Bowirrat Abdalla
Adelson School of Medicine, Department of Molecular Biology, Ariel University, Ariel 40700, Israel.
J Pers Med. 2022 Nov 2;12(11):1817. doi: 10.3390/jpm12111817.
Alzheimer's disease (AD) is a chronic multifactorial and complex neuro-degenerative disorder characterized by memory impairment and the loss of cognitive ability, which is a problem affecting the elderly. The pathological intracellular accumulation of abnormally phosphorylated Tau proteins, forming neurofibrillary tangles, and extracellular amyloid-beta (Aβ) deposition, forming senile plaques, as well as neural disconnection, neural death and synaptic dysfunction in the brain, are hallmark pathologies that characterize AD. The prevalence of the disease continues to increase globally due to the increase in longevity, quality of life, and medical treatment for chronic diseases that decreases the mortality and enhance the survival of elderly. Medical awareness and the accurate diagnosis of the disease also contribute to the high prevalence observed globally. Unfortunately, no definitive treatment exists that can be used to modify the course of AD, and no available treatment is capable of mitigating the cognitive decline or reversing the pathology of the disease as of yet. A plethora of hypotheses, ranging from the cholinergic theory and dominant Aβ cascade hypothesis to the abnormally excessive phosphorylated Tau protein hypothesis, have been reported. Various explanations for the pathogenesis of AD, such as the abnormal excitation of the glutamate system and mitochondrial dysfunction, have also been suggested. Despite the continuous efforts to deliver significant benefits and an effective treatment for this distressing, globally attested aging illness, multipronged approaches and strategies for ameliorating the disease course based on knowledge of the underpinnings of the pathogenesis of AD are urgently needed. Immunosenescence is an immune deficit process that appears with age (inflammaging process) and encompasses the remodeling of the lymphoid organs, leading to alterations in the immune function and neuroinflammation during advanced aging, which is closely linked to the outgrowth of infections, autoimmune diseases, and malignant cancers. It is well known that long-standing inflammation negatively influences the brain over the course of a lifetime due to the senescence of the immune system. Herein, we aim to trace the role of the immune system in the pathogenesis of AD. Thus, we explore alternative avenues, such as neuroimmune involvement in the pathogenesis of AD. We determine the initial triggers of neuroinflammation, which is an early episode in the pre-symptomatic stages of AD and contributes to the advancement of the disease, and the underlying key mechanisms of brain damage that might aid in the development of therapeutic strategies that can be used to combat this devastating disease. In addition, we aim to outline the ways in which different aspects of the immune system, both in the brain and peripherally, behave and thus to contribute to AD.
阿尔茨海默病(AD)是一种慢性多因素复杂神经退行性疾病,其特征为记忆障碍和认知能力丧失,这是一个影响老年人的问题。细胞内异常磷酸化的 Tau 蛋白病理性积聚,形成神经原纤维缠结,细胞外β淀粉样蛋白(Aβ)沉积,形成老年斑,以及大脑中的神经连接中断、神经死亡和突触功能障碍,是 AD 的标志性病理特征。由于寿命延长、生活质量提高以及慢性病医疗水平提升降低了死亡率并提高了老年人的存活率,该疾病在全球的患病率持续上升。医学认知和对该疾病的准确诊断也导致了全球范围内观察到的高患病率。不幸的是,目前尚无能够改变 AD 病程的确定性治疗方法,而且目前也没有可用的治疗方法能够减轻认知衰退或逆转该疾病的病理状态。已经报道了大量假说,从胆碱能理论、占主导地位的 Aβ 级联假说到异常过度磷酸化的 Tau 蛋白假说。也有人提出了关于 AD 发病机制的各种解释,如谷氨酸系统的异常兴奋和线粒体功能障碍。尽管一直在努力为这种令人痛苦的、全球公认的衰老疾病带来显著益处和有效治疗方法,但迫切需要基于对 AD 发病机制基础的了解,采取多方面的方法和策略来改善疾病进程。免疫衰老(immunosenescence)是一种随着年龄出现的免疫缺陷过程(炎症衰老过程),包括淋巴器官的重塑,导致衰老后期免疫功能改变和神经炎症,这与感染、自身免疫性疾病和恶性肿瘤的发生密切相关。众所周知,由于免疫系统衰老,长期炎症在一生中会对大脑产生负面影响。在此,我们旨在追踪免疫系统在 AD 发病机制中的作用。因此,我们探索替代途径,如神经免疫在 AD 发病机制中的参与情况。我们确定神经炎症的初始触发因素,神经炎症是 AD 症状前期的早期事件并促成疾病进展,以及可能有助于制定治疗策略以对抗这种毁灭性疾病的脑损伤潜在关键机制。此外,我们旨在概述免疫系统在大脑和外周的不同方面的表现方式,从而对 AD 产生影响。