中医药基于Nrf2信号通路改善糖尿病视网膜病变的研究进展OA

Diabetic retinopathy(DR)is a microvascular complication of diabetes and one of its most common complications.Prolonged hyperglycemia induces oxidative stress,inflammatory responses,apoptosis,and pathological angiogenesis,ultimately disrupting the blood-retinal barrier(BRB)and leading to visual impairment or even blindness.Recent studies show that the nuclear factor erythroid 2-related factor 2(Nrf2)signaling pathway plays an important role in the development of DR's pathological changes.Meanwhile,Chinese herbal monomers have been shown to modulate the Nrf2 signaling pathway,thereby intervening in the development of DR.In terms of inhibiting oxidative stress,saponin compounds such as platycodin-D and ginsenoside Rb1 downregulate the expression of malondialdehyde(MDA),thereby ameliorating retinal oxidative stress.Flavonoids such as total flavonoids from Pueraria lobata flower and puerarin upregulate the expression of superoxide dismutase(SOD)and glutathione peroxidase(GPx),effectively clearing lipid peroxides.Regarding the suppression of inflammation,phenolic compounds like resveratrol and chlorogenic acid inhibit the nuclear factor kappa B(NF-κB)pathway,reducing the release of tumor necrosis factor-alpha(TNF-α)and mitigating inflammatory responses.In the context of inhibiting apoptosis,polysaccharides such as Polygonatum sibiricum polysaccharide and Angelica sinensis polysaccharide downregulate the expression of the pro-apoptotic protein Bcl-2-associated X protein(Bax)and suppress the activity of the executioner Caspase-3,thereby reducing the apoptosis rate.As for the inhibition of neovascularization,compounds including bilobalide and physcion significantly decrease the protein expression of vascular endothelial growth factor(VEGF),leading to a reduction in retinal pathological angiogenesis.Furthermore,Chinese herbal compound prescriptions such as Tongluo Zhujing pills,Yiqi Huoxue Yangyin decoction,Qiming granules,and Danlou tablets can also intervene in the onset and progression of DR through the mechanisms described above.In summary,both Chinese herbal monomers and Chinese herbal compound prescriptions can modulate the Nrf2 signaling pathway to inhibit oxidative stress,alleviate inflammation,and participate in maintaining BRB integrity,suppressing retinal neovascularization,and preventing neurodegeneration,thereby delaying the progression of DR.Therefore,this paper reviews and summarizes recent studies at home and abroad on how traditional Chinese medicine(TCM)works to treat DR,and the relationship between the Nrf2 pathway and DR.It aims to provide research ideas for preventing and treating DR.