العلاقة البيوكيميائية بين البروينكيفالين والأمراض المزمنة
DOI:
https://doi.org/10.31185/bsj.Vol23.Iss48.1795الكلمات المفتاحية:
بروينكفالين؛ الأمراض المزمنة؛ المؤشرات الحيوية؛ قصور القلب؛ مستقبلات الأفيون، داء السكريالملخص
يُعدّ البروينكيفالين مؤشرًا حيويًا حديثًا حظي باهتمام كبير في السنوات الأخيرة نظرًا لأهميته المحتملة في تقييم وظائف الأعضاء والتنبؤ بمسار وتطور العديد من الأمراض المزمنة. هذا الببتيد هو طليعة الإنكيفالينات، وهي مشتقات أفيونية داخلية المنشأ تلعب دورًا حاسمًا في تنظيم عدد من العمليات الفيزيولوجية الأساسية، بما في ذلك الإحساس بالألم، وتنظيم الاستجابات الالتهابية، والحفاظ على التوازن العصبي الهرموني في الجسم. تهدف هذه المراجعة إلى تسليط الضوء على أحدث النتائج العلمية المتعلقة باستخدام البروينكيفالين كمؤشر حيوي في سياق مختلف الأمراض المزمنة، مع التركيز بشكل خاص على علاقته بوظائف الكلى، وأمراض القلب والأوعية الدموية، والاضطرابات الأيضية. تشير الأدلة الحديثة إلى أن قياس مستويات البروينكيفالين في الدم قد يوفر مؤشرًا مبكرًا ودقيقًا لاختلال وظائف الكلى، حتى في المراحل المبكرة التي قد لا تظهر فيها تغييرات واضحة في المؤشرات التقليدية. أظهرت سلسلة من الدراسات أن ارتفاع مستويات هذا المؤشر يرتبط بزيادة خطر حدوث مضاعفات في حالات أمراض الكلى المزمنة وفشل القلب، مما يعزز إمكانية استخدامه كأداة تنبؤيه لتقييم شدة المرض والتنبؤ بالنتائج السريرية. علاوة على ذلك، تتناول هذه المراجعة الآليات البيولوجية المحتملة التي تربط البروينكيفالين بعمليات الالتهاب والإجهاد التأكسدي والخلل الأيضي، وهي آليات محورية في تطور العديد من الأمراض المزمنة. في ضوء ذلك، يمكن اعتبار البروينكيفالين مؤشراً حيوياً واعداً ومتعدد الاستخدامات؛ ومع ذلك، لا يزال تطبيقه السريري يتطلب المزيد من الدراسات واسعة النطاق لتأكيد دقته، وتحديد نطاقاته المرجعية، واستكشاف إمكانية دمجه مع المؤشرات التشخيصية الأخرى لتحسين جودة التشخيص والتنبؤ بالنتائج السريرية.
المراجع
REFERENCES
1. Abrimian, A., Kraft, T., & Pan, Y.-X. (2021). Endogenous opioid peptides and alternatively spliced mu opioid receptor seven transmembrane carboxyl-terminal variants. International Journal of Molecular Sciences, 22(7), 3779. https://doi.org/10.3390/ijms22073779
2. Abu-Rumeileh, S., Barschke, P., Oeckl, P., Baiardi, S., Mammana, A., Mastrangelo, A., Al Shweiki, M. R., Steinacker, P., Ladogana, A., Capellari, S., Otto, M., & Parchi, P. (2022). Prodynorphin and proenkephalin in cerebrospinal fluid of sporadic Creutzfeldt–Jakob disease. International Journal of Molecular Sciences, 23(4), 2051. https://doi.org/10.3390/ijms23042051
3. Abubakar, M. Z., Abdulsalam, K., & Yahaya, I. A. (2020). Thyroid hormones profile of patients with type 2 diabetes mellitus in Kano, Nigeria. Annals of African Medical Research, 3(1). https://doi.org/10.4081/aamr.2020.112
4. Akgün, E., Lunzer, M. M., Tian, D., Ansonoff, M., Pintar, J., Bruce, D., Hawkinson, J. E., Wilcox, G. L., & Portoghese, P. S. (2021). FBNTI, a DOR-selective antagonist that allosterically activates MOR within a MOR-DOR heteromer. Biochemistry, 60(18), 1413–1419. https://doi.org/10.1021/acs.biochem.0c00498
5. Angulo, J. A., Ledoux, M., & McEwen, B. S. (1991). Chronic treatment with pentazocine or SFK 10047 decrease proenkephalin mRNA levels in the rat striatum and nucleus accumbens. Neuroscience Letters, 122(1), 47–49. https://doi.org/10.1016/0304-3940(91)90189-z
6. Arlt, B., Caironi, P., Meessen, J., et al. (2026). Clinical utility of proenkephalin A 119–159 for prediction of worsening renal function and prognosis in patients with sepsis – Results of a patient-level meta-analysis. Critical Care, 30, 164. https://doi.org/10.1186/s13054-026-05947-5
7. Assis, M. A., Carranza, P. G., & Ambrosio, E. (2021). A “drug-dependent” immune system can compromise protection against infection: The relationships between psychostimulants and HIV. Viruses, 13(5), 722. https://doi.org/10.3390/v13050722
13-Matsiras, D., Ventoulis, I., Verras, C., et al. (2025). Proenkephalin 119–159 in heart failure: From pathophysiology to clinical implications. Journal of Clinical Medicine. https://www.sciencedirect.com/science/article/pii/S0009912018300389
8. Badr, H., Shaban, M., & Gazala, E. (2023). Thyroid diseases as a risk of type 2 diabetes mellitus. Menoufia Medical Journal, 36. https://doi.org/10.59204/2314-6788.1035
9. Banerjee, S., Garimella, P. S., Hong, K. N., Bullen, A. L., Daniels, L. B., & Wettersten, N. (2024). Association between proenkephalin A and cardiovascular outcomes in ambulatory veterans. International Journal of Cardiology: Heart & Vasculature, 55, 101557. https://doi.org/10.1016/j.ijcha.2024.101557
10. Beunders, R., van Groenendael, R., Leijte, G. P., Kox, M., & Pickkers, P. (2020). Proenkephalin compared to conventional methods to assess kidney function in critically ill sepsis patients. Shock, 54(3), 308–314. https://doi.org/10.1097/SHK.0000000000001510
11. Bergasa, N. V., Vergalla, J., Swain, M. G., & Jones, E. A. (1996). Hepatic concentrations of proenkephalin-derived opioids are increased in a rat model of cholestasis. Liver, 16(5), 298–302. https://doi.org/10.1111/j.1600-0676.1996.tb00749.x
12. B. M., & Terdal, S. (2024). Artificial intelligence for early-stage detection of chronic kidney disease. International Journal of Electrical and Computer Engineering, 14(4), 4775–4790. https://doi.org/10.11591/ijece.v14i4.pp4775-4790
13. Bodnar, R. J. (2025). Endogenous opiates and behavior: 2024. Peptides, 191, 171422. https://doi.org/10.1016/j.peptides.2025.171422
14. Boyella, V. D., Nicastri, A. D., & Bergasa, N. V. (2008). Human hepatic met-enkephalin and delta opioid receptor-1 immunoreactivities in viral and autoimmune hepatitis. Annals of Hepatology, 7(3), 221–226. https://doi.org/10.1016/S1665-2681(19)31851-4
15. Chakrabarti, S., Liu, N. J., & Gintzler, A. R. (2021). Relevance of mu-opioid receptor splice variants and plasticity of their signaling sequelae to opioid analgesic tolerance. Cellular and Molecular Neurobiology, 41(5), 855–862. https://doi.org/10.1007/s10571-020-00934-y
16. Conibear, A. C. (2020). Deciphering protein post-translational modifications using chemical biology tools. Nature Reviews Chemistry, 4, 674–695. https://doi.org/10.1038/s41570-020-00223-8
17. Corder, G., Castro, D. C., Bruchas, M. R., & Scherrer, G. (2018). Endogenous and exogenous opioids in pain. Annual Review of Neuroscience, 41, 453–473. https://doi.org/10.1146/annurev-neuro-080317-061522
18. Cullen, J. M., & Cascella, M. (2023). Physiology, enkephalin. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK557764/
19. Dalefield, M. L., Scouller, B., Bibi, R., & Kivell, B. M. (2022). The kappa opioid receptor: A promising therapeutic target for multiple pathologies. Frontiers in Pharmacology, 13, 837671. https://doi.org/10.3389/fphar.2022.837671
20. Elnagar, G. M., Elseweidy, M. M., Mahmoud, Y. K., Elkomy, N. M. I. M., Althafar, Z. M., Alnomasy, S. F., Al-Gabri, N. A., & Shawky, M. (2022). 10-Dehydrogingerdione attenuates tramadol-induced nephrotoxicity by modulating renal oxidative stress, inflammation and apoptosis in experimental rats: Role of HO-1 activation and TLR4/NF-κB/ERK inhibition. International Journal of Molecular Sciences, 23(3), 1384. https://doi.org/10.3390/ijms23031384
21. Emmens, J. E., ter Maaten, J. M., Brouwers, F. P., et al. (2021). Proenkephalin and the risk of new-onset heart failure: Data from prevention of renal and vascular end-stage disease. Clinical Cardiology, 44(12), 1662–1672. https://doi.org/10.1002/clc.23729
22. Emmens, J. E., ter Maaten, J. M., Damman, K., et al. (2019). Proenkephalin, an opioid system surrogate, as a novel comprehensive renal marker in heart failure. Circulation: Heart Failure, 12(5), e005544. https://doi.org/10.1161/CIRCHEARTFAILURE.118.005544
23. Farag, M., et al. (2025). Cerebrospinal fluid proenkephalin predicts striatal atrophy decades before clinical motor diagnosis in Huntington's disease. Movement Disorders, 41, 95–106. https://doi.org/10.1002/mds.70062
24. Fricker, L. D., Margolis, E. B., Gomes, I., & Devi, L. A. (2020). Five decades of research on opioid peptides: Current knowledge and unanswered questions. Molecular Pharmacology, 98(2), 96–108. https://doi.org/10.1124/mol.120.119388
25. Gaborit, M., & Massotte, D. (2023). Therapeutic potential of opioid receptor heteromers in chronic pain and associated comorbidities. British Journal of Pharmacology, 180(7), 994–1013. https://doi.org/10.1111/bph.15772
26. Gao, S., & He, Q. (2024). Opioids and the kidney: Two sides of the same coin. Frontiers in Pharmacology, 15, 1421248. https://doi.org/10.3389/fphar.2024.1421248
27. García-Domínguez, M. (2024). Enkephalins and pain modulation: Mechanisms of action and therapeutic perspectives. Biomolecules, 14(8), 926. https://doi.org/10.3390/biom14080926
28. Grycuk, W., Jakubowska, Z., & Małyszko, J. (2023). Proenkephalin levels and its determinants in patients with end-stage kidney disease treated with hemodialysis and peritoneal dialysis. International Journal of Molecular Sciences, 24(19), 15015. https://doi.org/10.3390/ijms241915015
29. Grycuk, W., Jakubowska, Z., & Małyszko, J. (2025). Proenkephalin (PENK): A functional biomarker in chronic kidney diseases—Hope or just a new bystander? Journal of Nephrology, 38(7), 1785–1795. https://doi.org/10.1007/s40620-025-02268-8
30. -Hassoun, M. A., & Abass, E. A. (2025). Proenkephalin-A as a biomarker for type 2 diabetes in women with thyroid disorders. Journal of the Faculty of Medicine Baghdad, 67(3), 395–402. https://doi.org/10.32007/jfacmedbaghdad3162
31. Huang, N. (2025, October). Opioid receptor agonists in dermatology. DermNet NZ. Reviewed by I. Coulson. https://dermnetnz.org/topics/opioid-receptor-agonists-in-dermatology
32. JACC. (n.d.). Figure from study. https://www.jacc.org/cms/asset/ebe6c694-7bab-452e-a7d5-9c8d18b608be/fx1.jpg
33. Kanagala, P., Squire, I. B., Jones, D. J. L., et al. (2019). Proenkephalin and prognosis in heart failure with preserved ejection fraction: A GREAT network study. Clinical Research in Cardiology, 108(8), 940–949. https://doi.org/10.1007/s00392-019-01424-y
34. Karavitaki, N., Bettinger, J. J., Biermasz, N., Christ-Crain, M., Gadelha, M. R., Inder, W. J., Tsourdi, E., Wakeman, S. E., & Zatelli, M. (2024). Exogenous opioids and the human endocrine system: An Endocrine Society scientific statement. Endocrine Reviews, 45(6), 773–794. https://doi.org/10.1210/endrev/bnae023
35. Khorashadi, M., Beunders, R., Pickkers, P., & Legrand, M. (2020). Proenkephalin: A new biomarker for glomerular filtration rate and acute kidney injury. Nephron, 144(12), 655–661. https://doi.org/10.1159/000509352
36. Konradi, C., Macías, W., Dudman, J. T., & Carlson, R. R. (2003). Striatal proenkephalin gene induction: Coordinated regulation by cyclic AMP and calcium pathways. Molecular Brain Research, 115(2), 157–161. https://doi.org/10.1016/S0169-328X(03)00204-3
37. Kumar, R., Saha, P., Kumar, Y., Sahana, S., Dubey, A., & Prakash, O. (2020). A review on diabetes mellitus: Type 1 & Type 2. World Journal of Pharmaceutical and Pharmaceutical Sciences, 9, 838–850. https://doi.org/10.20959/wjpps202010-17336
38. Lin, L.-C., Chuan, M.-H., Liu, J.-H., et al. (2023). Proenkephalin as a biomarker correlates with acute kidney injury: A systematic review with meta-analysis and trial sequential analysis. Critical Care, 27, 481. https://doi.org/10.1186/s13054-023-04747-5
39. Liu, C., Liu, X., He, Z., et al. (2023). Proenkephalin-A secreted by renal proximal tubules functions as a brake in kidney regeneration. Nature Communications, 14, 7167. https://doi.org/10.1038/s41467-023-42929-5
40. López-Campos, J. L., Gutiérrez, C., & Calero, C. (2012). The potential role of racecadotril in the treatment of diarrhea associated with roflumilast. Archivos de Bronconeumología, 48(11), 426. https://doi.org/10.1016/j.arbr.2012.08.001
41. Machelska, H., & Celik, M. Ö. (2020). Opioid receptors in immune and glial cells—Implications for pain control. Frontiers in Immunology, 11, 300. https://doi.org/10.3389/fimmu.2020.00300
42. Martin, L., Martin, C., Peine, A., Imöhl, M., Kersten, A., Kramann, R., Saritas, T., Marx, N., Dreher, M., Marx, G., & Simon, T. P. (2025). Implementation and one-year evaluation of proenkephalin A in critical care. International Journal of Molecular Sciences, 26(6), 2602. https://doi.org/10.3390/ijms26062602
43. Matsiras, D., Ventoulis, I., Verras, C., et al. (2025). Proenkephalin 119-159 in heart failure: From pathophysiology to clinical implications. Journal of Clinical Medicine, 14(8), 2657. https://doi.org/10.3390/jcm14082657
44. Maytum, A., Obier, N., Cauchy, P., & Bonifer, C. (2024). Regulation of developmentally controlled enhancer activity by extrinsic signals in normal and malignant cells: AP-1 at the centre. Frontiers in Epigenetics and Epigenomics, 2, 1465958. https://doi.org/10.3389/freae.2024.1465958
45. Mori, T., Ohya, J., Itoh, T., Ise, Y., Shibasaki, M., & Suzuki, T. (2015). Effects of (+)-pentazocine on the antinociceptive effects of (−)-pentazocine in mice. Synapse, 69(3), 166–171. https://doi.org/10.1002/syn.21799
46. Oliveira, C. L., Duarte-Ramos, F., Alves da Costa, F., et al. (2024). Effects of inpatient creatinine testing frequency on acute kidney injury identification and staging: A historical cohort study. International Journal of Clinical Pharmacy, 46, 623–630. https://doi.org/10.1007/s11096-023-01697-4
47. Pottel, H., Delanaye, P., & Cavalier, E. (2024). Exploring renal function assessment: Creatinine, cystatin C, and estimated glomerular filtration rate focused on the European Kidney Function Consortium equation. Annals of Laboratory Medicine, 44(2), 135–143. https://doi.org/10.3343/alm.2023.0237
48. Primary response gene expression in the nervous system. (2010). In Neurotrophic Factors (Vol. 4, pp. 89–128). Academic Press. https://doi.org/10.1016/B978-0-08-057132-4.50008-3
49. Puri, C., Dannenberg, C., Ucci, A., et al. (2024). Pre-proenkephalin 1 is downregulated under unloading and is involved in osteoblast biology. Calcified Tissue International, 114(5), 524–534. https://doi.org/10.1007/s00223-024-01199-z
50. Qiu, Y., & Wang, Y.-J. (2024). Editorial: Opioids and opioid receptors in pain, addiction, and mood disorders. Frontiers in Psychiatry, 15, 1382894. https://doi.org/10.3389/fpsyt.2024.1382894
51. Quirion, B., Bergeron, F., Blais, V., & Gendron, L. (2020). The delta-opioid receptor; a target for the treatment of pain. Frontiers in Molecular Neuroscience, 13, 52. https://doi.org/10.3389/fnmol.2020.00052
52. Rau, M., Kurt, B., Hartmann, O., et al. (2024). Proenkephalin A 119–159 (penKid) and mortality in stable patients at high cardiovascular risk. Clinical Kidney Journal, 17(9), sfae246. https://doi.org/10.1093/ckj/sfae246
53. Safdar, A., Akram, W., Khan, M. A., & Muhammad, S. (2023). Optimal glomerular filtration rate equations for various age groups, disease conditions and ethnicities in Asia: A systematic review. Journal of Clinical Medicine, 12(5), 1822. https://doi.org/10.3390/jcm12051822
54. Santa Cruz Biotechnology. (n.d.). Proenkephalin A activators. https://www.scbt.com
55. Schulte, J., Dépret, F., Hartmann, O., Pickkers, P., & Laterre, P. F. (2024). Clinical performance of proenkephalin A 119–159 for the early diagnosis of acute kidney injury in patients with sepsis or septic shock. medRxiv. https://doi.org/10.1101/2024.10.11.24315291
56. Shenoy, S. S., & Lui, F. (2023). Biochemistry, endogenous opioids. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK532899
57. Siranart, N., Laohasurayotin, K., Phanthong, T., Sowalertrat, W., Ariyachaipanich, A., & Chokesuwattanaskul, R. (2023). Proenkephalin as a novel prognostic marker in heart failure patients: A systematic review and meta-analysis. International Journal of Molecular Sciences, 24(5), 4887. https://doi.org/10.3390/ijms24054887
58. Ślusarz, M. J. (2022). Molecular insights into the mechanism of sugar-modified enkephalin binding to opioid receptors. Computational Biology and Chemistry, 101, 107783. https://doi.org/10.1016/j.compbiolchem.2022.107783
59. Sobocińska, M., Giełdoń, A., Fichna, J., & Kamysz, E. (2019). 1-Substituted sialorphin analogues—Synthesis, molecular modelling and in vitro effect on enkephalins degradation by NEP. Amino Acids, 51, 1201–1207. https://doi.org/10.1007/s00726-019-02760-z
60. Soetedjo, N. N. M., Agustini, D., & Permana, H. (2024). The impact of thyroid disorder on cardiovascular disease: Unraveling the connection and implications for patient care. International Journal of Cardiology: Heart & Vasculature, 55, 101536. https://doi.org/10.1016/j.ijcha.2024.101536
61. Southerland, W. A., Gillis, J., Kuppalli, S., Fonseca, A., Mendelson, A., Horine, S. V., Bansal, N., & Gulati, A. (2021). Dual enkephalinase inhibitors and their role in chronic pain management. Current Pain and Headache Reports, 25(5), 29. https://doi.org/10.1007/s11916-021-00949-0
62. Spetea, M., & Schmidhammer, H. (2020). Opioids and their receptors: Present and emerging concepts in opioid drug discovery. Molecules, 25(23), 5658. https://doi.org/10.3390/molecules25235658
63. Szentkirályi-Tóth, S., et al. (2023). Estrogen-regulated peptidergic input to gonadotropin-releasing hormone neurons from the lateral septal kisspeptin network. bioRxiv. https://doi.org/10.1101/2023.09.20.557932
64. Walczak-Wieteska, P., Zuzda, K., Małyszko, J., & Andruszkiewicz, P. (2024). Proenkephalin A 119–159 in perioperative and intensive care—A promising biomarker or merely another option? Diagnostics, 14(21), 2364, 1–18. https://doi.org/10.3390/diagnostics14212364
65. Walczak-Wieteska, P., Zuzda, K., Małyszko, J., et al. (2025). Proenkephalin A 119–159 as an early biomarker of acute kidney injury in complex endovascular aortic repair: An explorative single-center cross-sectional study with the utilization of two measurement methods. Perioperative Medicine, 14(1), 66. https://doi.org/10.1186/s13741-025-00553-5
66. Wang, Y., Zhuang, Y., DiBerto, J. F., Zhou, X. E., Schmitz, G. P., Yuan, Q., Jain, M. K., Liu, W., Melcher, K., Jiang, Y., Roth, B. L., & Xu, H. E. (2023). Structures of the entire human opioid receptor family. Cell, 186(2), 413–427.e17. https://doi.org/10.1016/j.cell.2022.12.026
67. Voors, A. A., ter Maaten, J. M., Damman, K., et al. (2017). Proenkephalin, an opioid system surrogate, as a novel comprehensive renal marker in heart failure. Journal of the American College of Cardiology, 69(11), 1499–1509. https://doi.org/10.1016/j.jacc.2016.12.039
68. Zhu, T., Li, C., & Chu, X. (2024). Fluctuating chromatin facilitates enhancer–promoter communication by regulating transcriptional clustering dynamics. The Journal of Physical Chemistry Letters. https://doi.org/10.1021/acs.jpclett.4c02453
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