Division of Neurogeriatrics, Centre for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden.
Fondation Médéric Alzheimer, Paris, France.
J Intern Med. 2019 Oct;286(4):398-437. doi: 10.1111/joim.12959. Epub 2019 Aug 29.
Alzheimer's disease (AD), the most frequent cause of dementia, is escalating as a global epidemic, and so far, there is neither cure nor treatment to alter its progression. The most important feature of the disease is neuronal death and loss of cognitive functions, caused probably from several pathological processes in the brain. The main neuropathological features of AD are widely described as amyloid beta (Aβ) plaques and neurofibrillary tangles of the aggregated protein tau, which contribute to the disease. Nevertheless, AD brains suffer from a variety of alterations in function, such as energy metabolism, inflammation and synaptic activity. The latest decades have seen an explosion of genes and molecules that can be employed as targets aiming to improve brain physiology, which can result in preventive strategies for AD. Moreover, therapeutics using these targets can help AD brains to sustain function during the development of AD pathology. Here, we review broadly recent information for potential targets that can modify AD through diverse pharmacological and nonpharmacological approaches including gene therapy. We propose that AD could be tackled not only using combination therapies including Aβ and tau, but also considering insulin and cholesterol metabolism, vascular function, synaptic plasticity, epigenetics, neurovascular junction and blood-brain barrier targets that have been studied recently. We also make a case for the role of gut microbiota in AD. Our hope is to promote the continuing research of diverse targets affecting AD and promote diverse targeting as a near-future strategy.
阿尔茨海默病(AD)是最常见的痴呆症病因,正在成为一种全球性的流行疾病,迄今为止,尚无治愈或改变其进展的方法。这种疾病最重要的特征是神经元死亡和认知功能丧失,可能是由大脑中的几种病理过程引起的。AD 的主要神经病理学特征被广泛描述为淀粉样β(Aβ)斑块和聚集蛋白 tau 的神经原纤维缠结,这导致了疾病的发生。然而,AD 大脑还会遭受各种功能改变,如能量代谢、炎症和突触活动。近几十年来,人们发现了大量可以作为靶点的基因和分子,这些靶点可以改善大脑生理机能,从而为 AD 提供预防策略。此外,使用这些靶点的治疗方法可以帮助 AD 大脑在 AD 病理发展过程中维持功能。在这里,我们广泛回顾了最近的信息,这些信息为潜在的靶点提供了修改 AD 的方法,包括药物和非药物治疗方法,如基因治疗。我们提出,AD 不仅可以通过包括 Aβ和 tau 在内的联合治疗来治疗,还可以考虑胰岛素和胆固醇代谢、血管功能、突触可塑性、表观遗传学、神经血管连接和血脑屏障等最近研究的靶点。我们还提出了肠道微生物群在 AD 中的作用。我们希望能够促进对影响 AD 的不同靶点的持续研究,并促进多种靶点作为未来的治疗策略。
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