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阿尔茨海默病中血管紧张素假说的发展:疾病预防和治疗的进展?

The Coming of Age of the Angiotensin Hypothesis in Alzheimer's Disease: Progress Toward Disease Prevention and Treatment?

机构信息

Dementia Research Group, Translational Health Sciences, Bristol Medical School, University of Bristol, Southmead Hospital, Bristol, UK.

出版信息

J Alzheimers Dis. 2018;62(3):1443-1466. doi: 10.3233/JAD-171119.


DOI:10.3233/JAD-171119
PMID:29562545
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5870007/
Abstract

There is wide recognition of a complex association between midlife hypertension and cardiovascular disease and later development of Alzheimer's disease (AD) and cognitive impairment. While significant progress has been made in reducing rates of mortality and morbidity due to cardiovascular disease over the last thirty years, progress towards effective treatments for AD has been slower. Despite the known association between hypertension and dementia, research into each disease has largely been undertaken in parallel and independently. Yet over the last decade and a half, the emergence of converging findings from pre-clinical and clinical research has shown how the renin angiotensin system (RAS), which is very important in blood pressure regulation and cardiovascular disease, warrants careful consideration in the pathogenesis of AD. Numerous components of the RAS have now been found to be altered in AD such that the multifunctional and potent vasoconstrictor angiotensin II, and similarly acting angiotensin III, are greatly altered at the expense of other RAS signaling peptides considered to contribute to neuronal and cognitive function. Collectively these changes may contribute to many of the neuropathological hallmarks of AD, as well as observed progressive deficiencies in cognitive function, while also linking elements of a number of the proposed hypotheses for the cause of AD. This review discusses the emergence of the RAS and its likely importance in AD, not only because of the multiple facets of its involvement, but also perhaps fortuitously because of the ready availability of numerous RAS-acting drugs, that could be repurposed as interventions in AD.

摘要

人们普遍认识到,中年高血压与心血管疾病之间存在复杂的关联,而心血管疾病与阿尔茨海默病(AD)和认知障碍的后期发展也存在关联。尽管在过去三十年中,在降低心血管疾病死亡率和发病率方面取得了重大进展,但 AD 有效治疗方法的进展较为缓慢。尽管高血压和痴呆之间存在已知的关联,但针对这两种疾病的研究在很大程度上是并行和独立进行的。然而,在过去的十五年中,来自临床前和临床研究的趋同发现表明,肾素-血管紧张素系统(RAS)在血压调节和心血管疾病中非常重要,值得在 AD 的发病机制中仔细考虑。现在已经发现,AD 中 RAS 的许多成分发生了改变,因此多功能且强效的血管收缩素 II 和具有类似作用的血管紧张素 III 发生了极大的改变,而其他被认为有助于神经元和认知功能的 RAS 信号肽则减少。这些变化可能导致 AD 的许多神经病理学特征,以及观察到的认知功能逐渐下降,同时也将 AD 一些假设病因的元素联系起来。本文综述了 RAS 的出现及其在 AD 中的可能重要性,不仅因为其涉及的多个方面,还因为大量具有 RAS 作用的药物已经上市,这些药物可能被重新用于 AD 的干预治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4901/5870007/0946f52ce695/jad-62-jad171119-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4901/5870007/ab48ba1f5cdb/jad-62-jad171119-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4901/5870007/46853d519514/jad-62-jad171119-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4901/5870007/0946f52ce695/jad-62-jad171119-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4901/5870007/ab48ba1f5cdb/jad-62-jad171119-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4901/5870007/46853d519514/jad-62-jad171119-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4901/5870007/0946f52ce695/jad-62-jad171119-g003.jpg

相似文献

[1]
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J Alzheimers Dis. 2018

[2]
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[3]
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[4]
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[5]
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[6]
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[7]
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[8]
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[9]
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[10]
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引用本文的文献

[1]
Antihypertensive drug classes and risk of incident dementia: a multinational population-based cohort study.

Age Ageing. 2025-5-3

[2]
Hemoglobin in the brain frontal lobe tissue of patients with Alzheimer's disease is susceptible to reactive nitrogen species-mediated oxidative damage.

Redox Biol. 2025-5

[3]
Comparative effects of angiotensin II stimulating and inhibiting antihypertensives on dementia risk: a systematic review and meta-analysis.

Geroscience. 2025-4-4

[4]
Blood pressure and the brain: the conundrum of hypertension and dementia.

Cardiovasc Res. 2025-4-8

[5]
The Use of Antihypertensive Medication and In Vivo Alzheimer's Disease Pathology.

Ann Neurol. 2025-6

[6]
The Contribution of the Renin-Angiotensin System to Alzheimer's Disease.

Curr Top Behav Neurosci. 2025

[7]
Association of Hypertension with Different Cognitive Disorders.

J Clin Med. 2024-10-10

[8]
Antihypertensive medications and dementia in older adults with hypertension.

medRxiv. 2024-8-29

[9]
Racial/Ethnic Disparities in Use of Angiotensin II Receptor Type 2/4 Stimulatory Vs. Inhibitory Antihypertensive Among Hypertensive Adults in the USA.

J Racial Ethn Health Disparities. 2025-6

[10]
Carriers of Heterozygous Loss-of-Function ACE Mutations Are at Risk for Alzheimer's Disease.

Biomedicines. 2024-1-12

本文引用的文献

[1]
Rationale and Design of the Mechanistic Potential of Antihypertensives in Preclinical Alzheimer's (HEART) Trial.

J Alzheimers Dis. 2018

[2]
The Rationale and Design of the Reducing Pathology in Alzheimer's Disease through Angiotensin TaRgeting (RADAR) Trial.

J Alzheimers Dis. 2018

[3]
Polygenic risk score in postmortem diagnosed sporadic early-onset Alzheimer's disease.

Neurobiol Aging. 2017-10-10

[4]
Epigenetics and DNA methylomic profiling in Alzheimer's disease and other neurodegenerative diseases.

J Neurochem. 2017-10

[5]
Environment and Neurodegenerative Diseases: An Update on miRNA Role.

Microrna. 2017-12-6

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J Cereb Blood Flow Metab. 2017-8-7

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Ann Neurol. 2017-8

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Drug candidates in clinical trials for Alzheimer's disease.

J Biomed Sci. 2017-7-19

[9]
Small vessel disease, neurovascular regulation and cognitive impairment: post-mortem studies reveal a complex relationship, still poorly understood.

Clin Sci (Lond). 2017-6-30

[10]
Brain Perivascular Macrophages Initiate the Neurovascular Dysfunction of Alzheimer Aβ Peptides.

Circ Res. 2017-7-21

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