汇聚之路:抑郁症与阿尔茨海默病——共同的病理生理学和新的治疗方法。
Converged avenues: depression and Alzheimer's disease- shared pathophysiology and novel therapeutics.
机构信息
Department of Pharmacy, Birla Institute of Technology and Science (BITS), Pilani, 333031, Rajasthan, India.
出版信息
Mol Biol Rep. 2024 Jan 28;51(1):225. doi: 10.1007/s11033-023-09170-1.
Depression, a highly prevalent disorder affecting over 280 million people worldwide, is comorbid with many neurological disorders, particularly Alzheimer's disease (AD). Depression and AD share overlapping pathophysiology, and the search for accountable biological substrates made it an essential and intriguing field of research. The paper outlines the neurobiological pathways coinciding with depression and AD, including neurotrophin signalling, the hypothalamic-pituitary-adrenal axis (HPA), cellular apoptosis, neuroinflammation, and other aetiological factors. Understanding overlapping pathways is crucial in identifying common pathophysiological substrates that can be targeted for effective management of disease state. Antidepressants, particularly monoaminergic drugs (first-line therapy), are shown to have modest or no clinical benefits. Regardless of the ineffectiveness of conventional antidepressants, these drugs remain the mainstay for treating depressive symptoms in AD. To overcome the ineffectiveness of traditional pharmacological agents in treating comorbid conditions, a novel therapeutic class has been discussed in the paper. This includes neurotransmitter modulators, glutamatergic system modulators, mitochondrial modulators, antioxidant agents, HPA axis targeted therapy, inflammatory system targeted therapy, neurogenesis targeted therapy, repurposed anti-diabetic agents, and others. The primary clinical challenge is the development of therapeutic agents and the effective diagnosis of the comorbid condition for which no specific diagnosable scale is present. Hence, introducing Artificial Intelligence (AI) into the healthcare system is revolutionary. AI implemented with interdisciplinary strategies (neuroimaging, EEG, molecular biomarkers) bound to have accurate clinical interpretation of symptoms. Moreover, AI has the potential to forecast neurodegenerative and psychiatric illness much in advance before visible/observable clinical symptoms get precipitated.
抑郁症是一种全球范围内影响超过 2.8 亿人的高发疾病,与许多神经疾病共病,特别是阿尔茨海默病(AD)。抑郁症和 AD 具有重叠的病理生理学,寻找可解释的生物学基础使其成为一个重要而有趣的研究领域。本文概述了与抑郁症和 AD 相一致的神经生物学途径,包括神经生长因子信号、下丘脑-垂体-肾上腺轴(HPA)、细胞凋亡、神经炎症和其他病因因素。了解重叠途径对于确定可用于有效管理疾病状态的共同病理生理基础至关重要。抗抑郁药,特别是单胺能药物(一线治疗),显示出适度或没有临床益处。尽管传统抗抑郁药无效,但这些药物仍然是治疗 AD 中抑郁症状的主要药物。为了克服传统药物在治疗共病方面的无效性,本文讨论了一种新的治疗类别。这包括神经递质调节剂、谷氨酸能系统调节剂、线粒体调节剂、抗氧化剂、HPA 轴靶向治疗、炎症系统靶向治疗、神经发生靶向治疗、重新利用的抗糖尿病药物等。主要的临床挑战是开发治疗药物和有效诊断共病,而对于共病,目前没有特定的可诊断的量表。因此,将人工智能(AI)引入医疗保健系统是革命性的。人工智能与跨学科策略(神经影像学、脑电图、分子生物标志物)结合使用,有望对症状进行准确的临床解读。此外,人工智能有可能在可见/可观察到的临床症状出现之前,提前预测神经退行性和精神疾病。