中医药靶向mTOR信号通路治疗糖尿病肾病的研究进展

Traditional Chinese Medicine Targets mTOR Signaling Pathway for Treatment of Diabetic Kidney Disease:A Review

糖尿病肾病(DKD)是作为糖尿病(DM)常见并发症之一,是一种出现特定肾脏病理结构和功能改变的慢性肾脏病(CKD)。大多数学者认为,DKD发病机制与糖代谢紊乱、氧化应激、炎症反应、内质网应激、细胞自噬、脂代谢紊乱及外泌体调控等因素有关。现代研究发现,哺乳动物雷帕霉素靶蛋白(mTOR)相关信号通路在DKD中起着关键作用,可以维持肾小球足细胞稳态,参与DKD细胞自噬、肾纤维化、氧化应激、脂代谢紊乱、炎症反应等过程,是当代治疗DKD的新型靶点。越来越多的研究表明,中医药能通过调节mTOR信号通路抑制DKD肾组织损伤,延缓DKD进一步恶化,改善疾病预后,提升患者生活水平。该文通过总结mTOR相关信号通路结构与机制,详述其在DKD中的作用,并对近年来中药单体、中药相关提取物及中药复方通过该信号通路防治DKD的研究现状作简要综述,以期为中医药临床治疗DKD提供新思路与方式。

Diabetic kidney disease(DKD),a chronic kidney disease with unique pathological structural and functional alterations in the kidney,is a common complication of diabetes mellitus(DM).The majority of researchers believe that the occurrence of this disease is associated with glucose metabolism disorders,oxidative stress,inflammation,endoplasmic reticulum stress,autophagy,and disorders of lipid metabolism and exosome release.The mammalian target of rapamycin(mTOR)signaling pathway,which can maintain glomerular podocyte homeostasis and participate in autophagy,renal fibrosis,oxidative stress,lipid metabolism disorders,and inflammatory response in DKD,has been discovered to play a key role in DKD.Therefore,it has emerged as a novel target for the treatment of DKD.Studies have demonstrated that traditional Chinese medicine can prevent the renal damage in DKD by regulating the mTOR signaling pathway to delay the disease progression and improve the prognosis and the quality of life of the patients.This article summarizes the structure and role of the mTOR signaling pathway in DKD and briefs the research progress in the prevention and treatment of DKD via this signaling pathway by the active components,extracts,and compound prescriptions of Chinese medicines,aiming to present new ideas and approaches for the clinical treatment of DKD with traditional Chinese medicine.