Shanghai Frontiers Science Center of Drug Target Identification and Delivery, Engineering Research Center of Cell and Therapeutic Antibody, Ministry of Education, School of Pharmacy, Shanghai Jiao Tong University, Shanghai, 200240, China.
J Neuroinflammation. 2023 Jul 14;20(1):165. doi: 10.1186/s12974-023-02853-3.
Alzheimer's Disease (AD) contributes to most cases of dementia. Its prominent neuropathological features are the extracellular neuritic plaques and intercellular neurofibrillary tangles composed of aggregated β-amyloid (Aβ) and hyperphosphorylated tau protein, respectively. In the past few decades, disease-modifying therapy targeting Aβ has been the focus of AD drug development. Even though it is encouraging that two of these drugs have recently received accelerated US Food and Drug Administration approval for AD treatment, their efficacy or long-term safety is controversial. Tau has received increasing attention as a potential therapeutic target, since evidence indicates that tau pathology is more associated with cognitive dysfunction. Moreover, inflammation, especially neuroinflammation, accompanies AD pathological processes and is also linked to cognitive deficits. Accumulating evidence indicates that inflammation has a complex and tight interplay with tau pathology. Here, we review recent evidence on the interaction between tau pathology, focusing on tau post-translational modification and dissemination, and neuroinflammatory responses, including glial cell activation and inflammatory signaling pathways. Then, we summarize the latest clinical trials targeting tau and neuroinflammation. Sustained and increased inflammatory responses in glial cells and neurons are pivotal cellular drivers and regulators of the exacerbation of tau pathology, which further contributes to its worsening by aggravating inflammatory responses. Unraveling the precise mechanisms underlying the relationship between tau pathology and neuroinflammation will provide new insights into the discovery and clinical translation of therapeutic targets for AD and other tau-related diseases (tauopathies). Targeting multiple pathologies and precision therapy strategies will be the crucial direction for developing drugs for AD and other tauopathies.
阿尔茨海默病(AD)是导致大多数痴呆症的主要原因。其突出的神经病理学特征是细胞外神经突斑块和细胞内神经原纤维缠结,分别由聚集的β-淀粉样蛋白(Aβ)和过度磷酸化的 tau 蛋白组成。在过去的几十年中,针对 Aβ 的疾病修饰治疗一直是 AD 药物开发的重点。尽管最近有两种针对 AD 的药物因疗效显著而获得美国食品和药物管理局加速批准,但它们的疗效或长期安全性仍存在争议。由于证据表明 tau 病理学与认知功能障碍更为相关,tau 作为潜在的治疗靶点受到了越来越多的关注。此外,炎症,尤其是神经炎症,伴随着 AD 的病理过程,也与认知缺陷有关。越来越多的证据表明炎症与 tau 病理学之间存在复杂而紧密的相互作用。在这里,我们综述了 tau 病理学,重点是 tau 翻译后修饰和传播,以及神经炎症反应,包括神经胶质细胞激活和炎症信号通路之间相互作用的最新证据。然后,我们总结了最新的针对 tau 和神经炎症的临床试验。持续和增强的神经胶质细胞和神经元炎症反应是 tau 病理学恶化的关键细胞驱动因素和调节因素,通过加剧炎症反应进一步加重 tau 病理学。阐明 tau 病理学与神经炎症之间关系的确切机制将为 AD 和其他 tau 相关疾病(tau 病)的治疗靶点的发现和临床转化提供新的见解。针对多种病理和精准治疗策略将是开发 AD 和其他 tau 病药物的关键方向。
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