针对突触核蛋白病和tau蛋白病中患病蛋白的免疫疗法:来自临床试验的见解

Immunization targeting diseased proteins in synucleinopathy and tauopathy: insights from clinical trials.

作者信息

Zhan Xiaoni, Wen Gehua, Wu Xu, Li Jia-Yi

机构信息

School of Forensic Medicine, China Medical University, Shenyang, 110122, China.

Neural Plasticity and Repair Unit, Department of Experimental Medical Science, Wallenberg Neuroscience Center, Lund University, BMC A10, 22184, Lund, Sweden.

出版信息

Transl Neurodegener. 2025 Jul 1;14(1):33. doi: 10.1186/s40035-025-00490-9.

Abstract

Synucleinopathies and tauopathies are neurodegenerative disorders characterized by the pathological accumulation of α-synuclein (α-syn) and tau proteins, respectively. These disorders are traditionally managed with symptomatic treatments without addressing the underlying pathologies. Recent advancements in passive immunotherapies, notably the FDA approval of the amyloid-beta (Aβ)-targeting antibody lecanemab, have sparked new hope in directly targeting pathological proteins. However, unlike the extracellular Aβ pathology, immunotherapies aimed at α-syn and tau, which predominantly form intracellular inclusions, face substantial challenges. To date, the therapeutic efficacy of five α-syn and 14 tau antibodies has been assessed in patients with synucleinopathies and tauopathies. These immunizations have demonstrated promising preclinical outcomes in alleviating pathological and behavioral deficits, but have not yielded significant clinical improvements in symptoms or measurable biomarkers. Therefore, a clear understanding of potential causes for the discrepancies between preclinical successes and clinical outcomes is critical for the successful translation of immunotherapy in the future. In this review, we examine existing passive immunotherapeutic strategies targeting α-syn and tau, specifically in patients with Alzheimer's disease and Parkinson's disease. Lessons learned from initial trial failures are also discussed, including refinement of animal models, inclusion and stratification of participants, improvement of clinical evaluations, and development of biomarkers. Given the overlapping pathologies and clinical manifestations of synucleinopathies and tauopathies, we further explore the potential of combined therapies targeting co-pathologies, offering novel insights for future therapeutic development against these neurodegenerative disorders.

摘要

突触核蛋白病和tau蛋白病是神经退行性疾病,其特征分别是α-突触核蛋白(α-syn)和tau蛋白的病理性积聚。传统上,这些疾病采用对症治疗,而未针对潜在的病理机制。被动免疫疗法的最新进展,尤其是美国食品药品监督管理局(FDA)批准了靶向淀粉样β(Aβ)的抗体lecanemab,为直接靶向病理性蛋白带来了新希望。然而,与细胞外Aβ病理不同,针对主要形成细胞内包涵体的α-syn和tau的免疫疗法面临重大挑战。迄今为止,已在突触核蛋白病和tau蛋白病患者中评估了5种α-syn抗体和14种tau抗体的治疗效果。这些免疫疗法在减轻病理和行为缺陷方面已显示出有前景的临床前结果,但在症状或可测量的生物标志物方面尚未取得显著的临床改善。因此,清楚了解临床前成功与临床结果之间差异的潜在原因对于未来免疫疗法的成功转化至关重要。在这篇综述中,我们研究了针对α-syn和tau的现有被动免疫治疗策略,特别是在阿尔茨海默病和帕金森病患者中的应用。我们还讨论了从初步试验失败中吸取的教训,包括动物模型的优化、参与者的纳入和分层、临床评估的改进以及生物标志物的开发。鉴于突触核蛋白病和tau蛋白病在病理和临床表现上的重叠,我们进一步探讨了针对共同病理的联合疗法的潜力,为未来针对这些神经退行性疾病的治疗发展提供了新的见解。

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