Следствия множественных микроинсультов

Дж. Гленнер из Медицинской школы Калифорнийского университета в Сан- Диего исследовал мозг 350 пациентов с болезнью Альцгеймера и в 92% случаев обнаружил отложения амилоида. Обычно он начинает накапливаться в среднем (мышечном) слое стенки сосуда, затем продвигается наружу. Иногда амилоид полностью замещает стенку сосуда, по-видимому, размягчая ее, что вызывает кровотечение. Возможно, этим процессом объясняются мозговые кровоизлияния, которые иногда наблюдаются на поздних стадиях болезни Альцгеймера; тогда трудно бывает решить, страдает ли пациент именно от этого заболевания, или его слабоумие есть следствие множественных микроинсультов.

В выдвинутой Гленнером теории патогенеза болезни Альцгеймера основную роль играет амилоид сосудов головного мозга. Он полагает, что присутствующие в крови больного «амилоидогенные» белки могут превращаться в амилоид при участии фермента, находящегося в мозгу в кровеносных сосудах; амилоид повреждает сосуды, из-за чего в мозговую ткань просачиваются и другие белки крови. Эти белки токсичны для нейронов, они активируют фермент, превращающий нейрофиламенты в парные спиральные филаменты, что приводит к гибели клеток. Из погибших нейронов с нейро- фибриллярными клубками в них образуются сенильные бляшки.

Сенильные бляшки — один из трех основных симптомов, по которым невропатолог может идентифицировать болезнь Альцгеймера. Обычно бляшек больше всего в коре головного мозга, гиппокампе и миндалевидном теле — плотном скоплении клеток вблизи гиппокампа, которое особенно сильно повреждается при болезни; в пределах каждой из этих областей бляшки локализуются там, где располагаются аксоны и окончания нейронов, а не их тела. Количество бляшек четко коррелирует со степенью слабоумия. Г. Вишневски и Р. Терри, работавшие тогда в Медицинском колледже Альберта Эйнштейна, обнаружили, что сенильные бляшки по мере созревания претерпевают ряд определенных внешних изменений. Сначала они имеют вид сферических масс, от 50 до 200 мкм в диаметре, и состоят из дегенерирующих нервных окончаний, амилоида и одного из видов глиальных клеток (глиальные клетки — это опорные клетки мозга), участвующих в воспалительных процессах. Затем амилоид скапливается в центре, образуя ядро, оно оказывается окружено дегенерирующими аксонами, макрофагами (в организме эти клетки играют роль уборщиков «мусора») и глиальными клетками, которых теперь еще больше. Наконец, остатки клеток исчезают и остается отдельное скопление амилоида.

При том, что при болезни Альцгеймера накапливаются три вида аномальных белковых образований, в целом белка синтезируется в мозгу, судя по всему, меньше, чем в норме. Ч. Маротта и его коллеги (Медицинская школа Гарвардского университета) считают, что в мозгу больных недостаточно РНК (эта нуклеиновая кислота служит посредником при передаче информации от ДНК к аппарату синтеза белка), поскольку у них нарушена регуляция фермента, расщепляющего ее.

 

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