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1.广州医科大学 附属中医医院,广州 510130
2.广州医科大学,广州 510180
3.广州中医药大学 附属中医医院,广州 510130
Received:28 March 2021,
Published Online:29 July 2021,
Published:05 October 2021
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袁安琪,彭麟景,杜红彦.自噬在青光眼视神经损伤中的作用及中医药的干预研究进展[J].中国实验方剂学杂志,2021,27(19):233-242.
YUAN An-qi,PENG Lin-jing,DU Hong-yan.Role of Autophagy in Glaucoma-induced Optic Nerve Injury and Intervention with Traditional Chinese Medicine: A Review[J].Chinese Journal of Experimental Traditional Medical Formulae,2021,27(19):233-242.
袁安琪,彭麟景,杜红彦.自噬在青光眼视神经损伤中的作用及中医药的干预研究进展[J].中国实验方剂学杂志,2021,27(19):233-242. DOI: 10.13422/j.cnki.syfjx.20211898.
YUAN An-qi,PENG Lin-jing,DU Hong-yan.Role of Autophagy in Glaucoma-induced Optic Nerve Injury and Intervention with Traditional Chinese Medicine: A Review[J].Chinese Journal of Experimental Traditional Medical Formulae,2021,27(19):233-242. DOI: 10.13422/j.cnki.syfjx.20211898.
青光眼是一组以视网膜神经节细胞(RGCs)及其轴突数目进行性丢失、视野逐渐丧失和视神经萎缩为特征的常见致盲性眼病。青光眼的病理改变主要是RGCs及其轴突的变性、萎缩、丧失,最终导致视功能的永久性损害,其具体发病机制尚未明确。细胞自噬是将细胞内受损、变性或衰老的蛋白质及细胞器运输到溶酶体内进行消化降解以不断更新重塑再利用细胞的过程。通过临床案例分析和动物实验发现,中成药和一些中医疗法可能有靶向调控自噬通路的作用,该文从眼部组织对高眼压的应激反应、小梁网功能障碍、免疫调节及瘢痕调控等方面阐述自噬在青光眼眼压升高和视神经损伤机制中所起作用及部分中药成分影响自噬调节相关研究进行论述,探讨中西医结合调控自噬以防治青光眼视神经损害、预防早期视野丢失的可能性,发现各中药单体或中药提取物存在多通路、多作用靶点的特点,主要涉及磷脂酰肌醇3-激酶(PI3K)/蛋白激酶B(Akt)/哺乳动物雷帕霉素靶蛋白(mTOR)和腺苷酸活化蛋白激酶(AMPK)两条经典自噬信号通路,且目前中药的神经保护作用研究多集中于中枢神经受累的脑和脊髓病变,对于青光眼视神经损伤的保护机制仍需更深入的研究,此外,自噬在不同的实验动物模型和实验方法中展现出“双刃剑”一般的作用形式,怎样人为干预自噬能阻止RGCs凋亡、发挥保护效应仍是未来研究亟待解决的问题。
Glaucoma is a common blinding eye disease characterized by progressive loss of retinal ganglion cells (RGCs) and their axons, gradual loss of visual field, and optic atrophy. The pathological changes of glaucoma are mainly the degeneration, atrophy, and loss of RGCs and their axons, which can eventually lead to the permanent impairment of visual function. The specific pathogenesis of glaucoma remains unclear. Autophagy is a process in which damaged, denatured, or senescent proteins and organelles are transported to lysosomes for digestion and degradation in order to continuously renew and rebuild cells for reuse. As revealed by clinical case analysis and animal experiments, Chinese patent medicine and some traditional Chinese medicine (TCM) therapies may be able to target the autophagy pathway. This paper expounded the role of autophagy in glaucoma-induced ocular hypertension and optic nerve injury from the aspects of stress response of ocular tissue to high intraocular pressure, trabecular meshwork dysfunction, immune regulation, and scar regulation as well as the regulatory effects of some Chinese medicinal ingredients on autophagy, aiming to explore the possibility of integrated TCM and western medicine in regulating autophagy and preventing glaucoma-induced optic nerve injury and early visual field loss. It was found that Chinese medicinal monomers or extracts function via multiple pathways and multiple targets, mainly involving two classical autophagy pathways, namely phosphatidylinositol 3-kinase (PI3K)/protein kinase B (Akt)/mammalian target of rapamycin (mTOR) and adenosine monophosphate-activated protein kinase (AMPK). Moreover, the current studies on the neuroprotective effect of TCM mostly focus on the brain and spinal cord lesions of the central nervous system, and its protective mechanism against optic nerve injury in glaucoma still needs further investigation. In addition, autophagy was like a "double-edged sword" in different experimental animal models and methods. How to artificially intervene in autophagy to prevent the apoptosis of RGCs and protect the optic nerve injury is still an urgent problem to be solved in the future research.
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