Yuajit Chaowalit, Chatsudthipong Varanuj
J Med Assoc Thai. 2016 Jan;99 Suppl 1:S97-103.
Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited renal disorder caused by mutations of either PKD1 or PKD2 gene. Cyst formation initiates from a combination of abnormal cell proliferation along with enhanced fluid secretion. ADPKD is characterized by the progressive enlargement of cysts which destroy the renal parenchymal cells, resulting in renal failure. Currently, there is no effective treatment for this disease. Interestingly, several relevant therapeutic effects of herbal medicine relevant to pathogenic process of ADPKD have urged the researchers to search for potential candidate herb as nutraceutical for ADPKD therapy. Up to now, several natural compounds, such as triptolide, curcumin, ginkolide B, and steviol (stevia extract) have been shown to be able to retard cyst progression in ADPKD. The detailed mechanism of these compounds showed that triptolide enhanced calcium restoration, curcumin inhibited ERK & p-STAT3 pathways, ginkolide B inhibited Ras/MAPK pathway, and steviol activated AMPK, which inhibited CFTR channel and mTOR pathway in cell and mouse models of PKD. In addition, they are currently inpreclinical and clinical studies, respectively. This review focuses on the pathophysiology of ADPKD and the recent therapeutic approaches, especially a potential use of nutraceutical for the treatment of autosomal dominant polycystic kidney disease.
常染色体显性多囊肾病(ADPKD)是由PKD1或PKD2基因突变引起的最常见的遗传性肾脏疾病。囊肿形成始于异常细胞增殖与增强的液体分泌的结合。ADPKD的特征是囊肿逐渐增大,破坏肾实质细胞,导致肾衰竭。目前,这种疾病没有有效的治疗方法。有趣的是,与ADPKD致病过程相关的几种草药治疗作用促使研究人员寻找潜在的候选草药作为ADPKD治疗的营养保健品。到目前为止,几种天然化合物,如雷公藤内酯醇、姜黄素、银杏内酯B和甜菊醇(甜叶菊提取物)已被证明能够延缓ADPKD中的囊肿进展。这些化合物的详细机制表明,雷公藤内酯醇增强钙恢复,姜黄素抑制ERK和p-STAT3途径,银杏内酯B抑制Ras/MAPK途径,甜菊醇激活AMPK,在PKD细胞和小鼠模型中抑制CFTR通道和mTOR途径。此外,它们目前分别处于临床前和临床研究阶段。本综述重点关注ADPKD的病理生理学和最近的治疗方法,特别是营养保健品在常染色体显性多囊肾病治疗中的潜在应用。