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Nature子刊:“换血大法”治疗阿尔茨海默病具有可行性!

2022-08-20 露娜 生物探索

AD是老年人群中最常见的痴呆症原因。数十年来,研究人员一直致力于了解AD的遗传和分子基础,但尚未发现有效的治愈或改善措施。

既往研究表明,β-淀粉样蛋白的错误折叠、聚集和脑沉积是诱发AD的主要因素,因此,预防和去除错误折叠的蛋白质聚集体是治疗AD的潜在策略,目前开展的治疗方法也多聚焦在预防或清除β-淀粉样蛋白。

近日,发表在Nature子刊Molecular Psychiatry上一篇题为“Preventive and therapeutic reduction of amyloid deposition and behavioral impairments in a model of Alzheimer’s disease by whole blood exchange”的研究表明,通过与健康小鼠进行全血交换,患有AD小鼠的大脑淀粉样斑块的形成显著减少了40-80%,这预示着换血治疗或可有效治疗阿尔茨海默病

 

图片

图1 研究成果(图源:[1])

在假定外周循环会影响脑病理异常的前提下,研究人员尝试研究换血疗法对减少阿尔茨海默病病理的作用。研究者选用具有129S遗传背景的Tg2576小鼠作为AD的淀粉样变病理模型,由于这些小鼠携带淀粉样前体蛋白瑞典型突变基因,所以在成长到8-9个月大时,大脑中会表现出淀粉样沉积物。在Tg2576小鼠三个月大时,研究者从具有相同遗传背景的健康野生型小鼠中抽出“全血”,少量多次,来部分替换Tg2576小鼠的血液,连续进行10至14个月。

注:“全血”并非小鼠的全部血液,而是指未除去任何成分的血液

在该过程中,研究团队主要通过30号针头的肝素涂层注射器从颈静脉手动抽取300μL总血,然后将其缓慢注入(100 μL/min)到Tg2576小鼠的颈静脉中以补偿抽出的体积。重复6到8次这种换血操作,可实现每只动物每月1.8到2.4毫升的血液交换,这对应于每次手术时可替换原始血液的40%到60%。研究发现:

1. 换血疗法可显著减少老年鼠脑内淀粉样斑块的累积

实验中,在给携带阿尔茨海默病基因的小鼠多次进行输血治疗后发现,小鼠大脑中形成的淀粉样蛋白斑块减少了40%-80%;通过观察小鼠大脑矢状位横截面图,研究人员发现,在换血后的老年Tg2576小鼠脑内,仅观察到非常少量以及很小的脑淀粉样斑块;而相比之下,对照组老年小鼠的大脑皮层和海马体中,则出现了大量的脑淀粉样斑块(图2)。

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图2 血液交换治疗可减少脑淀粉样斑块的积累(图源:[1])

具体来说,接受全血疗法的老年小鼠脑内,淀粉样斑块的数量和覆盖面积都明显减少:与对照组相比,换血小鼠的大脑皮层和海马体中,淀粉样斑块的数量分别减少了50.0%和64.2%,覆盖面积分别减少了75.6%和75.9%。由此,不论从数量还是面积,换血疗法可有效地减少脑内斑块的形成。

2. 换血疗法可改善老年小鼠的空间记忆

为了研究血液交换是否会导致空间记忆的功能变化,在小鼠12.5个月大的时候对其进行时长1小时的巴恩斯迷宫测试,了解接受多次血液交换治疗的Tg2576小鼠的学习曲线(A)、短期记忆(B)和长期记忆(C)。研究团队分别在第5天、连续4天训练后评估短期记忆,在第12天评估长期记忆。

学习曲线(图2A)表示,各组之间的学习曲线没有差异,不同组别都有效地完成了学习任务。短期记忆分析(图2B)表明,与假手术动物或未处理的Tg2576小鼠相比,换血小鼠寻找目的地的时间明显缩短。长期记忆研究(图2C)表明,与假手术和未经处理的Tg2576相比,血液交换的小鼠保持了显著更高的性能。有趣的是,血液交换组的短期和长期记忆与未经治疗的野生型小鼠没有显着差异。这些结果表明,通过多次血液交换处理,Tg2576小鼠的空间记忆能力明显提高至在野生型动物中观察到的水平。

图片

图3 血液交换治疗改善空间记忆(图源:[1])

结果显示,具有病理性淀粉样斑块的老年小鼠,在经历输血治疗后,其空间记忆能力得到显著改善。

研究者推测,这种换血疗法能够降低血液中游离的β-淀粉样蛋白的水平,从而使相关蛋白在大脑和外周血液中重新分布,减少聚集。除此之外,换血疗法还可能阻止了β-淀粉样蛋白进入大脑或者减少了对它的重吸收过程。研究作者Claudio Soto博士表示,尽管目前治疗机制还不完全清楚,但新研究借助医疗中常用的技术来对改善阿尔茨海默病个体的血液状态,从而减少有毒物质的累积。这说明未来有可能通过在血液循环层面帮助治疗阿尔茨海默病,这可能为AD开辟一种新的疾病缓解干预措施。

参考资料:

[1]Urayama A, Moreno-Gonzalez I, Morales-Scheihing D, et al. Preventive and therapeutic reduction of amyloid deposition and behavioral impairments in a model of Alzheimer's disease by whole blood exchange. Mol Psychiatry. 2022 Jul 15. doi: 10.1038/s41380-022-01679-4. Epub ahead of print. PMID: 35835859.

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    2023-03-06 liye789132251
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    2022-08-21 ms5000001410456216

    全血交换

    0

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JAMA子刊:患有儿童遗传病“唐氏综合征”的患者阿尔茨海默病的进展和纵向认知能力的发展变化

这项研究发现了症状性AD的发展与DS患者中进行性认知下降存在高风险相关性,为DS成人预防AD的临床试验提供信息。

全血交换可以为阿尔茨海默病提供疾病改善疗法

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