帕金森病治疗的新希望

Aminur Rahman
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摘要

帕金森病(PD)是全球第二大最常见的神经退行性疾病,预计到2040年全球至少有1200万人受到影响。Hoehn和Yahr量表的第4或第5阶段被称为晚期帕金森病(PD),其特征是严重的运动缺陷,摔倒的风险很高,在行动方面的独立性极其有限,以及认知和精神障碍。运动波动和运动障碍经常影响晚期PD患者,其中运动障碍在诊断后5.81年内出现,运动波动在10年内出现。当运动波动首次出现时,需要持续监测,以决定何时开始进一步治疗。因此,迫切需要改进治疗方法来解决这些运动症状。脑深部电刺激、阿波啡皮下输注、左旋多巴-卡比多巴肠道凝胶输注、磁共振引导下的高强度聚焦超声(FUS)是四种器械辅助治疗PD晚期的新希望。器械辅助疗法的选择现在主要是由患者的运动特征驱动的,非运动症状对成功治疗的交付和维持的决策过程影响最小。在初步的人体试验中,正在研究被动和主动抗蛋白á-synuclein疫苗接种。单克隆抗体(mab),如prasinezumab,靶向 - synuclein聚集体,可通过被动接种将血清中游离á-synuclein水平降低97%。在主动疫苗接种中使用á-synuclein片段或等效表位来刺激免疫反应也正在研究中。尽管利用胎儿脑细胞的细胞再生疗法在少数情况下是成功的,但由于缺乏胎儿组织,这种治疗并不实用。目前正在研究多巴胺产生细胞的可持续来源,如干细胞、从诱导多能干细胞(iPSCs)获得的多巴胺能祖细胞或来自胚胎干细胞(ESCs)的细胞。孟加拉国J医学2023;第34卷,第2(1)号补编:182-183
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New Hope in Parkinson’s Disease Management
Parkinson’s disease (PD) is the second most common neurodegenerative disorder worldwide, projected to affect at least 12 million people worldwide by 2040. The Hoehn and Yahr Scale stages 4 or 5 are referred to as advanced Parkinson’s disease (PD), which is characterized by significant motor deficits, a high risk of falling, extremely limited independence in terms of mobility, and cognitive and psychotic disorders. Motor fluctuations and dyskinesias frequently affect persons living with advanced PD, in which dyskinesia develops within 5.81 years from diagnosis, and motor fluctuations within 10 years. Continuous monitoring is necessary when motor fluctuations first appear to decide when to start an advanced treatment. Consequently, there is a vast need for improved treatments to address these motor symptoms. Deep brain stimulation, apomorphine subcutaneous infusion, levodopa-carbidopa intestinal gel infusion, and magnetic resonance-guided high-intensity focused ultrasound (FUS) are four device-aided therapies that provide new hope for treating PD in its advanced stages. The selection of device-assisted therapies is now mostly driven by the motor profile of the patient, with non-motor symptoms having a minimal impact on the decision-making process for the delivery and maintenance of successful therapy. In preliminary human trials, passive and active antiprotein á—synuclein vaccinations are being investigated. Monoclonal antibodies (mAbs) like prasinezumab that target the aggregates of á— synuclein can reduce the levels of free á—synuclein in serum by 97% by passive vaccination. The use of á—synuclein fragments or equivalent epitopes in active vaccination to stimulate an immune response is also being investigated. Although cell-based regeneration therapies utilizing fetal brain cells are successful in a small number of cases, this treatment is not practical due to the lack of fetal tissue. A sustainable source of dopamine-producing cells, such as stem cells, dopaminergic progenitors obtained from induced pluripotent stem cells (iPSCs), or cells derived from embryonic stem cells (ESCs), is currently being researched. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 182-183
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