单核细胞和阿尔茨海默病

阿尔茨海默病(Alzheimer's disease,AD)是神经退行性疾病中最常见的类型.胞外β淀粉样蛋白(amyloid beta,AB)的沉积和胞内神经原纤维的缠结是典型的AD神经病理学特征.单核细胞是天然免疫细胞,可以有效清除坏死细胞及碎片.在AD模型鼠上的许多实验研究表明,Aβ可以使单核细胞向大脑募集,从而限...     

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。     

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。     

β淀粉样蛋白25-35诱导皮质神经元tau蛋白过度磷酸化

目前阿尔茨海默病(Alzheimerdisease,AD)研究仍缺乏理想的动物模型,细胞模型通过复制AD的某些分子生化改变,可用于研究AD的发病机制和筛选治疗药物。脑内β淀粉样蛋白(Aβ)的大量沉积和tau蛋白过度磷酸化是AD的两大主要分子生化改变。淀粉样瀑布学说认为Aβ可直接诱导神经元tau     

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。     

免疫治疗阿尔茨海默病的研究及其意义

阿尔茨海默病(AD)是一种神经退行性疾病,其显著病理特征之一为患者脑内产生由42个氨基酸构成的β-淀粉样蛋白(β-amyloid protein,Aβ42),目前认为Aβ42的纤维化和沉积是AD发生和发展的一个主要因素.该文就以减轻脑内Aβ42的负荷、阻止和逆转Aβ42的纤维化和沉积为最终目标的免疫治疗AD的主要方法、效果以及其研究意义进行综述,为相关领域的研究者提供参考.     

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。     

阿尔茨海默病的分子生物学

为阐明阿尔茨海默病(AD)的病因,在分子生 物学方面主要进行了以下研究:(1)AD脑内蓄积物质的形成机制;(2)AD的分子遗传学;(3)AD神经细胞死亡。 老年斑(SP)是由沉着淀粉样蛋白的中心部和边缘部线头样神经突起及反应性胶质细胞构成的。该淀粉样蛋白的主要成分为β/A4蛋白,1987年已阐明了它是由长前体(淀粉样β/A4蛋白前体:APP)产生的。目前研究的主要课题是把APP作为一种膜蛋白,研究其分解途径和与之有关的蛋白酶。     

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。     

阿尔茨海默病的免疫治疗

β淀粉样蛋白(Aβ)的沉积是阿尔茨海默病发病的始发因素,所形成的老年斑是该病的主要病理改变之一。针对Aβ的免疫治疗包括主动免疫和被动免疫,许多动物实验证明Aβ的免疫治疗可以预防或清除脑中淀粉样蛋白沉积,并使动物认知功能改善。虽然Aβ疫苗的临床试验中部分患者脑内特定区域淀粉样蛋白的沉积得到有效遏制,但由于严重的副作用而终止。免疫治疗真正运用于人类阿尔茨海默病的预防和治疗仍有很多问题需要解决。     

Epilepsy and anomalies of neuronal migration: MRI and clinical aspects

Neuronal migration disorders are the result of disturbed brain development. In such disorders, neurons are abnormally located. In diagnosing these conditions, magnetic resonance imaging is superior to any other imaging technique. This enables us to improve our knowledge of the clinical correlates of neuronal migration. With reference to migrational disorder, a retrospective study of all 303 patients with epileptic seizures referred for magnetic resonance imaging during a 3-year period was performed, 13 patients (aged 12-41, mean age 27) were identified. They represent 4.3% of the entire study group. Of the patients with known epilepsy, 6.7% and of the mentally retarded, 13.7% had migrational disorders. Four patients had schizencephaly as the dominant finding, one was classified as hemimegalencephaly, 2 had isolated heterotopias, and 6 had localized pachy- and/or poly-microgyria. The clinical pictures are complex. Ectopias of grey matter are recognised foci of epilepsy, but from an epileptological and a clinical viewpoint little attention has been given to these disorders. The present study shows that malmigration is not rare in epilepsy patients, especially not in the mentally retarded.     

Classification of methods in transcranial Electrical Stimulation (tES) and evolving strategy from historical approaches to contemporary innovations

Transcranial Electrical Stimulation (tES) encompasses all methods of non-invasive current application to the brain used in research and clinical practice. We present the first comprehensive and technical review, explaining the evolution of tES in both terminology and dosage over the past 100 years of research to present day. Current transcranial Pulsed Current Stimulation (tPCS) approaches such as Cranial Electrotherapy Stimulation (CES) descended from Electrosleep (ES) through Cranial Electro-stimulation Therapy (CET), Transcerebral Electrotherapy (TCET), and NeuroElectric Therapy (NET) while others like Transcutaneous Cranial Electrical Stimulation (TCES) descended from Electroanesthesia (EA) through Limoge, and Interferential Stimulation. Prior to a contemporary resurgence in interest, variations of transcranial Direct Current Stimulation were explored intermittently, including Polarizing current, Galvanic Vestibular Stimulation (GVS), and Transcranial Micropolarization. The development of these approaches alongside Electroconvulsive Therapy (ECT) and pharmacological developments are considered. Both the roots and unique features of contemporary approaches such as transcranial Alternating Current Stimulation (tACS) and transcranial Random Noise Stimulation (tRNS) are discussed. Trends and incremental developments in electrode montage and waveform spanning decades are presented leading to the present day. Commercial devices, seminal conferences, and regulatory decisions are noted. We conclude with six rules on how increasing medical and technological sophistication may now be leveraged for broader success and adoption of tES.     

Hepatic Considerations in the Use of Antiepileptic Drugs

Summary: Virtually all of the major antiepileptic drugs (AEDs) can cause hepatotoxicity, although fatal hepatic reactions are rare. The mechanisms, incidences, and risk profiles for such reactions differ from drug to drug. With carbamazepine and phenytoin, hepatotoxicity may be due to drug hypersensitivity. Although the profiles of patients at risk have not been well-defined for these two antiepileptic drugs, it would appear from reports in the literature that older adolescents and adults are at higher risk than children of developing serious or fatal hepatotoxicity. Once hepatotoxicity develops, mortality rates are 10–38% with phenytoin and 25% for carbamazepine. The risk profile for valproate fatal hepatotoxicity has been more clearly defined. Those at primary risk of fatal hepatic dysfunction are children under the age of 2 years who are receiving multiple anticonvulsants and also have significant medical problems in addition to severe epilepsy. The risk is considerably lower for patients over the age of 2 years on valproate monotherapy. In contrast to the risk profile with other AEDs, adults receiving valproate as monotherapy have the lowest risk of hepatotoxicity. Fatal hepatic dysfunction coincident with valproate may be the result of aberrant drug metabolism. Concomitant use of AEDs that induce microsomal P450 enzymes (e.g., phenytoin and phenobarbital) may enhance the production of a toxic metabolite, and hence the greater risk of hepatotoxicity with polypharmacy.     

Vascular Malformations and Epilepsy: Clinical Considerations and Basic Mechanisms

Summary: Vascular malformations (VMs) are associated with epilepsy. The natural history of the various VMs, clinical presentation, and tendency to provoke epilepsy determine treatment strategies. Investigations have probed the mechanisms of epileptogenesis associated with these lesions. Electrophysiologic changes are associated with epileptogenic cortex adjacent to VMs. Putative pathophysiologic mechanisms of epileptogenesis include neuronal cell loss, glial proliferation and abnormal glial physiology, altered neurotransmitter levels, free radical formation, and aberrant second messenger physiology.     

Neonatal Seizures: Problems in Diagnosis and Classification

Summary: The clinical identification of neonatal seizures is critical for the recognition of brain dysfunction; however, diagnosis is often difficult because of the poorly organized and varied nature of these behaviors. Current classification systems are limited in their ability to communicate motor, autonomic, and electroencephalo-graphic features of seizures precisely and to provide a basis for uniform effective diagnosis, therapy, and determination of prognosis. Recent investigations of neonates, utilizing bedside electroencephalographic/polygraphic/ video monitoring techniques, have provided the basis for improved diagnosis and classification of seizures in the newborn. These studies have demonstrated that not all clinical phenomena currently considered to be seizures require electrocortical epileptiform activity for their initiation or elaboration. In addition, the specific clinical character of the phenomena considered to be seizures, the clinical state of the infant, and the character of the EEG indicate the probable pathophysiological mechanisms involved and suggest probable etiologies, prognosis, and therapy. Similarities between animal models that demonstrate reflex physiology and neonates with motor automatisms and tonic posturing suggest that these clinical behaviors may not be epileptic in origin but, rather, primitive movements of progression and posture mediated by brainstem mechanisms. Although not all clinical behaviors currently considered to be neonatal seizures may have similar pathophysiological mechanisms, they are clinically significant because they all indicate brain dysfunction.     

Valproate Monotherapy in the Management of Generalized and Partial Seizures

Summary: For decades, therapeutic tradition has promoted the concept of polypharmacy in the management of epilepsy. In recent years, however, studies have shown that, for most patients, monotherapy can provide comparable or better seizure control than administration of multiple anticonvulsants, while diminishing the potential for adverse reactions, drug interactions, and poor compliance. Valproate is an important monotherapeutic agent that is highly effective in the control of idiopathic primary and secondarily generalized epilepsies, and partial seizures that do not generalize. Comparative studies have found that valproate is at least as effective as phenytoin and carbamazepine in the treatment of generalized and partial seizures. Given the similar efficacy, other factors such as pharmacokinetics and side effects may therefore determine anticonvulsant selection for monotherapy.     

Carbamazepine Efficacy and Utilization in Children

Summary: Carbamazepine is effective for preventing partial and generalized tonic-clonic seizures in children. Although absence epilepsies are more common in children than adults, an estimated 80% of children with epilepsy have seizure types or epilepsies that are potentially responsive to carbamazepine. The differential diagnosis of ictal staring is an especially important issue in children because absence and atypical absence seizures are more prevalent in children than adults. Age-related pharmacokinetic differences and drug interactions are major considerations in children. On average, children have higher clearance rates of carbamazepine, shorter half-lives, and higher ratios of carbamazepine-10, 11-epoxide to carbamazepine than adults. In addition, children with severe epilepsy are more likely to require multiple-drug therapy, which can lead to complex drug interactions. When carbamazepine is administered along with valproate, drug protein binding interactions can cause intermittent side effects.     

Un nouveau cadre conceptuel de travail pour la psychiatrie

In an attempt to place psychiatric thinking and the training of future psychiatrists more centrally into the context of modern biology, the author outlines the beginnings of a new intellectual framework for psychiatry that derives from current biological thinking about the relationship of mind to brain. The purpose of this framework is twofold. First, it is designed to emphasize that the professional requirements for future psychiatrists will demand a greater knowledge of the structure and functioning of the brain than is currently available in most training programs. Second, it is designed to illustrate that the unique domain which psychiatry occupies within academic medicine, the analysis of the interaction between social and biological determinants of behavior, can best be studied by also having a full understanding of the biological components of behavior.