脑内β淀粉样蛋白清除的研究进展

脑内β淀粉样蛋白(Aβ)的清除主要包括细胞外降解、细胞内吞和外流转运。Aβ降解酶包括neprilysin、内皮素转化酶、胰岛素降解酶、血管紧张索转换酶、纤溶酶和基质金属蛋白酶-9等。细胞内吞由低密度脂蛋白受体相关蛋白和清道夫受体介导。转运清除包括血脑屏障转运和非特异性脑间质液泵流清除。针对上述三种清除途径,出现了以此为切入点的三种新的阿尔茨海默病治疗策略,包括上调Aβ降解酶基因表达或增加其活性以及促进细胞内吞清除和外流转运等干预措施。     

阿尔茨海默病中β-淀粉样蛋白清除机制的研究进展

β-淀粉样蛋白(Aβ)形成的斑块沉积是阿尔茨海默病(AD)的一个特征性病理改变。在早发型和散发型AD患者脑中均可出现Aβ清除障碍。了解Aβ清除途径的具体机制对寻找有效的AD治疗策略至关重要。本文将对Aβ细胞内降解清除途径、血脑屏障转运清除途径、脑间质液泵流清除途径及脑脊液吸收清除途径的具体机制作一综述。     

干预Aβ代谢及其毒性治疗阿尔茨海默病的研究现状及展望

β淀粉样蛋白(Aβ)是阿尔茨海默病(AD)特征性病理改变之一。淀粉样前体蛋白(APP)经分泌酶水解后产生有毒性的Aβ,转运至大脑异常聚集产生Aβ寡聚体,从而引起线粒体功能障碍、氧化应激、突触传递功能障碍等,最终引起乙酰胆碱酯酶神经元坏死,导致痴呆。因此减少Aβ在脑内的产生、促进Aβ清除、抑制Aβ聚集以及降低其神经毒性已成为治疗AD的主要措施之一,本文针对干预Aβ代谢及其神经毒性治疗AD的研究作一综述。     

血脑屏障与β-淀粉样蛋白相互作用在阿尔茨海默病的研究进展

既往研究普遍认为血脑屏障的破坏为血管性痴呆的始动因素,β淀粉样蛋白(Aβ)沉积为阿尔茨海默病的始动因素。然而随着对阿尔茨海默病发病机制研究的深入,越来越多的证据表明,血脑屏障与Aβ相互作用共同促进阿尔茨海默病的发生发展。     

干预Aβ代谢及其毒性治疗AD的研究现状及展望

阿尔茨海默病（AD）是老年痴呆最常见的原因,发病机制尚不清楚。近代研究提示,β淀粉样蛋白（Aβ）异常聚集及其神经毒性是AD的主要发病机制之一,因此如何减少Aβ在脑内聚集以及降低其毒心已成为治疗AD的主要措施之一,本文针对干预Aβ代谢及其神经毒性治疗AD的研究作一综述。     

Aducanumab治疗减少阿尔茨海默病患者脑内β淀粉样蛋白沉积

阿尔茨海默病(AD)的主要病理表现包括:β淀粉样蛋白(Aβ)沉积形成的老年斑、神经元纤维缠结同时合并突触功能障碍及其他神经退行性病变。Aducanumab是一种选择性针对聚集态Aβ的人单克隆抗体。在AD转基因小鼠的基础实验中,aducanumab通过血脑屏障进入脑内,与脑实质内的Aβ结合,降低脑内可溶性及不可溶性Aβ,且呈剂量效应关系。临床试验中,在AD临床前驱期和轻度阶段,每月静脉滴注1次aducanumab,持续1年,能有效减少脑内Aβ,作用也呈剂量依赖性和时间依赖性,受试者的认知功能衰退速度也有所减缓,表现为简明精神状态量表(MMSE)及临床痴呆量表总分(CDR-SB)评分下降速度减缓。Aducanumab的安全性和耐受性的主要问题是Aβ相关的影像学异常(ARIA)。目前aducanumab治疗AD的Ⅲ期临床试验正在进行,如能证实其具有延缓AD认知功能衰退,将是Aβ学说的强有力支持。     

α-分泌酶与阿尔茨海默病的治疗

淀粉样前体蛋白(APP)在脑内经β和γ分泌酶的作用生成β淀粉样蛋白(Aβ),也可在α和γ分泌酶的作用下从Aβ序列内部进行降解,生成sAPPα而避免Aβ的生成,sAPPα可对神经细胞产生神经营养和神经保护作用。Aβ在脑内沉积从而对细胞造成毒性作用即Aβ毒性学说被认为是阿尔茨海默病(AD)发病机制之一。目前AD的治疗策略主要集中于抑制β分泌酶和γ分泌酶的研究。新近的研究显示,一类属于解聚素和金属蛋白酶(主要指ADAM10、ADAM17和ADAM9)分子具有α分泌酶的功能,提高α分泌酶的表达可以降低Aβ,有可能在AD的治疗中具有潜在作用。     

β淀粉样蛋白诱导脑内神经元凋亡及褪黑素的保护作用

目的　探讨凋亡机制在 β 淀粉样蛋白 (Aβ)脑内致阿尔茨海默病 (AD)作用中的意义及褪黑素 (MT)对Aβ脑内神经毒性的干预效果。方法　将Aβ1 4 0 微量注射至大鼠右侧海马CA1区 ,7d后 ,用尼氏染色检测神经元丢失 ,HE染色、TUNEL染色及透射电镜检测细胞凋亡 ;用免疫组化SABC法检测Bax/Bcl 2的表达。结果　Aβ组右侧海马CA1区发现大量凋亡细胞 ,而假手术对照组和生理盐水对照组未发现细胞凋亡 ;Aβ组Bax表达增强 ,而Bcl 2表达在上述三组间无明显差异 ;MT组海马CA1区神经元计数为 47.4± 5 .9,明显多于Aβ组 (2 9.4± 4.5 ) ,但少于生理盐水对照组 (79.8± 7.6 )和假手术对照组 (83.1± 8.5 ) ,MT组细胞凋亡 (8.4± 3.7)少于Aβ组 (18.9± 6 .1)。 结论　Aβ能诱导脑内神经元凋亡 ,并可能与促进Bax的表达有关 ;MT能明显减轻Aβ的脑内神经毒性 ,补充MT可能有助于AD的防治     

急性脑梗死患者血浆β淀粉样蛋白的水平及意义

目的探讨急性脑梗死患者血浆β淀粉样蛋白(Aβ)的水平及其意义。方法采用放射免疫分析法测定95例急性脑梗死患者血浆中Aβ的水平,并与72例健康对照者进行比较。结果急性脑梗死患者血浆Aβ水平显著高于健康对照者,两组之间差异有统计学意义,急性脑梗死患者血浆Aβ水平与梗死体积大小以及NIHSS评分无相关性。结论急性脑梗死患者血浆Aβ水平异常增高,这些异常增多的Aβ可能会通过受损的血脑屏障进入脑内,发挥神经毒性作用,促使Alzheimer病(AD)的发生或加速AD的进展。     

朊病毒蛋白样作用的β淀粉样蛋白

β淀粉样蛋白(Aβ)在阿尔茨海默病(AD)的发病中所起的作用至今尚不完全清楚。近年来的几项研究,提出Aβ可能与朊病毒蛋白类似,可以在脑组织中传播。首先,Aβ在物理化学性质及增值方式方面都与朊病毒蛋白类似。其次,通过外周途径或脑内注射的方式向动物模型注射外源性Aβ后,均可引起脑内Aβ沉积。最后细胞水平的实验直接证明了Aβ可以在细胞之间传递。     

A Multifaceted Role for apoE in the Clearance of Beta-Amyloid across the Blood-Brain Barrier

Background: While apolipoprotein E4 (apoE4) is highly correlated with the development of Alzheimer's disease (AD), its role in AD pathology and, in particular, beta-amyloid (Aβ) removal from the brain, is not clearly defined. Objective: To elucidate the influence of apoE on the clearance of Aβ across the blood-brain barrier (BBB). Methods: Aβ(1-42) was intracerebrally administered to transgenic mice expressing human apoE isoforms and examined in the periphery. Results: apoE3 and apoE4 mice had 5 times and 2 times, respectively, more Aβ(1-42) appearing in the plasma than wild-type or apoE knockout mice, indicating an enhanced clearance of Aβ from the brain to the periphery. In vitro, unbound basolateral apoE3 (i.e., not bound to Aβ), and to a lesser extent unbound apoE4, at concentrations ≤10 nM facilitated basolateral-to-apical fluorescein-Aβ(1-42) transcytosis across a BBB model, while apoE isoforms bound to Aβ significantly disrupted Aβ transcytosis. Additionally, following apical exposure to the BBB model, we found that apoE4 bound to Aβ is able to penetrate the BBB more readily than apoE3 bound to Aβ and does so via the RAGE (receptor for advanced glycation end products) transporter. Conclusion: These studies indicate a multifaceted, isoform-dependent role for apoE in the exchange of Aβ across the BBB and may partially explain the association of apoE4 and Aβ brain accumulation in AD.     

Lipopolysaccharide alters the blood–brain barrier transport of amyloid β protein: A mechanism for inflammation in the progression of Alzheimer’s disease

Alzheimer’s disease (AD) brains are characterized by accumulation of amyloid β protein (Aβ) and neuroinflammation. Increased blood-to-brain influx and decreased brain-to-blood efflux across the blood–brain barrier (BBB) have been proposed as mechanisms for Aβ accumulation. Epidemiological studies suggest that the nonsteroidal anti-inflammatory drug (NSAID) indomethacin slows the progression of AD. We hypothesized that inflammation alters BBB handling of Aβ. Mice treated with lipopolysaccharide (LPS) had increased brain influx and decreased brain efflux of Aβ, recapitulating the findings in AD. Neither influx nor efflux was mediated by LPS acting directly on BBB cells. Increased influx was mediated by a blood-borne factor, indomethacin-independent, blocked by the triglyceride triolein, and not related to expression of the blood-to-brain transporter of Aβ, RAGE. Serum levels of IL-6, IL-10, IL-13, and MCP-1 mirrored changes in Aβ influx. Decreased efflux was blocked by indomethacin and accompanied by decreased protein expression of the brain-to-blood transporter of Aβ, LRP-1. LPS paradoxically increased expression of neuronal LRP-1, a major source of Aβ. Thus, inflammation potentially increases brain levels of Aβ by three mechanisms: increased influx, decreased efflux, and increased neuronal production.     

Role of the cannabinoid system in the transit of beta-amyloid across the blood–brain barrier

Emerging evidence suggests beta-amyloid (Aβ) deposition in the Alzheimer's disease (AD) brain is the result of impaired clearance, due in part to diminished Aβ transport across the blood–brain barrier (BBB). Recently, modulation of the cannabinoid system was shown to reduce Aβ brain levels and improve cognitive behavior in AD animal models. The purpose of the current studies was to investigate the role of the cannabinoid system in the clearance of Aβ across the BBB. Using in vitro and in vivo models of BBB clearance, Aβ transit across the BBB was examined in the presence of cannabinoid receptor agonists and inhibitors. In addition, expression levels of the Aβ transport protein, lipoprotein receptor-related protein1 (LRP1), were determined in the brain and plasma of mice following cannabinoid treatment. Cannabinoid receptor agonism or inhibition of endocannabinoid-degrading enzymes significantly enhanced Aβ clearance across the BBB (2-fold). Moreover, cannabinoid receptor inhibition negated the stimulatory influence of cannabinoid treatment on Aβ BBB clearance. Additionally, LRP1 levels in the brain and plasma were elevated following cannabinoid treatment (1.5-fold), providing rationale for the observed increase in Aβ transit from the brain to the periphery. The current studies demonstrate, for the first time, a role for the cannabinoid system in the transit of Aβ across the BBB. These findings provide insight into the mechanism by which cannabinoid treatment reduces Aβ burden in the AD brain and offer additional evidence on the utility of this pathway as a treatment for AD.     

Stimulation of the Retinoid X Receptor Facilitates Beta-Amyloid Clearance Across the Blood–Brain Barrier

Alzheimer’s disease (AD) is a neurodegenerative process characterized, in part, by the accumulation of beta-amyloid proteins (Aβ) in the brain. Evidence now suggests that the excessive Aβ accumulation is the result of impaired clearance from the brain. Recent studies have indicated that retinoid X receptor (RXR) activation stimulates the metabolic clearance of Aβ and rapidly reverses Aβ-induced behavioral deficits, doing so in an apoE-dependent manner. Previously, we reported that soluble apoE (i.e., not bound to Aβ) facilitated Aβ transit across the blood–brain barrier (BBB). As Aβ clearance from the brain involves both metabolic and BBB-mediated processes, the current studies investigated the impact of RXR stimulation on Aβ clearance across the BBB. Treatment with RXR agonists increased Aβ clearance across the BBB both in vitro and in vivo. Moreover, this processes appeared to involve apoE as RXR agonism did not stimulate Aβ BBB clearance when apoE was absent. Thus, RXR activation could mitigate Aβ brain burden by promoting both the metabolic and BBB clearance of Aβ, offering a novel approach to the treatment of AD.     

Aβ????-RAGE interaction disrupts tight junctions of the blood-brain barrier via Ca2?-calcineurin signaling

The blood-brain barrier (BBB), which is formed by adherens and tight junctions (TJs) of endothelial cells, maintains homeostasis of the brain. Disrupted intracellular Ca2? homeostasis and breakdown of the BBB have been implicated in the pathogenesis of Alzheimer's disease (AD). The receptor for advanced glycation end products (RAGE) is known to interact with amyloid β-peptide (Aβ) and mediate Aβ transport across the BBB, contributing to the deposition of Aβ in the brain. However, molecular mechanisms underlying Aβ-RAGE interaction-induced alterations in the BBB have not been identified. We found that Aβ???? induces enhanced permeability, disruption of zonula occludin-1 (ZO-1) expression in the plasma membrane, and increased intracellular calcium and matrix metalloproteinase (MMP) secretion in cultured endothelial cells. Neutralizing antibodies against RAGE and inhibitors of calcineurin and MMPs prevented Aβ????-induced changes in ZO-1, suggesting that Aβ-RAGE interactions alter TJ proteins through the Ca2?-calcineurin pathway. Consistent with these in vitro findings, we found disrupted microvessels near Aβ plaque-deposited areas, elevated RAGE expression, and enhanced MMP secretion in microvessels of the brains of 5XFAD mice, an animal model for AD. We have identified a potential molecular pathway underlying Aβ-RAGE interaction-induced breakage of BBB integrity. This pathway might play an important role in the pathogenesis of AD.     

Brain-reactive autoantibodies prevalent in human sera increase intraneuronal amyloid-β(1-42) deposition

Previous studies have reported immunoglobulin-positive neurons in Alzheimer's disease (AD) brains, an observation indicative of blood-brain barrier (BBB) breakdown. Recently, we demonstrated the nearly ubiquitous presence of brain-reactive autoantibodies in human sera. The significance of these observations to AD pathology is unknown. Here, we show that IgG-immunopositive neurons are abundant in brain regions exhibiting AD pathology, including intraneuronal amyloid-β(42) (Aβ(42)) and amyloid plaques, and confirm by western analysis that brain-reactive autoantibodies are nearly ubiquitous in human serum. To investigate a possible interrelationship between neuronal antibody binding and Aβ pathology, we tested the effects of human serum autoantibodies on the intraneuronal deposition of soluble Aβ(42) peptide in adult mouse neurons in vitro (organotypic brain slice cultures). Binding of human autoantibodies to mouse neurons dramatically increased the rate and extent of intraneuronal Aβ(42) accumulation in the mouse cerebral cortex and hippocampus. Additionally, individual sera exhibited variable potency related to their capacity to enhance intraneuronal Aβ(42) peptide accumulation and immunolabel neurons in AD brain sections. Replacement of human sera with antibodies targeting abundant neuronal surface proteins resulted in a comparable enhancement of Aβ(42) accumulation in mouse neurons. Overall, results suggest that brain-reactive autoantibodies are ubiquitous in the blood and that a defective BBB allows these antibodies to access the brain interstitium, bind to neuronal surfaces and enhance intraneuronal deposition of Aβ(42) in AD brains. Thus, in the context of BBB compromise, brain-reactive autoantibodies may be an important risk factor for the initiation and/or progression of AD as well as other neurodegenerative diseases.     

阿尔茨海默病转基因果蝇模型β淀粉样蛋白对胆碱能突触的毒性影响

目的研究β淀粉样蛋白（Aβ）多肽对阿尔茨海默病（AD）转基因果蝇大脑中胆碱神能经元突触的影响。方法分别建立转Aβ40,Aβ42基因果蝇AD两个模型组,以野生果蝇（canton-s）作为对照组。采用生物素染色和激光共聚焦成像记录投射神经元的形态;通过全细胞膜片钳方法记录各组投射神经元胆碱能的自发突触后电流和微兴奋性突触后电流;检测各组果蝇的嗅觉短期记忆能力。结果与对照组相比较,Aβ42组的自发突触后电流的频率和振幅均有明显降低,差异有统计学意义（P〈0.05）;Aβ42组微兴奋性突触后电流的频率明显下降,差异有统计学意义（P〈0.05）。在巴甫洛夫的嗅觉相关的短期学习记忆测试中,与对照组相比较,Aβ40,Aβ42两组果蝇学习记忆指数均明显降低,差异有统计学意义（P均〈0.05）。结论 Aβ肽对胆碱能突触传递的影响提示,其可能是由Aβ肽引起胆碱能神经元变性和记忆不断下降的可能机制之一。     

阿尔茨海默病患者Aβ40测定与载脂蛋白E基因关系

目的:探讨阿尔茨海默病(AD)患者体内β淀粉样蛋白(Aβ)的代谢异常。方法:随机选取70例正常人(对照组)、55例AD患者,检验其血浆中Aβ40水平和载脂蛋白E基因(ApoE)多态性,将AD按轻、中重度和不同ApoE基因型分组后与相应的对照组进行比较。结果:AD组、轻度AD组Aβ40较对照组差异无显著性(P>0.05);中重度AD组Aβ40较对照组升高,差异有显著性(P<0.05);有ApoEε4AD组较相应对照组Aβ40升高,有显著性差异(P<0.05),其它组别无显著性差异(P>0.05)。结论:AD患者体内Aβ40异常,与疾病的严重程度相关,与ApoEε4基因型相关。     

蛋白质氧化与阿尔茨海默病

阿尔茨海默病（AD）是与老年相关的进展性神经变性疾病,主要分子病理学特征为脑内淀粉样蛋白（Aβ）沉积形成的老年斑和过度磷酸化tau蛋白所形成的神经纤维缠结.氧化应激是包括AD在内的神经变性病的一个重要发病机制.本文介绍了氧化应激后蛋白质发生改变的类型、AD进展期间脑内蛋白质的氧化、Aβ沉积和tau蛋白过度磷酸化的原因以及今后对AD进行预防与治疗的一些策略.     

In vitro and in vivo study of dolichyl phosphate on the efflux activity of P-glycoprotein at the blood–brain barrier

It has been commonly recognized that accumulated amyloid-β (Aβ) in the brain plays a crucial role in the pathogenesis of Alzheimer's disease (AD). Since the deficiency of the P-glycoprotein (P-gp) at the blood–brain barrier (BBB) in AD may aggravate Aβ deposition and the P-gp reversal agents display lower selectivity of the action, to selectively restore activity of the efflux pump is eagerly required. This study was designed to investigate the influence of dolichyl-phosphate (dolichyl-P) on the P-gp at the BBB. The results revealed that treatment with dolichyl-P increased transendothelial transfer of Rhodamine123 (Rh123) and Aβ₄₂ from the apical compartment to the basolateral compartment but reduced that from the basolateral compartment to the apical compartment in the co-culture of rat brain microvessel endothelial cells (rBMECs) and astrocytes, down regulated P-gp expression in rBMECs and significantly elevated content of Rh123 in rat cortex and hippocampus tissues. The present results implied that accumulated dolichyl-P in the brain may exert an important role in the depression of the P-gp at the BBB, which may suggest valuable clues to promote function of the pump at the BBB in AD.