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阿尔茨海默病与炎症:细胞及治疗机制综述

Alzheimer's disease and inflammation: a review of cellular and therapeutic mechanisms.

作者信息

Halliday G, Robinson S R, Shepherd C, Kril J

机构信息

Prince of Wales Medical Research Institute, Randwick, Australia.

出版信息

Clin Exp Pharmacol Physiol. 2000 Jan-Feb;27(1-2):1-8. doi: 10.1046/j.1440-1681.2000.03200.x.

Abstract
  1. Of the neurodegenerative diseases that cause dementia, Alzheimer's disease (AD) is the most common. Three major pathologies characterize the disease: senile plaques, neurofibrillary tangles and inflammation. We review the literature on events contributing to the inflammation and the treatments thought to target this pathology. 2. The senile plaques of AD consist primarily of complexes of the beta-amyloid protein. This protein is central to the pathogenesis of the disease. 3. Inflammatory microglia are consistently associated with senile plaques in AD, although the classic inflammatory response (immunoglobulin and leucocyte infiltration) is absent. beta-Amyloid fragments appear to mediate such inflammatory mechanisms by activating the complement pathway in a similar fashion to immunoglobulin. 4. Epidemiological studies have identified a reduced risk of AD in patients with arthritis and in leprosy patients treated with anti-inflammatory drugs. Longitudinal studies have shown that the consumption of anti-inflammatory medications reduces the risk of AD only in younger patients (< 75 years). 5. There is a considerable body of in vitro evidence indicating that the inflammatory response of microglial cells is reduced by non-steroidal anti-inflammatory drugs (NSAID). However, no published data are available concerning the effects of these medications on brain pathology in AD. 6. Cyclo-oxygenase 2 enzyme is constitutively expressed in neurons and is up-regulated in degenerative brain regions in AD. Non-steroidal anti-inflammatory drugs may reduce this expression. 7. Platelets are a source of beta-amyloid and increased platelet activation and increased circulating beta-amyloid have been identified in AD. Anti-platelet medication (including NSAID) would prevent such activation and its potentially harmful consequences. 8. Increased levels of luminal beta-amyloid permeabilizes the blood-brain barrier (BBB) and increases vasoconstriction of arterial vessels, paralleling the alterations observed with infection and inflammation. Cerebral amyloidosis is highly prevalent in AD, compromising the BBB and vasoactivity. Anti-inflammatory medications may alleviate these problems.
摘要
  1. 在导致痴呆症的神经退行性疾病中,阿尔茨海默病(AD)最为常见。该疾病具有三种主要病理特征:老年斑、神经原纤维缠结和炎症。我们回顾了有关导致炎症的相关事件以及旨在针对这一病理特征的治疗方法的文献。2. AD的老年斑主要由β-淀粉样蛋白复合物组成。这种蛋白质是该疾病发病机制的核心。3. 炎症性小胶质细胞始终与AD中的老年斑相关,尽管缺乏经典的炎症反应(免疫球蛋白和白细胞浸润)。β-淀粉样蛋白片段似乎通过以与免疫球蛋白类似的方式激活补体途径来介导这种炎症机制。4. 流行病学研究发现,关节炎患者和接受抗炎药物治疗的麻风病患者患AD的风险降低。纵向研究表明,仅在较年轻患者(<75岁)中,服用抗炎药物可降低患AD的风险。5. 有大量体外证据表明,非甾体抗炎药(NSAID)可降低小胶质细胞的炎症反应。然而,尚无关于这些药物对AD脑病理影响的已发表数据。6. 环氧化酶2在神经元中组成性表达,在AD的退行性脑区中上调。非甾体抗炎药可能会降低这种表达。7. 血小板是β-淀粉样蛋白的来源,在AD中已发现血小板活化增加和循环β-淀粉样蛋白增加。抗血小板药物(包括NSAID)可预防这种活化及其潜在的有害后果。8. 管腔内β-淀粉样蛋白水平升高会使血脑屏障(BBB)通透性增加,并增加动脉血管的血管收缩,这与感染和炎症时观察到的变化相似。脑淀粉样血管病在AD中非常普遍,会损害BBB和血管活性。抗炎药物可能会缓解这些问题。

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