Skaper Stephen D
Neurodegeneration Research Department, Neurology and GI Centre of Excellence for Drug Discovery, GlaxoSmithKline Research and Development Limited, Harlow, Essex CM19 5 AW, United Kingdom.
Ann N Y Acad Sci. 2007 Dec;1122:23-34. doi: 10.1196/annals.1403.002.
The importance of glial cell-propagated inflammation (i.e., neuroinflammation) disorders such as Alzheimer's disease (AD) was viewed previously as a bystander effect, or epiphenomenon, with inflammation occurring when damaged neurons elicit an activation response by glia. However, an accumulating body of evidence has challenged this earlier perspective and indicates a more active role of neuroinflammation in the pathophysiology of progressive neurodegenerative disorders such as AD, Parkinson's disease, amyotrophic lateral sclerosis, and multiple sclerosis. This insight into pathophysiology evolved in concert with the appreciation that the brain is not as immunologically privileged as once thought. The central nervous system (CNS) has its own resident immune system, in which glial cells (microglia, astrocytes, and oligodendrocytes) not only serve supportive and nutritive roles for neurons but also engage from time to time in several "inflammatory" processes that defend the CNS from pathogens and help it to recover from stress and injury. These otherwise "normal" glial functions can sometimes result in a more severe and chronic neuroinflammatory cycle that actually promotes or propagates neurodegenerative disease. Excessive glial cell activation may thus constitute a viable target for the discovery of and development of neurodegenerative disease therapeutics. Suggestive clinical evidence in support of neuroinflammation as a drug discovery target for chronic neurodegenerative diseases, such as AD, comes from epidemiological and genetic linkage data. For example, long-term use of nonsteroidal anti-inflammatory drugs is correlated with a protective effect against AD, and certain polymorphisms in the genes for interleukin 1 and other proinflammatory mediator genes are associated with increased risk. In AD and Parkinson's disease, activated microglia and complement proteins have been identified in the brain regions most affected in these disorders. This report will briefly review selected clinical and preclinical data that reflect the prevailing approaches targeting neuroinflammation as a pathophysiological process contributing to the onset or progression of neurodegenerative diseases, as well as their neuroprotective potential.
胶质细胞介导的炎症(即神经炎症)性疾病,如阿尔茨海默病(AD),其重要性以前被视为一种旁观者效应或附带现象,即当受损神经元引发胶质细胞的激活反应时才会发生炎症。然而,越来越多的证据对这一早期观点提出了挑战,并表明神经炎症在诸如AD、帕金森病、肌萎缩侧索硬化症和多发性硬化症等进行性神经退行性疾病的病理生理学中发挥着更积极的作用。这种对病理生理学的认识与人们认识到大脑并非像曾经认为的那样具有免疫特权同步发展。中枢神经系统(CNS)有其自身的固有免疫系统,其中胶质细胞(小胶质细胞、星形胶质细胞和少突胶质细胞)不仅为神经元发挥支持和营养作用,而且还不时参与多种“炎症”过程,以保护CNS免受病原体侵害,并帮助其从应激和损伤中恢复。这些原本“正常”的胶质细胞功能有时会导致更严重和慢性的神经炎症循环,实际上促进或加剧神经退行性疾病。因此,过度的胶质细胞激活可能成为发现和开发神经退行性疾病治疗方法的一个可行靶点。支持将神经炎症作为慢性神经退行性疾病(如AD)药物发现靶点的临床证据来自流行病学和基因连锁数据。例如,长期使用非甾体抗炎药与对AD的保护作用相关,白细胞介素1和其他促炎介质基因的某些多态性与患病风险增加有关。在AD和帕金森病中,已在这些疾病中受影响最严重的脑区中发现了活化的小胶质细胞和补体蛋白。本报告将简要回顾一些临床和临床前数据,这些数据反映了将神经炎症作为导致神经退行性疾病发病或进展的病理生理过程的主要研究方法,以及它们的神经保护潜力。