Acknowledge of New Pathogenesis of Acquired Aplastic Anemia Based on the TCM"Congenital and Acquired"Theory
10.16466/j.issn1005-5509.2025.10.001
- VernacularTitle:从中医先后天理论谈获得性再生障碍性贫血的发病新认识
- Author:
Ch-uan'ao XIN
1
;
Peicheng WANG
1
;
Yingying SHEN
1
Author Information
1. 浙江中医药大学附属第一医院(浙江省中医院) 杭州 310006;浙江中医药大学第一临床医学院
- Publication Type:Journal Article
- Keywords:
aplastic anemia;
pathogenesis;
gene mutation;
integrated of traditional and western medicines;
natural endowment;
marrow exhaustion;
congenital deficiency;
acquired malnourishment
- From:
Journal of Zhejiang Chinese Medical University
2025;49(10):1213-1219
- CountryChina
- Language:Chinese
-
Abstract:
[Objective]To elucidate the pathogenesis of acquired aplastic anemia(AA)by integrating the traditional Chinese medicine(TCM)theory of"congenital deficiency and acquired malnourishment"with contemporary medical advancements.[Methods]Based on the etiological and pathogenesis theory of"congenital deficiency and acquired malnourishment"in TCM,combined with the research results of genetics,immunology,epigenetics,metabolism and other studies of modern medicine,this paper systematically discusses the specific mechanisms of"congenital deficiency",such as genetic predisposition factors and germline mutations,and"acquired malnourishment",such as lifestyle,environmental factors,immune abnormalities,metabolic and epigenetic abnormalities,and analyzes their association with disease onset,progression and treatment response.[Results]Studies have revealed that the occurrence of acquired AA is the result of the combined effect of"congenital deficiency"and"acquired malnourishment".The generalized concept of"congenital deficiency"encompasses non-pathogenic germline genetic variations,such as specific human leukocyte antigen(HLA)haplotypes,heterozygous mutations in genes like Fanconi anemia nucleotide-core complex(FANC)that significantly influence disease susceptibility,response to immunosuppressive therapy(IST),and risk of malignant transformation."Acquired malnourishment"manifests as environmental factor,such as proximity to chemical plants,newly renovated residences,lifestyle including high-fat diet,chronic sleep deprivation,consumption of contaminated water and infectious risk factors.These factors trigger hematopoietic failure through mechanisms including somatic mutations,epigenetic dysregulation involving DNA methyltransferase 3A(DNMT3A),ten-eleven translocation 2(TET2),metabolic disturbances,immune imbalance and gut microbiota dysbiosis,acting alone or synergistically with genetic susceptibility(the"Two-Hit"theory).In treatment,it is necessary to take into account both congenital deficiency and acquired malnourishment:for the"congenital deficiency"caused by germ line mutations(caused by germ line mutations),it is recommended that transplant intervention should be considered for key germline mutations,and transplantation should be considered for key germline mutations.In response to"acquired malnourishment",TCM shows multi-target treatment by improving telomerase through"nourishing the kidney"and"strengthening the spleen"to regulate immune,metabolism and microbiota combined with lifestyle intervention.[Conclusion]A profound understanding of the multidimensional mechanisms underlying the generalized concepts of"congenital deficiency"and"acquired malnourishment"is crucial for precision diagnostics and therapeutics,including optimizing transplant indications and developing targeted TCM/western integrated interventions to improve prognosis.Future research necessitates the integration of disease differentiation and syndrome differentiation to advance personalized treatment strategies.
