摘要:目的" 觀察鞘內(nèi)注射PPARγ激動劑Pioglitazone對神經(jīng)病理性疼痛大鼠痛行為及星形膠質(zhì)細(xì)胞活性的影響。方法" 將220~250 g的雄性SPF級SD大鼠64只按隨機(jī)數(shù)字表法分為4組:Sham+DMSO組(二甲基亞砜,S+D組)、Sham+Pioglitazone組(S+P組)、CCI+DMSO組(I+D組)、CCI+ Pioglitazone組(I+P組)。通過結(jié)扎大鼠坐骨神經(jīng)致慢性壓迫性損傷(CCI)建立神經(jīng)病理性疼痛模型。從CCI術(shù)后第3天開始鞘內(nèi)注射相應(yīng)藥物至術(shù)后第14天。于術(shù)前及術(shù)后第3、7、14、21天檢測大鼠右后爪機(jī)械縮足閾值(PWMT)和熱縮足反射潛伏期(PWTL),并于術(shù)后第14天取大鼠脊髓腰膨大部,采用免疫印跡法測定脊髓背角星形膠質(zhì)細(xì)胞標(biāo)記物GFAP蛋白表達(dá),采用ELISA檢測炎性因子TNF-α、IL-1β和IL-6表達(dá)。結(jié)果" S+D組、S+P組術(shù)后第3、7、14、21天PWMT、PWTL與術(shù)前比較,差異無統(tǒng)計學(xué)意義(Pgt;0.05);I+D組和I+P組術(shù)后第3、7、14、21天PWMT和PWTL值低于術(shù)前(Plt;0.05);S+P組術(shù)后第3、7、14、21天PWMT和PWTL值與S+D組比較,差異無統(tǒng)計學(xué)意義(Pgt;0.05);I+D組和I+P組術(shù)后第3、7、14、21天PWMT和PWTL值低于S+D組(Plt;0.05);I+P組術(shù)后第3、7、14天PWMT和PWTL高于I+D組(Plt;0.05)。S+D組和S+P組GFAP蛋白和TNF-α、IL-1β、IL-6表達(dá)比較,差異無統(tǒng)計學(xué)意義(Pgt;0.05);I+D組和I+P組GFAP蛋白和TNF-α、IL-1β、IL-6表達(dá)高于S+D組和S+P組(Plt;0.05),而I+P組GFAP蛋白和TNF-α、IL-1β、IL-6表達(dá)低于I+D組(Plt;0.05)。結(jié)論" 鞘內(nèi)注射Pioglitazone能緩解神經(jīng)病理性疼痛模型大鼠的機(jī)械痛和熱痛行為,其機(jī)制可能與抑制脊髓背角星形膠質(zhì)細(xì)胞的活性,進(jìn)而抑制炎性因子TNF-α、IL-1β和IL-6的釋放有關(guān)。
關(guān)鍵詞:神經(jīng)病理性疼痛;過氧化物酶體增殖物激活受體γ;星形膠質(zhì)細(xì)胞;膠質(zhì)纖維酸性蛋白;炎性因子
中圖分類號:R441.1" " " " " " " " " " " " " " " " "文獻(xiàn)標(biāo)識碼:A" " " " " " " " " " " " " " " " "DOI:10.3969/j.issn.1006-1959.2023.07.015
文章編號:1006-1959(2023)07-0085-05
Effects of Intrathecal Injection PPARγ Agonist Pioglitazone on the Pain Behavior
and Astrocyte Activity in Rats with Neuropathic Pain
HUANG Tong-hong,LING Guo-xu,ZHONG Yu
(Department of Anesthesia,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,Guangxi,China)
Abstract:Objective" To investigate the effects of intrathecal injection PPARγ agonist Pioglitazone on the pain behavior and astrocyte activity in rats with neuropathic pain.Methods" Sixty-four male adult Sprague-Dawley rats of 220-250 g were randomly divided into 4 groups: Sham+DMSO group (dimethyl sulfoxide, S+D group), Sham+Pioglitazone (S+P) group, CCI+DMSO (I+D) group, CCI+Pioglitazone (I+P) group. The rat model of neuropathic pain was established by chronic sciatic nerve ligation (CCI). The homologous drugs were injected intrathecally from the third day after CCI for 14 days. The paw withdrawal mechanical threshold (PWMT) and paw withdrawal thermal latency (PWTL) of the right hind paw were measured before operation and on the 3rd, 7th, 14th and 21st day after operation. The lumbar enlargement of the spinal cord was taken on the 14 th day after operation. The expression of astrocyte marker GFAP protein in the spinal dorsal horn was determined by Western blotting, and the expression of inflammatory factors TNF-α, IL-1β and IL-6 was detected by ELISA.Results" There was no significant difference in PWMT and PWTL between before operation and on the 3rd, 7th, 14th and 21st day after operation in S+D group and S+P group (Pgt;0.05). The values of PWMT and PWTL in I+D group and I+P group on the 3rd, 7th, 14th and 21st day after operation were lower than those before operation (Plt;0.05). There was no significant difference in PWMT and PWTL between S+P group and S+D group on the 3rd, 7th, 14th and 21st day after operation (Pgt;0.05). The values of PWMT and PWTL in I+D group and I+P group were lower than those in S+D group on the 3rd, 7th, 14th and 21st day after operation (Plt;0.05). The PWMT and PWTL in I+P group were higher than those in I+D group a on the 3rd, 7th, 14th day after operation (Plt;0.05). There was no significant difference in the expression of GFAP protein and TNF-α, IL-1β and IL-6 between S+D group and S+P group (Pgt;0.05). The expression of GFAP protein and TNF-α, IL-1β and IL-6 in I+D group and I+P group were higher than those in S+D group and S+P group (Plt;0.05), while the expressions of GFAP protein and TNF-α, IL-1β and IL-6 in I+P group were lower than those in I+D group (Plt;0.05).Conclusion" Intrathecal injection Pioglitazone can alleviate both mechanical allodynia and thermal hyperalgesia in rats with neuropathic pain, and its mechanisms may be related to the inhibition of astrocyte activity, and then alleviated proinflammatory cytokine (TNF-α, IL-1β and IL-6) release.
Key words:Neuropathic pain;Peroxisome proliferator activated receptor γ;Astrocyte;Glial fibrillary acidic protein;Inflammatory cytokines
神經(jīng)病理性疼痛(neuropathic pain)是由軀體感覺神經(jīng)系統(tǒng)病變或疾病引起的一種常見的慢性疼痛。流行病學(xué)調(diào)查顯示[1],全世界約有3%~18%的人口患有神經(jīng)病理性疼痛。因神經(jīng)病理性疼痛的發(fā)生機(jī)制復(fù)雜且未完全明確,臨床治療效果有限,對患者造成嚴(yán)重困擾,已成為全球性的社會和經(jīng)濟(jì)負(fù)擔(dān)。研究表明[2-4],活化的PPARγ參與神經(jīng)病理性疼痛,在脊髓的痛覺調(diào)制中發(fā)揮關(guān)鍵作用,是神經(jīng)病理性疼痛的病理生理基礎(chǔ)。而鞘內(nèi)給予PPARγ激動劑Pioglitazone可以很好地緩解疼痛,但其具體作用機(jī)制尚不明確[5]。近年來研究發(fā)現(xiàn)[6,7],脊髓背角星形膠質(zhì)細(xì)胞在痛覺敏化的產(chǎn)生和維持過程中起重要作用。但在神經(jīng)病理性疼痛發(fā)生發(fā)展的過程中,PPARγ與星形膠質(zhì)細(xì)胞之間的關(guān)聯(lián)需進(jìn)一步探討驗證。本實驗通過結(jié)扎大鼠坐骨神經(jīng)建立神經(jīng)病理性疼痛模型,觀察鞘內(nèi)注射PPARγ激動劑Pioglitazone對神經(jīng)病理性疼痛大鼠痛行為及星形膠質(zhì)細(xì)胞活性的影響,現(xiàn)報道如下。
1材料與方法
1.1實驗動物" SPF級雄性SD大鼠64只(體重220~250 g),來源于廣西醫(yī)科大學(xué)動物實驗中心(質(zhì)量合格證許可證號:SCXK桂2014-0002)。實驗大鼠均于SPF級無菌室內(nèi)單獨分籠飼養(yǎng),均能自由飲食飲水,保證每日光照時間為7:00~19∶00,室溫維持在22 ℃~25 ℃。本研究所有動物實驗均經(jīng)廣西醫(yī)科大學(xué)動物實驗倫理委員會批準(zhǔn)并按照廣西醫(yī)科大學(xué)動物實驗委員會制定的標(biāo)準(zhǔn)進(jìn)行實驗操作。
1.2藥物、主要試劑和儀器" PPARγ激動劑Pioglitazone(美國Cayman Chemical公司);DMSO(美國Sigma公司);兔抗GFAP抗體(美國CST公司);兔抗Tubulin抗體(proteintech group公司);HRP二抗(美國CST公司);ECL發(fā)光液(美國Millipore公司);IL-1β、IL-6、TNF-α的ELISA試劑盒(武漢USCN Life Science公司);v on Frey纖毛絲(美國Stoehing公司);ME410C型全自動熱輻射刺激儀(中國醫(yī)學(xué)科學(xué)院生物醫(yī)學(xué)工程研究所);全自動酶標(biāo)儀Gen 5(美國 BioTek公司);4-0可吸收鉻腸線(上海醫(yī)療器械有限公司);PE-10導(dǎo)管(英國 Smiths medical公司)。
1.3方法
1.3.1模型建立和分組" 64只成年雄性SPF級SD大鼠隨機(jī)分為4組(n=16):Sham+DMSO(Dimethyl sulfoxide,二甲基亞砜,S+D)組、Sham+Pioglitazone(S+P)組、CCI+DMSO(I+D)組、CCI+Pioglitazone(I+P)組。各組大鼠進(jìn)行行為學(xué)測定(8只)、術(shù)后第14天的Western blot檢測(4只)、術(shù)后第14天ELISA檢測(4只)。通過結(jié)扎大鼠坐骨神經(jīng)致慢性壓迫性損傷(CCI)建立神經(jīng)病理性疼痛模型,于CCI術(shù)后第3天開始至術(shù)后第14天,各組分別鞘內(nèi)注射溶劑5%二甲基亞楓(DMSO)10 μl或PPARγ激動劑Pioglitazone 100 μg(溶于10 μl的5%DMSO中),1次/d。并檢測各組大在術(shù)前及術(shù)后第3、7、14、21天5個時間點于給藥后半小時的痛行為學(xué)改變。于術(shù)后第14天給藥后半小時取大鼠脊髓腰膨大處(L4~L6)。
1.3.2鞘內(nèi)置管" 經(jīng)腹腔注射戊巴比妥鈉(40 mg/kg),大鼠麻醉后進(jìn)行固定,消毒鋪單,定位L5~L6間隙后作長約1 cm的皮膚縱切口,充分暴露L5~L6棘突間隙,用去尖磨鈍的22G針頭穿刺至蛛網(wǎng)膜下腔,可見大鼠劇烈甩尾,拔針可見外溢的清亮腦脊液,換PE-10導(dǎo)管于相同位置置入約2 cm,使用微量注射器注入生理鹽水確認(rèn)導(dǎo)管通暢后火封導(dǎo)管遠(yuǎn)端,在髂嵴處將導(dǎo)管縫合固定于肌肉,導(dǎo)管埋于皮下,于頸部或兩耳中間引出,外露3 cm固定。大鼠排除標(biāo)準(zhǔn):術(shù)后出現(xiàn)下肢單癱、截癱、偏癱等運動障礙,導(dǎo)管脫落,導(dǎo)管過短。鞘內(nèi)置管成功標(biāo)準(zhǔn):置管后3 d,鞘內(nèi)緩慢注射2%利多卡因10 μl作試驗劑量,再注入10 μl生理鹽水沖管,約10 s內(nèi)大鼠雙后肢不能負(fù)重、拖地以及針刺無小腿回縮等逃避反應(yīng),并于30 min內(nèi)恢復(fù),即鞘內(nèi)置管成功。
1.3.3慢性坐骨神經(jīng)壓迫(CCI)模型制備" 經(jīng)腹腔注射戊巴比妥鈉(40 mg/kg),大鼠麻醉后進(jìn)行固定,消毒鋪單,于大鼠右側(cè)大腿股骨下緣,距脊柱旁開0.5~1 cm處作長約1 cm的切口,分離肌肉,暴露坐骨神經(jīng)主干。按每道間隔1 mm的距離于坐骨神經(jīng)起始處上方用4-0鉻制羊腸線結(jié)扎4道,以后肢輕微抽動為結(jié)扎時的力度標(biāo)準(zhǔn)。S組僅暴露同側(cè)坐骨神經(jīng),不進(jìn)行結(jié)扎。
1.3.4行為學(xué)測定" ①機(jī)械性縮足閾值(PWMT)測定:將大鼠放置于鐵絲網(wǎng)架子上的透明有機(jī)玻璃箱中30 min以適應(yīng)環(huán)境。采用Von Frey纖維絲(1~15 g)觸壓大鼠右側(cè)腳掌后中部,先從1 g開始,設(shè)定觸壓時間不超過4 s,以出現(xiàn)抬足、舔足等行為為陽性反應(yīng),重復(fù)測定5次,每次間隔30 s。有3次或3次以上陽性反應(yīng)時的刺激力度為PWMT。無陽性反應(yīng)時則更換大一級力度的纖維絲,反之則更換小一級力度的纖維絲,以誘發(fā)大鼠出現(xiàn)陽性結(jié)果的最低Von Frey纖維絲力度為大鼠PWMT。若刺激力度超過15 g或低于1 g,則直接記為15 g或1 g;②熱縮足反射潛伏期(PWTL)測定:將大鼠置在厚3 mm的玻璃板上方的透明有機(jī)玻璃箱內(nèi),待30 min大鼠適應(yīng)環(huán)境后將輻射熱源對準(zhǔn)大鼠右后足中部,一旦大鼠的右后爪移動,停止刺激并記錄時間,最長照射時間不超過25 s以避免大鼠灼傷。重復(fù)測定5次,每次間隔5~6 min,取后3次的平均值作為PWTL。
1.3.5 Western blot檢測脊髓水平GFAP的表達(dá)" 經(jīng)腹腔注射戊巴比妥鈉(60 mg/kg)深麻醉后,迅速取脊髓腰膨大處(L4~L6),勻漿提取蛋白質(zhì),BCA法測定蛋白質(zhì)濃度。10% SDS-PAGE膠分離目的蛋白,200 mA 60 min濕轉(zhuǎn)至PVDF膜上,轉(zhuǎn)膜后于5%脫脂牛奶中室溫封閉1 h。4 ℃過夜孵育一抗GFAP抗體(1∶1000),Tubulin抗體(1∶5000),TBST洗滌3次,10 min/次,室溫孵育HRP二抗(1∶5000)1 h。使用ECL化學(xué)發(fā)光法掃膜。所得條帶經(jīng)Image J 軟件分析灰度值,以目的蛋白和內(nèi)參Tubulin灰度值的比值作為蛋白表達(dá)水平進(jìn)行定量分析。
1.3.6 ELISA檢測炎癥因子TNF-α、IL-1β和IL-6的表達(dá)" 大鼠深麻醉后取脊髓腰膨大處(L4~L6),勻漿提取蛋白質(zhì),采用BCA法測定蛋白質(zhì)濃度。按試劑盒說明書于96孔板中加入適量蛋白質(zhì)樣品,在1×PBS中均質(zhì)化,并用相應(yīng)的ELISA試劑盒檢測炎癥因子TNF-α、IL-1β和IL-6的表達(dá)。反應(yīng)終止后立即使用酶標(biāo)儀測量A450值,細(xì)胞因子水平以pg/mg表示。
1.4統(tǒng)計學(xué)方法" 采用SPSS 25.0統(tǒng)計學(xué)軟件進(jìn)行分析,計量資料以(x±s)表示,比較采用方差分析或t檢驗。以Plt;0.05為差異有統(tǒng)計學(xué)意義。
2結(jié)果
2.1各組痛行為學(xué)結(jié)果比較" S+D組、S+P組術(shù)后第3、7、14、21天PWMT、PWTL與術(shù)前比較,差異無統(tǒng)計學(xué)意義(Pgt;0.05);I+D組和I+P組術(shù)后術(shù)后第3、7、14、21天PWMT和PWTL值低于術(shù)前(Plt;0.05);S+P組術(shù)后第3、7、14、21天PWMT和PWTL值與S+D組比較,差異無統(tǒng)計學(xué)意義(Pgt;0.05);I+D組和I+P組術(shù)后第3、7、14、21天PWMT和PWTL值低于S+D組(Plt;0.05);I+P組術(shù)后第3、7、14天PWMT和PWTL高于I+D組(Plt;0.05),見表1、表2。
2.2各組GFAP蛋白和炎癥因子表達(dá)比較" S+D組和S+P組GFAP蛋白和TNF-α、IL-1β、IL-6表達(dá)比較,差異無統(tǒng)計學(xué)意義(Pgt;0.05);I+D組和I+P組GFAP蛋白和TNF-α、IL-1β、IL-6表達(dá)高于S+D組和S+P組(Plt;0.05),而I+P組GFAP蛋白和TNF-α、IL-1β、IL-6表達(dá)低于I+D組(Plt;0.05),見表3、圖1。
3討論
神經(jīng)病理性疼痛以自發(fā)性疼痛、痛覺過敏和痛覺異常為特點[1],其分子機(jī)制的研究至今仍未取得突破。本研究中大鼠坐骨神經(jīng)結(jié)扎模型所致神經(jīng)病理性疼痛的部分特征與臨床患者坐骨神經(jīng)痛類似,是目前研究神經(jīng)病理性疼痛最經(jīng)典的實驗動物模型之一。本研究中與S組大鼠相比,可明確觀察到結(jié)扎坐骨神經(jīng)后大鼠出現(xiàn)術(shù)側(cè)后肢抬起、縮足、足外翻等行為,并且經(jīng)檢測,大鼠的痛行為學(xué)指標(biāo)PWMT和PWTL于術(shù)后出現(xiàn)下降,提示該模型制備成功[8]。
PPARγ屬于核激素受體超家族的一員,是一種轉(zhuǎn)錄調(diào)節(jié)因子,最先被發(fā)現(xiàn)高表達(dá)于脂肪組織中[9],參與脂肪生成調(diào)節(jié),后證實其也表達(dá)于淋巴細(xì)胞、巨噬細(xì)胞等免疫細(xì)胞中,與機(jī)體炎癥反應(yīng)關(guān)系密切。近年來研究表明[10,11],PPARγ也表達(dá)于神經(jīng)系統(tǒng)脊髓背角Ⅰ~Ⅳ板層。脊髓是疼痛信號處理的初級中樞,外周傷害性刺激信號經(jīng)由一級傳入纖維傳入脊髓背角,經(jīng)整合后再向上傳遞[12]。Zhang M等[13]研究發(fā)現(xiàn),PPARγ激動劑ELB00824可通過抑制神經(jīng)元的超敏反應(yīng)和氧化應(yīng)激緩解化療藥物引起的神經(jīng)病理性疼痛。Okine BN等[14]研究發(fā)現(xiàn),Pioglitazone作為PPARγ激動劑可減輕炎性疼痛動物模型中的痛覺過敏特征。由此提示,PPARγ與疼痛信號傳導(dǎo)及中樞敏化的形成密切相關(guān),PPARγ激活后可能參與神經(jīng)病理性疼痛的發(fā)生發(fā)展。Griggs RB等[10]研究表明,鞘內(nèi)注射100 μg Pioglitazone可不引起大鼠運動功能損傷,又達(dá)到顯著緩解大鼠痛行為的效果。因此,本研究選擇鞘內(nèi)注射100 μg Pioglitazone進(jìn)行實驗,并通過CCI術(shù)后第3天開始鞘內(nèi)連續(xù)注射PPARγ激動劑Pioglitazone(100 μg/10 μl)至術(shù)后第14天,分別檢測相應(yīng)時間點給藥后大鼠痛行為學(xué)改變,結(jié)果顯示S+D組、S+P組術(shù)后第3、7、14、21天PWMT、PWTL與術(shù)前比較,差異無統(tǒng)計學(xué)意義(Pgt;0.05);I+D組和I+P組術(shù)后術(shù)后第3、7、14、21天PWMT和PWTL值低于術(shù)前(Plt;0.05);S+P組術(shù)后第3、7、14、21天PWMT和PWTL值與S+D組比較,差異無統(tǒng)計學(xué)意義(Pgt;0.05);I+D組和I+P組術(shù)后第3、7、14、21天PWMT和PWTL值低于S+D組(Plt;0.05);I+P組術(shù)后第3、7、14天PWMT和PWTL高于I+D組(Plt;0.05),表明連續(xù)鞘內(nèi)注射Pioglitazone后大鼠痛行為學(xué)改善,有效減輕坐骨神經(jīng)結(jié)扎致的神經(jīng)病理性疼痛,說明PPARγ參與并調(diào)節(jié)神經(jīng)病理性疼痛,給予PPARγ的激動劑Pioglitazone可減輕神經(jīng)病理性疼痛的發(fā)生和發(fā)展。
PPARγ在星形膠質(zhì)細(xì)胞中也有表達(dá),但既往傳統(tǒng)觀點認(rèn)為神經(jīng)膠質(zhì)細(xì)胞僅是對神經(jīng)元起著支持和營養(yǎng)作用,不具有細(xì)胞之間的信號傳遞功能,因而認(rèn)為疼痛在脊髓水平的調(diào)制和整合與脊髓膠質(zhì)細(xì)胞無關(guān)[10]。隨著研究的深入,已證實神經(jīng)損傷會激活膠質(zhì)細(xì)胞,其中星形膠質(zhì)細(xì)胞主要負(fù)責(zé)維持晚期神經(jīng)病理性疼痛[15,16]。當(dāng)脊髓星形膠質(zhì)細(xì)胞被激活時,能產(chǎn)生和釋放大量與疼痛相關(guān)的致炎因子,如TNF-α、IL-1β和IL-6等,從而觸發(fā)一系列極其復(fù)雜的反應(yīng)過程,是脊髓參與疼痛調(diào)制過程、導(dǎo)致痛覺改變或痛覺過敏的重要機(jī)制之一[17,18]。其中,炎癥因子參與神經(jīng)炎癥反應(yīng)可直接激活外周傷害性感受神經(jīng)元,導(dǎo)致神經(jīng)病理性狀態(tài),形成外周敏化[19];并且可引起神經(jīng)元異常興奮,導(dǎo)致脊髓水平痛信號的轉(zhuǎn)導(dǎo)和傳遞增強(qiáng),維持疼痛持續(xù)發(fā)展[20]。GFAP是星形膠質(zhì)細(xì)胞活化的標(biāo)志物。本研究結(jié)果顯示,S+D組和S+P組GFAP蛋白和TNF-α、IL-1β、IL-6表達(dá)比較,差異無統(tǒng)計學(xué)意義(Pgt;0.05);I+D組和I+P組GFAP蛋白和TNF-α、IL-1β、IL-6表達(dá)高于S+D組和S+P組(Plt;0.05),而I+P組GFAP蛋白和TNF-α、IL-1β、IL-6表達(dá)低于I+D組(Plt;0.05),提示給予PPARγ激動劑Pioglitazone干預(yù)后大鼠痛行為學(xué)減輕,抑制脊髓背角GFAP的表達(dá),使得致炎因子TNF-α、IL-1β和IL-6的釋放減少,表明阻斷疼痛持續(xù)發(fā)展與抑制星形膠質(zhì)細(xì)胞活化有關(guān)。然而神經(jīng)病理性疼痛發(fā)生機(jī)制復(fù)雜,在神經(jīng)病理性疼痛中PPARγ通過何種途徑抑制GFAP發(fā)揮鎮(zhèn)痛作用以及引起的相關(guān)級聯(lián)反應(yīng)仍需要進(jìn)一步深入研究。
綜上所述,鞘內(nèi)注射PPARγ激動劑Pioglitazone能有效改善神經(jīng)病理性疼痛大鼠痛行為,其機(jī)制可能與抑制星形膠質(zhì)細(xì)胞活化、減輕星形膠質(zhì)細(xì)胞源性神經(jīng)炎癥反應(yīng)有關(guān)。
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收稿日期:2022-09-19;修回日期:2022-09-30
編輯/杜帆
基金項目:廣西自然科學(xué)基金項目(編號:2015GXNSFAA139154、2017GXNSFBA198039)
作者簡介:黃彤虹(1996.5-),女,廣東汕頭人,碩士研究生,主要從事疼痛信號傳導(dǎo)機(jī)制研究
通訊作者:鐘妤(1978.10-),女,廣西芩溪人,博士,副主任醫(yī)師,主要從事臨床麻醉及疼痛信號傳導(dǎo)機(jī)制研究