Wilcock Donna M, Colton Carol A
Duke University Medical Center, Department of Medicine Division of Neurology, Durham, NC 27710, USA.
J Alzheimers Dis. 2008 Dec;15(4):555-69. doi: 10.3233/jad-2008-15404.
Therapeutic approaches to the treatment of Alzheimer's disease are focused primarily on the amyloid-beta peptide which aggregates to form amyloid deposits in the brain. The amyloid hypothesis states that amyloid is the precipitating factor that results in the other pathologies of Alzheimer's disease. One such therapy that has attracted significant attention is anti-amyloid-beta immunotherapy. First described in 1999, immunotherapy uses anti-amyloid-beta antibodies to lower brain amyloid levels. Active and passive immunization were shown to lower brain amyloid levels and improve cognition in multiple transgenic mouse models. Mechanisms of action were studied in these mice and revealed a complex set of mechanisms that depended on the type of antibody used. When active immunization advanced to clinical trials a subset of patients developed meningoencephalitis, an event not predicted in mouse studies. It was suspected that a T-cell response due to the type of adjuvant used was the cause. Passive immunization has also advanced to Phase III clinical trials on the basis of successful transgenic mouse studies. Reports from the active immunization clinical trial indicated that, similarly to effects observed in mouse studies, amyloid levels in brain were reduced.
治疗阿尔茨海默病的方法主要集中在β-淀粉样蛋白上,该蛋白会聚集形成大脑中的淀粉样沉积物。淀粉样蛋白假说认为,淀粉样蛋白是导致阿尔茨海默病其他病理变化的诱发因素。一种备受关注的治疗方法是抗β-淀粉样蛋白免疫疗法。免疫疗法于1999年首次被描述,它使用抗β-淀粉样蛋白抗体来降低大脑中的淀粉样蛋白水平。在多个转基因小鼠模型中,主动免疫和被动免疫均显示可降低大脑淀粉样蛋白水平并改善认知能力。对这些小鼠进行了作用机制研究,结果揭示了一套复杂的机制,这取决于所使用抗体的类型。当主动免疫进入临床试验阶段时,一部分患者出现了脑膜脑炎,这是在小鼠研究中未预测到的情况。人们怀疑这是由于所用佐剂类型引发的T细胞反应所致。基于成功的转基因小鼠研究,被动免疫也已进入III期临床试验。主动免疫临床试验的报告表明,与在小鼠研究中观察到的效果类似,大脑中的淀粉样蛋白水平降低了。