Article(id=1322954198907757063, tenantId=1146029695717560320, journalId=1319373162502258839, issueId=1322954180431847810, articleNumber=null, orderNo=null, doi=10.16016/j.2097-0927.202509003, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1756656000000, receivedDateStr=2025-09-01, revisedDate=1763308800000, revisedDateStr=2025-11-17, acceptedDate=null, acceptedDateStr=null, onlineDate=1793346460319, onlineDateStr=2026-10-30, pubDate=1765728000000, pubDateStr=2025-12-15, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793346460319, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793346460319, creator=13701087609, updateTime=1793346460319, updator=13701087609, issue=Issue{id=1322954180431847810, tenantId=1146029695717560320, journalId=1319373162502258839, year='2025', volume='47', issue='23', pageStart='2881', pageEnd='3008', issueExtLink='null', onlineDate='null', pubDate='1765728000000', pubDateStr='2025-12-15', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793346455915, creator='13701087609', updateTime=1793346455915, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=2933, endPage=2942, ext={EN=ArticleExt(id=1322954199364936200, articleId=1322954198907757063, tenantId=1146029695717560320, journalId=1319373162502258839, language=EN, title=Neferine attenuates parkinson’s disease via modulating microglial pyroptosis mediated by ROS/NLRP3/Caspase-1 signaling pathway, columnId=1320435149808980440, journalTitle=Journal of Army Medical University, columnName=Neuroscience, runingTitle=null, highlight=null, articleAbstract=
Objective

To demonstrate that neferine (Nef) alleviates Parkinson’s disease (PD) by inhibiting microglial pyroptosis mediated through the reactive oxygen species (ROS)/NOD-like receptor protein 3 (NLRP3)/Caspase-1 pathway.

Methods

BV2 microglial cells were divided into: control group, lipopolysaccharides (LPS)-adenosine triphosphate (ATP) group, and LPS-ATP+Nef group. Pyroptosis was induced by 1 μg/mL LPS + 5 mmol/L ATP, with 2 mmol/L Nef pretreatment. Eighteen 10-12-week-old male C57BL/6 mice (22~25 g) were randomly assigned to: control (n=6), 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) (n=6), and MPTP+Nef (n=6) groups. Detection methods included: flow cytometry for pyroptosis, Cell Counting Kit-8 (CCK-8) for viability, 2',7'-dichlorodihydrofluorescein diacetate (DCFH-DA) for ROS, commercial kits for malondialdehyde (MDA), superoxide dismutase (SOD), glutathione (GSH), ELISA/Western blot for interleukin-1β (IL-1β)/IL-18, immunofluorescence/immunohistochemistry for NLRP3/Caspase-1, tyrosine hydroxylase (TH) immunohistochemistry, hematoxylin-eosin staining for neuropathology, and modified neurological severity score (mNSS).

Results

Versus control, LPS-ATP group showed decreased viability (P=0.002), increased pyroptosis (P<0.001), elevated ROS (P<0.001)/MDA (P<0.001)/IL-1β (P<0.001)/IL-18 (P<0.001), upregulated NLRP3 (P<0.001)/Caspase-1 (P<0.001), and reduced GSH (P<0.001)/SOD (P<0.001). Nef treatment reversed these effects (all P<0.05). According to the results of murine studies, compared with the control group, the MPTP group had increased mNSS (P<0.001)/tissue ROS (P<0.001), downregulated TH (P<0.001), upregulated NLRP3 (P<0.001)/Caspase-1 (P<0.001). Nef treatment significantly attenuated the MPTP-induced deleterious effects (P<0.05). Histopathological analysis revealed that control group exhibited uniformly distributed hippocampal neurons with distinct nuclear morphology; MPTP group showed neuronal swelling, interstitial edema, and nuclear atrophy; MPTP+Nef group demonstrated ameliorated neuronal damage.

Conclusion

Nef inhibits microglial pyroptosis via ROS/NLRP3/Caspase-1 axis, ameliorating PD neuroinflammation and pathology.

, authors=Fenfen LIU1, Dan FENG1, Yun LIU1, Fangya ZUO1, Xiuhong GUO2, Yuqi LIU1, Lanlan CHEN3, Yujie WANG1, Jinyong TIAN4, authorsList=Fenfen LIU, Dan FENG, Yun LIU, Fangya ZUO, Xiuhong GUO, Yuqi LIU, Lanlan CHEN, Yujie WANG, Jinyong TIAN, authorCompany=null, correspAuthors=Jinyong TIAN, authorNote=null, correspAuthorsNote=null, copyrightStatement=© 2025 Journal of Army Medical University, copyrightOwner=Editorial Office of Journal of Army Medical University, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322954202821042708, articleId=1322954198907757063, tenantId=1146029695717560320, journalId=1319373162502258839, language=CN, title=甲基莲心碱通过抑制ROS/NLRP3/Caspase-1通路减少小胶质细胞焦亡并改善帕金森病神经炎症, columnId=1322954199448822281, journalTitle=陆军军医大学学报, columnName=神经科学·论著, runingTitle=null, highlight=null, articleAbstract=
目的

证实甲基莲心碱(neferine,Nef)通过抑制活性氧(reactive oxygen species,ROS)/NOD样受体热蛋白结构域相关蛋白3(NOD-like receptor thermal protein domain associated protein 3,NLRP3)/Caspase-1通路介导的小胶质细胞焦亡,从而改善帕金森病(Parkinson’s disease,PD)症状。

方法

将小鼠小胶质细胞BV2分为对照组、脂多糖(lipopolysaccharides,LPS)-三磷酸腺苷(adenosine triphosphate,ATP)组、LPS-ATP+Nef组,采用1 μg/mL LPS联合5 mmol/L ATP诱导小胶质细胞焦亡,对LPS-ATP诱导的小胶质细胞给予2 μmol/L Nef预处理。取18只10~12周龄C57BL/6雄性小鼠(体质量22~25 g),采用计算机随机数生成法将小鼠分为:对照组(n=6)、1-甲基-4-苯基-1,2,3,6-四氢吡啶(1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine,MPTP)组(n=6)、MPTP+Nef组(n=6)。采用流式细胞仪检测细胞焦亡,CCK-8检测细胞活力,2',7'-二氯荧光素二乙酸酯(2',7'-Dichlorodihydrofluorescein diacetate,DCFH-DA)探针表征ROS,试剂盒检测丙二醛(malondialdehyde,MDA)、超氧化物歧化酶(superoxide dismutase,SOD)、谷胱甘肽(glutathione,GSH)。应用ELISA法及Western blot检测白介素1β(interleukin-1β,IL-1β)及白介素18(interleukin-18,IL-18),免疫荧光及免疫组化检测NLRP3及Caspase-1表达,免疫组化检测酪氨酸羟化酶(tyrosine hydroxylase,TH)蛋白表达。采用苏木素-伊红染色试剂盒观察脑组织病理学变化。采用小鼠神经功能缺损评分(modified neurological severity score,mNSS)评价小鼠神经功能损伤。

结果

LPS-ATP组与对照组相比,细胞活力降低(P=0.002),细胞焦亡增加(P<0.001),ROS(P<0.001)、MDA(P<0.001)、IL-1β(P<0.001)、IL-18(P<0.001)水平升高,NLRP3(P<0.001)和Caspase-1(P<0.001)表达上调,GSH水平(P<0.001)和SOD活性(P<0.001)降低。LPS-ATP+Nef组与LPS-ATP组比较,细胞活力增强(P=0.047),细胞焦亡减少(P<0.001),ROS(P=0.002)、MDA(P<0.001)、IL-1β(P<0.001)、IL-18(P=0.004)水平降低,NLRP3(P<0.001)及Caspase-1(P<0.001)表达下调,GSH水平(P<0.001)及SOD活性(P<0.001)升高。小鼠实验表明:MPTP组与对照组相比,mNSS得分(P<0.001)及组织ROS水平(P<0.001)增加,TH蛋白下调(P<0.001),NLRP3(P<0.001)及Caspase-1(P<0.001)表达上调,而Nef处理可明显抑制上述MPTP对小鼠的影响(P<0.05)。在组织病理学方面,对照组小鼠海马神经元分布均匀,细胞核结构清晰,MPTP组表现为部分神经元肿胀,出现间质水肿、核萎缩,而MPTP+Nef组神经元损伤有所改善。

结论

Nef通过ROS/NLRP3/Caspase-1通路抑制小胶质细胞焦亡,从而有效改善PD神经炎症及组织损伤。

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田锦勇,E-mail:
TIAN Jinyong,E-mail:
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Sci Rep,2017,7:12283., articleTitle=Neferine ameliorates cardiomyoblast apoptosis induced by doxorubicin:possible role in modulating NADPH oxidase/ROS-mediated NFκB redox signaling cascade, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1322954203534074389, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954198907757063, xref=1, ext=[AuthorCompanyExt(id=1322954203542462998, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954198907757063, companyId=1322954203534074389, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1Graduate School,Guizhou University of Traditional Chinese Medicine,Guiyang,Guizhou), AuthorCompanyExt(id=1322954203550851607, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954198907757063, companyId=1322954203534074389, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1贵州中医药大学研究生院,贵州 贵阳)]), AuthorCompany(id=1322954203647320600, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954198907757063, xref=2, ext=[AuthorCompanyExt(id=1322954203659903513, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954198907757063, companyId=1322954203647320600, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2Department of Critical Care Medicine,the First People’s Hospital of Qingzhen City,Guiyang,Guizhou), AuthorCompanyExt(id=1322954203932533274, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954198907757063, companyId=1322954203647320600, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2清镇市第一人民医院重症医学科,贵州 贵阳)]), AuthorCompany(id=1322954204008030747, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954198907757063, xref=3, ext=[AuthorCompanyExt(id=1322954204020613660, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954198907757063, companyId=1322954204008030747, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3Graduate School,Zunyi Medical University,Zunyi,Guizhou), AuthorCompanyExt(id=1322954204033196573, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954198907757063, companyId=1322954204008030747, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3遵义医科大学研究生院,贵州 遵义)]), AuthorCompany(id=1322954204335186462, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954198907757063, xref=4, ext=[AuthorCompanyExt(id=1322954204343575071, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954198907757063, companyId=1322954204335186462, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=4Department of General Practice,Guizhou Provincial People’s Hospital,Guiyang,Guizhou,China), AuthorCompanyExt(id=1322954204356157984, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954198907757063, companyId=1322954204335186462, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=4贵州省人民医院全科医学科,贵州 贵阳)])], figs=[ArticleFig(id=1322954211452920406, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954198907757063, language=EN, label=Figure 1, caption=Nef inhibited LPS-ATP-induced pyroptosis in microglia cells, figureFileSmall=oGHnYqMrtOp2Ejz24ZBcTQ==, figureFileBig=MQNFnwfa50LULyvq7IDbXQ==, tableContent=null), ArticleFig(id=1322954211515834967, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954198907757063, language=CN, label=图1, caption=Nef抑制LPS-ATP诱导的小胶质细胞焦亡

A:Cell viability detected by CCK-8 assay; B:Pyroptosis rate detected by flow cytometry. LPS:lipopolysaccharides; ATP:adenosine triphosphate; Nef:neferine

, figureFileSmall=oGHnYqMrtOp2Ejz24ZBcTQ==, figureFileBig=MQNFnwfa50LULyvq7IDbXQ==, tableContent=null), ArticleFig(id=1322954211729744472, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954198907757063, language=EN, label=Figure 2, caption=Nef inhibited LPS-ATP-induced oxidative stress and inflammatory response, figureFileSmall=VmVlQVY2tckgPKQMvfO7zw==, figureFileBig=2RurCe4qgwem31C4VxLgpg==, tableContent=null), ArticleFig(id=1322954211813630553, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954198907757063, language=CN, label=图2, caption=Nef抑制LPS-ATP诱导的小胶质细胞氧化应激及炎症反应

A:ROS detected by DCF; B:MDA content; C:SOD viability; D:GSH content; E:Concentrations of IL-1β and IL-18. ROS:reactive oxygen species; MDA:malondialdehyde; SOD:superoxide dismutase; GSH:glutathione; LPS:lipopolysaccharides; ATP:adenosine triphosphate; Nef:neferine; DCF:2',7'-Dichlorofluorescein; IL-1β:interleukin-1β; IL-18:interleukin-18

, figureFileSmall=VmVlQVY2tckgPKQMvfO7zw==, figureFileBig=2RurCe4qgwem31C4VxLgpg==, tableContent=null), ArticleFig(id=1322954211910099546, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954198907757063, language=EN, label=Figure 3, caption=Nef suppressed the expression of LPS-ATP-induced pyroptosis-related proteins., figureFileSmall=cifW2Ce8ByxoAZN5i5A5mA==, figureFileBig=XWtvs7etHaoQKkjFW18ZqA==, tableContent=null), ArticleFig(id=1322954211993985627, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954198907757063, language=CN, label=图3, caption=Nef抑制LPS-ATP诱导的焦亡相关蛋白表达

A:NLRP3 and Caspase-1 detected by immunocytochemistry; B:The bar graph of the immunofluorescence results; C:IL-1β and IL-18 detected by Western blotting. NLRP3:nod-like receptor thermal protein domain associated protein 3; IL-1β:interleukin-1β; IL-18:interleukin-18; LPS:lipopolysaccharides; ATP:adenosine triphosphate; Nef:neferine

, figureFileSmall=cifW2Ce8ByxoAZN5i5A5mA==, figureFileBig=XWtvs7etHaoQKkjFW18ZqA==, tableContent=null), ArticleFig(id=1322954212069483100, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954198907757063, language=EN, label=Figure 4, caption=Nef alleviated MPTP-induced PD symptoms in mice, figureFileSmall=jZXRTagaNYN8aifK1SJQug==, figureFileBig=BtpRqKcovV/Xy1TrjIhfpQ==, tableContent=null), ArticleFig(id=1322954212140786269, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954198907757063, language=CN, label=图4, caption=Nef缓解MPTP诱导的小鼠PD症状

A:Neurological scores evaluated by mNSS; B:ROS detected by DCF; C:TH protein in the substantia nigra detected by immunohistochemistry; D:Histopathlogical change in the hippocampus analyzed by hematoxylin and eosin staining; E:BrdU+/NeuN+ cells labeled by immunofluorescence staining. mNSS:modified neurological severity score; ROS:reactive oxygen species; Nef:neferine; DCF:2',7'-Dichlorofluorescein; IL-1β:interleukin-1β; IL-18:interleukin-18; MPTP:1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine; BrdU:5-bromo-2'-deoxyuridine; NeuN:neuronal nuclei; TH:tyrosine hydroxylase

, figureFileSmall=jZXRTagaNYN8aifK1SJQug==, figureFileBig=BtpRqKcovV/Xy1TrjIhfpQ==, tableContent=null), ArticleFig(id=1322954212233060958, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954198907757063, language=EN, label=Figure 5, caption=Nef inhibited the activation of pyroptosis-related pathway in MPTP-induced PD mice, figureFileSmall=IgQwGUm6X2yAT4nEMWqp/Q==, figureFileBig=0yMA61u8eMMwvfineFnOIQ==, tableContent=null), ArticleFig(id=1322954212333724255, tenantId=1146029695717560320, journalId=1319373162502258839, articleId=1322954198907757063, language=CN, label=图5, caption=Nef抑制MPTP诱导的PD小鼠焦亡通路激活

A:NLRP3 and Caspase-1 in the hippocampus detected by immunohistochemistry; B:Concentrations of IL-1β and IL-18 in brain tissues; MPTP:1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine; Nef:neferine; NLRP3:nod-like receptor thermal protein domain associated protein 3; IL-1β:interleukin-1β; IL-18:interleukin-18

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甲基莲心碱通过抑制ROS/NLRP3/Caspase-1通路减少小胶质细胞焦亡并改善帕金森病神经炎症
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刘纷纷 1 , 冯丹 1 , 刘韵 1 , 左方娅 1 , 郭修红 2 , 刘钰淇 1 , 陈兰兰 3 , 王玉洁 1 , 田锦勇 4
陆军军医大学学报 | 神经科学·论著 2025,47(23): 2933-2942
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陆军军医大学学报 |神经科学·论著 2025 , 47 (23) : 2933 -2942
甲基莲心碱通过抑制ROS/NLRP3/Caspase-1通路减少小胶质细胞焦亡并改善帕金森病神经炎症
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刘纷纷1, 冯丹1, 刘韵1, 左方娅1, 郭修红2, 刘钰淇1, 陈兰兰3, 王玉洁1, 田锦勇4
作者信息
  • 1贵州中医药大学研究生院,贵州 贵阳
  • 2清镇市第一人民医院重症医学科,贵州 贵阳
  • 3遵义医科大学研究生院,贵州 遵义
  • 4贵州省人民医院全科医学科,贵州 贵阳
通讯作者:
田锦勇,E-mail:
TIAN Jinyong,E-mail:
Neferine attenuates parkinson’s disease via modulating microglial pyroptosis mediated by ROS/NLRP3/Caspase-1 signaling pathway
Fenfen LIU1, Dan FENG1, Yun LIU1, Fangya ZUO1, Xiuhong GUO2, Yuqi LIU1, Lanlan CHEN3, Yujie WANG1, Jinyong TIAN4
Affiliations
  • 1Graduate School,Guizhou University of Traditional Chinese Medicine,Guiyang,Guizhou
  • 2Department of Critical Care Medicine,the First People’s Hospital of Qingzhen City,Guiyang,Guizhou
  • 3Graduate School,Zunyi Medical University,Zunyi,Guizhou
  • 4Department of General Practice,Guizhou Provincial People’s Hospital,Guiyang,Guizhou,China
出版时间: 2025-12-15 doi: 10.16016/j.2097-0927.202509003
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目的

证实甲基莲心碱(neferine,Nef)通过抑制活性氧(reactive oxygen species,ROS)/NOD样受体热蛋白结构域相关蛋白3(NOD-like receptor thermal protein domain associated protein 3,NLRP3)/Caspase-1通路介导的小胶质细胞焦亡,从而改善帕金森病(Parkinson’s disease,PD)症状。

方法

将小鼠小胶质细胞BV2分为对照组、脂多糖(lipopolysaccharides,LPS)-三磷酸腺苷(adenosine triphosphate,ATP)组、LPS-ATP+Nef组,采用1 μg/mL LPS联合5 mmol/L ATP诱导小胶质细胞焦亡,对LPS-ATP诱导的小胶质细胞给予2 μmol/L Nef预处理。取18只10~12周龄C57BL/6雄性小鼠(体质量22~25 g),采用计算机随机数生成法将小鼠分为:对照组(n=6)、1-甲基-4-苯基-1,2,3,6-四氢吡啶(1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine,MPTP)组(n=6)、MPTP+Nef组(n=6)。采用流式细胞仪检测细胞焦亡,CCK-8检测细胞活力,2',7'-二氯荧光素二乙酸酯(2',7'-Dichlorodihydrofluorescein diacetate,DCFH-DA)探针表征ROS,试剂盒检测丙二醛(malondialdehyde,MDA)、超氧化物歧化酶(superoxide dismutase,SOD)、谷胱甘肽(glutathione,GSH)。应用ELISA法及Western blot检测白介素1β(interleukin-1β,IL-1β)及白介素18(interleukin-18,IL-18),免疫荧光及免疫组化检测NLRP3及Caspase-1表达,免疫组化检测酪氨酸羟化酶(tyrosine hydroxylase,TH)蛋白表达。采用苏木素-伊红染色试剂盒观察脑组织病理学变化。采用小鼠神经功能缺损评分(modified neurological severity score,mNSS)评价小鼠神经功能损伤。

结果

LPS-ATP组与对照组相比,细胞活力降低(P=0.002),细胞焦亡增加(P<0.001),ROS(P<0.001)、MDA(P<0.001)、IL-1β(P<0.001)、IL-18(P<0.001)水平升高,NLRP3(P<0.001)和Caspase-1(P<0.001)表达上调,GSH水平(P<0.001)和SOD活性(P<0.001)降低。LPS-ATP+Nef组与LPS-ATP组比较,细胞活力增强(P=0.047),细胞焦亡减少(P<0.001),ROS(P=0.002)、MDA(P<0.001)、IL-1β(P<0.001)、IL-18(P=0.004)水平降低,NLRP3(P<0.001)及Caspase-1(P<0.001)表达下调,GSH水平(P<0.001)及SOD活性(P<0.001)升高。小鼠实验表明:MPTP组与对照组相比,mNSS得分(P<0.001)及组织ROS水平(P<0.001)增加,TH蛋白下调(P<0.001),NLRP3(P<0.001)及Caspase-1(P<0.001)表达上调,而Nef处理可明显抑制上述MPTP对小鼠的影响(P<0.05)。在组织病理学方面,对照组小鼠海马神经元分布均匀,细胞核结构清晰,MPTP组表现为部分神经元肿胀,出现间质水肿、核萎缩,而MPTP+Nef组神经元损伤有所改善。

结论

Nef通过ROS/NLRP3/Caspase-1通路抑制小胶质细胞焦亡,从而有效改善PD神经炎症及组织损伤。

帕金森病  /  细胞焦亡  /  小胶质细胞  /  甲基莲心碱
Objective

To demonstrate that neferine (Nef) alleviates Parkinson’s disease (PD) by inhibiting microglial pyroptosis mediated through the reactive oxygen species (ROS)/NOD-like receptor protein 3 (NLRP3)/Caspase-1 pathway.

Methods

BV2 microglial cells were divided into: control group, lipopolysaccharides (LPS)-adenosine triphosphate (ATP) group, and LPS-ATP+Nef group. Pyroptosis was induced by 1 μg/mL LPS + 5 mmol/L ATP, with 2 mmol/L Nef pretreatment. Eighteen 10-12-week-old male C57BL/6 mice (22~25 g) were randomly assigned to: control (n=6), 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) (n=6), and MPTP+Nef (n=6) groups. Detection methods included: flow cytometry for pyroptosis, Cell Counting Kit-8 (CCK-8) for viability, 2',7'-dichlorodihydrofluorescein diacetate (DCFH-DA) for ROS, commercial kits for malondialdehyde (MDA), superoxide dismutase (SOD), glutathione (GSH), ELISA/Western blot for interleukin-1β (IL-1β)/IL-18, immunofluorescence/immunohistochemistry for NLRP3/Caspase-1, tyrosine hydroxylase (TH) immunohistochemistry, hematoxylin-eosin staining for neuropathology, and modified neurological severity score (mNSS).

Results

Versus control, LPS-ATP group showed decreased viability (P=0.002), increased pyroptosis (P<0.001), elevated ROS (P<0.001)/MDA (P<0.001)/IL-1β (P<0.001)/IL-18 (P<0.001), upregulated NLRP3 (P<0.001)/Caspase-1 (P<0.001), and reduced GSH (P<0.001)/SOD (P<0.001). Nef treatment reversed these effects (all P<0.05). According to the results of murine studies, compared with the control group, the MPTP group had increased mNSS (P<0.001)/tissue ROS (P<0.001), downregulated TH (P<0.001), upregulated NLRP3 (P<0.001)/Caspase-1 (P<0.001). Nef treatment significantly attenuated the MPTP-induced deleterious effects (P<0.05). Histopathological analysis revealed that control group exhibited uniformly distributed hippocampal neurons with distinct nuclear morphology; MPTP group showed neuronal swelling, interstitial edema, and nuclear atrophy; MPTP+Nef group demonstrated ameliorated neuronal damage.

Conclusion

Nef inhibits microglial pyroptosis via ROS/NLRP3/Caspase-1 axis, ameliorating PD neuroinflammation and pathology.

Parkinson’ s disease  /  pyroptosis  /  microglia  /  neferine
刘纷纷, 冯丹, 刘韵, 左方娅, 郭修红, 刘钰淇, 陈兰兰, 王玉洁, 田锦勇. 甲基莲心碱通过抑制ROS/NLRP3/Caspase-1通路减少小胶质细胞焦亡并改善帕金森病神经炎症. 陆军军医大学学报, 2025 , 47 (23) : 2933 -2942 . DOI: 10.16016/j.2097-0927.202509003
Fenfen LIU, Dan FENG, Yun LIU, Fangya ZUO, Xiuhong GUO, Yuqi LIU, Lanlan CHEN, Yujie WANG, Jinyong TIAN. Neferine attenuates parkinson’s disease via modulating microglial pyroptosis mediated by ROS/NLRP3/Caspase-1 signaling pathway[J]. Journal of Army Medical University, 2025 , 47 (23) : 2933 -2942 . DOI: 10.16016/j.2097-0927.202509003
帕金森病(Parkinson’s disease,PD)是第二大神经退行性疾病,其临床特征主要表现为进行性运动功能障碍[1-3]。据统计,全球约1 000万人受PD影响,且其患病率随年龄增长而升高[4]。临床资料显示,近30年来PD发病率呈上升趋势[5]。因此,深入研究PD的发病机制并探索有效的治疗策略具有重要临床意义。
细胞焦亡是一种由gasdermin介导的细胞程序性死亡方式,典型的细胞焦亡途径由炎性小体介导,炎性小体在结构上通常包含Nod样受体(Nod-like receptor,NLR)或AIM2样受体蛋白(AIM2-like receptor,ALR)、凋亡相关斑点样蛋白(apoptosis-associated speck-like protein containing a CARD,ASC)、Caspase-1前体蛋白[6-9]。在焦亡过程中,炎性小体促进Caspase-1前体蛋白裂解为活化型Caspase-1,后者可进一步切割gasdermin以裂解为N端gasdermin(N-GSDMD)及C端gasdermin(C-GSDMD),N-GSDMD可在细胞膜上形成非选择性膜孔,从而促进水流入及细胞裂解;同时Caspase-1催化白介素1β(interleukin-1β,IL-1β)及白介素18(interleukin-18,IL-18)的前体裂解为成熟形式,并通过N-GSDMD膜孔释放至胞外,诱发细胞焦亡[10-12]。
小胶质细胞作为中枢神经系统中的常驻巨噬细胞,在清除病原体和维持脑内稳态中发挥关键作用[13-16]。小胶质细胞焦亡在PD发病过程中具有重要意义。在PD动物模型和细胞模型中均观察到小胶质细胞焦亡的激活,抑制该过程可减轻神经炎症反应,并逆转多巴胺能神经元丢失和运动行为缺陷[15-17]。此外,小胶质细胞焦亡受活性氧(reactive oxygen species,ROS)/NOD样受体热蛋白结构域相关蛋白3(NOD-like receptor thermal protein domain associated protein 3,NLRP3)/Caspase-1通路正向调控,而抑制ROS/NLRP3/Caspase-1通路可有效干扰小胶质细胞焦亡的发生[18-20]。因此,ROS/NLRP3/Caspase-1通路有望成为抑制小胶质细胞焦亡并改善PD症状的重要靶点。
甲基莲心碱(neferine,Nef)是荷花绿色胚芽的主要成分,具有抗炎、抗氧化、抗血小板等生物活性,在癌症、心血管疾病、睡眠不足等疾病的治疗中发挥重要作用[21-23]。动物模型显示,Nef可有效抑制神经退行性疾病突变蛋白表达,改善模型小鼠的运动缺陷[24]。然而,目前仍不明确Nef对PD的治疗作用及确切机制。既往证据指出,Nef可通过ROS/NLRP3/Caspase-1通路抑制内皮细胞氧化应激及细胞焦亡[25],提示ROS/NLRP3/Caspase-1通路可能是Nef发挥抗炎及抗氧化作用的关键靶点。同时,鉴于ROS/NLRP3/Caspase-1通路对小胶质细胞焦亡的重要影响,本研究推测在PD中ROS/NLRP3/Caspase-1通路介导Nef对小胶质细胞焦亡的抑制作用。
鉴于此,本研究拟采用脂多糖(lipopolysaccharides,LPS)联合三磷酸腺苷(adenosine triphosphate,ATP)诱导的小胶质细胞模型,以及1-甲基-4-苯基-1,2,3,6-四氢吡啶(1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine,MPTP)诱导的小鼠PD模型,探讨Nef对PD的治疗作用,并着重探究其在调控小胶质细胞焦亡中的作用,以期明确Nef的作用靶点,为PD治疗提供新的机制见解和候选药物。
小鼠小胶质细胞BV2细胞购自中国普诺赛公司;10~12周龄C57BL/6雄性小鼠购自中国维通利华(北京)公司;胎牛血清购自美国Gibco公司;青-链霉素混合液及杜氏改良Eagle培养基(dulbecco’s modified eagle medium,DMEM)高糖培养基、ATP购自中国生工生物公司;MPTP购自美国Sigma Aldrich公司。LPS及Nef购自美国MedChemExprss公司;聚偏氟乙烯(polyvinylidene fluoride,PVDF)膜购自中国索莱宝生物公司;FAM-FLICA Caspase-1(YVAD)检测试剂盒及碘化丙锭染剂购自美国ImmunoChemistry Technologies公司;CCK-8试剂盒、小鼠IL-1β ELISA试剂盒、小鼠IL-18 ELISA试剂盒、丙二醛(MDA)检测试剂盒、GSH检测试剂盒、SOD活性检测试剂盒(WST-8法)、免疫染色封闭液、DCFH-DA探针、DAPI染色液、苏木素伊红(HE)染色试剂盒、二喹啉甲酸(bicinchoninic acid,BCA)检测试剂盒、Western blot封闭液、增强型化学发光底物(enhanced chemilumines-cence,ECL)显色试剂均购自中国碧云天生物公司;4%多聚甲醛、荧光素偶联的山羊抗兔抗体、柠檬酸盐修复液、辣根过氧化物酶(horseradish peroxidase,HRP)交联的Boost免疫组化检测试剂(山羊抗兔)、HRP交联的二抗、甘油醛-3-磷酸脱氢酶(glyceraldehyde-3-phosphate dehydrogenase,GAPDH)抗体均购自美国Cell signaling公司;NLRP3、Caspase-1抗体、IL-1β抗体、IL-18抗体均购自美国Arigobio公司;5-溴-2’-脱氧尿苷(5-bromo-2'-deoxyuridine,BrdU)抗体及神经元细胞核抗原(neuronal nuclei,NeuN)抗体购自美国Abcam公司;酪氨酸羟化酶(tyrosine hydroxylase,TH)抗体购自中国三鹰生物公司。
细胞培养基配置如下:10%胎牛血清+1%青-链霉素混合液+DMEM高糖培养基。小鼠小胶质细胞BV2细胞培养于细胞培养基中,孵育箱环境条件设置为37 ℃、5%CO2。取生长状况良好的BV2细胞,分为对照组、LPS-ATP组、LPS-ATP+Nef组。对照组细胞正常培养,不接受LPS-ATP诱导及Nef给药。LPS-ATP组采用LPS联合ATP诱导细胞焦亡,使用1 μg/mL LPS联合5 mmol/L ATP诱导24 h。LPS-ATP+Nef组预先给予2 μmol/L Nef处理4 h,后采用LPS联合ATP诱导细胞焦亡。
取BV2细胞并接种于96孔板,进行实验分组及处理。然后,每孔加入CCK-8溶液,37 ℃孵育1 h。采用酶标仪检测450 nm处光密度[D(450)]值,计算细胞活力。
消化、收集细胞后,PBS溶液重悬细胞,1 000×g离心细胞5 min,移除上清液,采用FAM-FLICA Caspase-1(YVAD)检测试剂盒标记焦亡细胞。加入碘化丙锭染剂,室温避光复染5 min,使用流式细胞仪表征细胞焦亡。
采用ELISA检测细胞培养上清液中IL-1β及IL-18含量。收集细胞培养基,100×g离心5 min,取上清,使用小鼠IL-1β ELISA试剂盒或小鼠IL-18 ELISA试剂盒检测,检测步骤严格遵循产品使用说明书。
为评估细胞的氧化应激水平,本研究收集各组细胞样品,并检测丙二醛(malondialdehyde,MDA)、超氧化物歧化酶(superoxide dismutase,SOD)、谷胱甘肽(glutathione,GSH),所用试剂盒包括MDA检测试剂盒、SOD活性检测试剂盒、GSH检测试剂盒,操作步骤严格遵循产品使用指南。
为检测细胞中的NLRP3及Caspase-1蛋白,取细胞样品,去除培养基,4%多聚甲醛室温固定细胞15 min。移除固定液并洗涤细胞。为表征海马组织中的NLRP3及Caspase-1蛋白,取海马CA1区石蜡组织切片,脱蜡水化后置于柠檬酸钠缓冲液(pH=6.0)中,使用微波炉加热20 min,冷却至室温后使用0.1% Triton X-100进行通透处理。
加入含5%正常羊血清的封闭液封闭1 h。移除封闭液并洗涤后,加入NLRP3(稀释度1∶100)或Caspase-1抗体(1∶100)或BrdU抗体(稀释度1∶300)或NeuN(稀释度1∶100),4 ℃孵育过夜。移除一抗并洗涤。加入荧光素偶联的山羊抗兔抗体(稀释度1∶400),室温避光孵育1 h。DAPI染色液复染细胞核,中性树胶封片。荧光显微镜下观察荧光成像。
本研究以C57BL/6雄性小鼠(体质量22~25 g,10~12周龄)为PD造模对象。小鼠自由饮食饮水,饲养湿度为(60±1)%,温度为(22±1)℃,12 h光暗交替循环。小鼠经适应性饲养1周后进行实验处理。采用计算机随机数生成法将小鼠为对照组、MPTP组、MPTP+Nef组(n=6)。MPTP组:腹腔注射25 mg/kg MPTP,每天1次,连续注射7 d。MPTP+Nef组:腹腔注射25 mg/kg MPTP,连续注射7 d,最后1次MPTP注射1.5 h后进行Nef腹腔注射,20 mg/kg,持续5 d。对照组:腹腔注射与MPTP等量的生理盐水,持续7 d,后连续腹腔注射与Nef等量的生理盐水,持续5 d。
本研究采用改良mNSS对小鼠的神经损伤进行量化。评分在造模后24 h于安静环境下进行,由不知分组的研究人员通过观察小鼠的自发运动、行走姿态及前爪伸展等行为进行判定。具体标准如下:0分(无异常),1分(对侧前爪无法伸展),2分(爬行时向对侧转圈),3分(行走时向对侧倾倒),4分(无法行走或意识丧失)。得分越高,表明神经功能损伤越严重。
本研究使用活性氧检测试剂盒(DCFH-DA探针)检测细胞及组织样品中的ROS含量,DCFH-DA探针溶于无血清培养基,最终浓度为10 μmol/L。取各组小胶质细胞样品,去除细胞培养基,加入DCFH-DA探针,37 ℃孵育细胞20 min。激光共聚焦显微镜观察荧光成像,表征荧光强度,计算ROS相对变化。为检测海马组织中的ROS含量,取小鼠海马组织,匀浆,离心后弃上清,加入DCFH-DA探针溶液重悬沉淀,37 ℃孵育20 min。激光共聚焦显微镜检测,激发波长488 nm,发射波长525 nm。
收集小鼠海马体组织CA1区,脱水、石蜡包埋、切片。取石蜡组织切片,脱蜡、水化,采用苏木素伊红染色试剂盒进行组织病理学染色,染色步骤严格遵循产品说明书。染色结束后采用中性树胶封片,显微镜下观察组织病理学变化。
为评估海马组织中的炎症小体活性,采用免疫组化检测海马CA1区NLRP3、Caspase-1蛋白;为检测黑质区多巴胺能神经元的变化,采用免疫组化检测黑质区冠状位脑切片中的TH蛋白。取小鼠相应脑片的石蜡切片,脱蜡水化后置于柠檬酸钠缓冲液(pH6.0)中,使用微波炉高火加热至沸腾后转为中低火保持微沸20 min。自然冷却至室温后加入用PBS配制的3%过氧化氢溶液,室温孵育10 min。PBS冲洗3次,每次5 min。加入含5%正常羊血清的封闭液,室温封闭1 h。封闭结束后,加入NLRP3抗体(稀释度1∶100)或Caspase-1抗体(稀释度1∶100)或TH抗体(稀释度1∶500),4 ℃孵育过夜。PBS冲洗3次,每次5 min。加入HRP交联的Boost免疫组化检测试剂,室温孵育30 min。DAB试剂显色,显色完成后立即将切片放入蒸馏水中终止反应。用苏木精染液复染细胞核,流水冲洗返蓝。脱水和中性树胶封片后,于显微镜下观察。
取细胞或海马组织样品,使用RIPA裂解液进行裂解。待充分裂解后4 ℃下以12 000×g离心10 min,取上清液。BCA检测试剂盒用于上清液中蛋白浓度检测。取蛋白样品,并加入上样缓冲液,混匀后95 ℃下加热蛋白10 min,后通过SDS-PAGE凝胶电泳系统进行蛋白分离,湿式转膜仪进行蛋白冰转。待蛋白转移至PVDF膜后,加入封闭液,室温摇床振荡1 h。封闭结束后,加入一抗,4 ℃孵育过夜。一抗孵育结束后,加入二抗(稀释度1∶10 000),室温孵育1 h。采用ECL显色试剂进行显色处理。上机,获取蛋白条带图像。以GAPDH为内参,计算蛋白相对水平。一抗产品信息及稀释度如下:IL-1β抗体(稀释度1∶1 000)、IL-18抗体(稀释度1∶1 000)、GAPDH抗体(稀释度1∶1 000)。
使用GraphPad Prism 9.0软件进行数据绘图,使用SPSS 23.0软件进行统计学分析。实验数据以x¯±s表示。采用单因素方差分析进行组间比较,事后两两比较为Tukey检验。统计学分析均为双尾检验。P<0.05表明差异具有统计学意义。
为探究Nef对LPS-ATP诱导小胶质细胞损伤的影响,本研究采用CCK-8检测细胞活力,采用流式细胞仪检测细胞焦亡率。CCK-8实验显示,对照组[(100.92±4.62)%]、LPS-ATP组[(67.07±6.45)%]、LPS-ATP+Nef组[(83.23±7.65)%]的细胞活力差异存在统计学意义(F=21.250,P<0.01),其中LPS-ATP组细胞活力低于对照组(P=0.002),LPS-ATP+Nef组细胞活力高于LPS-ATP组(P=0.047)。细胞焦亡检测结果显示,LPS-ATP组焦亡率高于对照组(P<0.001),LPS-ATP+Nef组焦亡率低于LPS-ATP组(P<0.001)。结果提示Nef抑制LPS-ATP诱导的小胶质细胞焦亡(图1)。
为进一步探究Nef对LPS-ATP诱导小胶质细胞氧化损伤和炎症反应的影响,本研究采用DCFH-DA荧光探针标记细胞内ROS,应用ELISA检测MDA、SOD、GSH、IL-1β、IL-18。DCFH-DA探针荧光结果显示,LPS-ATP组DCFH探针荧光强度较对照组增加(P<0.001),LPS-ATP+Nef组与LPS-ATP组相比,DCFH探针荧光强度降低(P=0.002,图2A)。LPS-ATP组与对照组相比,MDA升高(P<0.001),SOD(P<0.001)及GSH(P<0.001)降低。LPS-ATP+Nef组与LPS-ATP组相比,MDA降低(P<0.001),SOD(P<0.001)及GSH(P<0.001)升高,差异具有统计学意义(P<0.001,图2B~D)。ELISA实验结果显示,LPS-ATP组与对照组相比,IL-1β(P<0.001)及IL-18升高(P<0.001),LPS-ATP+Nef组与LPS-ATP组相比,IL-1β(P<0.001)及IL-18(P<0.001,图2E)降低。以上结果提示Nef抑制LPS-ATP诱导的小胶质细胞氧化应激及炎症反应。
为探究Nef对LPS-ATP诱导的焦亡相关蛋白表达的影响,本研究采用免疫荧光检测NLRP3、Caspase-1表达,并使用Western blot检测IL-1β、IL-18表达。免疫荧光结果显示,LPS-ATP组NLRP3及Caspase-1表达多于对照组(P<0.001),LPS-ATP+Nef组NLRP3及Caspase-1表达少于LPS-ATP组(P<0.001,图3A、B)。Western blot结果表明,LPS-ATP组IL-1β(P<0.001)及IL-18(P<0.001)的相对表达量显著高于对照组,LPS-ATP+Nef组IL-1β(P<0.001)及IL-18(P=0.004)的相对表达量显著低于LPS-ATP组(图3C)。以上结果提示Nef抑制LPS-ATP诱导的焦亡相关蛋白表达。
为探究Nef对PD小鼠的影响,本研究使用mNSS评分评估神经功能损伤,采用免疫组化检测TH蛋白、HE染色观察海马组织病理学变化、免疫荧光检测海马组织中的BrdU及NeuN蛋白。mNSS评分结果显示,MPTP组神经损伤得分高于对照组(P<0.001),MPTP+Nef组神经损伤得分低于MPTP组(P<0.001,图4A)。DCFH-DA检测脑组织ROS结果表明,MPTP组ROS相对量较对照组升高(P<0.001),MPTP+Nef组与MPTP组相比ROS相对量(P<0.001,图4B)降低。由此可见,对照组ROS生成低于MPTP组,MPTP+Nef组ROS生成低于MPTP组。
此外,本研究使用免疫组化检测黑质区TH的表达。结果显示,MPTP组脑黑质中TH表达显著低于对照组(P<0.001),MPTP+Nef组脑黑质中TH表达高于MPTP组(P<0.001,图4C)。组织病理学染色结果显示,对照组海马CA1区神经元分布均匀,胞核结构清晰,MPTP组海马组织CA1区中神经元肿胀,且伴随有间质水肿及核萎缩,MPTP+Nef组海马组织CA1区神经元损伤较MPTP组有所改善(图4D)。本研究应用NeuN+标记神经元,并检测与NeuN共定位的增殖标记物BrdU,以评估神经元生长情况。MPTP组BrdU+NeuN+细胞显著少于对照组(P<0.001),而MPTP+Nef组BrdU+NeuN+细胞多于MPTP组(P=0.025,图4E)。以上结果提示Nef缓解MPTP诱导的小鼠PD症状。
为进一步验证Nef是否通过抑制焦亡缓解PD,本研究采用免疫组化检测NLRP3、Caspase-1表达,采用ELISA检测IL-1β、IL-18含量。免疫组化结果显示,MPTP组海马体组织CA1区中NLRP3及Caspase-1表达高于对照组(P<0.001),MPTP+Nef组海马体组织CA1区中NLRP3及Caspase-1表达低于MPTP组(P<0.001,P=0.002,图5A)。ELISA结果显示,MPTP组IL-1β及IL-18含量高于对照组,MPTP+Nef组IL-1β及IL-18含量低于MPTP组(P<0.001,图5B)。以上结果提示Nef抑制MPTP诱导的PD小鼠焦亡通路激活。
Nef作为一种主要的双苄基异奎林生物碱,在神经退行性变疾病中表现出神经保护潜力。YIN等[26]研究证实,Nef可通过减轻脑组织中的炎症反应和氧化应激水平,改善神经退行性病理变化。LIN等[27]研究显示,Nef处理可抑制小胶质细胞中促炎因子的形成及释放。本研究在此基础上,进一步证实Nef可抑制LPS-ATP诱导的小胶质细胞焦亡,并表现出明显的抗炎活性。小胶质细胞焦亡在PD发病机制中具有重要作用。一方面,小胶质细胞发生细胞焦亡,引起促炎细胞因子向胞外释放并引发神经炎症;另一方面,小胶质细胞焦亡也导致小胶质细胞的吞噬作用受限,加剧神经损伤[28]。本研究动物实验显示,Nef治疗能减轻PD小鼠的多巴胺能神经元的损伤,并降低脑组织中的促炎细胞因子水平及ROS含量。上述结果表明,Nef可能通过减少小胶质细胞焦亡抑制神经炎症,进而改善PD症状。
ROS/NLRP3/Caspase-1通路是调控细胞焦亡的关键机制之一。ROS可促进NLRP3炎性小体的组装及Caspase-1的活化。目前观点认为,ROS通过促进NLRP3炎性小体形成而诱导活化型Caspase-1产生,后者可切割gasdermin、IL-18、IL-1β的前体,从而触发细胞焦亡[29-30]。Nef作为一种抗氧化剂,能够直接与ROS反应并清除ROS,抑制其生成与积累。YIN等[26]研究表明,Nef可显著降低神经退行性疾病模型大鼠脑组织中的ROS水平。本研究动物及细胞实验进一步证实,Nef能抑制ROS/NLRP3/Caspase-1信号通路。以上结果表明,Nef在神经退行性疾病中可能通过清除ROS,发挥抗氧化及抗炎作用。因此,Nef可能通过抑制ROS的生成,干扰下游NLRP3炎性小体组装及Caspase-1前体的切割,从而抑制小胶质细胞焦亡。
本研究基于动物及细胞模型,揭示了Nef在PD中的神经保护潜力,但尚未深入探讨Nef调控ROS生成的具体机制,为当前研究的局限性。有证据表明,线粒体ROS与NAPDH氧化酶的相互作用可导致ROS升高,而Nef预处理能预防线粒体功能障碍,并抑制NADPH氧化酶表达[31],这一研究提示Nef的抗氧化机制与线粒体功能障碍相关,因此,后续研究可重点探究Nef是否通过调节线粒体功能进而抑制ROS的生成与积累,从而为Nef治疗PD提供充分的理论依据。
综上所述,本研究证明Nef可能通过ROS/NLRPS/Caspase-1通路抑制小胶质细胞焦亡,进而缓解PD相关的神经炎症和组织损伤。该发现为阐释Nef在PD治疗中的潜在作用机制提供了理论支持,并为其进一步临床应用奠定了基础。

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2025年第47卷第23期
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doi: 10.16016/j.2097-0927.202509003
  • 接收时间:2025-09-01
  • 首发时间:2026-10-30
  • 出版时间:2025-12-15
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  • 收稿日期:2025-09-01
  • 修回日期:2025-11-17
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    1贵州中医药大学研究生院,贵州 贵阳
    2清镇市第一人民医院重症医学科,贵州 贵阳
    3遵义医科大学研究生院,贵州 遵义
    4贵州省人民医院全科医学科,贵州 贵阳

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