S-腺苷蛋氨酸及其临床应用

张婧韬; 张尧; 杨艳玲

doi:10.16689/j.cnki.cn11-9349/r.2026.03.004

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肿瘤代谢与营养电子杂志 ›› 2026, Vol. 13 ›› Issue (3) : 354-359. DOI: 10.16689/j.cnki.cn11-9349/r.2026.03.004

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S-腺苷蛋氨酸及其临床应用

张婧韬, 张尧, 杨艳玲

作者信息 +

S-adenosylmethionine and its clinical applications

¹Zhang Jingtao, ¹Zhang Yao, ¹Yang Yanling

Author information +

文章历史 +

摘要

S-腺苷蛋氨酸(SAM)是1953年发现的一种天然内源性化合物,是哺乳动物细胞中的主要甲基供体,在肝脏中合成最为丰富。SAM参与脱氧核糖核酸(DNA)、核糖核酸(RNA)、蛋白质的甲基化、多胺合成及谷胱甘肽前体供应,在细胞生长、分化及功能稳态维持中发挥核心作用,其代谢涉及蛋氨酸循环、叶酸循环及蛋氨酸挽救途径的复杂网络调控。在临床应用方面,已证实SAM对治疗肝内胆汁淤积、酒精性肝病等肝脏疾病有效。在肿瘤研究领域,SAM稳态失衡可作为肝癌、肺癌等恶性肿瘤的诊断或预后生物标志物。补充SAM可逆转促癌基因异常甲基化、干预多条信号通路,在胃癌、乳腺癌、胶质母细胞瘤及黑色素瘤等多种模型中有抑癌潜力,可与化疗或免疫治疗协同增效,还可减轻化疗所致的肝损伤。在遗传代谢病及神经精神疾病治疗中,补充SAM可防治蛋氨酸腺苷转移酶缺乏症患者的脑损害,并可作为难治性抑郁症的有效辅助治疗策略。尽管SAM在多种疾病的治疗应用前景广阔,但诸多临床证据仍不充分,亟需更多研究填补机制空白,并提供高级别的临床证据。

Abstract

S-adenosylmethionine (SAM), a natural endogenous compound discovered in 1953, is the principal methyl donor in mammalian cells. It is synthesized most abundantly in the liver. SAM plays a central role in maintaining cell growth, differentiation, and functional homeostasis by participating in the methylation of DNA, RNA, and proteins, polyamine synthesis, and the provision of glutathione precursors. Its metabolism involves a complex regulatory network encompassing the methionine cycle, folate cycle, and methionine salvage pathway. In clinical applications, the effect of SAM in treating liver diseases such as intrahepatic cholestasis and alcoholic liver disease is well-established. In oncology, dysregulation of SAM homeostasis has been proposed as a diagnostic or prognostic biomarker for malignancies including liver and lung cancer. Experimental studies indicate that SAM showed anti-cancer effects in various models, such as gastric cancer, breast cancer, glioblastoma, and melanoma, by reversing the aberrant methylation of oncogenes and intervening in multiple signaling pathways. It can also produce synergistic effects when combined with chemotherapy or immunotherapy. SAM has been shown to alleviate chemotherapy-induced liver injury. In inherited metabolic disorders, SAM has been confirmed to improve neurological symptoms in patients with methionine adenosyltransferase deficiency. It also serves as an effective adjunctive treatment strategy for refractory depression. Although SAM holds broad application prospects in multiple diseases, current clinical evidence remains insufficient, necessitating more comprehensive studies to fill mechanistic gaps and provide high-level clinical evidence.

导出引用

张婧韬, 张尧, 杨艳玲. S-腺苷蛋氨酸及其临床应用[J]. 肿瘤代谢与营养电子杂志. 2026, 13(3): 354-359 https://doi.org/10.16689/j.cnki.cn11-9349/r.2026.03.004

Zhang Jingtao, Zhang Yao, Yang Yanling. S-adenosylmethionine and its clinical applications[J]. Electronic Journal of Metabolism and Nutrition of Cancer. 2026, 13(3): 354-359 https://doi.org/10.16689/j.cnki.cn11-9349/r.2026.03.004

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