攻克类风湿关节炎相关疼痛:质子感应受体。

Tackling Pain Associated with Rheumatoid Arthritis: Proton-Sensing Receptors.

机构信息

Department of Life Sciences, National Central University, Taoyuan City, Taiwan.

出版信息

Adv Exp Med Biol. 2018;1099:49-64. doi: 10.1007/978-981-13-1756-9_5.

Abstract

Rheumatoid arthritis (RA), characterized by chronic inflammation of synovial joints, is often associated with ongoing pain and increased pain sensitivity. Chronic pain that comes with RA turns independent, essentially becoming its own disease. It could partly explain that a significant number (50%) of RA patients fail to respond to current RA therapies that focus mainly on suppression of joint inflammation. The acute phase of pain seems to associate with joint inflammation in early RA. In established RA, the chronic phase of pain could be linked to inflammatory components of neuron-immune interactions and noninflammatory components. Accumulating evidence suggests that the initial inflammation and autoimmunity in RA (preclinical RA) begin outside of the joint and may originate at mucosal sites and alterations in the composition of microbiota located at mucosal sites could be essential for mucosal inflammation, triggering joint inflammation. Fibroblast-like synoviocytes in the inflamed joint respond to cytokines to release acidic components, lowering pH in synovial fluid. Extracellular proton binds to proton-sensing ion channels, and G-protein-coupled receptors in joint nociceptive fibers may contribute to sensory transduction and release of neurotransmitters, leading to pain and hyperalgesia. Activation of peripheral sensory neurons or nociceptors further modulates inflammation, resulting in neuroinflammation or neurogenic inflammation. Peripheral and central nerves work with non-neuronal cells (such as immune cells, glial cells) in concert to contribute to the chronic phase of RA-associated pain. This review will discuss actions of proton-sensing receptors on neurons or non-neuronal cells that modulate RA pathology and associated chronic pain, and it will be beneficial for the development of future therapeutic treatments.

摘要

类风湿关节炎(RA),以滑膜关节的慢性炎症为特征,常伴有持续疼痛和疼痛敏感性增加。与 RA 相伴而来的慢性疼痛变得独立,本质上成为其自身的疾病。这部分可以解释为什么相当数量(50%)的 RA 患者对主要针对抑制关节炎症的当前 RA 治疗无反应。RA 早期的急性疼痛阶段似乎与关节炎症有关。在已确立的 RA 中,慢性疼痛阶段可能与神经元-免疫相互作用的炎症成分和非炎症成分有关。越来越多的证据表明,RA(临床前 RA)中的初始炎症和自身免疫始于关节外,可能起源于黏膜部位,位于黏膜部位的微生物群落组成的改变可能对黏膜炎症至关重要,引发关节炎症。炎症关节中的成纤维样滑膜细胞对细胞因子作出反应,释放酸性成分,降低滑液中的 pH 值。细胞外质子与质子感应离子通道结合,关节伤害感受纤维中的 G 蛋白偶联受体可能有助于感觉转导和神经递质的释放,导致疼痛和痛觉过敏。外周感觉神经元或伤害感受器的激活进一步调节炎症,导致神经炎症或神经原性炎症。外周和中枢神经与非神经元细胞(如免疫细胞、神经胶质细胞)协同作用,有助于 RA 相关疼痛的慢性阶段。这篇综述将讨论质子感应受体对神经元或非神经元细胞的作用,这些作用调节 RA 病理和相关慢性疼痛,并有助于开发未来的治疗方法。

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