[Acetylcholinesterase inhibitors in Alzheimer's disease: further comments on their mechanisms of action and therapeutic consequences].

André Nieoullon
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引用次数: 13

Abstract

Cholinergic treatments in Alzheimer's disease are related to the decline of cholinergic central transmission evidenced many years ago in patients. Donepezil, rivastigmine and galantamine have been shown to improve the biodisponibility of acetylcholine at synaptic level by decreasing its enzymatic degradation through acetylcholinesterases. Indeed these cholinesterase inhibitors have shown clinical beneficial effects especially at the early stages of the disease and when the cognitive deterioration is still limited. However, depending on patients, their efficacy can be discussed since the amplitude of the improvement has been recognized as limited. Nevertheless, cholinesterase inhibitors can improve the cognitive capacities or attentional processes in patients and their capability to be autonomous in daily life activities. Differences reported between the three different major cholinesterase inhibitors could be due to different pharmacokinetic and pharmacodynamic properties, especially with regard to the duration and reversibility of acetylcholinesterase inhibition. Since the resulting effect of the different compounds is to increase the synaptic acetylcholine disponibility in all cases, it is generally accepted that therapeutic effects are related to cholinergic stimulation in the brain structures involved in the regulation of cognitive and behavioral processes, with special reference to alpha7 nicotinic receptor subtype, which are concentrated in the cerebral cortex and hippocampal formation. Because of the involvement of such nicotinic receptor subtype in presynaptic activation of numerous neurotransmitters synaptic functions, one can propose that such general stimulation of brain structures contributes to behavioral improvement. Interestingly, data from experimental literature also showed that acetylcholinesterase inhibitors may have neuroprotective effects and could thus act as disease modifiers in patients, slowing the progression of behavioral deterioration since acetylcholinesterases themselves could contribute to the degenerative process. However such a speculative proposal has to be demonstrated in patients.

[阿尔茨海默病中的乙酰胆碱酯酶抑制剂:对其作用机制和治疗效果的进一步评论]。
阿尔茨海默病的胆碱能治疗与多年前患者胆碱能中枢传递的下降有关。多奈哌齐、利瓦斯汀和加兰他明已被证明通过降低乙酰胆碱酯酶的酶降解来改善乙酰胆碱在突触水平的生物降解。事实上,这些胆碱酯酶抑制剂已经显示出临床有益的效果,特别是在疾病的早期阶段和认知退化仍然有限的时候。然而,根据患者的情况,他们的疗效可以讨论,因为改善的幅度被认为是有限的。然而,胆碱酯酶抑制剂可以改善患者的认知能力或注意力过程,以及他们在日常生活活动中的自主能力。三种不同的主要胆碱酯酶抑制剂之间的差异可能是由于不同的药代动力学和药效学性质,特别是在乙酰胆碱酯酶抑制的持续时间和可逆性方面。由于不同化合物的作用在所有情况下都是增加突触乙酰胆碱的可降解性,因此普遍认为治疗效果与胆碱能刺激参与认知和行为过程调节的大脑结构有关,特别是阿尔法7烟碱受体亚型,它集中在大脑皮层和海马结构中。由于这种尼古丁受体亚型参与了许多神经递质突触功能的突触前激活,人们可以提出这种对大脑结构的普遍刺激有助于行为改善。有趣的是,来自实验文献的数据也表明,乙酰胆碱酯酶抑制剂可能具有神经保护作用,因此可以作为患者的疾病调节剂,减缓行为恶化的进展,因为乙酰胆碱酯酶本身可能有助于退行性过程。然而,这种推测性的建议必须在患者身上得到证明。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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