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阿尔茨海默病中液体生物标志物的临床意义。

Clinical significance of fluid biomarkers in Alzheimer's Disease.

机构信息

Lab for Clinical Neurochemistry and Neurochemical Dementia Diagnostics, Department of Psychiatry and Psychotherapy, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany.

Department of Neurodegeneration Diagnostics, Medical University of Białystok, Białystok, Poland.

出版信息

Pharmacol Rep. 2020 Jun;72(3):528-542. doi: 10.1007/s43440-020-00107-0. Epub 2020 May 8.

Abstract

The number of patients with Alzheimer's Disease (AD) and other types of dementia disorders has drastically increased over the last decades. AD is a complex progressive neurodegenerative disease affecting about 14 million patients in Europe and the United States. The hallmarks of this disease are neurotic plaques consist of the Amyloid-β peptide (Aβ) and neurofibrillary tangles (NFTs) formed of hyperphosphorylated Tau protein (pTau). Currently, four CSF biomarkers: Amyloid beta 42 (Aβ42), Aβ42/40 ratio, Tau protein, and Tau phosphorylated at threonine 181 (pTau181) have been indicated as core neurochemical AD biomarkers. However, the identification of additional fluid biomarkers, useful in the prognosis, risk stratification, and monitoring of drug response is sorely needed to better understand the complex heterogeneity of AD pathology as well as to improve diagnosis of patients with the disease. Several novel biomarkers have been extensively investigated, and their utility must be proved and eventually integrated into guidelines for use in clinical practice. This paper presents the research and development of CSF and blood biomarkers for AD as well as their potential clinical significance. Upper panel: Aβ peptides are released from transmembrane Amyloid Precursor Protein (APP) under physiological conditions (blue arrow). In AD, however, pathologic accumulation of Aβ monomers leads to their accumulation in plaques (red arrow). This is reflected in decreased concentration of Aβ1-42 and decreased Aβ42/40 concentration ratio in the CSF. Lower panel: Phosphorylated Tau molecules maintain axonal structures; hyperphosphorylation of Tau (red arrow) in AD leads to degeneration of axons, and release of pTau molecules, which then accumulate in neurofibrillary tangles. This process is reflected by increased concentrations of Tau and pTau in the CSF.

摘要

在过去几十年中,阿尔茨海默病(AD)和其他类型的痴呆症患者数量急剧增加。AD 是一种复杂的进行性神经退行性疾病,影响着欧洲和美国约 1400 万患者。这种疾病的特征是神经斑块由淀粉样β肽(Aβ)组成,神经原纤维缠结(NFTs)由过度磷酸化的 Tau 蛋白(pTau)组成。目前,四种 CSF 生物标志物:β淀粉样蛋白 42(Aβ42)、Aβ42/40 比值、Tau 蛋白和 Tau 蛋白在苏氨酸 181 位磷酸化(pTau181)已被确定为核心神经化学 AD 生物标志物。然而,需要确定额外的液体生物标志物,以便更好地了解 AD 病理学的复杂异质性,并改善对患有该病的患者的诊断,这些生物标志物可用于预后、风险分层和药物反应监测。已经广泛研究了几种新型生物标志物,必须证明它们的效用,并最终将其纳入临床实践指南中。本文介绍了 AD 的 CSF 和血液生物标志物的研究和开发及其潜在的临床意义。上图:在生理条件下,Aβ 肽从跨膜淀粉样前体蛋白(APP)中释放(蓝色箭头)。然而,在 AD 中,Aβ 单体的病理性积累导致其在斑块中积累(红色箭头)。这反映在 CSF 中 Aβ1-42 浓度降低和 Aβ42/40 浓度比降低。下图:磷酸化 Tau 分子维持轴突结构;AD 中的 Tau 过度磷酸化(红色箭头)导致轴突退化,并释放 pTau 分子,然后这些分子在神经原纤维缠结中积累。这一过程反映在 CSF 中 Tau 和 pTau 浓度增加。

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