Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Department of Nuclear Medicine and PET, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, J220, 8200, Aarhus, Denmark.
J Neural Transm (Vienna). 2023 Jun;130(6):737-753. doi: 10.1007/s00702-023-02633-6. Epub 2023 Apr 16.
The ultimate origin of Lewy body disorders, including Parkinson's disease (PD) and Dementia with Lewy bodies (DLB), is still incompletely understood. Although a large number of pathogenic mechanisms have been implicated, accumulating evidence support that aggregation and neuron-to-neuron propagation of alpha-synuclein may be the core feature of these disorders. The synuclein, origin, and connectome (SOC) disease model of Lewy body disorders was recently introduced. This model is based on the hypothesis that in the majority of patients, the first alpha-synuclein pathology arises in single location and spreads from there. The most common origin sites are the enteric nervous system and the olfactory system. The SOC model predicts that gut-first pathology leads to a clinical body-first subtype characterized by prodromal autonomic symptoms and REM sleep behavior disorder. In contrast, olfactory-first pathology leads to a brain-first subtype with fewer non-motor symptoms before diagnosis. The SOC model further predicts that body-first patients are older, more commonly develop symmetric dopaminergic degeneration, and are at increased risk of dementia-compared to brain-first patients. In this review, the SOC model is explained and compared to alternative models of the pathogenesis of Lewy body disorders, including the Braak staging system, and the Unified Staging System for Lewy Body Disorders. Postmortem evidence from brain banks and clinical imaging data of dopaminergic and cardiac sympathetic loss is reviewed. It is concluded that these datasets seem to be more compatible with the SOC model than with those alternative disease models of Lewy body disorders.
路易体障碍(包括帕金森病[PD]和路易体痴呆[DLB])的最终起源仍不完全清楚。尽管有大量的发病机制被牵涉其中,但越来越多的证据支持α-突触核蛋白的聚集和神经元间传播可能是这些疾病的核心特征。最近引入了路易体障碍的突触核蛋白、起源和连接组(SOC)疾病模型。该模型基于以下假设:在大多数患者中,第一个α-突触核蛋白病理学首先出现在单个部位,并从那里扩散。最常见的起源部位是肠神经系统和嗅觉系统。SOC 模型预测,肠道首先出现的病理学导致以自主症状和 REM 睡眠行为障碍为前驱期的躯体首现亚型。相比之下,嗅觉首现的病理学导致以大脑首现为主的亚型,在诊断前较少出现非运动症状。SOC 模型进一步预测,躯体首现的患者比大脑首现的患者年龄更大,更常出现对称的多巴胺能变性,并且痴呆的风险增加。在这篇综述中,解释了 SOC 模型,并与路易体障碍发病机制的替代模型(包括 Braak 分期系统和路易体障碍统一分期系统)进行了比较。从脑库的尸检证据和多巴胺能和心脏自主神经丧失的临床影像学数据进行了回顾。结论是,这些数据集似乎与 SOC 模型更兼容,而与路易体障碍的替代疾病模型不兼容。
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