脂质代谢重编程在代谢相关脂肪性肝病进展中的作用机制
DOI: 10.12449/JCH260923
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:程新月负责撰写论文;罗磊负责课题设计及修改论文;刘熔、曹帅兵负责文献检索及整理;禄保平负责拟定写作思路及最后定稿。
Mechanism of action of lipid metabolic reprogramming in the progression of metabolic dysfunction-associated fatty liver disease
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摘要: 代谢相关脂肪性肝病(MAFLD)是全球患病率最高的慢性肝病,其疾病谱涵盖从肝脂肪变性到代谢相关脂肪性肝炎、肝纤维化、肝硬化及肝细胞癌的演进过程。近年来,MAFLD的研究范式已从“脂质堆积”转向“脂质代谢重编程”,其作为疾病发生进展的关键环节,受多维度分子网络调控。本综述系统梳理MAFLD中脂质代谢重编程的分子机制:解析脂质代谢紊乱的核心作用,重点阐述内质网-线粒体接触等细胞器互作失调的介导作用;聚焦脂毒性诱发的铁死亡等新型程序性细胞死亡,揭示其加剧肝损伤的通路;整合腺苷一磷酸活化的蛋白质激酶、核转录因子红系2相关因子2等关键信号通路的调控网络,探讨液-液相分离、微蛋白调控等新兴机制。展望了靶向脂质代谢重编程关键节点的潜在治疗策略,为MAFLD的病理机制研究及精准干预提供理论依据。Abstract: Metabolic dysfunction-associated fatty liver disease (MAFLD) is the chronic liver disease with the highest prevalence rate globally, and its disease spectrum encompasses a progressive continuum from hepatic steatosis to metabolic dysfunction-associated steatohepatitis, liver fibrosis, liver cirrhosis, and eventually hepatocellular carcinoma. In recent years, the research paradigm of MAFLD has shifted from “lipid accumulation” to “lipid metabolic reprogramming”, which, as a critical link in disease development and progression, is regulated by multidimensional molecular networks. This article systematically reviews the molecular mechanisms of lipid metabolic reprogramming in MAFLD from the following aspects: it analyzes the core role of lipid metabolism disorders, with a focus on how dysregulation of membranous organelle interactions, such as endoplasmic reticulum-mitochondria contacts, mediates metabolic imbalance; it concentrates on novel programmed cell death pathways induced by lipotoxicity, especially ferroptosis, and reveals the pathways through which they exacerbate liver injury; furthermore, it comprehensively analyzes the multi-layered regulatory network of the key signaling pathways such as adenosine monophosphate-activated protein kinase and nuclear factor-erythroid 2-related factor 2 and explores the emerging mechanisms such as liquid-liquid phase separation and microprotein regulation; finally, it provides an outlook on the potential therapeutic strategies targeting critical nodes of lipid metabolic reprogramming, so as to provide a theoretical basis for investigating the pathological mechanisms of MAFLD and developing precise interventions.
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