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与粉样蛋白相关的成像异常:表现,指标和机制

Steven M Greenberg¹, Francesco Bax^2,3, Susanne J van Veluw²

¹J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. sgreenberg@mgh.harvard.edu.

Nature reviews. Neurology

|January 10, 2025

概括

与粉样蛋白相关的成像异常 (ARIA) 是新的阿尔茨海默病治疗的关键副作用. 了解 ARIA 的理解

科学领域:

神经学神经学
免疫学免疫学免疫学
放射学放射学是一门学科.

背景情况:

针对粉样β (Aβ) 的FDA批准的单克隆抗体代表了一类新的疾病修饰性阿尔茨海默病 (AD) 治疗方法.
与粉样蛋白相关的成像异常 (ARIA) 是与抗Aβ免疫疗法相关的最重要的不良反应.

研究的目的:

审查ARIA的检测,病理生理机制和临床影响.
突出大脑粉样血管病变 (CAA) 在ARIA发展中的作用.
强调需要在抗Aβ免疫治疗中安全管理ARIA的策略.

主要方法:

审查ARIA (ARIA-E和ARIA-H) 的放射性外观.
对ARIA临床风险因素和神经病理学的分析.
对抗Aβ免疫疗法的动物模型的研究结果的检查.

主要成果:

ARIA表现为 edem/effusions (ARIA-E) 或出血性病变 (ARIA-H),包括微型出血和出血.
大脑粉样血管病变 (CAA) 在ARIA中起着核心作用,作为动员Aβ的直接目标或接受者.
大多数ARIA病例是轻微的,但约5%是严重的,导致住院,残疾或死亡.

结论:

在阿尔茨海默病中,ARIA是安全有效使用抗Aβ免疫疗法的关键考虑因素.
进一步研究预测,建模,预防和治疗ARIA是必不可少的.
管理ARIA挑战了患者选择和同时使用药物的使用.

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