Lebouvier Thibaud, Chaumette Tanguy, Paillusson Sébastien, Duyckaerts Charles, Bruley des Varannes Stanislas, Neunlist Michel, Derkinderen Pascal
INSERM U913, CHU Nantes, Nantes, France.
Eur J Neurosci. 2009 Sep;30(5):735-41. doi: 10.1111/j.1460-9568.2009.06873.x. Epub 2009 Aug 27.
Parkinson's disease is the second most common neurodegenerative disease after Alzheimer's disease. It has been classically considered that the pathological hallmarks of Parkinson's disease, namely Lewy bodies and Lewy neurites, affect primarily the substantia nigra. Nevertheless, it has become increasingly evident in recent years that Parkinson's disease is a multicentric neurodegenerative process that affects several neuronal structures outside the substantia nigra, among which is the enteric nervous system. Remarkably, recent reports have shown that the lesions in the enteric nervous system occurred at a very early stage of the disease, even before the involvement of the central nervous system. This led to the postulate that the enteric nervous system could be critical in the pathophysiology of Parkinson's disease, as it could represent a route of entry for a putative environmental factor to initiate the pathological process (Braak's hypothesis). Besides their putative role in the spreading of the pathological process, it has also been suggested that the pathological alterations within the enteric nervous system could be involved in the gastrointestinal dysfunction frequently encountered by parkinsonian patients. The scope of the present article is to review the available studies on the enteric nervous system in Parkinson's disease patients and in animal models of the disease. We further discuss the strategies that will help in our understanding of the roles of the enteric nervous system, both in the pathophysiology of the disease and in the pathophysiology of the gastrointestinal symptoms.
帕金森病是仅次于阿尔茨海默病的第二常见神经退行性疾病。传统观点认为，帕金森病的病理特征，即路易小体和路易神经突，主要影响黑质。然而，近年来越来越明显的是，帕金森病是一个多中心神经退行性过程，会影响黑质以外的几个神经元结构，其中包括肠神经系统。值得注意的是，最近的报告表明，肠神经系统的病变在疾病的非常早期就已出现，甚至在中枢神经系统受累之前。这导致了一种假设，即肠神经系统在帕金森病的病理生理学中可能至关重要，因为它可能代表一种假定环境因素启动病理过程的进入途径（布拉克假说）。除了它们在病理过程传播中的假定作用外，也有人提出肠神经系统内的病理改变可能与帕金森病患者经常出现的胃肠功能障碍有关。本文的范围是回顾关于帕金森病患者和该疾病动物模型中肠神经系统的现有研究。我们进一步讨论有助于我们理解肠神经系统在疾病病理生理学和胃肠症状病理生理学中作用的策略。
