1)天津市第一中心医院中医科,天津 300190;2)天津中医药大学中医学院,天津 301617;3)天津中医药大学第一附属医院心血管科,天津 300381
国家自然科学基金(82204965),天津市卫生健康委员会中医中西医结合科研课题(2023184)和天津市名中医刘纳文工作室专项(津财预指[2024]100号)资助。
1)Department of Traditional Chinese Medicine, Tianjin First Central Hospital, Tianjin 300190, China;2)School of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China;3)Department of Cardiology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin 300381, China
This work was supported by grants from The National Natural Science Foundation of China (82204965), Tianjin Municipal Health Commission Scientific Research Project on Traditional Chinese Medicine and Integrated Chinese-Western Medicine (2023184), and Special Funding for the Inheritance Studio of Tianjin Famous Traditional Chinese Medicine Doctors (2024100).
泛凋亡(PANoptosis)是一种整合了细胞焦亡、凋亡和坏死性凋亡3种死亡特征的程序性细胞死亡模式。泛凋亡的核心机制是泛凋亡小体(PANoptosome)组装和激活,该过程受到上游关键分子——干扰素调节因子1(IRF1)、转化生长因子β激活激酶1(TAK1)、作用于RNA1的腺苷脱氨酶(ADAR1)的调控,以及多种细胞器功能的影响,靶向相关机制是调节泛凋亡的有效途径。目前认为炎症在心血管疾病中发挥关键作用,鉴于泛凋亡具有高度促炎性,因此探索泛凋亡在心血管疾病中的作用有重要价值。本文综述了心血管疾病中泛凋亡的已知证据,包括心肌缺血/再灌注损伤、心肌梗死、心力衰竭、致心律失常性心肌病、脓毒症诱导的心肌病、心脏毒性损伤、动脉粥样硬化、腹主动脉瘤、胸主动脉瘤和夹层、血管毒性损伤,对于深入理解心血管疾病的病理生理机制具有重要的临床意义。
The innate immune system detects cellular stressors and microbial infections, activating programmed cell death (PCD) pathways to eliminate intracellular pathogens and maintain homeostasis. Among these pathways, pyroptosis, apoptosis, and necroptosis represent the most characteristic forms of PCD. Although initially regarded as mechanistically distinct, emerging research has revealed significant crosstalk among their signaling cascades. Consequently, the concept of PANoptosis has been proposed—an inflammatory cell death pathway driven by caspases and receptor-interacting protein kinases (RIPKs), and regulated by the PANoptosome, which integrates key features of pyroptosis, apoptosis, and necroptosis. The core mechanism of PANoptosis involves the assembly and activation of the PANoptosome, a macromolecular complex composed of three structural components: sensor proteins, adaptor proteins, and effector proteins. Sensors detect upstream stimuli and transmit signals downstream, recruiting critical molecules via adaptors to form a molecular scaffold. This scaffold activates effectors, triggering intracellular signaling cascades that culminate in PANoptosis. The PANoptosome is regulated by upstream molecules such as interferon regulatory factor 1 (IRF1), transforming growth factor beta-activated kinase 1 (TAK1), and adenosine deaminase acting on RNA 1 (ADAR1), which function as molecular switches to control PANoptosis. Targeting these switches represents a promising therapeutic strategy. Furthermore, PANoptosis is influenced by organelle functions, including those of the mitochondria, endoplasmic reticulum, and lysosomes, highlighting organelle-targeted interventions as effective regulatory approaches. Cardiovascular diseases (CVDs), the leading global cause of morbidity and mortality, are profoundly impacted by PCD. Extensive crosstalk among multiple cell death pathways in CVDs suggests a complex regulatory network. As a novel cell death modality bridging pyroptosis, apoptosis, and necroptosis, PANoptosis offers fresh insights into the complexity of cell death and provides innovative strategies for CVD treatment. This review summarizes current evidence linking PANoptosis to various CVDs, including myocardial ischemia/reperfusion injury, myocardial infarction, heart failure, arrhythmogenic cardiomyopathy, sepsis-induced cardiomyopathy, cardiotoxic injury, atherosclerosis, abdominal aortic aneurysm, thoracic aortic aneurysm and dissection, and vascular toxic injury, thereby providing critical clinical insights into CVD pathophysiology. However, the current understanding of PANoptosis in CVDs remains incomplete. First, while PANoptosis in cardiomyocytes and vascular smooth muscle cells has been implicated in CVD pathogenesis, its role in other cell types—such as vascular endothelial cells and immune cells (e.g., macrophages)—warrants further investigation. Second, although pathogen-associated molecular patterns (PAMPs) and damage-associated molecular patterns (DAMPs) are known to activate the PANoptosome in infectious diseases, the stimuli driving PANoptosis in CVDs remain poorly defined. Additionally, methodological challenges persist in identifying PANoptosome assembly in CVDs and in establishing reliable PANoptosis models. Beyond the diseases discussed, PANoptosis may also play a role in viral myocarditis and diabetic cardiomyopathy, necessitating further exploration. In conclusion, elucidating the role of PANoptosis in CVDs opens new avenues for drug development. Targeting this pathway could yield transformative therapies, addressing unmet clinical needs in cardiovascular medicine.
陈馨浓,杨颖溪,郭晓辰,张军平,刘纳文.泛凋亡(PANoptosis):心血管疾病的新靶点[J].生物化学与生物物理进展,2025,52(5):1113-1125
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