电子科技大学医学院
2030科技部重点研发计划(2022ZD0208500)和四川省科技厅项目(2024YFHZ0359)
1.Sichuan Provincial People’s Hospital,Medical School,University of Electronic Science and Technology of China,Chengdu,611731;2.China
2030 Major Project of the Ministry of Science and Technology (Grant No. 2022ZD0208500) and the Sichuan Science and Technology Program (Grant No. 2024YFHZ0359).
阿尔茨海默病(Alzheimer's disease, AD)是一种进行性神经退行性疾病,是老年痴呆症最常见的原因。其特征为认知功能下降、日常生活能力丧失以及行为和心理症状,严重影响患者生活质量,并给家庭和社会带来沉重负担。近年来的研究显示,GABA能中间神经元通过精确调控大脑节律振荡来维护神经网络的稳态,其功能受损不仅是Aβ病理引发神经网络过度兴奋的重要因素,而且是AD认知衰退过程中的核心病理机制之一。本文系统综述:(1)AD进程中特定GABA能中间神经元亚型病理机制的差异性;(2)GABA能中间神经元-兴奋性神经元环路失衡导致神经网络振荡异常的分子机制;(3)基于GABA能系统调控的新型治疗策略,为深入理解GABA能中间神经元在AD病理中的损伤机制开辟了新的视角,并展望了通过精准神经调控实现转化医学前景的可能。本文关键参考文献在表1中列出。
Alzheimer's disease (AD), a progressive neurodegenerative disorder and the leading cause of dementia in the elderly, is characterized by severe cognitive decline, loss of daily living abilities, and neuropsychiatric symptoms. This condition imposes a substantial burden on patients, families, and society. Despite extensive research efforts, the complex pathogenesis of AD, particularly the early mechanisms underlying cognitive dysfunction, remains incompletely understood, posing significant challenges for timely diagnosis and effective therapeutic intervention. Among the various cellular components implicated in AD, GABAergic interneurons have emerged as critical players in the pathological cascade, playing a pivotal role in maintaining neural network integrity and function in key brain regions affected by the disease. GABAergic interneurons represent a heterogeneous population of inhibitory neurons essential for sustaining neural network homeostasis. They achieve this by precisely modulating rhythmic oscillatory activity (e.g., theta and gamma oscillations), which are crucial for cognitive processes such as learning and memory. These interneurons synthesize and release the inhibitory neurotransmitter GABA, exerting potent control over excitatory pyramidal neurons through intricate local circuits. Their primary mechanism involves synaptic inhibition, thereby modulating the excitability and synchrony of neural populations. Emerging evidence highlights the significant involvement of GABAergic interneuron dysfunction in AD pathogenesis. Contrary to earlier assumptions of their resistance to the disease, specific subtypes exhibit vulnerability or altered function early in the disease process. Critically, this impairment is not merely a consequence but appears to be a key driver of network hyperexcitability, a hallmark feature of AD models and potentially a core mechanism underlying cognitive deficits. For instance, parvalbumin-positive (PV+) interneurons display biphasic alterations in activity. Both suppressing early hyperactivity or enhancing late activity can rescue cognitive deficits, underscoring their causal role. Somatostatin-positive (SST+) neurons are highly sensitive to amyloid-beta (Aβ) dysfunction. Their functional impairment drives AD progression via a dual pathway: compensatory hyperexcitability promotes Aβ generation, while released SST-14 forms toxic oligomers with Aβ, collectively accelerating neuronal loss and amyloid deposition, forming a vicious cycle. Vasoactive intestinal peptide-positive (VIP+) neurons, although potentially spared in number early in the disease, exhibit altered firing properties (e.g., broader spikes, lower frequency), contributing to network dysfunction (e.g., in CA1). Furthermore, VIP release induced by 40Hz sensory stimulation (GENUS) enhances glymphatic clearance of Aβ, demonstrating a direct link between VIP neuron function and modulation of amyloid pathology. Given their central role in network stability and their demonstrable dysfunction in AD, GABAergic interneurons represent promising therapeutic targets. Current research primarily explores three approaches: increasing interneuron numbers (e.g., improving cortical PV+ interneuron counts and behavior in APP/PS1 mice with the antidepressant citalopram; transplanting stem cells differentiated into functional GABAergic neurons to enhance cognition), enhancing neuronal activity (e.g., using low-dose levetiracetam or targeted activation of specific molecules to boost PV+ interneuron excitability, restoring neural network γ-oscillations and memory; non-invasive neuromodulation techniques like 40Hz repetitive transcranial magnetic stimulation (rTMS), GENUS, and minimally invasive electroacupuncture to improve inhibitory regulation, promote memory, and reduce Aβ), and direct GABA system intervention (clinical and animal studies reveal reduced GABA levels in AD-affected brain regions; early GABA supplementation improves cognition in APP/PS1 mice, suggesting a therapeutic time window). Collectively, these findings establish GABAergic interneuron intervention as a foundational rationale and distinct pathway for AD therapy. In conclusion, GABAergic interneurons, particularly the PV+, SST+, and VIP+ subtypes, play critical and subtype-specific roles in the initiation and progression of AD pathology. Their dysfunction significantly contributes to network hyperexcitability, oscillatory deficits, and cognitive decline. Understanding the heterogeneity in their vulnerability and response mechanisms provides crucial insights into AD pathogenesis. Targeting these interneurons through pharmacological, neuromodulatory, or cellular approaches offers promising avenues for developing novel, potentially disease-modifying therapies.
陈柯翰,杨正江,高子馨,姚远,尧德中,杨吟,陈科. GABA能中间神经元在阿尔茨海默病 病理进程中的重要作用[J].生物化学与生物物理进展,,():
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