Jenner Peter
Neurodegenerative Disease Research Centre, Hodgkin Building, GKT School of Biomedical Sciences, King's College, SE1 1UL, London, UK.
Parkinsonism Relat Disord. 2003 Jan;9(3):131-7. doi: 10.1016/s1353-8020(02)00115-3.
Current research into Parkinson's disease (PD) is directed at developing novel agents and strategies for improved symptomatic management. The aim of this research is to provide effective and maintained symptom control throughout the course of the disease without loss of efficacy and without priming the basal ganglia for the onset of dyskinesia. To achieve these objectives, it is important to have relevant animal models of PD in which new pharmacological agents and treatment strategies can be assessed prior to clinical assessment. At present, the most effective experimental model of PD is the methyl phenyl tetrahydropyridine (MPTP)-treated primate. Primates treated with MPTP develop motor disturbances resembling those seen in idiopathic PD, including bradykinesia, rigidity and postural abnormalities. In addition, MPTP-treated primates are responsive to all commonly used antiparkinsonian agents and display treatment-associated motor complications such as dyskinesia, wearing-off and on-off, which occur during the long-term treatment of the illness. This review examines how studies conducted in MPTP-treated primates have contributed to the development of dopaminergic therapies. There is now accumulating evidence that the pulsatile manner in which short-acting agents stimulate striatal dopamine receptors is a key contributing factor to the priming of the basal ganglia for dyskinesia induction. It has been suggested that providing more continuous stimulation of dopamine receptors will avoid the development of motor complications, particularly dyskinesia. So far, the actions of all commonly used antiparkinsonian drugs assessed in MPTP-treated primates have proved to be highly predictive of drug action in PD. These primate studies have demonstrated that long-acting dopamine agonists and levodopa given in combination with a catechol-O-methyl transferase (COMT) inhibitor (to increase its relatively short half-life), induce significantly less dyskinesia than occurs with standard levodopa therapy.
目前对帕金森病(PD)的研究旨在开发新的药物和策略,以改善症状管理。这项研究的目的是在疾病的整个过程中提供有效且持续的症状控制,而不会丧失疗效,也不会使基底神经节引发运动障碍。为实现这些目标,拥有相关的帕金森病动物模型很重要,在临床评估之前可以在这些模型中评估新的药物和治疗策略。目前,最有效的帕金森病实验模型是用甲基苯基四氢吡啶(MPTP)处理的灵长类动物。用MPTP处理的灵长类动物会出现类似于特发性帕金森病所见的运动障碍,包括运动迟缓、僵硬和姿势异常。此外,用MPTP处理的灵长类动物对所有常用的抗帕金森病药物都有反应,并表现出与治疗相关的运动并发症,如运动障碍、疗效减退和症状波动,这些并发症在疾病的长期治疗过程中会出现。这篇综述探讨了在MPTP处理的灵长类动物中进行的研究如何促进了多巴胺能疗法的发展。现在有越来越多的证据表明,短效药物刺激纹状体多巴胺受体的脉冲方式是基底神经节引发运动障碍的一个关键因素。有人提出,提供对多巴胺受体更持续的刺激将避免运动并发症的发生,特别是运动障碍。到目前为止,在MPTP处理的灵长类动物中评估的所有常用抗帕金森病药物的作用已被证明对帕金森病中的药物作用具有高度预测性。这些灵长类动物研究表明,长效多巴胺激动剂与左旋多巴联合使用儿茶酚-O-甲基转移酶(COMT)抑制剂(以增加其相对较短的半衰期),与标准左旋多巴疗法相比,引起的运动障碍明显更少。