Hoogenraad Tjaard U
Department of Neurology, University Medical Centre, Utrecht, 3941 VD 20 Utrecht, The Netherlands.
Int J Alzheimers Dis. 2011;2011:492686. doi: 10.4061/2011/492686. Epub 2011 Sep 22.
Breakthrough in treatment of Alzheimer's disease with a shift from irrational dangerous chelation therapy to rational safe evidence based oral zinc therapy. Evidence based medicine: After synthesizing the best available clinical evidence I conclude that oral zinc therapy is a conscientious choice for treatment of free copper toxicosis in individual patients with Alzheimer's disease. Hypothesis 1: Age related free copper toxicosis is a causal factor in pathogenesis of Alzheimer's disease. There are 2 neurodegenerative diseases with abnormalities in copper metabolism: (a) the juvenile form with degeneration in the basal ganglia (Wilson's disease) and (b) the age related form with cortical neurodegeneration (Alzheimer's disease). Initially the hypothesis has been that neurodegeneration was caused by accumulation of copper in the brain but later experiences with treatment of Wilson's disease led to the conviction that free plasma copper is the toxic form of copper: it catalyzes amyloid formation thereby generating oxidative stress, free radicals and degeneration of cortical neurons. Hypothesis 2: Oral zinc therapy is an effective and safe treatment of free copper toxicosis in Alzheimer's disease. Proposed dosage: 50 mg elementary zinc/day. Warning: Chelation therapy is irrational and dangerous in treatment of copper toxicosis in Alzheimer's disease.
从不合理的危险螯合疗法转向基于合理安全证据的口服锌疗法。循证医学：综合现有最佳临床证据后，我得出结论，口服锌疗法是治疗阿尔茨海默病个体患者游离铜中毒的审慎选择。假设1：与年龄相关的游离铜中毒是阿尔茨海默病发病机制中的一个因果因素。有两种铜代谢异常的神经退行性疾病：(a) 基底神经节退化的青少年型（威尔逊病）和(b) 与年龄相关的皮质神经退行性变的类型（阿尔茨海默病）。最初的假设是神经退行性变是由大脑中铜的积累引起的，但后来威尔逊病的治疗经验使人们确信游离血浆铜是铜的毒性形式：它催化淀粉样蛋白形成，从而产生氧化应激、自由基和皮质神经元变性。假设2：口服锌疗法是治疗阿尔茨海默病游离铜中毒的有效且安全的方法。建议剂量：每日50毫克元素锌。警告：螯合疗法在治疗阿尔茨海默病铜中毒时既不合理又危险。
