pathogenic mechanisms

致病机制
  • 文章类型: Journal Article
    多发性硬化症(MS)是一种以炎症为特征的中枢神经系统(CNS)的异质性自身免疫介导的疾病,脱髓鞘和慢性进行性神经变性。在其广泛而不可预测的神经精神症状中,行为变化很常见,甚至从疾病的早期阶段开始,虽然它们与高级MS的认知缺陷有关。根据DSM-5,行为障碍包括注意力缺陷,反对,挑衅和行为障碍,焦虑,恐慌,强迫症(强迫症),破坏性和情绪障碍,而其他人也包括烦躁,激动,侵略和执行功能障碍。大约30%至80%的MS患者表现出与疾病进展相关的行为变化。它们通常与抑郁症和其他神经精神疾病相结合,但通常与运动障碍无关,提示不同的病理机制。这些和其他改变导致MS的残疾。虽然没有关于MS行为变化的具体神经病理学数据,脱髓鞘动物模型与人类白质和神经炎症异常有相似之处。神经影像学显示前额叶皮质萎缩,半球间抑制和破坏额叶-纹状体-丘脑和额顶网络。这表明MS病理学中脑紊乱的多区域模式,尽管其致病机制有待进一步阐明。社会的好处,心理,报告了行为干预和运动。在对PubMed进行系统分析的基础上,谷歌学者和科克伦图书馆,目前的流行病学,临床,回顾了神经影像学和致病证据,这些证据可能有助于早期识别MS的行为症状,并推广新的治疗目标和策略。
    Multiple sclerosis (MS) is a heterogenous autoimmune-mediated disease of the central nervous system (CNS) characterized by inflammation, demyelination and chronic progressive neurodegeneration. Among its broad and unpredictable range of neuropsychiatric symptoms, behavioral changes are common, even from the early stages of the disease, while they are associated with cognitive deficits in advanced MS. According to DSM-5, behavioral disorders include attention deficits, oppositional, defiant and conduct disorders, anxiety, panic, obsessive-compulsive disorders (OCD), disruptive and emotional disorders, while others include also irritability, agitation, aggression and executive dysfunctions. Approximately 30 to 80% of individuals with MS demonstrate behavioral changes associated with disease progression. They are often combined with depression and other neuropsychiatric disorders, but usually not correlated with motor deficits, suggesting different pathomechanisms. These and other alterations contribute to disability in MS. While no specific neuropathological data for behavioral changes in MS are available, those in demyelination animal models share similarities with white matter and neuroinflammatory abnormalities in humans. Neuroimaging revealed prefrontal cortical atrophy, interhemispheric inhibition and disruption of fronto-striato-thalamic and frontoparietal networks. This indicates multi-regional patterns of cerebral disturbances within the MS pathology although their pathogenic mechanisms await further elucidation. Benefits of social, psychological, behavioral interventions and exercise were reported. Based on systematical analysis of PubMed, Google Scholar and Cochrane library, current epidemiological, clinical, neuroimaging and pathogenetic evidence are reviewed that may aid early identification of behavioral symptoms in MS, and promote new therapeutic targets and strategies.
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  • 文章类型: Journal Article
    皮肤恶性黑色素瘤(MM)是世界上最常见和侵袭性的肿瘤之一。其相关的高死亡率主要是由于其转移,而MM的早期诊断和治疗具有良好的预后。即使在早期局部阶段的皮肤浅表MM也可能已经出现淋巴结浸润和远处转移。因此,了解MM发展的可控危险因素和致病机制,传播,和转移模式,以及早期诊断,对于降低与皮肤恶性黑色素瘤相关的高死亡率至关重要。遗传因素是有罪的,尽管终生获得性基因突变似乎更频繁地参与MM的发展。皮肤黑素细胞每年仅分裂两次,并且由于环境侵袭性因素而有时间积累基因突变。如紫外线照射。在寻找更有希望的治疗方法时,基质金属蛋白酶已经引起了人们的极大兴趣,例如MMP-1,MMP-2,MMP-9和MMP-13,它们与更具侵袭性的癌症形式和早期转移有关。因此,MMP分泌或活性的特异性合成抑制剂的开发可能代表MM患者个性化治疗的更有希望和有效的方法。
    Skin malignant melanoma (MM) is one of the most frequent and aggressive neoplasia worldwide. Its associated high mortality rates are mostly due to its metastases, while diagnosis and treatment of MM in its early stages is of favorable prognostic. Even skin superficial MMs at incipient local stages can already present with lymph node invasion and distant metastases. Therefore, knowledge of the controllable risk factors and pathogenic mechanisms of MM development, spreading, and metastatic pattern, as well as early diagnosis, are essential to decrease the high mortality rates associated with cutaneous malignant melanoma. Genetic factors are incriminated, although lifetime-acquired genetic mutations appear to be even more frequently involved in the development of MM. Skin melanocytes divide only twice per year and have time to accumulate genetic mutations as a consequence of environmental aggressive factors, such as UV exposure. In the search for more promising therapies, matrix metalloproteinases have become of significant interest, such as MMP-1, MMP-2, MMP-9, and MMP-13, which have been linked to more aggressive forms of cancer and earlier metastases. Therefore, the development of specific synthetic inhibitors of MMP secretion or activity could represent a more promising and effective approach to the personalized treatment of MM patients.
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  • 文章类型: Journal Article
    肝癌是一个重大的全球健康挑战,肝细胞癌(HCC)是最常见的形式,特点是发病率和死亡率高。尽管靶向治疗和免疫疗法取得了进展,晚期肝癌的预后仍然很差.这强调了迫切需要更深入地了解HCC的分子机制,以便能够早期检测和开发新的治疗策略。翻译后修饰(PTMs)是细胞生物学中至关重要的调控机制。影响蛋白质功能,互动,和本地化。这些修改,包括磷酸化,乙酰化,甲基化,泛素化,和糖基化,发生在蛋白质合成后,在各种细胞过程中起着至关重要的作用。蛋白质组学和分子生物学的最新进展突出了PTM的复杂网络,强调它们在维持细胞稳态和疾病发病机制中的关键作用。PTM的失调与HCC中的几种恶性细胞过程有关,如改变细胞增殖,迁移,免疫逃避,和代谢重编程,有助于肿瘤生长和转移。本文旨在全面了解各种PTM在肝癌中的病理机制和临床意义。通过探索PTM的多方面相互作用及其对肝癌进展的影响,我们强调了PTM作为生物标志物和治疗靶点的潜力.这篇综述的意义在于它有可能为新的治疗方法的发展提供信息,并改善早期干预肝癌的预后工具。
    Liver cancer is a significant global health challenge, with hepatocellular carcinoma (HCC) being the most prevalent form, characterized by high incidence and mortality rates. Despite advances in targeted therapies and immunotherapies, the prognosis for advanced liver cancer remains poor. This underscores the urgent need for a deeper understanding of the molecular mechanisms underlying HCC to enable early detection and the development of novel therapeutic strategies. Post-translational modifications (PTMs) are crucial regulatory mechanisms in cellular biology, affecting protein functionality, interactions, and localization. These modifications, including phosphorylation, acetylation, methylation, ubiquitination, and glycosylation, occur after protein synthesis and play vital roles in various cellular processes. Recent advances in proteomics and molecular biology have highlighted the complex networks of PTMs, emphasizing their critical role in maintaining cellular homeostasis and disease pathogenesis. Dysregulation of PTMs has been associated with several malignant cellular processes in HCC, such as altered cell proliferation, migration, immune evasion, and metabolic reprogramming, contributing to tumor growth and metastasis. This review aims to provide a comprehensive understanding of the pathological mechanisms and clinical implications of various PTMs in liver cancer. By exploring the multifaceted interactions of PTMs and their impact on liver cancer progression, we highlight the potential of PTMs as biomarkers and therapeutic targets. The significance of this review lies in its potential to inform the development of novel therapeutic approaches and improve prognostic tools for early intervention in the fight against liver cancer.
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  • 文章类型: Journal Article
    股骨头坏死(ONFH)是一种导致患者疼痛和不适的疾病,其致病机制尚未完全了解。虽然有许多研究表明多种因素可能有助于其发展,目前的治疗包括手术和非手术两种选择.然而,这些治疗方法还有很大的改进空间,特别是在预防术后并发症和优化手术程序方面。纳米材料,作为一种小分子材料,在治疗骨组织疾病方面显示出巨大的希望,包括ONFH。事实上,几种纳米复合材料在预防ONFH,促进骨组织修复和生长,优化手术治疗。本文全面概述了ONFH的当前治疗方法,包括它们的优点和局限性,并回顾了纳米材料治疗这种疾病的最新进展。此外,本文探讨了使用纳米材料治疗ONFH的治疗机制,并确定了改善患者预后的新方法和新思路.
    Osteonecrosis of the femoral head (ONFH) is a condition that causes considerable pain and discomfort for patients, and its pathogenic mechanisms are not yet fully understood. While there have been many studies that suggest multiple factors may contribute to its development, current treatments involve both surgical and nonsurgical options. However, there is still much room for improvement in these treatment methods, particularly when it comes to preventing postoperative complications and optimizing surgical procedures. Nanomaterials, as a type of small molecule material, have shown great promise in treating bone tissue diseases, including ONFH. In fact, several nanocomposite materials have demonstrated specific effects in preventing ONFH, promoting bone tissue repair and growth, and optimizing surgical treatment. This article provides a comprehensive overview of current treatments for ONFH, including their advantages and limitations, and reviews the latest advances in nanomaterials for treating this condition. Additionally, this article explores the therapeutic mechanisms involved in using nanomaterials to treat ONFH and to identify new methods and ideas for improving outcomes for patients.
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  • 文章类型: Journal Article
    大气细颗粒物(PM2.5)会危害人体的各个系统。由于目前对流行病学和毒理学理解的局限性,PM2.5在各种人类系统中引起的疾病类型和致病机制尚不清楚。在这项研究中,PM2.5在呼吸道引起的疾病类型,循环,内分泌,女性和男性泌尿生殖系统已被研究,并在分子水平上确定了致病机制。结果表明,PM2.5极有可能诱发肺气肿,再灌注损伤,恶性甲状腺肿瘤,卵巢子宫内膜异位症,和肾炎分别在上述每个系统中。最重要的共存基因,细胞成分,生物过程,分子功能,PM2.5靶向的五个系统中的通路是Fos原癌基因(FOS),细胞外基质,泌尿生殖系统发育,赋予拉伸强度的细胞外基质结构成分,和铁性分别。每个系统中PM2.5显著且独特靶向的差异表达基因是BTG2(呼吸),BIRC5(循环),NFE2L2(内分泌),TBK1(女性泌尿生殖系统)和STAT1(男性泌尿生殖系统)。重要的疾病相关细胞成分,生物过程,和分子功能是由PM2.5特异性诱导的。例如,对受伤的反应,血管形态发生,身体形态发生,对内质网应激的负调节,和对I型干扰素的反应分别是每个系统中最独特的生物过程。PM2.5主要作用于肿瘤(呼吸道)的PD-L1表达和PD-1检查点通路等关键疾病相关通路,细胞周期(循环),凋亡(内分泌),抗原加工和呈递(女性泌尿生殖系统),和神经活性配体-受体相互作用(男性泌尿生殖系统)。本研究为阐明PM2.5相关疾病类型提供了新的分析策略,是流行病学调查的重要补充。它阐明了PM2.5暴露的风险,阐明致病机制,为推动PM2.5相关疾病精准防治提供科学支撑。
    Atmospheric fine particulate matter (PM2.5) can harm various systems in the human body. Due to limitations in the current understanding of epidemiology and toxicology, the disease types and pathogenic mechanisms induced by PM2.5 in various human systems remain unclear. In this study, the disease types induced by PM2.5 in the respiratory, circulatory, endocrine, and female and male urogenital systems have been investigated and the pathogenic mechanisms identified at molecular level. The results reveal that PM2.5 is highly likely to induce pulmonary emphysema, reperfusion injury, malignant thyroid neoplasm, ovarian endometriosis, and nephritis in each of the above systems respectively. The most important co-existing gene, cellular component, biological process, molecular function, and pathway in the five systems targeted by PM2.5 are Fos proto-oncogene (FOS), extracellular matrix, urogenital system development, extracellular matrix structural constituent conferring tensile strength, and ferroptosis respectively. Differentially expressed genes that are significantly and uniquely targeted by PM2.5 in each system are BTG2 (respiratory), BIRC5 (circulatory), NFE2L2 (endocrine), TBK1 (female urogenital) and STAT1 (male urogenital). Important disease-related cellular components, biological processes, and molecular functions are specifically induced by PM2.5. For example, response to wounding, blood vessel morphogenesis, body morphogenesis, negative regulation of response to endoplasmic reticulum stress, and response to type I interferon are the top uniquely existing biological processes in each system respectively. PM2.5 mainly acts on key disease-related pathways such as the PD-L1 expression and PD-1 checkpoint pathway in cancer (respiratory), cell cycle (circulatory), apoptosis (endocrine), antigen processing and presentation (female urogenital), and neuroactive ligand-receptor interaction (male urogenital). This study provides a novel analysis strategy for elucidating PM2.5-related disease types and is an important supplement to epidemiological investigation. It clarifies the risks of PM2.5 exposure, elucidates the pathogenic mechanisms, and provides scientific support for promoting the precise prevention and treatment of PM2.5-related diseases.
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  • 文章类型: Journal Article
    背景:越来越多的研究表明,2019年冠状病毒病(COVID-19)患者的静脉血栓栓塞(VTE)发生率明显高于健康人群。然而,机制仍未完全阐明。本研究旨在进一步研究这种并发症发生的分子机制。
    方法:COVID-19和VTE的基因表达谱从基因表达综合(GEO)数据库下载。在确定了COVID-19和VTE的常见差异表达基因(DEGs)后,功能注释,蛋白质-蛋白质相互作用(PPI)网络,模块构造,并进行了hub基因鉴定。最后,我们构建了一个转录因子(TF)-基因调控网络和一个TF-miRNA调控网络的hub基因。
    结果:总共选择了42个常见DEG用于后续分析。功能分析显示,生物学功能和信号通路共同参与了VTE和COVID-19的发生和发展。最后,使用cytohubba插件鉴定了8个重要的hub基因,包括RSL24D1、RPS17、RPS27、HINT1、COX7C、RPL35、RPL34和NDUFA4,作为COVID-19和VTE的诊断标志物具有较好的价值。
    结论:我们的研究揭示了COVID-19和VTE的共同发病机制。这些共同通路和关键基因可能为进一步的机理研究提供新的思路。
    BACKGROUND: A growing body of research has shown that patients with coronavirus disease 2019 (COVID-19) have significantly higher rates of venous thromboembolism (VTE) than healthy. However, the mechanism remains incompletely elucidated. This study aimed to further investigate the molecular mechanisms underlying the development of this complication.
    METHODS: The gene expression profiles of COVID-19 and VTE were downloaded from the Gene Expression Omnibus (GEO) database. After identifying the common differentially expressed genes (DEGs) for COVID-19 and VTE, functional annotation, a protein-protein interactions (PPI) network, module construction, and hub gene identification were performed. Finally, we constructed a transcription factor (TF)-gene regulatory network and a TF-miRNA regulatory network for hub genes.
    RESULTS: A total of 42 common DEGs were selected for subsequent analyses. Functional analyses showed that biological function and signaling pathways collectively participated in the development and progression of VTE and COVID-19. Finally, 8 significant hub genes were identified using the cytoHubba plugin, including RSL24D1, RPS17, RPS27, HINT1, COX7C, RPL35, RPL34, and NDUFA4, which had preferable values as diagnostic markers for COVID-19 and VTE.
    CONCLUSIONS: Our study revealed the common pathogenesis of COVID-19 and VTE. These common pathways and pivotal genes may provide new ideas for further mechanistic studies.
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  • 文章类型: Journal Article
    背景:阿尔茨海默病(Alzheimer\'sdisease,AD)是一种复杂的神经退行性疾病,伴随着老年人的认知功能损害,其中β-淀粉样蛋白的细胞外积累和高磷酸化tau的细胞内聚集被认为是流行的理论。然而,确切的AD机制尚未确定。此外,在III期试验中没有有效的治疗方法可以根除AD,探索新的治疗方法势在必行。
    目的:大量关于认知损害的最新临床前研究有助于阐明AD的病理学。这篇综述概述了AD病理生物学的一些进展,并讨论了天然化合物的神经保护作用。如酚类化合物,天然多糖和寡糖,肽,和脂质,强调AD的治疗潜力。
    方法:涉及PubMed的电子数据库,WebofScience,和谷歌学者被搜索到2023年10月。文章是使用像阿尔茨海默病这样的关键词进行的,致病机制,天然化合物,和神经保护。
    结果:这篇综述总结了几种AD病理以及天然化合物如天然多糖和寡糖的神经保护作用。肽,和脂质。
    结论:我们已经讨论了AD的致病机制以及天然产物对神经退行性疾病的作用,特别是在治疗AD方面。具体来说,我们研究了天然化合物与阿尔茨海默病之间的分子途径和联系,例如通过NF-κB,Nrf2和mTOR通路。在临床试验中探索天然化合物的生物活性和有效性时,需要进一步的研究,这可能为AD患者提供有希望的治疗。
    BACKGROUND: Alzheimer\'s disease (AD) is a complicated neurodegenerative disease with cognitive impairment occurring in the older people, in which extracellular accumulation of β-amyloid and intracellular aggregation of hyperphosphorylated tau are regarded as the prevailing theories. However, the exact AD mechanism has not been determined. Moreover, there is no effective treatment available in phase III trials to eradicate AD, which is imperative to explore novel treatments.
    OBJECTIVE: A number of up-to-date pre-clinical studies on cognitive impairment is beneficial to clarify the pathology of AD. This review recapitulates several advances in AD pathobiology and discusses the neuroprotective effects of natural compounds, such as phenolic compounds, natural polysaccharides and oligosaccharides, peptide, and lipids, underscoring the therapeutic potential for AD.
    METHODS: Electronic databases involving PubMed, Web of Science, and Google Scholar were searched up to October 2023. Articles were conducted using the keywords like Alzheimer\'s disease, pathogenic mechanisms, natural compounds, and neuroprotection.
    RESULTS: This review summarized several AD pathologies and the neuroprotective effects of natural compounds such as natural polysaccharides and oligosaccharides, peptide, and lipids.
    CONCLUSIONS: We have discussed the pathogenic mechanisms of AD and the effect natural products on neurodegenerative diseases particularly in treating AD. Specifically, we investigated the molecular pathways and links between natural compounds and Alzheimer\'s disease such as through NF-κB, Nrf2, and mTOR pathway. Further investigation is necessary in exploring the bioactivity and effectiveness of natural compounds in clinical trials, which may provide a promising treatment for AD patients.
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  • 文章类型: Journal Article
    心律失常性心肌病(ACM)是一种罕见的遗传性心脏病,其特征是心肌逐渐被纤维脂肪组织取代。临床上,ACM在患者中表现出广泛的变异性;症状可能包括晕厥和室性心动过速,也包括猝死,后者往往是其唯一的表现。已经发现大约一半的ACM患者在编码心脏插入椎间盘蛋白的一个或多个基因中存在变异;最涉及的基因是plakophilin2(PKP2),desmoglein2(DSG2),和desmoplakin(DSP)。心脏插层盘在心肌细胞之间提供机械和电代谢耦合。在所谓的复合区域中,桥粒和附着点的蛋白质相互作用保证了机械通讯,而相邻心脏细胞之间的电代谢耦合取决于间隙连接。虽然ACM在近三十年前就已经被首次描述过,导致其发展的致病机制仍然仅部分已知。对不同动物模型的若干研究指出Wnt/β-连环蛋白信号与Hippo途径的组合的参与。这里,我们对现有的ACM小鼠模型进行了概述,这些模型在插入的椎间盘组件中具有变体,特别关注潜在的致病机制。Prospective,对疾病发病机制的机械见解将导致ACM的有效靶向治疗的发展。
    Arrhythmogenic cardiomyopathy (ACM) is a rare genetic cardiac disease characterized by the progressive substitution of myocardium with fibro-fatty tissue. Clinically, ACM shows wide variability among patients; symptoms can include syncope and ventricular tachycardia but also sudden death, with the latter often being its sole manifestation. Approximately half of ACM patients have been found with variations in one or more genes encoding cardiac intercalated discs proteins; the most involved genes are plakophilin 2 (PKP2), desmoglein 2 (DSG2), and desmoplakin (DSP). Cardiac intercalated discs provide mechanical and electro-metabolic coupling among cardiomyocytes. Mechanical communication is guaranteed by the interaction of proteins of desmosomes and adheren junctions in the so-called area composita, whereas electro-metabolic coupling between adjacent cardiac cells depends on gap junctions. Although ACM has been first described almost thirty years ago, the pathogenic mechanism(s) leading to its development are still only partially known. Several studies with different animal models point to the involvement of the Wnt/β-catenin signaling in combination with the Hippo pathway. Here, we present an overview about the existing murine models of ACM harboring variants in intercalated disc components with a particular focus on the underlying pathogenic mechanisms. Prospectively, mechanistic insights into the disease pathogenesis will lead to the development of effective targeted therapies for ACM.
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  • 文章类型: Journal Article
    人类脲原体物种越来越被认为是人类泌尿生殖道感染中的机会病原体,不孕症,不良妊娠,新生儿发病率,和其他成人侵入性感染。尽管一些一般性评论集中在脲原体的检测和临床表现上。,分子流行病学,抗菌素耐药性,解脲支原体的发病机制。没有得到充分的解释。这篇综述的目的是为分子流行病学的当前理解和未来研究前景提供有价值的见解,抗菌素耐药性,和人脲原体感染的发病机制。本文综述了脲原体的常规培养和检测方法以及最新的分子鉴定技术。我们还回顾了全球脲原体属抗生素耐药性的流行和机制。除了常规抗生素,新型抗生素对脲原体具有出色的体外抗菌活性。被描述。此外,我们讨论了脲原体的致病机制。,包括附着力,促炎作用,细胞毒性,和免疫逃逸效应,从病理学的角度来看,相关分子,和遗传学。
    Human Ureaplasma species are being increasingly recognized as opportunistic pathogens in human genitourinary tract infections, infertility, adverse pregnancy, neonatal morbidities, and other adult invasive infections. Although some general reviews have focused on the detection and clinical manifestations of Ureaplasma spp., the molecular epidemiology, antimicrobial resistance, and pathogenesis of Ureaplasma spp. have not been adequately explained. The purpose of this review is to offer valuable insights into the current understanding and future research perspectives of the molecular epidemiology, antimicrobial resistance, and pathogenesis of human Ureaplasma infections. This review summarizes the conventional culture and detection methods and the latest molecular identification technologies for Ureaplasma spp. We also reviewed the global prevalence and mechanisms of antibiotic resistance for Ureaplasma spp. Aside from regular antibiotics, novel antibiotics with outstanding in vitro antimicrobial activity against Ureaplasma spp. are described. Furthermore, we discussed the pathogenic mechanisms of Ureaplasma spp., including adhesion, proinflammatory effects, cytotoxicity, and immune escape effects, from the perspectives of pathology, related molecules, and genetics.
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  • 文章类型: Journal Article
    多发性硬化症(MS)是一种以炎症为特征的自身免疫介导的中枢神经系统疾病,脱髓鞘和慢性进行性神经变性。在其广泛且不可预测的临床症状中,认知障碍(CI)是一种常见的致残特征,极大地影响了患者的生活质量。根据MS的表型,其患病率为20%至88%,种类繁多,在原发性进行性MS中频率和严重程度最高。涉及不同的认知领域,CI通常与抑郁症和其他神经精神症状有关,但通常与运动和其他缺陷无关,提示不同的病理生理机制。虽然没有MS中CI的具体神经病理学数据,现代研究提供了证据,证明它是由特定疾病的大脑改变引起的。多模态神经成像,除了皮质和深层皮质下灰质和白质的结构变化外,表现出额顶叶功能障碍,丘脑-海马,默认模式和与认知相关的网络,网络间连接的破坏和γ-氨基丁酸(GABA)系统的参与。这提供了一个概念框架来解释异常的病理生理过程,包括氧化应激,线粒体功能障碍,自身免疫反应和必需信号通路的破坏可预测/引起特定的认知障碍。MS中的CI与大脑紊乱的多区域模式有关,虽然其复杂的致病机制有待进一步阐明。这篇文章,基于对PubMed的系统分析,谷歌学者和科克伦图书馆,回顾当前的流行病学,临床,神经影像学和病理学证据可以帮助早期识别MS中的CI,并告知新的治疗靶点和策略。
    Multiple sclerosis (MS) is an autoimmune-mediated disease of the central nervous system characterized by inflammation, demyelination and chronic progressive neurodegeneration. Among its broad and unpredictable range of clinical symptoms, cognitive impairment (CI) is a common and disabling feature greatly affecting the patients\' quality of life. Its prevalence is 20% up to 88% with a wide variety depending on the phenotype of MS, with highest frequency and severity in primary progressive MS. Involving different cognitive domains, CI is often associated with depression and other neuropsychiatric symptoms, but usually not correlated with motor and other deficits, suggesting different pathophysiological mechanisms. While no specific neuropathological data for CI in MS are available, modern research has provided evidence that it arises from the disease-specific brain alterations. Multimodal neuroimaging, besides structural changes of cortical and deep subcortical gray and white matter, exhibited dysfunction of fronto-parietal, thalamo-hippocampal, default mode and cognition-related networks, disruption of inter-network connections and involvement of the γ-aminobutyric acid (GABA) system. This provided a conceptual framework to explain how aberrant pathophysiological processes, including oxidative stress, mitochondrial dysfunction, autoimmune reactions and disruption of essential signaling pathways predict/cause specific disorders of cognition. CI in MS is related to multi-regional patterns of cerebral disturbances, although its complex pathogenic mechanisms await further elucidation. This article, based on systematic analysis of PubMed, Google Scholar and Cochrane Library, reviews current epidemiological, clinical, neuroimaging and pathogenetic evidence that could aid early identification of CI in MS and inform about new therapeutic targets and strategies.
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