铁死亡在非酒精性脂肪性肝病发病和治疗中的作用

吴龙云; 鲁晓岚

doi:10.3969/j.issn.1001-5256.2023.07.025

铁死亡在非酒精性脂肪性肝病发病和治疗中的作用

DOI: 10.3969/j.issn.1001-5256.2023.07.025

吴龙云,
鲁晓岚^, ,

上海市浦东医院(复旦大学附属浦东医院)消化内科，上海 201399

基金项目:

国家自然科学基金 (82070587)

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：吴龙云负责论文构思，文献检索及分析，表格制作，论文撰写；鲁晓岚负责论文构思，文章润色及修订。

详细信息

通信作者:
鲁晓岚，xiaolan_lu@163.com (ORCID：0000-0001-5745-6373)

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出版历程
- 收稿日期: 2022-10-14
- 录用日期: 2022-12-12
- 出版日期: 2023-07-20

Research advances in ferroptosis in the pathogenesis and treatment of nonalcoholic fatty liver disease

Longyun WU,
Xiaolan LU^{,
,}

Department of Gastroenterology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai 201399, China

Research funding:

National Natural Science Foundation of China (82070587)

More Information

Corresponding author: LU Xiaolan xiaolan_lu@163.com (ORCID: 0000-0001-5745-6373)

摘要

摘要: 铁死亡是以铁依赖和脂质过氧化为特征的非凋亡性细胞死亡方式。非酒精性脂肪性肝病(NAFLD)是以脂肪浸润为主要病理特征，与胰岛素抵抗和遗传易感性密切相关的一类代谢性疾病。肝脏单纯脂肪变性向脂肪性肝炎转变的机制仍不清楚，有研究发现肝细胞性铁死亡可能是脂肪性肝炎炎症启动的触发因素。本综述重点关注铁代谢异常和脂质过氧化在促进NAFLD发生及发展中的作用，并归纳总结一些铁死亡相关抑制剂在NAFLD治疗中的应用前景。
- 铁死亡 /
- 铁代谢障碍 /
- 非酒精性脂肪性肝病 /
- 脂质过氧化作用 /
- 药物疗法
Abstract: Ferroptosis is a pattern of non-apoptotic cell death characterized by iron dependence and lipid peroxidation. Nonalcoholic fatty liver disease (NAFLD) is a metabolic disease with fat infiltration as its main pathological feature, and it is closely associated with insulin resistance and genetic susceptibility. The mechanism of transition from hepatic steatosis alone to steatohepatitis remains unclear, and studies have shown that ferroptosis in hepatocytes may be the trigger for the inflammatory initiation of steatohepatitis. This article reviews the role of abnormal iron metabolism and lipid peroxidation in promoting the development and progression of NAFLD and summarizes the application prospect of ferroptosis-related inhibitors in the treatment of NAFLD.
- Ferroptosis /
- Iron Metabolism Disorders /
- Non-alcoholic Fatty Liver Disease /
- Lipid Peroxidation /
- Drug Therapy

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图 1 铁死亡及其抑制剂在NAFLD中作用的模式

注：FSP1，铁死亡抑制蛋白1；SLC3A2，溶质载体家族3成员2; SLC7A11，溶质载体家族7成员11；PUFA-PL, 多不饱和脂肪酸-磷脂；PUFA-PL-OOH，多不饱和脂肪酸-磷脂乙醇胺过氧化氢；LOX，脂氧合酶；ACSL4，酰基辅酶A合成酶长链家族成员4；LPCAT3，溶血磷脂酰胆碱酰基转移酶3；GSSG，氧化型谷胱甘肽；GPX4，谷胱甘肽过氧化物酶4；BMP4, 骨形态发生蛋白4；Tβ4，胸腺素β4；DHODH，二氢乳清酸脱氢酶；DMF，富马酸二甲酯；GB，银杏内酯B；DA，脱氢松香酸；KP，山奈酚；NADP⁺，氧化烟酰胺腺嘌呤二核苷酸磷酸；NADPH，烟酰胺腺嘌呤二核苷酸。

Figure 1. The diagram delineating the role of ferroptosis and its inhibitors in NAFLD

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表 1 铁死亡、细胞凋亡、自噬、坏死性凋亡、细胞焦亡的形态学和生化特征

Table 1. Morphological and biochemical characteristics of ferroptosis, apoptosis, autophagy, necroptosis and pyroptosis

细胞死亡种类	形体学特征					生化特征
细胞死亡种类	细胞形态	细胞核	细胞器	细胞质膜	其他	生化特征
铁死亡	细胞变圆	细胞核正常、染色体无凝聚	线粒体体积变小，线粒体膜密度增加，外膜破裂、嵴缩小或消失	质膜无破裂		铁和ROS过载，脂质过氧化，MAPK激活，system Xc^-的抑制、胱氨酸的摄取减少、GSH的消耗，AA介质的释放
细胞凋亡	细胞体积变小	细胞核体积减少，核碎裂、染色质凝聚	线粒体结构无明显变化	细胞质膜出泡、细胞骨架解体	凋亡小体的形成	caspase的激活，寡核苷酸染色体DNA片段，PS暴露
自噬	初期细胞无变化	染色质缺乏凝聚	自噬溶酶体形成	质膜没有变化或可能出泡	自噬空泡的积累	LC3-Ⅰ向LC3-Ⅱ转化，底物降解，溶酶体活力增加
坏死性凋亡	细胞肿胀	染色质适当凝集	细胞器肿胀	质膜破裂	细胞组分进入微环境	ATP水平下降，DAMP的释放，PARP1的活化
焦亡	细胞肿胀	细胞核固缩	细胞器变形	质膜成孔	细胞组分进入微环境	炎性小体的形成，caspase- 1和Gasdermin D的激活，促炎因子的释放
注：ROS，活性氧；MAPK，促分裂原活化蛋白激酶；system Xc^-，抑制胱氨酸/谷氨酸逆转运体；GSH，谷胱甘肽; AA，花生四烯酸；PS，磷脂酰丝氨酸；LC，微管相关蛋白轻链；DAMP，损伤相关分子模式；PARP1，多聚腺苷二磷酸核糖聚合酶1。

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表 2 铁死亡抑制剂在NAFLD治疗中的应用

Table 2. The inhibitors of ferroptosis in the treatment of NAFLD

药物	适应证¹⁾	作用机制	不良反应	研究现状	前景
维生素E	活检明确为NASH的、非糖尿病性、成年患者	抑制脂质氧化	可能增加出血性脑中风、前列腺癌的发生率	写入2018年NAFLD管理指南^[27]，推荐剂量：800 IU/d、口服	临床研究数据有限，谨慎用药
吡格列酮	肝活检已确诊的NASH患者(无论是否合并2型糖尿病)	抑制ACSL4	体质量的增加、骨质疏松的发生、膀胱癌患病率的升高	写入2018年NAFLD管理指南，未提供推荐剂量	临床研究数据有限，谨慎用药
艾地苯醌		提高GPX4的表达		有研究者建议也许可将该药扩大适应证，比如存在胰岛素抵抗的2型糖尿病和脂肪肝	进一步临床试验验证
富马酸二甲酯		降低细胞内ROS和脂质过氧化水平，防止GSH消耗和脂质过氧化物积累，促进GPX4的转录		动物实验阶段	开展临床试验
胸腺素β4		通过GPX4抑制铁死亡		动物实验阶段	开展临床试验
铁螯合剂		控制铁超载		尚无铁螯合剂在NAFLD中的研究报道	开展相关基础实验
Ferrostatin-1		抑制脂质过氧化		动物实验阶段	开展临床试验
Liproxstatin		抑制脂质过氧化		动物实验阶段	开展临床试验
山奈酚		抑制LPCAT3的表达		动物实验阶段	开展临床试验
银杏内酯B		激活Nrf2		动物实验阶段	开展临床试验
脱氢松香酸		激活Nrf2		动物实验阶段	开展临床试验
槲皮素		降低线粒体ROS		动物实验阶段	开展临床试验
注：1)此处的适应证主要针对NAFLD的治疗。

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