Роль микроРНК в поддержании низко – интенсивного воспаления у пациентов с дискогенной болью в спине и комморбидными расстройствами сна

Хроническая дискогенная боль в спине и коморбидные расстройства сна (инсомния) представляют собой труднокурабельную патологию в практике невролога. В развитии коморбидности предполагается наличие общих патогенетических путей, но однозначных связующих «мостиков» до конца не определено. В современных исследованиях раскрывается феномен низкоинтенсивного воспаления НИВ, который имеет место в основе прогрессирования дегенерации межпозвонковых дисков и инсомнии. В клинической практике невролога нет валидизированных специфических и чувствительных методов определения течения НИВ, потому необходима разработка перспективных диагностических панелей, одним из которых выступают сигнатуры малых некодирующих рибонуклеиновых кислот (микроРНК), так как в доклинических исследованиях показано их участие в эпигенетическом контроле НИВ. Установлено влияние микроРНК в поддержании LGI, нейропластичности и дисфункции циркадных. Цель данного обзора – обновление знаний неврологов о роли микроРНК (через связующий «мостик» – НИВ) в патогенезе хронического болевого синдрома, ассоциированного с инсомнией у пациентов с дегенерацией межпозвонковых дисков (ДМПД), и оценить их в диагностическом потенциале. Проведен поиск публикаций в базах данных PubMed, Springer, Reseаrch Gate, Google Scholar, Cochrane и e-Library за 2016–2026 гг. В анализ включены оригинальные доклинические и клинические исследования, систематические обзоры. Обобщены данные о более чем 40 микроРНК, вовлеченных в регуляцию ключевых воспалительных путей (NF-κB, NLRP3-инфламмасома и др.), циркадных генов (PER, BMAL1, CLOCK и др.) в клетках межпозвонковых дисков (МПД) и центральной нервной системе. Выделена сигнатура из наиболее перспективных кандидатов (miR-29a, miR-132, miR-155, miR-34a-5p, семейство let-7), одновременно участвующих в регуляции НИВ, болевой сигнализации и циркадных ритмов. Показано, что уровень экспрессии некоторых микроРНК (miR-340-5p, miR-494) коррелирует с тяжестью ДМПД по данным МРТ и может быть использован в качестве чувствительного эпигенетического биомаркера. МикроРНК являются перспективными эпигенетическими биомаркерами и терапевтическими мишенями для персонализированной терапии дискогенной боли в спине и инсомнии при ДМПД. Необходимы дальнейшие «мостовые» и валидационные клинические исследования для внедрения сигнатуры микроРНК в практику невролога.

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