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Российский физиологический журнал им. И.М. Сеченова, 2023, T. 109, № 10, стр. 1349-1397

Органофосфат-индуцированная патология: механизмы развития, принципы терапии и особенности экспериментальных исследований

Н. В. Гончаров 1, 2, *, Д. А. Белинская 2, П. В. Авдонин 3

1 НИИ гигиены, профпатологии и экологии человека ФМБА России
г.п. Кузьмоловский, Ленинградская обл., Россия

2 Институт эволюционной физиологии и биохимии им. И.М. Сеченова РАН
Санкт-Петербург, Россия

3 Институт биологии развития им. Н.К. Кольцова РАН
Москва, Россия

* E-mail: ngoncharov@gmail.com

Поступила в редакцию 04.09.2023
После доработки 25.09.2023
Принята к публикации 25.09.2023

Аннотация

Органофосфаты (ОФ) – одни из наиболее распространенных ксенобиотиков нейротоксического действия. При остром отравлении ОФ в результате подавления активности синаптической ацетилхолинэстеразы (АХЭ) развивается холинергический синдром, который может трансформироваться в эпилептический статус. В течение нескольких суток после острого отравления может развиться так называемый промежуточный синдром, который связан с продолжительным ингибированием АХЭ, десенситизацией никотиновых рецепторов, функциональной деградацией синапсов и мышечных волокон. Через 10–20 дней после однократного острого или неоднократного подострого отравления может развиться ОФ-индуцированная отставленная полинейропатия (ОФИП) – нейродегенеративное заболевание, признаками которого являются атаксия, потеря функции дистальных отделов сенсорных и моторных аксонов периферических нервов. Возникновение нервно-психического расстройства, вызванное хроническим воздействием относительно малотоксичных фосфорорганических соединений (ХФР), обычно не связано с острым отравлением, среди симптомов – когнитивные расстройства, хроническая усталость и экстрапирамидные симптомы. Перече-нь возможных заболеваний или патологических состояний (синдромов), развивающихся в результате острого, подострого или хронического воздействия ОФ на организм человека, в последние годы расширился за счет ряда известных нейродегенеративных заболеваний (болезни Альцгеймера, Паркинсона, рассеянный склероз и др.). Старение организма в целом и старение мозга в частности рассмотрены в обзоре с точки зрения последствий отравления ОФ, которые могут служить неспецифическим триггером старения и связанных с ним нейродегенеративных заболеваний. Синдром Персидского залива не является следствием интоксикации ОФ, но также представляет интерес и рассмотрен в контексте именно ОФ-индуцированной патологии, поскольку его этиология и патогенез связаны с воздействием на организм ингибиторов холинэстераз. Кроме того, в обзоре представлены данные, свидетельствующие о важной роли эндотелия сосудов в развитии ОФ-индуцированной патологии; первые предположения были высказаны клиницистами в конце 1980-х, а первые экспериментальные данные были получены в начале 2000-х годов. Изложены принципы терапии острых отравлений с учетом экспериментальных данных последних лет. Представлены некоторые методы исследования ОФ в экспериментах in vitro, ex vivo и in vivo с лабораторными животными, в том числе с применением ингибиторов карбоксилэстераз; важнейшей частью исследований in vivo был и остается поиск новых биомаркеров для оценки эффективности средств адъювантной и регенеративной терапии.

Ключевые слова: органофосфаты, холинэстераза, холинергический синдром, эпилептический статус, нейродегенеративные заболевания, старение, эндотелий

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