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从床边到实验台再回归床边:转化孤独症谱系障碍模型

From bedside to bench and back: Translating ASD models.

作者信息

Drozd Hayley P, Karathanasis Sotirios F, Molosh Andrei I, Lukkes Jodi L, Clapp D Wade, Shekhar Anantha

机构信息

Program in Medical Neurobiology, Stark Neurosciences Institute, Indiana University School of Medicine, Indianapolis, IN, United States.

Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States.

出版信息

Prog Brain Res. 2018;241:113-158. doi: 10.1016/bs.pbr.2018.10.003. Epub 2018 Nov 7.

Abstract

Autism spectrum disorders (ASD) represent a heterogeneous group of disorders defined by deficits in social interaction/communication and restricted interests, behaviors, or activities. Models of ASD, developed based on clinical data and observations, are used in basic science, the "bench," to better understand the pathophysiology of ASD and provide therapeutic options for patients in the clinic, the "bedside." Translational medicine creates a bridge between the bench and bedside that allows for clinical and basic science discoveries to challenge one another to improve the opportunities to bring novel therapies to patients. From the clinical side, biomarker work is expanding our understanding of possible mechanisms of ASD through measures of behavior, genetics, imaging modalities, and serum markers. These biomarkers could help to subclassify patients with ASD in order to better target treatments to a more homogeneous groups of patients most likely to respond to a candidate therapy. In turn, basic science has been responding to developments in clinical evaluation by improving bench models to mechanistically and phenotypically recapitulate the ASD phenotypes observed in clinic. While genetic models are identifying novel therapeutics targets at the bench, the clinical efforts are making progress by defining better outcome measures that are most representative of meaningful patient responses. In this review, we discuss some of these challenges in translational research in ASD and strategies for the bench and bedside to bridge the gap to achieve better benefits to patients.

摘要

自闭症谱系障碍(ASD)是一组异质性疾病,其定义为社交互动/沟通缺陷以及兴趣、行为或活动受限。基于临床数据和观察结果建立的ASD模型,在基础科学(即“实验台”研究)中用于更好地理解ASD的病理生理学,并为临床(即“病床边”)患者提供治疗选择。转化医学在实验台和病床边之间架起了一座桥梁,使临床和基础科学发现能够相互挑战,以增加为患者带来新疗法的机会。从临床角度来看,生物标志物研究正在通过行为、遗传学、成像方式和血清标志物等测量方法,拓展我们对ASD可能机制的理解。这些生物标志物有助于对ASD患者进行亚分类,从而更精准地将治疗靶向到最有可能对候选疗法产生反应的更同质化患者群体。反过来,基础科学也一直在通过改进实验台模型来回应临床评估的进展,以便在机制和表型上重现临床观察到的ASD表型。虽然基因模型在实验台层面识别出新的治疗靶点,但临床研究也在通过定义更能代表有意义的患者反应的更好的疗效指标取得进展。在本综述中,我们讨论了ASD转化研究中的一些挑战,以及实验台和病床边为弥合差距以给患者带来更大益处的策略。

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