Department of Environmental Medicine, Lung Biology and Disease Program, University of Rochester Medical Center, Rochester, NY 1464, USA.
Toxicol Appl Pharmacol. 2011 Jul 15;254(2):72-85. doi: 10.1016/j.taap.2009.10.022. Epub 2011 Feb 4.
Chronic obstructive pulmonary disease (COPD) is a global health problem. The current therapies for COPD are poorly effective and the mainstays of pharmacotherapy are bronchodilators. A better understanding of the pathobiology of COPD is critical for the development of novel therapies. In the present review, we have discussed the roles of oxidative/aldehyde stress, inflammation/immunity, and chromatin remodeling in the pathogenesis of COPD. An imbalance of oxidants/antioxidants caused by cigarette smoke and other pollutants/biomass fuels plays an important role in the pathogenesis of COPD by regulating redox-sensitive transcription factors (e.g., NF-κB), autophagy and unfolded protein response leading to chronic lung inflammatory response. Cigarette smoke also activates canonical/alternative NF-κB pathways and their upstream kinases leading to sustained inflammatory response in lungs. Recently, epigenetic regulation has been shown to be critical for the development of COPD because the expression/activity of enzymes that regulate these epigenetic modifications have been reported to be abnormal in airways of COPD patients. Hence, the significant advances made in understanding the pathophysiology of COPD as described herein will identify novel therapeutic targets for intervention in COPD.
慢性阻塞性肺疾病(COPD)是一个全球性的健康问题。目前 COPD 的治疗方法效果不佳,药物治疗的主要方法是支气管扩张剂。更好地了解 COPD 的病理生物学对于开发新的治疗方法至关重要。在本综述中,我们讨论了氧化/醛应激、炎症/免疫和染色质重塑在 COPD 发病机制中的作用。香烟烟雾和其他污染物/生物质燃料引起的氧化剂/抗氧化剂失衡通过调节氧化还原敏感转录因子(如 NF-κB)、自噬和未折叠蛋白反应,导致慢性肺部炎症反应,在 COPD 的发病机制中起着重要作用。香烟烟雾还激活经典/替代 NF-κB 途径及其上游激酶,导致肺部持续的炎症反应。最近,表观遗传调控被证明对 COPD 的发展至关重要,因为调节这些表观遗传修饰的酶的表达/活性已在 COPD 患者的气道中报告异常。因此,本文所述的对 COPD 病理生理学的深入理解将为 COPD 的干预确定新的治疗靶点。