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阿尔茨海默病病理交汇点的胰岛素抵抗:综述。

Insulin Resistance at the Crossroad of Alzheimer Disease Pathology: A Review.

机构信息

The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China.

Tissue Repair and Cytoprotection Research Group, Center for Genetic Engineering and Biotechnology, Havana, Cuba.

出版信息

Front Endocrinol (Lausanne). 2020 Nov 5;11:560375. doi: 10.3389/fendo.2020.560375. eCollection 2020.

Abstract

Insulin plays a major neuroprotective and trophic function for cerebral cell population, thus countering apoptosis, beta-amyloid toxicity, and oxidative stress; favoring neuronal survival; and enhancing memory and learning processes. Insulin resistance and impaired cerebral glucose metabolism are invariantly reported in Alzheimer's disease (AD) and other neurodegenerative processes. AD is a fatal neurodegenerative disorder in which progressive glucose hypometabolism parallels to cognitive impairment. Although AD may appear and progress in virtue of multifactorial nosogenic ingredients, multiple interperpetuative and interconnected vicious circles appear to drive disease pathophysiology. The disease is primarily a metabolic/energetic disorder in which amyloid accumulation may appear as a by-product of more proximal events, especially in the late-onset form. As a bridge between AD and type 2 diabetes, activation of c-Jun N-terminal kinase (JNK) pathway with the ensued serine phosphorylation of the insulin response substrate (IRS)-1/2 may be at the crossroads of insulin resistance and its subsequent dysmetabolic consequences. Central insulin axis bankruptcy translates in neuronal vulnerability and demise. As a link in the chain of pathogenic vicious circles, mitochondrial dysfunction, oxidative stress, and peripheral/central immune-inflammation are increasingly advocated as major pathology drivers. Pharmacological interventions addressed to preserve insulin axis physiology, mitochondrial biogenesis-integral functionality, and mitophagy of diseased organelles may attenuate the adjacent spillover of free radicals that further perpetuate mitochondrial damages and catalyze inflammation. Central and/or peripheral inflammation may account for a local flood of proinflammatory cytokines that along with astrogliosis amplify insulin resistance, mitochondrial dysfunction, and oxidative stress. All these elements are endogenous stressor, pro-senescent factors that contribute to JNK activation. Taken together, these evidences incite to identify novel multi-mechanistic approaches to succeed in ameliorating this pandemic affliction.

摘要

胰岛素对脑细胞群体具有重要的神经保护和营养作用,从而对抗细胞凋亡、β-淀粉样毒性和氧化应激;有利于神经元存活;并增强记忆和学习过程。胰岛素抵抗和大脑葡萄糖代谢受损在阿尔茨海默病(AD)和其他神经退行性过程中普遍存在。AD 是一种致命的神经退行性疾病,其进行性葡萄糖代谢低下与认知障碍相平行。尽管 AD 可能由于多因素的发病成分而出现和进展,但多个相互作用和相互关联的恶性循环似乎推动了疾病的病理生理学。该疾病主要是一种代谢/能量障碍,其中淀粉样蛋白的积累可能是更接近的事件的副产品,尤其是在迟发性形式中。作为 AD 和 2 型糖尿病之间的桥梁,c-Jun N 末端激酶 (JNK) 通路的激活及其随后胰岛素反应底物 (IRS)-1/2 的丝氨酸磷酸化可能处于胰岛素抵抗及其随后代谢紊乱后果的十字路口。中枢胰岛素轴的破产导致神经元易损性和死亡。作为致病恶性循环链条中的一个环节,线粒体功能障碍、氧化应激以及外周/中枢免疫炎症越来越被认为是主要的病理驱动因素。旨在维持胰岛素轴生理学、线粒体生物发生-整体功能和病变细胞器的自噬的药物干预可能会减轻自由基的相邻溢出,从而进一步加剧线粒体损伤并催化炎症。中枢和/或外周炎症可能导致局部促炎细胞因子的泛滥,这些细胞因子与星形胶质细胞增生一起放大胰岛素抵抗、线粒体功能障碍和氧化应激。所有这些因素都是内源性应激源、促衰老因素,有助于 JNK 的激活。综上所述,这些证据促使人们寻找新的多机制方法来成功改善这种流行疾病。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f77d/7674493/193d63e7ca7c/fendo-11-560375-g0001.jpg

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