Bayraktaroglu Irem, Ortí-Casañ Natalia, Van Dam Debby, De Deyn Peter P, Eisel Ulrich L M
Department of Molecular Neurobiology, Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, The Netherlands.
Department of Neurology and Alzheimer Research Centre, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
Immun Ageing. 2025 Aug 21;22(1):33. doi: 10.1186/s12979-025-00529-5.
Alzheimer's disease (AD) is an age-related neurodegenerative disorder and the most common cause of dementia. While the amyloid cascade hypothesis has long dominated AD research, emerging evidence suggests that neuroinflammation may play a more central role in disease onset and progression. Increasingly, AD is recognized as a multifactorial disorder influenced by systemic inflammation and immune dysregulation, shifting focus toward peripheral immune mechanisms as potential contributors to neurodegeneration. This review explores the hypothesis that inflammaging, the age-related increase in pro-inflammatory mediators, combined with lifelong exposure to infections, injuries, metabolic changes, and chronic diseases, among others, may prime the immune system, amplifying neuroinflammation and influencing the progression and exacerbation of AD pathology. To this end, we examined how systemic immune disturbances, including chronic pain, post-operative cognitive dysfunction, viral and bacterial infections, gut microbiome dysregulation, and cardiovascular disease, may act as risk factors for AD. Overall, evidence suggests that modulating peripheral inflammation, accompanied by early diagnosis, could significantly reduce the risk of developing AD. Furthermore, we highlight key immune signaling pathways involved in both central and peripheral immune responses, such as the NLRP3 inflammasome and TREM2, which represent promising therapeutic targets for modulating inflammation while preserving protective immune functions. Strategies aimed at reducing systemic inflammation, identifying early biomarkers, and intervening before significant neurodegeneration occurs may provide novel approaches to delay or prevent AD onset. In conclusion, this review underscores the crucial role of systemic inflammation in AD pathogenesis and progression. By targeting peripheral immune dysfunction, we may advance our understanding of AD mechanisms and develop more effective therapeutic interventions to mitigate disease risk and progression.
阿尔茨海默病(AD)是一种与年龄相关的神经退行性疾病,也是痴呆最常见的病因。虽然淀粉样蛋白级联假说长期主导着AD研究,但新出现的证据表明,神经炎症可能在疾病的发生和发展中发挥更核心的作用。越来越多的研究认为,AD是一种受全身炎症和免疫失调影响的多因素疾病,这使得人们将注意力转向外周免疫机制,认为其可能是神经退行性变的促成因素。本综述探讨了这样一种假说:炎症衰老,即促炎介质随年龄增长而增加,再加上终生暴露于感染、损伤、代谢变化和慢性疾病等因素,可能会使免疫系统致敏,放大神经炎症,并影响AD病理的进展和恶化。为此,我们研究了包括慢性疼痛、术后认知功能障碍、病毒和细菌感染、肠道微生物群失调以及心血管疾病在内的全身免疫紊乱如何可能成为AD的危险因素。总体而言,有证据表明,调节外周炎症并结合早期诊断,可显著降低患AD的风险。此外,我们强调了参与中枢和外周免疫反应的关键免疫信号通路,如NLRP3炎性小体和触发受体表达于髓细胞2(TREM2),它们代表了在保留保护性免疫功能的同时调节炎症的有前景的治疗靶点。旨在减少全身炎症、识别早期生物标志物并在显著神经退行性变发生之前进行干预的策略,可能会提供延缓或预防AD发病的新方法。总之,本综述强调了全身炎症在AD发病机制和进展中的关键作用。通过针对外周免疫功能障碍,我们可能会加深对AD机制的理解,并开发出更有效的治疗干预措施,以降低疾病风险和减缓疾病进展。
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