Student's Research Committee, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran.
Department of Pharmacy, University "G. d' Annunzio" of Chieti-Pescara, Via Dei Vestini 31, 66100, Chieti, Italy.
Clin Drug Investig. 2019 Jul;39(7):607-624. doi: 10.1007/s40261-019-00793-6.
Multiple sclerosis (MS) is a devastating chronic autoimmune demyelinating disease of the central nervous system (CNS), thought to affect more than 2.5 million people worldwide. Regulation of the sleep-wake cycle might influence disease activity and the frequency of relapses in patients. As melatonin (or sleep hormone) involves the regulation of circadian rhythms, much attention has been paid to the management of MS symptoms with melatonin. This review describes the pharmacological mechanisms underlying the neuroprotective effects of melatonin and recent clinical evidence from MS patients. Apparent risks and benefits of melatonin therapies are also discussed. Various in vivo and clinical data presented in this up-to-date review suggest that melatonin may possibly possess a protective role against the behavioral deficits and neuropathological characteristics of MS. Multiple mechanisms of the neuroprotective effects of melatonin such as mitochondrial protection and antioxidant, anti-inflammatory, and anti-apoptotic properties, as well as its anti-demyelinating function are also discussed. A large body of evidence shows that melatonin potently regulates the immune system, demyelination, free radical generation, and inflammatory responses in neural tissue, which are mediated by multiple signal transduction cascades. In the present article, we focus on different pathways that are targeted by melatonin to prevent the development and progression of MS.
多发性硬化症（MS）是一种破坏性的中枢神经系统（CNS）慢性自身免疫性脱髓鞘疾病，据认为影响全球超过 250 万人。睡眠-觉醒周期的调节可能会影响患者的疾病活动和复发频率。由于褪黑素（或睡眠激素）参与昼夜节律的调节，因此人们对褪黑素治疗 MS 症状给予了极大关注。这篇综述描述了褪黑素的神经保护作用的药理学机制以及来自 MS 患者的最新临床证据。还讨论了褪黑素治疗的明显风险和益处。本综述中提出的各种体内和临床数据表明，褪黑素可能对 MS 的行为缺陷和神经病理学特征具有保护作用。褪黑素的神经保护作用的多种机制，如线粒体保护和抗氧化、抗炎和抗细胞凋亡特性，以及其抗脱髓鞘功能也在讨论中。大量证据表明，褪黑素能有力地调节免疫系统、脱髓鞘、自由基生成和神经组织中的炎症反应，这是通过多种信号转导级联来介导的。在本文中，我们重点介绍了褪黑素针对的不同途径，以预防 MS 的发展和进展。
