在过去的十年中,细胞应力(包括因拉伸而沉淀的应力)在引发分娩的机制中起着重要作用,这一观点已经得到了广泛的关注。这种细胞应激的一个关键后果是增加了危险相关分子模式(DAMP)的产生。已知分子的这个多样化家族通过与模式识别受体(PRR)相互作用(包括Toll样受体(TLR))来引发炎症。TLR是在细菌和病毒感染过程中检测病原相关分子模式(PAMP)的关键先天免疫系统监视受体。这在绒膜羊膜炎期间也可见。TLR的激活通常会导致促炎转录因子核因子κB(NF-kB)的激活以及促炎细胞因子的下游产生。据认为,在人胎膜中,DAMPs和PAMPs都可能通过它们与PRRs的相互作用以及其下游炎症级联反应的诱导而导致组织重塑和减弱。由于感染驱动的早产(PTB)的发生率很高,包括那些发生早产胎膜早破(pPROM)的疾病,TLR在绒毛膜羊膜炎引起的胎膜中的作用已成为相当多的研究主题。该领域的大多数工作都集中在PAMP对整个胎膜及其产生的炎症级联反应的影响上。了解这一点很重要,为了开发新颖的预防,检测和治疗方法,其目的是减少大量受感染驱动的PTB的母亲,包括患有pPROM的母亲。研究由这些内源性配体(DAMP)激活羊膜间充质和上皮细胞中的PRRs系统驱动的无菌炎症的作用很重要。这些细胞对于维持人类胎膜的完整性和强度至关重要。这篇综述旨在(1)总结迄今为止与DAMPs和PRRs在胎膜弱化中的作用有关的知识,以及(2)讨论通过途径操纵策略更好地理解这些途径所带来的临床潜力。包括那些带有pPROM的产品。研究由这些内源性配体(DAMP)激活羊膜间充质和上皮细胞中的PRRs系统驱动的无菌炎症的作用很重要。这些细胞对于维持人类胎膜的完整性和强度至关重要。这篇综述旨在(1)总结迄今为止与DAMPs和PRRs在胎膜弱化中的作用有关的知识,以及(2)讨论通过途径操纵策略更好地理解这些途径所带来的临床潜力。包括那些带有pPROM的产品。研究由这些内源性配体(DAMP)激活羊膜间充质和上皮细胞中的PRRs系统驱动的无菌炎症的作用很重要。这些细胞对于维持人类胎膜的完整性和强度至关重要。这篇综述旨在(1)总结迄今为止与DAMPs和PRRs在胎膜弱化中的作用有关的知识,以及(2)讨论通过途径操纵策略更好地理解这些途径所带来的临床潜力。
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The Role of Danger Associated Molecular Patterns in Human Fetal Membrane Weakening.
The idea that cellular stress (including that precipitated by stretch), plays a significant role in the mechanisms initiating parturition, has gained considerable traction over the last decade. One key consequence of this cellular stress is the increased production of Danger Associated Molecular Patterns (DAMPs). This diverse family of molecules are known to initiate inflammation through their interaction with Pattern Recognition Receptors (PRRs) including, Toll-like receptors (TLRs). TLRs are the key innate immune system surveillance receptors that detect Pathogen Associated Molecular Patterns (PAMPs) during bacterial and viral infection. This is also seen during Chorioamnionitis. The activation of TLR commonly results in the activation of the pro-inflammatory transcription factor Nuclear Factor Kappa-B (NF-kB) and the downstream production of pro-inflammatory cytokines. It is thought that in the human fetal membranes both DAMPs and PAMPs are able, perhaps via their interaction with PRRs and the induction of their downstream inflammatory cascades, to lead to both tissue remodeling and weakening. Due to the high incidence of infection-driven Pre-Term Birth (PTB), including those that have preterm Premature Rupture of the Membranes (pPROM), the role of TLR in fetal membranes with Chorioamnionitis has been the subject of considerable study. Most of the work in this field has focused on the effect of PAMPs on whole pieces of fetal membrane and the resultant inflammatory cascade. This is important to understand, in order to develop novel prevention, detection, and therapeutic approaches, which aim to reduce the high number of mothers suffering from infection driven PTB, including those with pPROM. Studying the role of sterile inflammation driven by these endogenous ligands (DAMPs) activating PRRs system in the mesenchymal and epithelial cells in the amnion is important. These cells are key for the maintenance of the integrity and strength of the human fetal membranes. This review aims to (1) summarize the knowledge to date pertinent to the role of DAMPs and PRRs in fetal membrane weakening and (2) discuss the clinical potential brought by a better understanding of these pathways by pathway manipulation strategies.