Fessel Jeffrey
Emeritus, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
Alzheimers Dement (N Y). 2019 Dec 9;5:899-905. doi: 10.1016/j.trci.2019.11.007. eCollection 2019.
After the midninth decade of age, the incidence rates of Alzheimer's disease (AD) and the presence of active TGF-β1 show comparable increases. The hypothesis is proposed that the reason why advanced age is a major risk factor for AD is a progressive decrease with advancing age in the numbers of TGFR2 receptors in the brain, with the consequence of a decline in the neurotrophic efficacy of TGF-β1 and 2 despite their already increased levels in older persons. Alternative, possible reasons are discussed but rejected because either those reasons may also affect young persons or because they cannot be validated in a clinical trial. The proposed hypothesis may be validated in persons with aMCI after raising their brain levels of TGF-β1 and 2 by using a combination of three drugs, lithium, memantine, plus either glatiramer or venlafaxine, and then assessing their progression to AD.
在90岁中期之后,阿尔茨海默病(AD)的发病率和活性转化生长因子-β1(TGF-β1)的出现呈现出类似的增长。有人提出假说,高龄成为AD主要风险因素的原因是随着年龄增长,大脑中TGFR2受体数量逐渐减少,其结果是尽管老年人中TGF-β1和TGF-β2水平已经升高,但它们的神经营养功效仍会下降。文中还讨论了其他可能的原因,但均被排除,因为这些原因要么也会影响年轻人,要么无法在临床试验中得到验证。通过联合使用三种药物(锂盐、美金刚,再加格拉替雷或文拉法辛)提高轻度认知障碍(aMCI)患者大脑中TGF-β1和TGF-β2的水平,然后评估他们向AD的进展情况,所提出的假说可能会在这些患者中得到验证。