Bassil Fares, Fernagut Pierre-Olivier, Bezard Erwan, Meissner Wassilios G
Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France.
Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France; Service de Neurologie, CHU de Bordeaux, Pessac, France.
Prog Neurobiol. 2014 Jul;118:1-18. doi: 10.1016/j.pneurobio.2014.02.005. Epub 2014 Feb 28.
Insulin and Insulin Growth Factor-1 (IGF-1) play a major role in body homeostasis and glucose regulation. They also have paracrine/autocrine functions in the brain. The Insulin/IGF-1 signaling pathway contributes to the control of neuronal excitability, nerve cell metabolism and cell survival. Glucagon like peptide-1 (GLP-1), known as an insulinotropic hormone has similar functions and growth like properties as insulin/IGF-1. Growing evidence suggests that dysfunction of these pathways contribute to the progressive loss of neurons in Alzheimer's disease (AD) and Parkinson's disease (PD), the two most frequent neurodegenerative disorders. These findings have led to numerous studies in preclinical models of neurodegenerative disorders targeting insulin/IGF-1 and GLP-1 signaling with currently available anti-diabetics. These studies have shown that administration of insulin, IGF-1 and GLP-1 agonists reverses signaling abnormalities and has positive effects on surrogate markers of neurodegeneration and behavioral outcomes. Several proof-of-concept studies are underway that attempt to translate the encouraging preclinical results to patients suffering from AD and PD. In the first part of this review, we discuss physiological functions of insulin/IGF-1 and GLP-1 signaling pathways including downstream targets and receptors distribution within the brain. In the second part, we undertake a comprehensive overview of preclinical studies targeting insulin/IGF-1 or GLP-1 signaling for treating AD and PD. We then detail the design of clinical trials that have used anti-diabetics for treating AD and PD patients. We close with future considerations that treat relevant issues for successful translation of these encouraging preclinical results into treatments for patients with AD and PD.
胰岛素和胰岛素样生长因子-1(IGF-1)在机体稳态和葡萄糖调节中发挥着重要作用。它们在大脑中还具有旁分泌/自分泌功能。胰岛素/IGF-1信号通路有助于控制神经元兴奋性、神经细胞代谢和细胞存活。胰高血糖素样肽-1(GLP-1)作为一种促胰岛素分泌激素,具有与胰岛素/IGF-1相似的功能和生长特性。越来越多的证据表明,这些信号通路的功能障碍会导致阿尔茨海默病(AD)和帕金森病(PD)这两种最常见的神经退行性疾病中神经元的逐渐丧失。这些发现促使人们针对胰岛素/IGF-1和GLP-1信号通路,利用现有的抗糖尿病药物,在神经退行性疾病的临床前模型中进行了大量研究。这些研究表明,给予胰岛素、IGF-1和GLP-1激动剂可逆转信号异常,并对神经退行性变的替代标志物和行为结果产生积极影响。目前正在进行几项概念验证研究,试图将令人鼓舞的临床前结果应用于AD和PD患者。在本综述的第一部分,我们讨论胰岛素/IGF-1和GLP-1信号通路的生理功能,包括下游靶点和大脑内受体分布。在第二部分,我们全面概述了针对胰岛素/IGF-1或GLP-1信号通路治疗AD和PD的临床前研究。然后,我们详细介绍了使用抗糖尿病药物治疗AD和PD患者的临床试验设计。最后,我们对未来的考虑进行了探讨,这些考虑涉及将这些令人鼓舞的临床前结果成功转化为AD和PD患者治疗方法的相关问题。