帕金森病纹状体多巴胺合成的恢复:病毒载体介导的酶替代策略。

Restoration of the striatal dopamine synthesis for Parkinson's disease: viral vector-mediated enzyme replacement strategy.

作者信息

Carlsson Thomas, Björklund Tomas, Kirik Deniz

机构信息

CNS Disease Modeling Unit, Department of Experimental Medical Science, Lund University, BMC A11, 221 84 Lund, Sweden.

出版信息

Curr Gene Ther. 2007 Apr;7(2):109-20. doi: 10.2174/156652307780363125.

Abstract

Parkinson's disease is the second most common neurodegenerative disease. It is charaterized by a progressive loss of dopamine (DA) producing neurons in the midbrain, which result in a decline of DA innervations present in the forebrain, in particular, the striatum. The disease leads to appearance of motor symptoms involving akinesia/bradykinesia, gait disturbances, postural imbalance and tremor. Oral administration of L-3,4-dihydroxyphenylalanine (L-DOPA), the precursor of DA, provides very good symptomatic relief, but this intermittent and pharmacological treatment is compromised by severe side effects, such as the appearance of abnormal involuntary movements. Viral vector-mediated direct gene transfer techniques are currently being explored in order to provide continuous and stable synthesis of DA in the brain. This review focuses on the basic idea of DA replacement, first describing the enzymatic machinery important for DA synthesis and secondly the various alternative strategies pursued in several laboratories. The DOPA delivery strategy, based on the co-transduction of tyrosine hydroxylase (TH), and GTP cyclohydrolase 1 (GCH1) genes, has been shown to be a powerful approach providing a robust behavioral recovery and reversal of side effects of the pulsatile administration of L-DOPA medication. The DA delivery strategy, on the other hand, aims at triple transduction of the TH, GCH1 and aromatic amino-acid decarboxylase (AADC) enzymes, and thereby provide a higher rate of conversion of DOPA to DA. Finally, transduction of AADC alone has been proposed as a means to improve the conversion of peripherally administered L-DOPA. As the basic scientific rationale behind these strategies are well understood and the results of the animal experiments are very encouraging, we are now entering into an exciting phase with increasing momentum toward the first clinical applications using this experimental therapy in patients suffering from PD.

摘要

帕金森病是第二常见的神经退行性疾病。其特征是中脑产生多巴胺(DA)的神经元逐渐丧失,这导致前脑尤其是纹状体中DA神经支配的减少。该疾病会导致出现运动症状,包括运动不能/运动迟缓、步态障碍、姿势失衡和震颤。口服DA的前体L-3,4-二羟基苯丙氨酸(L-DOPA)可提供很好的症状缓解,但这种间歇性的药物治疗会受到严重副作用的影响,如出现异常不自主运动。目前正在探索病毒载体介导的直接基因转移技术,以便在大脑中实现DA的持续稳定合成。本综述聚焦于DA替代的基本理念,首先描述对DA合成重要的酶机制,其次介绍几个实验室所采用的各种替代策略。基于酪氨酸羟化酶(TH)和GTP环化水解酶1(GCH1)基因共转导的多巴递送策略,已被证明是一种有效的方法,可实现强大的行为恢复并逆转L-DOPA药物脉冲给药的副作用。另一方面,DA递送策略旨在对TH、GCH1和芳香族氨基酸脱羧酶(AADC)进行三联转导,从而提高多巴向DA的转化率。最后,有人提出单独转导AADC作为提高外周给予L-DOPA转化率的一种手段。由于这些策略背后的基本科学原理已得到充分理解,且动物实验结果非常令人鼓舞,我们现在正进入一个令人兴奋的阶段,朝着在帕金森病患者中首次应用这种实验性疗法的方向发展,且势头越来越强劲。

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