脊髓损伤后细胞焦亡调控机制及治疗策略

Regulatory mechanisms and therapeutic strategies for pyroptosis after spinal cord injury

背景:调节细胞死亡和神经炎症是治疗脊髓损伤的两个重要途径,细胞焦亡是一种与神经炎症密切相关的程序性死亡模式,针对性靶向抑制脊髓损伤后焦亡,是一项有前景的治疗策略。目的:归纳细胞焦亡在脊髓损伤中的分子机制、正负向调节因子及治疗策略的研究进展。方法:以“spinal cord injury,pyroptosis,nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3),Caspase,Gasdermin D(GSDMD),IL-1β,IL-18”为检索词,在PubMed和Web of Science数据库进行检索,最终纳入93篇英文文献。结果与结论:①作为新发现的程序性死亡方式,细胞焦亡已被证实在脊髓损伤后继发性损伤阶段起重要作用。②在脊髓损伤后细胞焦亡的调节因子中,CD73、NRF2、GDF-11、多巴胺、FANCC和miR-423-5P可抑制细胞焦亡,TLR4和Aopps可促进细胞焦亡。③在治疗策略方面,中药活性成分丹皮酚、雷公藤红素、桦木酸、胡椒碱、山奈酚、喜树碱,各种细胞来源的外泌体,药物二甲双胍、拓扑替康、锂、锌和一氧化碳释放分子3能有效抑制焦亡,减轻脊髓继发性损伤,但这些药物的毒副反应和具体剂量有待深入研究。④细胞焦亡加重脊髓损伤的具体分子机制仍知之甚少,非经典途径及其他炎性小体的作用值得进一步探索。⑤目前脊髓损伤后焦亡的研究仅停留在动物实验阶段,尚无相关临床研究,且无批准的靶向治疗药物。⑥细胞焦亡在脊髓损伤后的应用具有巨大潜能,未来需继续研究其具体调控机制,为脊髓损伤的治疗提供新的作用靶点。

BACKGROUND:Cell death and neuroinflammation are two important targets in the treatment of spinal cord injury.Pyroptosis is a programmed cell death closely related to neuroinflammation and targeted inhibition of pyroptosis after spinal cord injury is a promising therapeutic strategy.OBJECTIVE:To summarize the molecular mechanism,positive and negative regulatory factors and therapeutic strategies of pyroptosis in spinal cord injury.METHODS:The search terms were“spinal cord injury,pyroptosis,nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3),Caspase,Gasdermin D(GSDMD),IL-1β,IL-18”and 93 English literatures included in PubMed and Web of Science were finally selected for review.RESULTS AND CONCLUSION:As a newly discovered programmed cell death,pyroptosis has been shown to play an important role in the secondary injury stage after spinal cord injury.Among the regulatory factors of pyroptosis after spinal cord injury,CD73,NRF2,GDF-11,dopamine,FANCC and miR-423-5P could inhibit pyroptosis,while TLR4 and Aopps could promote pyroptosis.In terms of treatment,the active ingredients of traditional Chinese medicine(paeonol,tripterine,betulinic acid,piperine,kaempferol,and camptothecin),exosomes of various cell origins,and some drugs(metformin,topotecan,lithium,zinc,and carbon monoxide-releasing molecule 3)can effectively inhibit pyroptosis and reduce secondary spinal cord injury,but the toxicity and specific dose of these drugs need to be further studied.The specific molecular mechanism by which pyroptosis aggravates spinal cord injury is still poorly understood.The role of non-classical pathways and other inflammasomes is worth further exploration.At present,the research on pyroptosis after spinal cord injury only stays at the animal experiment stage.There are no related clinical studies and no approved targeted therapeutic drugs.(6)The application of pyroptosis after spinal cord injury has great potential,and its specific regulatory mechanism should be further studied in the future to provide a new target for the treatment of spinal cord injury.