基于TGF-β/Smad信号通路探讨中药防治放射性肺损伤的作用及机制研究进展

Research Progress on the Role and Mechanisms of Traditional Chinese Medicine in Preventing and Treating Radiation-Induced Lung Injury via the TGF-β/Smad Signaling Pathway

关键词:  RILI  中药  TGF-β/Smad  信号通路

Key words:  RILI  TCM  TGF-β/Smad  signaling pathway

摘要:

放射性肺损伤（Radiation-induced lung injury, RILI）作为一种以放射性肺炎（Radiation-Induced Pneumonitis, RP）和放射性肺纤维化（Radiation-Induced Pulmonary Fibrosis, RPF）为主要病程的疾病，是胸部肿瘤经放射治疗后不可避免的肺部疾病，严重影响患者的生存质量。转化生长因子-β（Transforming growth factor-β, TGF-β）/Smad信号通路传导途径及其调控的相关细胞因子与RILI的发生发展密切相关。多种中药和中药有效成分均可通过调节TGF-β/Smad信号通路抑制炎症因子活化及细胞外基质(Extra cellular matrix, ECM）合成，减少胶原沉积，降低肺组织炎症浸润及纤维化水平，改善肺功能。研究发现，中药具有调节免疫、抗氧化、调节代谢、抗炎、抗纤维化等作用，并且中药防治RILI的药理作用及机制已有大量研究，但中药及中药复方治疗RILI具体发挥作用的成分及其机制尚未明确，且多途径间的协同作用亟须关注。该文综述了TGF-β/Smad信号通路在中药防治放射性肺损伤的研究进展，为中药在RILI疾病中的临床应用和基础研究提供参考，旨在为中药临床转化应用及RILI机制研究提供多维度理论依据，进一步探索RILI的创新治疗策略。

Abstract:

Radiation-induced lung injury (RILI), a disease primarily characterized by radiation pneumonitis (RP) and radiation pulmonary fibrosis (RPF), is an inevitable pulmonary complication following thoracic tumor radiotherapy, significantly impairing patients' quality of life. The TGF-β/Smad signaling pathway and its regulated cytokines are critically involved in the pathogenesis and progression of RILI. Multiple active components of Chinese herbal medicine have demonstrated therapeutic potential by modulating the TGF-β/Smad pathway to suppress inflammatory factor activation, inhibit extracellular matrix (ECM) synthesis, reduce collagen deposition, alleviate pulmonary inflammatory infiltration and fibrosis, and improve lung function. Research has demonstrated that traditional Chinese medicine (TCM) exhibits immunomodulatory, antioxidant, metabolic regulatory, anti-inflammatory, and anti-fibrotic properties. While substantial studies have explored the pharmacological mechanisms of TCM in preventing and treating RILI, the precise bioactive components responsible for its therapeutic effects particularly in compound herbal formulations and their underlying mechanisms remain to be fully elucidated. Furthermore, the synergistic interplay among multiple pathways demands urgent attention. This review synthesizes current advances in understanding how TCM modulates the TGF-β/Smad signaling pathway to mitigate radiation-induced lung injury. By providing a comprehensive reference for both clinical practice and fundamental research, we aim to establish a multidimensional theoretical framework to facilitate the clinical translation of TCM and mechanistic investigation of RILI, ultimately paving the way for innovative treatment strategies.