炙马钱子胶囊抑制BIPN的临床疗效及基于lncRNA ZFAS1(XIST)活化FAK信号通路抑制神经炎症的机制

The Mechanism of BIPN Intervention by Strychnine Based on lncRNA ZFAS1(XIST)/FAK Signaling Pathway

[目的]评估炙马钱子胶囊医治硼替佐米相关性周围神经病(bortezomib induced peripheral neuropathy,BIPN)的有效性,初步探究其基于长链非编码RNA(long noncoding RNA,lncRNA)X失活特异性转录本(X inactive specific transcript,XIST)/锌指结构反义转录本1(ZNFX1 antisense RNA 1,ZFAS1)干预BIPN的机制。[方法]通过前瞻性非随机对照的研究方法,共收集20例符合多发性骨髓瘤中西医诊断并接受硼替佐米(bortezomib,BTZ)治疗而且发生BIPN接受炙马钱子胶囊治疗的患者,与未接受马钱子治疗的患者进行中医症候积分、神经毒性评分、周围神经病变(peripheral neuropathy,PN)分级、部分周围神经传导速度的比较。通过自身对照,采集治疗组患者的外周血液样本,使用酶联免疫吸附试验(enzyme linked immunosorbent assay,ELISA)检测炎症相关因子表达。培养DRG 50B11细胞,通过细胞增殖毒性检测筛选马钱子最佳作用浓度和时间及BTZ最佳作用时间,随机分为正常对照组、BTZ组、马钱子+BTZ组,以实时荧光定量聚合酶链式反应(Real-time quantitative polymerase chain reaction,Real-time qPCR)检测炎症相关因子及细胞总RNA相关指标表达,分析差异性及相关性。[结果]临床研究显示,与对照组比较,患者治疗后PN、中医证候积分、神经毒性评分降低,周围神经传导速度增加(P<0.05),无明显不良反应。实验研究显示,与治疗前比较,白细胞介素-17(interleukin-17,IL-17)、IL-1β、IL-6、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、神经生长因子(nerve growth factor,NGF)、脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)表达均降低(P<0.05),且与时间存在显著负相关性(P<0.01)。与BTZ组比较,马钱子+BTZ组IL-17、TNF-α、IL-1β、IL-6、NGF、BDNF、lncRNA XIST、纤维粘连蛋白1(fibronectin 1,FN1)、磷酸化局部黏着斑激酶(phospho-focal adhesion kinase,p-FAK)表达降低(P<0.05),miR-96-5P、miR-1271-5P表达升高(P<0.05),lncRNA ZFAS1表达量差异无统计学意义(P>0.05);lncRNA XIST表达与IL-17、TNF-α、IL-1β、IL-6、NGF、BDNF、FN1、p-FAK表达显著正相关(P<0.01),与miR-96-5P存在中等负相关性(P<0.05),与miR-1271-5P存在极弱相关或无相关性(P>0.05)。[结论]炙马钱子胶囊在一定程度上可缓解BIPN且较为安全,其机制可能与调控lncRNA XIST,促进miR-96-5P/FN1表达,抑制p-FAK介导的神经炎症有关。

[Objective]To assess the effectiveness of prepared strychnine in the treatment of bortezomib-induced peripheral neuropathy(BIPN)and explore the mechanism of intervention of BIPN based on long noncoding RNA(lncRNA)X inactivated specific transcript(XIST)/ZNFX1 antisense RNA 1(ZFAS1).[Methods]Twenty patients diagnosed as multiple myeloma who received bortezomib(BTZ)and developed BIPN and received strgchnine treatment were collected by prospective non-randomized controlled study method.The traditional Chinese medicine(TCM)symptom score,neurotoxicity score,peripheral neuropathy(PN)grade,and partial peripheral nerve conduction velocity were compared with patients who did not receive strychnine treatment.Using self-control,peripheral blood samples were collected from patients in the treatment group,and enzyme-linked immunosorbent assay(ELISA)was used to detect the expression of inflammationrelated factors.DRG 50B11 cells were cultured and screened by cell counting kit-8(CCK-8)for the optimal acting concentration and time of strychnine and the optimal acting time of BTZ,and the cases were randomly divided into normal control group,BTZ group,and strychnine+BTZ group.Real-time quantitative polymerase chain reaction(Real-time qPCR)was used to detect the expression levels of inflammation-related factors and total RNA related indexes,and it analyzed the differences and correlations.[Results]The clinical study showed that compared with control group,PN,TCM syndrome scores and neurotoxicity score were decreased after treatment,while peripheral nerve conduction velocity was increased(P<0.05),and there were no significant adverse effects.The experimental results showed that compared with those before treatment,the expression of interleukin-17(IL-17),tumor necrosis factor-α(TNF-α),IL-1β,IL-6,nerve growth factor(NGF)and brain-derived neurotrophic factor(BDNF)were reduced(P<0.05),and there was a significant negative correlation with time(P<0.01).Compared with BTZ group,the expression levels of IL-17,TNF-α,IL-1β,IL-6,NGF,BDNF,the lncRNA XIST,fibronectin 1(FN1)and phospho-focal adhesion kinase(p-FAK)were decreased in strychnine+BTZ group(P<0.05),while the expressions of miR-96-5P and miR-1271-5P increased(P<0.05),without significant difference in the expression of lncRNA ZFAS1(P>0.05).lncRNA XIST expression levels were significantly positively correlated with the expressions of IL-17,TNF-α,IL-1β,IL-6,NGF,BDNF,FN1 and p-FAK(P<0.01),but no moderate negative correlated with miR-96-5P(P<0.05),or very weakly correlated or no correlated with miR-1271-5P(P>0.05).[Conclusion]Prepared strychnine capsule can alleviate BIPN to a certain extent and is relatively safe,and its mechanism may be related to the regulation of lncRNA XIST for promoting the expression of miR-96-5P/FN1 and inhibit p-FAK-mediated neuroinflammation.