中草药干预铁死亡：糖尿病微血管并发症新策略

Chinese herbal medicine intervention in ferroptosis: A novel therapeutic strategy for diabetic microvascular complications

关键词:  中草药  铁死亡  糖尿病  糖尿病微血管病变  糖尿病视网膜病变  糖尿病肾脏病

Key words:  Chinese herbal medicine  ferroptosis  diabetes mellitus  diabetic microvascular disease  diabetic retinopathy  diabetic kidney disease

摘要:

糖尿病微血管病变严重危害患者预后，其多种临床表现可能共享共同的病理基础。铁死亡作为一种铁依赖性的非凋亡性细胞死亡方式，被认为是该病变潜在的共同机制。文章概述了铁死亡在糖尿病微血管并发症中的作用，阐明其通过细胞内铁过载、脂质过氧化及抗氧化防御失衡等机制，驱动糖尿病视网膜病变、糖尿病肾病、糖尿病神经病变、糖尿病心肌病及糖尿病足溃疡的发生与发展。在此基础上，重点综述了中草药及其活性成分通过调控核因子E2相关因子2（Nrf2）、谷胱甘肽（GSH）/谷胱甘肽过氧化物酶4（GPX4）、铁代谢等相关通路抑制铁死亡，从而改善上述并发症的研究进展。从糖尿病微血管病变共同病理机制的视角，阐明中草药靶向铁死亡防治糖尿病微血管病变的潜在价值，为相关防治策略提供理论依据与研究思路。

Abstract:

Diabetic microvascular complications significantly impact patient prognosis, with various clinical manifestations potentially sharing a common pathological foundation. Ferroptosis, a non-apoptotic form of iron-dependent cell death, is posited as a potential unifying mechanism underlying these complications. This article provides a comprehensive overview of the role of ferroptosis in diabetic microvascular complications, elucidating its contribution to the onset and progression of diabetic retinopathy, nephropathy, neuropathy, cardiomyopathy, and foot ulcers through mechanisms such as intracellular iron overload, lipid peroxidation, and antioxidant defense imbalance. Furthermore, the article reviews the advancements in research on traditional Chinese medicines and their active components in inhibiting ferroptosis by modulating pathways such as regulating nuclear factor erythroid 2-related factor 2 (Nrf2), glutathione (GSH) /glutathione peroxidase 4 (GPX4), and iron metabolism, thereby ameliorating these complications. The article underscores the value of targeting ferroptosis with traditional Chinese medicines for preventing and treating diabetic microvascular issues.