Huntington's disease

亨廷顿氏病
  • 文章类型: Journal Article
    亨廷顿病(HD),一种罕见的常染色体显性神经退行性疾病,导致基底神经节神经元的逐渐退化,特别是在纹状体。HD显示了各种各样的症状,来自舞蹈等运动干扰,肌张力障碍,和运动迟缓更衰弱的症状,如认知能力下降,行为异常,和精神病。目前的研究表明,饮食干预作为减缓HD进展的可行策略的潜在用途。最值得注意的是,地中海,素食主义者,食肉动物,paleo,生酮饮食因其对各种神经退行性疾病的神经保护和症状调节的假设影响而受到关注。尽管这些饮食之间的营养差异很大,他们有一个基本前提,即饮食因素对改变与神经变性相关的生物学通路有影响.了解这些饮食方案与HD发病机制之间的复杂相互作用,可以为根据个体的特定需求和遗传背景量身定制的个性化干预措施开辟途径。最终,阐明这些饮食对HD的多方面影响为开发将饮食策略与常规治疗相结合的综合治疗方法提供了有希望的框架。
    Huntington\'s disease (HD), a rare autosomal dominant neurodegenerative disease, causes the gradual deterioration of neurons in the basal ganglia, specifically in the striatum. HD displays a wide range of symptoms, from motor disturbances such as chorea, dystonia, and bradykinesia to more debilitating symptoms such as cognitive decline, behavioral abnormalities, and psychiatric disturbances. Current research suggests the potential use of dietary interventions as viable strategies for slowing the progression of HD. Most notably, the Mediterranean, vegan, carnivore, paleo, and ketogenic diets have gained attention due to their hypothesized impact on neuroprotection and symptomatic modulation in various neurodegenerative disorders. Despite substantial nutritional differences among these diets, they share a fundamental premise-that dietary factors have an influential impact in modifying pertinent biological pathways linked to neurodegeneration. Understanding the intricate interactions between these dietary regimens and HD pathogenesis could open avenues for personalized interventions tailored to the individual\'s specific needs and genetic background. Ultimately, elucidating the multifaceted effects of these diets on HD offers a promising framework for developing comprehensive therapeutic approaches that integrate dietary strategies with conventional treatments.
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  • 文章类型: Journal Article
    背景:尽管亨廷顿病(HD)通常被认为是运动的三联症,认知,和精神症状,人们越来越认识到HD是一种影响整个身体的系统性疾病。
    目的:这篇综述旨在引起人们对HD患者这些系统性非运动症状的关注。
    方法:我们通过搜索MEDLINE(从1966年到2023年9月)确定了以英文发表的相关研究,使用以下主题词:亨廷顿病,自主性,系统性,心血管,呼吸,胃肠,泌尿,性和皮肤,和其他特定症状。
    结果:对123篇文章的数据进行了严格审查,重点关注与HD相关的系统特征,比如心血管,呼吸,胃肠,泌尿,性和出汗
    结论:本系统综述提请注意HD患者的各种系统性和自主神经并发症。并非所有这些都与原发性HD症状或CAG重复的严重程度相关。需要更多的研究来更好地了解HD的全身和自主神经功能障碍的病理生理学和治疗。
    BACKGROUND: Although Huntington\'s disease (HD) is usually thought of as a triad of motor, cognitive, and psychiatric symptoms, there is growing appreciation of HD as a systemic illness affecting the entire body.
    OBJECTIVE: This review aims to draw attention to these systemic non-motor symptoms in HD.
    METHODS: We identified relevant studies published in English by searching MEDLINE (from 1966 to September 2023), using the following subject headings: Huntington disease, autonomic, systemic, cardiovascular, respiratory, gastrointestinal, urinary, sexual and cutaneous, and additional specific symptoms.
    RESULTS: Data from 123 articles were critically reviewed with focus on systemic features associated with HD, such as cardiovascular, respiratory, gastrointestinal, urinary, sexual and sweating.
    CONCLUSIONS: This systematic review draws attention to a variety of systemic and autonomic co-morbidities in patients with HD. Not all of them correlate with the severity of the primary HD symptoms or CAG repeats. More research is needed to better understand the pathophysiology and treatment of systemic and autonomic dysfunction in HD.
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  • 文章类型: Meta-Analysis
    背景:亨廷顿病(HD)是一种常染色体显性疾病,由亨廷顿蛋白编码基因中异常高的CAG重复序列引起,HTT.这种遗传改变导致突变形式的蛋白质(mHTT)的表达和细胞内聚集体的形成。在受影响的区域内诱导炎症状态。这种炎症反应的功能障碍导致CNS组织样品和体液中相关炎症标记物的水平升高。本研究旨在研究HD中炎症分子的外周/血液浓度。
    方法:在MEDLINE中进行了搜索,Scopus,WebofScience,和Embase数据库直到3月30日,2023年。随机效应荟萃分析用于探索HD中炎性分子的浓度。亚组和敏感性分析用于评估纳入研究之间的异质性。该研究方案已在PROSPERO中注册,ID号为CRD42022296078。
    结果:10项研究纳入荟萃分析。与对照组相比,HD中的白细胞介素6(IL-6)和IL-10的血浆水平更高。其他生物标志物,即,补体成分C反应蛋白(CRP),C3,干扰素-γ(IFN-γ),IL-1,IL-2,IL-8和肿瘤坏死因子-α(TNF-α),两组之间没有显着差异。此外,亚组分析结果确定,在显证前和显证前的HD患者中,体液中这些生物标志物水平无显著差异.
    结论:本研究的结果为HD患者与健康对照组相比存在更高的血浆IL-6和IL-10水平提供了证据。
    Huntington\'s disease (HD) is an autosomal dominant disease caused by an abnormally high number of CAG repeats at the huntingtin-encoding gene, HTT. This genetic alteration results in the expression of a mutant form of the protein (mHTT) and the formation of intracellular aggregates, inducing an inflammatory state within the affected areas. This dysfunction of inflammatory response leads to elevated levels of related inflammatory markers in both CNS tissue samples and body fluids. This study aims to investigate peripheral/blood concentrations of inflammatory molecules in HD.
    A search was conducted in MEDLINE, Scopus, Web of Science, and Embase databases until March 30th, 2023. Random-effect meta-analysis was used for exploring concentrations of inflammatory molecules in HD. Subgroup and sensitivity analyses were used to assess heterogeneity among the included studies. The study protocol has been registered in PROSPERO with the ID number CRD42022296078.
    Ten studies were included in the meta-analysis. Plasma levels of Interleukin 6 (IL-6) and IL-10 were higher in HD compared to controls. Other biomarkers, namely, complement component C-reactive protein (CRP), C3, interferon-γ (IFN-γ), IL-1, IL-2, IL-8, and tumor necrosis factor-α (TNF-α), did not show any significant differences between the two groups. In addition, the subgroup analysis results established no significant differences in levels of these biomarkers in body fluids among premanifest and manifest HD patients.
    The results of this study provide evidence for the presence of higher plasma levels of IL-6 and IL-10 in HD patients in comparison with healthy controls.
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  • 文章类型: Journal Article
    Huntington\'s disease (HD) is a rare, inherited disorder with a broad spectrum of manifestations that vary with disease severity and progression. Although genetic testing can readily confirm the initial diagnosis of HD, markers sensitive to HD progression are needed to aid the development of individual treatment plans. The current analysis aims to identify plasma Interleukin-6 (IL-6) as a marker of disease progression in HD patients. A systematic search of PubMed and Medline from conception through October 2021 was conducted. Studies reporting plasma IL-6 levels of mutation-positive HD patients and healthy controls that met inclusion criteria were selected. The search strategy collected 303 studies, 9 of which met analysis inclusion criteria. From included studies, plasma IL-6 levels of 469 individuals with the HD mutation and 206 healthy controls were collected. Plasma IL-6 levels were meta-analytically compared between healthy controls and individuals with the confirmed HD mutation at all stages of disease and correlated to performance on standardized measures of total cognitive and motor function. Plasma IL-6 was significantly increased in HD groups compared to controls (g = 0.73, 95% CI = 0.31,1.16, P < 0.01) and increased significantly throughout most stages of disease progression, notably between pre-manifest and manifest (g = 0.31, 95% CI = 0.04,0.59, P < 0.05) and early and moderate HD stages (g = 0.52, 95% CI = 0.18,0.86, P < 0.01). Significant correlations between plasma IL-6 levels and HD symptomatic progression were identified, with increased cytokine levels associated with more severe motor impairments (r = 0.179, 95% CI = 0.0479,0.304, P = 0.008) and more extreme disabilities in activities of daily living and/or work tasks (r = -0.229, 95% CI = -0.334, -0.119, P < 0.001). Conclusively, plasma IL-6 levels correlate with disease and motor symptom progression and may act as a viable marker for clinical use. Analysis is limited by small study numbers and highlights the need for future work to identify definitive ranges or rates of change of plasma IL-6 levels that correlate to progressive HD disease states.
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  • 文章类型: Journal Article
    干细胞由于其巨大的治疗潜力多年来一直是研究的主题。大多数神经系统疾病,如多发性硬化症(MS),肌萎缩侧索硬化(ALS),阿尔茨海默病(AD),帕金森病(PD),和亨廷顿病(HD)是无法治愈或非常难以治疗。因此,寻求使用自体干细胞的新疗法。它们往往是患者康复或减缓病情进展的唯一希望症状。在分析了有关干细胞在神经退行性疾病中的使用的文献之后,得出了最重要的结论。MSC细胞疗法的有效性已在ALS和HD疗法中得到证实。MSC细胞减缓ALS进展并显示早期有希望的功效迹象。在HD中,他们减少亨廷顿(Htt)聚集和刺激内源性神经发生。使用造血干细胞(HSC)的MS疗法诱导了免疫系统的促炎和免疫调节成分的显着重新校准。iPSC细胞允许准确的PD建模。它们是患者特异性的,因此可将免疫排斥的风险降至最低,在长期观察中,在大脑中没有形成任何肿瘤。源自骨髓间充质基质细胞(BM-MSC-EV)和人脂肪来源的基质/干细胞(hASC)细胞的胞外囊泡被广泛用于治疗AD。由于Aβ42沉积物的减少和增加神经元的存活,他们提高记忆和学习能力。尽管有许多动物模型和临床试验研究,细胞疗法仍需要改进,以增加其在人体中的有效性。
    Stem cells have been the subject of research for years due to their enormous therapeutic potential. Most neurological diseases such as multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), Alzheimer\'s disease (AD), Parkinson\'s disease (PD), and Huntington\'s disease (HD) are incurable or very difficult to treat. Therefore new therapies are sought in which autologous stem cells are used. They are often the patient\'s only hope for recovery or slowing down the progress of the disease symptoms. The most important conclusions arise after analyzing the literature on the use of stem cells in neurodegenerative diseases. The effectiveness of MSC cell therapy has been confirmed in ALS and HD therapy. MSC cells slow down ALS progression and show early promising signs of efficacy. In HD, they reduced huntingtin (Htt) aggregation and stimulation of endogenous neurogenesis. MS therapy with hematopoietic stem cells (HSCs) inducted significant recalibration of pro-inflammatory and immunoregulatory components of the immune system. iPSC cells allow for accurate PD modeling. They are patient-specific and therefore minimize the risk of immune rejection and, in long-term observation, did not form any tumors in the brain. Extracellular vesicles derived from bone marrow mesenchymal stromal cells (BM-MSC-EVs) and Human adipose-derived stromal/stem cells (hASCs) cells are widely used to treat AD. Due to the reduction of Aβ42 deposits and increasing the survival of neurons, they improve memory and learning abilities. Despite many animal models and clinical trial studies, cell therapy still needs to be refined to increase its effectiveness in the human body.
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  • 文章类型: Journal Article
    亨廷顿病(HD)是一种神经退行性疾病,其特征是严重的运动,认知和精神症状。所有年龄段的患者都可能出现神经系统功能障碍,这导致了运动控制的逐渐丧失和言语残疾,吞咽,通讯,等。这种疾病的分子基础是众所周知的,因为HD与突变基因有关,三核苷酸扩增,编码亨廷顿蛋白。这种蛋白质与神经发生有关,其功能的丧失导致神经退行性疾病。尽管这种疾病的遗传原因已经知道了几十年,目前尚无有效的治疗方法来预防发病或消除症状的进展。因此,本综述的重点是开发及时准确诊断HD的新方法,以帮助开发可以减轻症状严重程度并控制其进展的治疗方法.大多数疗法包括突变的亨廷顿基因的基因沉默机制,旨在抑制其表达,以及使用各种物质作为药物具有非常有希望的结果。在本次审查中,讨论了HD诊断的最新方法,以及对遗传咨询的需求和应用治疗的最新介绍。
    Huntington\'s disease (HD) is a neurodegenerative disorder characterized by severe motor, cognitive and psychiatric symptoms. Patients of all ages can present with a dysfunction of the nervous system, which leads to the progressive loss of movement control and disabilities in speech, swallowing, communications, etc. The molecular basis of the disease is well-known, as HD is related to a mutated gene, a trinucleotide expansion, which encodes to the huntingtin protein. This protein is linked to neurogenesis and the loss of its function leads to neurodegenerative disorders. Although the genetic cause of the disorder has been known for decades, no effective treatment is yet available to prevent onset or to eliminate the progression of symptoms. Thus, the present review focused on the development of novel methods for the timely and accurate diagnosis of HD in an aim to aid the development of therapies which may reduce the severity of the symptoms and control their progression. The majority of the therapies include gene-silencing mechanisms of the mutated huntingtin gene aiming to suppress its expression, and the use of various substances as drugs with highly promising results. In the present review, the latest approaches on the diagnosis of HD are discussed along with the need for genetic counseling and an up-to-date presentation of the applied treatments.
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  • 文章类型: Review
    亨廷顿病(HD)是一种遗传性疾病,神经退行性疾病的特点是三位一体的症状:运动,认知和精神病学。HD是由基因突变引起的,亨廷顿基因中CAG重复序列的扩增,这导致纹状体的中等多刺神经元(MSN)的损失。细胞替代疗法(CRT)已成为HD的一种可能疗法,旨在替换那些在疾病过程中丢失的细胞并减轻其症状。最初的临床前研究使用原代胎儿纹状体细胞来提供主要证据,证明CRT可以在移植到HD模型中后在某些行为任务上带来功能恢复。如果CRT要成为可行的治疗选择和人类多能干细胞(hPSC)来源,则需要替代的供体细胞来源。它们已经经历了向疾病过程中丢失的MSN的分化,被证明是强有力的候选人。本章的重点是回顾在hPSC衍生的MSN移植后对动物进行功能评估的工作。我们讨论了评估移植物功能的不同方法,以及迄今取得的成果。此外,本章介绍并讨论了该领域仍然存在的挑战。
    Huntington\'s disease (HD) is a hereditary, neurodegenerative disorder characterized by a triad of symptoms: motor, cognitive and psychiatric. HD is caused by a genetic mutation, expansion of the CAG repeat in the huntingtin gene, which results in loss of medium spiny neurons (MSNs) of the striatum. Cell replacement therapy (CRT) has emerged as a possible therapy for HD, aiming to replace those cells lost to the disease process and alleviate its symptoms. Initial pre-clinical studies used primary fetal striatal cells to provide proof-of-principal that CRT can bring about functional recovery on some behavioral tasks following transplantation into HD models. Alternative donor cell sources are required if CRT is to become a viable therapeutic option and human pluripotent stem cell (hPSC) sources, which have undergone differentiation toward the MSNs lost to the disease process, have proved to be strong candidates. The focus of this chapter is to review work conducted on the functional assessment of animals following transplantation of hPSC-derived MSNs. We discuss different ways that graft function has been assessed, and the results that have been achieved to date. In addition, this chapter presents and discusses challenges that remain in this field.
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  • 文章类型: Journal Article
    神经退行性疾病是一类无法治愈和衰弱的疾病,其特征是中枢神经系统中细胞的进行性变性和死亡。它们有多种潜在机制;然而,它们都有共同的退化特征,如线粒体功能障碍。根据最近的研究,神经退行性疾病与功能失调的线粒体的积累有关。线粒体的选择性自噬,称为线粒体自噬,可以特异性降解细胞内过量或功能失调的线粒体。在这次审查中,我们强调了最近发现的线粒体自噬在神经退行性疾病中的作用。收集了多项研究,包括那些与线粒体的重要性有关的,线粒体自噬保护线粒体健康的机制,以及有丝分裂中的规范和非规范途径。本文综述了线粒体自噬在神经退行性疾病中的重要作用。讨论了线粒体自噬在神经退行性疾病中的研究进展,综述了线粒体自噬相关蛋白在神经系统疾病中的作用。此外,我们还强调了神经变性的药理学进展。
    Neurodegenerative diseases are a class of incurable and debilitating diseases characterized by progressive degeneration and death of cells in the central nervous system. They have multiple underlying mechanisms; however, they all share common degenerative features, such as mitochondrial dysfunction. According to recent studies, neurodegenerative diseases are associated with the accumulation of dysfunctional mitochondria. Selective autophagy of mitochondria, called mitophagy, can specifically degrade excess or dysfunctional mitochondria within cells. In this review, we highlight recent findings on the role of mitophagy in neurodegenerative disorders. Multiple studies were collected, including those related to the importance of mitochondria, the mechanism of mitophagy in protecting mitochondrial health, and canonical and non-canonical pathways in mitophagy. This review elucidated the important function of mitophagy in neurodegenerative diseases, discussed the research progress of mitophagy in neurodegenerative diseases, and summarized the role of mitophagy-related proteins in neurological diseases. In addition, we also highlight pharmacological advances in neurodegeneration.
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  • 文章类型: Journal Article
    背景:亨廷顿病(HD),一个无法治愈的人,多代人,常染色体显性疾病,在受影响的人及其家庭照顾者中创造独特的挑战和无数与精神相关的压力源。精神上的痛苦,悲伤/损失的经历,和应对策略尚未在HD护理人员中进行系统研究。
    目的:为了全面定义精神苦难,悲伤/损失,以及HD护理人员使用的应对策略。
    方法:进行了PRISMA-ScR范围研究文献综述。使用归纳和开放编码对纳入研究文章的数据进行主题组织。一个接地的,演绎法被用来划定主题的划界分类法,其中包括所有三个总体领域。四位审稿人,采用改进的德尔菲方法,确定研究参与者在每项研究中展示了哪些主题。
    结果:583篇文章中的36篇符合审查标准;没有一篇发表在姑息治疗文献中。调查主要集中在内心(自我形象)的痛苦和存在的焦虑;只有很少看到更深入的神/超个人的痛苦,破坏了宗教关系,或者意味着痛苦。HD护理人员经历深刻的悲伤/损失,表达为被剥夺权利的悲伤,与他们所爱的人的模棱两可的损失有关,家庭结构的丧失,社会联系,和个人损失。一半的研究报告了适应不良的HD照顾者应对策略,其特征是功能失调的逃避方案;相比之下,超越/创造性的策略往往是未经探索的。
    结论:HD看护者经历了长时间的悲伤和其他形式的精神痛苦,因为他们逐渐失去亲人和破坏自己的生活。有了改进的评估工具,由精神和姑息治疗专家组成的团队将能够更好地支持HD家庭护理人员。
    Huntington\'s disease (HD), an incurable, multi-generational, autosomal dominant disorder, creating unique challenges and a myriad of spiritually-related stressors in those affected and their familial caregivers. Spiritual suffering, experiences of grief/loss, and coping strategies have not been systematically studied in HD caregivers.
    To comprehensively define spiritual suffering, grief/loss, and coping strategies used by HD caregivers.
    A PRISMA-ScR scoping literature review was conducted. Data from included research articles were organized thematically using induction and open coding. A grounded, deductive approach was used to delineate a demarcated taxonomy of themes, which encompasses all three over-arching domains. Four reviewers, employing a modified Delphi approach, ascertained which themes were demonstrated by research participants in each study.
    36 of 583 articles met the review criteria; none were published in the palliative care literature. Investigations primarily focused on intrapersonal (self-image) distress and existential angst; only rarely looking deeper into divine/transpersonal suffering, disrupted religious relationships, or meaning distress. HD caregivers experience profound grief/loss, expressed as disenfranchised grief that is associated with the ambiguous loss of their loved one, loss of family structure, social connectedness, and personal losses. Half of the studies reported maladaptive HD caregiver coping strategies-characterized by dysfunctional escape schemes; in contrast, transcendent/creative strategies were often unexplored.
    HD caregivers experience prolonged grief and other forms of spiritual suffering as they progressively lose their loved ones and disruption to their own lives. With an improved assessment tool, teams with spiritual and palliative care experts will better be able to support HD family caregivers.
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  • 文章类型: Journal Article
    4号染色体上的亨廷顿基因具有显性遗传的CAG三核苷酸重复扩增,最终导致亨廷顿病(HD),一种完全渗透的神经系统疾病。来自欧洲的人口的频率是东亚的10-100倍。通过各种过程,包括蛋白质停滞的损害,转录,和细胞功能,以及突变蛋白的直接毒性,突变的亨廷顿蛋白在细胞水平引发神经元功能障碍和损失。随着疾病的恶化,大脑与纹状体的初始宏观改变一起受到影响。由于目前很少有药物可以改变疾病的进程,姑息治疗,症状控制是治疗的基石。近年来,随着疾病的发展,研究大脑的细胞病理学和总体结构变化已经取得了巨大的进展。在过去的十年中,医学研究和可能的治疗方案大幅增加。旨在减少突变亨廷顿蛋白数量的新疗法是最乐观的。然而,一种策略是反义寡核苷酸治疗,目前正在进行临床试验。这些对照试验可能会帮助我们在管理甚至消除这种令人讨厌的疾病方面再领先一英寸。
    The Huntington\'s gene on chromosome 4 has a dominantly inherited CAG trinucleotide repeat expansion, ultimately resulting in Huntington\'s disease (HD), a completely penetrant neurological condition. The frequency is 10-100 times higher in the population descended from Europe than in East Asia. Through various processes, including impairment of proteostasis, transcription, and cell function, as well as direct toxicity of the mutant protein, mutated huntingtin triggers neuronal malfunction and loss at the cellular level. As the disease worsens, the brain becomes affected together with the striatum\'s initial macroscopic alterations. Since there are presently few medications that can change the course of the disease, palliative therapy, and symptom control are the cornerstone of treatment. Studying the cellular pathology and gross structural changes to the brain which occur as the illness advances have made enormous progress in recent years. There\'s been a substantial increase in medical studies and possible treatment options over the past ten years. The new treatments that aim to reduce amounts of mutant huntingtin are the most optimistic. However, one strategy is antisense oligonucleotide treatment, for which clinical trials are currently being conducted. These control trials might help us get another inch ahead of managing and perhaps even eliminating this nasty disease.
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