胶质纤维酸性蛋白在阿尔茨海默病神经病理学中的作用及其作为早期诊断和病情进展血液生物标志物的潜力。

The Role of Glial Fibrillary Acidic Protein in the Neuropathology of Alzheimer's Disease and Its Potential as a Blood Biomarker for Early Diagnosis and Progression.

作者信息

Bandara Ekanayaka M S, Asih Prita R, Pedrini Steve, Hone Eugene, Fernando Warnakulasuriya Mary Ann Dipika Binosha, Martins Ralph N

机构信息

Centre of Excellence for Alzheimer's Disease Research and Care, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.

Alzheimer's Research Australia, Ralph and Patricia Sarich Neuroscience Research Institute, Nedlands, WA, 6009, Australia.

出版信息

Mol Neurobiol. 2025 Jul 21. doi: 10.1007/s12035-025-05219-3.

Abstract

Alzheimer's disease (AD) is a neurodegenerative disease characterised by neuropathological hallmarks, including extracellular amyloid plaques and neurofibrillary tangles. The disease is clinically defined by cognitive dysfunction, including learning, memory deficits, and behavioural changes. With the rising global prevalence of AD, early diagnosis is critical for implementing effective interventions before irreversible neuronal damage occurs. Biomarkers correlating amyloid deposition, tau pathology, neuroinflammation, and neurodegeneration are currently being investigated using cerebrospinal fluid analysis and positron emission tomography imaging. These methods are invasive or costly, limiting their widespread clinical utility. Blood-based biomarkers offer a promising alternative due to accessibility, cost-effectiveness, and feasibility for large-scale screening. Among blood-based biomarkers, plasma glial fibrillary acidic protein (GFAP) levels have gained interest in identifying individuals at risk of AD at preclinical stages. However, significant challenges remain, including methodological inconsistencies, analytical variability, and the need for standardisation across immunoassay platforms to ensure the clinical applicability of plasma GFAP measurement in AD diagnosis. Additionally, the specificity of GFAP for AD needs further evaluation, as increased plasma levels are also observed in other diseases. Similar issues are found with p-tau 217, the blood biomarker candidate for AD that has received the most attention. This review summarises the role of GFAP in the neuropathology of AD, provides evidence on plasma GFAP as an early blood biomarker for AD and identifies key knowledge gaps that need to be addressed. Future advancements in assay development and large-scale longitudinal studies are essential to validate its diagnostic and prognostic potential for community-based AD screening.

摘要

阿尔茨海默病(AD)是一种神经退行性疾病,其特征在于神经病理学特征,包括细胞外淀粉样斑块和神经原纤维缠结。该疾病在临床上由认知功能障碍定义,包括学习、记忆缺陷和行为改变。随着全球AD患病率的上升,早期诊断对于在不可逆的神经元损伤发生之前实施有效干预至关重要。目前正在使用脑脊液分析和正电子发射断层扫描成像研究与淀粉样蛋白沉积、tau病理学、神经炎症和神经退行性变相关的生物标志物。这些方法具有侵入性或成本高昂,限制了它们的广泛临床应用。基于血液的生物标志物由于其可及性、成本效益和大规模筛查的可行性而提供了一种有前景的替代方法。在基于血液的生物标志物中,血浆胶质纤维酸性蛋白(GFAP)水平在识别临床前阶段有AD风险的个体方面引起了关注。然而,仍然存在重大挑战,包括方法不一致、分析变异性以及跨免疫测定平台标准化的需求,以确保血浆GFAP测量在AD诊断中的临床适用性。此外,GFAP对AD的特异性需要进一步评估,因为在其他疾病中也观察到血浆水平升高。在p-tau 217方面也发现了类似问题,p-tau 217是AD最受关注的血液生物标志物候选物。本综述总结了GFAP在AD神经病理学中的作用,提供了血浆GFAP作为AD早期血液生物标志物的证据,并确定了需要解决的关键知识差距。检测方法开发和大规模纵向研究的未来进展对于验证其在社区AD筛查中的诊断和预后潜力至关重要。

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