Brain volume change following anti-amyloid β immunotherapy for Alzheimer's disease: amyloid-removal-related pseudo-atrophy.

IF 46.5 1区 医学 Q1 CLINICAL NEUROLOGY
Christopher R S Belder, Delphine Boche, James A R Nicoll, Zane Jaunmuktane, Henrik Zetterberg, Jonathan M Schott, Frederik Barkhof, Nick C Fox
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引用次数: 0

Abstract

Progressive cerebral volume loss on MRI is a hallmark of Alzheimer's disease and has been widely used as an outcome measure in clinical trials, with the prediction that disease-modifying treatments would slow loss. However, in trials of anti-amyloid immunotherapy, the participants who received treatment had excess volume loss. Explanations for this observation range from reduction of amyloid β plaque burden and related inflammatory changes through to treatment-induced toxicity. The excess volume changes are characteristic of only those immunotherapies that achieve amyloid β lowering; are compatible with plaque removal; and evidence to date does not suggest an association with harmful effects. Based on the current evidence, we suggest that these changes can be described as amyloid-removal-related pseudo-atrophy. Better understanding of the causes and consequences of these changes is important to enable informed decisions about treatments. Patient-level analyses of data from the trials are urgently needed, along with longitudinal follow-up and neuroimaging data, to determine the long-term trajectory of these volume changes and their clinical correlates. Post-mortem examination of cerebral tissue from treated patients and evaluation of potential correlation with antemortem neuroimaging findings are key priorities.

抗淀粉样蛋白β免疫疗法治疗阿尔茨海默病后的脑容量变化:淀粉样蛋白清除相关假性萎缩。
核磁共振成像显示的渐进性脑容量损失是阿尔茨海默病的特征之一,已被广泛用作临床试验的结果测量指标,并预测改变病情的治疗会减缓容量损失。然而,在抗淀粉样蛋白免疫疗法试验中,接受治疗的参与者的脑容量损失过多。对这一现象的解释包括淀粉样β斑块负担的减轻和相关炎症变化,以及治疗引起的毒性。只有那些能降低淀粉样β斑块的免疫疗法才会出现过量的体积变化,而且这种变化与斑块的清除是一致的。根据目前的证据,我们认为这些变化可被描述为与淀粉样蛋白清除相关的假性萎缩。更好地了解这些变化的原因和后果对于做出明智的治疗决定非常重要。目前急需对试验数据进行患者层面的分析,并提供纵向随访和神经影像学数据,以确定这些体积变化的长期轨迹及其临床相关性。对接受过治疗的患者的脑组织进行死后检查,并评估其与死前神经影像学检查结果的潜在相关性,是当务之急。
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来源期刊
Lancet Neurology
Lancet Neurology 医学-临床神经学
CiteScore
58.70
自引率
1.00%
发文量
572
审稿时长
6-12 weeks
期刊介绍: The Lancet Neurology is the world-leading clinical neurology journal. It publishes original research that advocates for change in, or sheds light on, neurological clinical practice. The topics covered include cerebrovascular disease, Alzheimer's disease and other dementias, epilepsy, migraine, neurological infections, movement disorders, multiple sclerosis, neuromuscular disorders, peripheral nerve disorders, pediatric neurology, sleep disorders, and traumatic brain injury. The journal publishes a range of article types, including Articles (including randomized clinical trials and meta-analyses), Review, Rapid Review, Comment, Correspondence, and Personal View. It also publishes Series and Commissions that aim to shape and drive positive change in clinical practice and health policy in areas of need in neurology. The Lancet Neurology is an internationally trusted source of clinical, public health, and global health knowledge. It has an Impact Factor of 48.0, making it the top-ranked clinical neurology journal out of 212 journals worldwide.
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