移、成管能力,提升促血管新生相关基因和蛋白表达,还可以激活血管内皮生长因子/内皮型一氧化氮合成酶信号通路,调控微血管生成过程和间充质干细胞的Notch信号通路,活化蛋白激酶D1/缺氧诱导因子-1α/血管内皮生长因子信号通路,抑制沉默信息调节因子3/β-连环蛋白/过氧化物酶体增殖物激活受体γ信号通路等介导心肌梗死区域的血管再生功能。后续还需深入探讨中药促血管新生的作用机制及药效物质基础,为中医药防治缺血性心脏病的再生医学研究提供依据。

Myocardial infarction is a common clinical disease, which belongs to the category of thoracic obstruction and angina pectoris in traditional Chinese medicine(TCM). Angiogenesis and revascularization are effective ways to treat myocardial infarction. TCM has unique advantages and potential in promoting angiogenesis and improving myocardial ischemia. Studies have shown that TCM compounds,monomers and effective components can mediate the mechanisms of promoting angiogenesis after myocardial infarction through different targets and pathways. Through combing the literature, it is concluded that TCM can enhance the ability of stem cell vascular repair and regeneration;it can regulate the secretion of angiogenic factors and the expression of their receptors;In addition, it can target and regulate exosomes to transmit miRNA related to angiogenesis, activate downstream signals, increase the survival, migration and tube forming ability of endothelial cells, and enhance the expression of angiogenesis related genes and proteins;it can also activate VEGF/eNOS signaling pathway;regulate the process of angiogenesis and mesenchymal stem cells of Notch signaling pathway;activate PKD1/HIF-1α/VEGF signaling pathway;inhibit SIRT3/β-catenin/PPARγ signal pathway mediates the function of angiogenesis in myocardial infarction area. The follow-up needs to further explore the action mechanism and pharmacodynamic material basis of TCM to promote angiogenesis, to provide basis for regenerative medicine research of TCM in the prevention and treatment of ischemic heart disease.