Аннотация
Несмотря на активно проводимые исследования, значительная часть больных эпилепсией страдает фармакорезистентными формами заболевания. Это делает актуальным поиск новых методов лечения. В последние годы активно обсуждается возможная роль кишечно-мозговых взаимодействий в патогенезе эпилепсии. Последние экспериментальные и клинические исследования показывают корреляцию баланса кишечной микробиоты и выраженности эпилептогенеза. При этом различные методы модификации состава микробиоты показывают существенное влияние на течение эпилепсии. Тем не менее, остается открытым вопрос основного рецепторного звена оси кишечник - мозг, своеобразного интерфейса между кишечными микроорганизмами и регуляторными системами организма.
Целью настоящего обзора является анализ путей и степени вовлеченности кишечной микробиоты в патогенез и саногенез эпилепсии. Среди таких путей выделены нервно-проводниковый, метаболитный, иммунный и эндокринный. Анализ полученных на сегодняшний день данных показывает существенную роль в этих процессах рецепторов, активируемых пролифератором пероксисом (PPARs). Экспрессия этих рецепторов в основных структурах оси кишечник - мозг, наличие их лигандов среди метаболитов представителей микробиоты, а также описанные для агонистов некоторых PPARs противосудорожная и/или нейропротекторная активность позволяют выдвинуть гипотезу о роли PPARs в организме в качестве упомянутого выше сигнального интерфейса в оси кишечник - мозг. Отдельно в работе рассматривается терапевтический потенциал агонистов PPARs при лечении эпилепсии.
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