Why is Alzheimer’s disease so difficult to treat? - Krishna Sudhir

Prevodilac: Jovana Babic Lektor: Milenka Okuka

Around the world, tens of millions of people have Alzheimer's disease,

Širom sveta, desetine miliona ljudi boluje od Alchajmerove bolesti,

a debilitating brain disorder that gradually destroys a person's memory

iscrpljujućeg moždanog poremećaja koji postepeno uništava čovekovo pamćenje

and other cognitive abilities.

i druge kognitivne sposobnosti.

It takes a heavy toll on both patients and families,

To je veliki teret i za pacijenta i za njegovu porodicu

as caring for a loved one with Alzheimer's can be emotionally overwhelming

jer briga o voljenoj osobi koja pati od ove bolesti

može biti emocionalno preplavljujuća i finansijski zahtevna.

and financially difficult.

While doctors have studied Alzheimer's for decades,

Iako su lekari proučavali Alchajmerovu bolest decenijama,

conducting hundreds of clinical trials,

sprovodili stotine kliničkih istraživanja,

there is still no effective preventive treatment or cure.

efikasna prevencija i lek i dalje ne postoje.

So, why is Alzheimer's disease so difficult to treat?

Dakle, zašto je Alchajmerova bolest tako teška za lečenje?

Alzheimer's accounts for 60 to 80% of all dementia patients worldwide.

Alchajmerova bolest je uzrok demencije kod 60% do 80% pacijenata širom sveta.

Dementia is a broader term, used to describe a variety of conditions

Demencija je širok pojam koji se koristi za opis brojnih stanja

that affect a patient's memory, thinking skills, and everyday functions.

koja utiču na pacijentovo pamćenje, mišljenje i svakodnevne aktivnosti.

Most Alzheimer's patients first notice symptoms in their 60s,

Većina pacijenata sa Alchajmerom prvi put primete simptome u 60-im godinama

experiencing mild memory problems,

doživljavajući blage probleme sa pamćenjem

like losing track of dates or forgetting what they just learned.

poput gubitka pojma o vremenu ili zaboravljanja onoga što su upravo naučili.

Some experience other changes, like frequent shifts in mood,

Neki doživljavaju i druge promene, poput čestih promena raspoloženja,

increased anxiety and agitation,

povećane anksioznosti i uznemirenosti,

and problems with coping in new situations.

i problema u snalaženju u novim situacijama.

Symptoms typically progress gradually over years

Simptomi obično postepeno napreduju tokom godina,

and eventually a person with Alzheimer's may require constant care.

dok na kraju osoba sa Alchajmerom dođe do stadijuma da zahteva konstantnu negu.

Some rare forms of Alzheimer's are caused by a single inherited gene variant.

Neki retki oblici Alchajmera nastaju zbog nasleđene varijacije u jednom genu.

But most of the time Alzheimer's is due to the complex interaction

Ali u većini slučajeva, Alchajmer je rezultat kompleksne interakcije

of multiple genes in combination with lifestyle and environmental factors,

više gena u kombinaciji sa životnim navikama i faktorima sredine

so it's impossible to predict who will develop the disease.

zbog čega je nemoguće predvideti kod koga će se bolest razviti.

Alzheimer's involves a long, chronic process,

Alchajmerova bolest je dug, hroničan proces,

resulting in many changes to the brain,

koji dovodi do mnogih promena u mozgu,

that likely starts to unfold at least 1 to 2 decades before symptoms first appear.

a koji verovatno počinje da se odvija 10 do 20 godina pre pojave prvih simptoma.

So it's been difficult for scientists to pinpoint

Zbog ovoga je naučnicima jako teško da odrede

exactly what triggers this process

šta tačno pokreće ovaj proces

and what causes the many symptoms of Alzheimer's.

i šta tačno uzrokuje mnoge simptome Alchajmera.

But thanks to continued research, they're beginning to put this puzzle together.

Ipak, uz pomoć brojnih istraživanja, krenuli su da slažu kockice.

Initially, scientists noticed that the brains of Alzheimer's patients

U početku, naučnici su primetili da se u mozgovima pacijenata sa Alchajmerom

display an abnormal buildup of a compound called beta-amyloid.

nakuplja ogromna količina supstance koja se zove beta-amiloid.

Beta-amyloid is created when a large protein,

Beta-amiloid nastaje kada se veliki protein,

amyloid-beta precursor protein, or APP, is broken down.

amiloidni prekursorski protein ili APP razgradi.

APP plays an essential role in the brain, aiding in neural growth and repair.

APP ima ključnu ulogu u mozgu, gde pomaže u rastu i regeneraciji neurona.

However, in Alzheimer's patients, it's thought that APP is improperly cleaved,

Međutim, kod pacijenata sa Alchajmerom, smatra se da se APP nepravilno razlaže,

creating sticky beta-amyloid byproducts, which easily clump together.

stvarajući lepljive beta-amiloidne nusprodukte koji se lako slepljuju.

These plaques can build up in the spaces between neurons,

Ovi plakovi se nakupljaju u prostorima između neurona

and interfere with normal brain signaling.

i ometaju normalnu komukikaciju među njima.

But this likely isn't the full story.

Ipak, ovo nije cela priča.

While all patients with Alzheimer's have plaques,

Iako svi pacijenti sa Alchajmerovom bolešću imaju plakove,

not all people with plaques have or will develop dementia.

ovu bolest nemaju ili je neće dobiti svi ljudi koji imaju plakove.

And Alzheimer's symptoms don't always become more severe

Simptomi Alchajmerove bolesti se ne moraju pogoršavati

as plaques accumulate in the brain.

zajedno sa akumulacijom plakova.

In the 1980s, another protein, tau, emerged as a possible contributor.

Tokom 1980-ih, otkriveno je da protein tau moguće doprinosi razvoju bolesti.

Tau's normal role is as a scaffolding protein,

Normalna uloga tau proteina leži

to help reinforce the internal structure of neurons and give them their shape.

u održavanju unutrašnje struktire neurona, dajući im njihov oblik.

But in Alzheimer's patients, tau is modified and misfolded,

Ali kod Alchajmerove bolesti, tau je modifikovan i pogrešne strukture

causing it, like beta-amyloid, to become sticky and to clump.

što dovodi do toga da postane lepljiv i grupiše se poput beta-amiloida.

These tau tangles accumulate within neurons and are toxic,

Ove nakupine tau proteina se akumuliraju unutar neurona i toksične su,

causing the cells to eventually die.

dovodeći do ćelijske smrti.

In patients, plaques normally appear before tangles,

Kod pacijenata se plakovi uglavnom pojavljuju pre nakupina tau proteina,

yet questions still remain.

ali to i dalje nije cela priča.

Do amyloid plaques trigger tau dysfunction?

Da li amiloidni plakovi uzrokuju disfunkciju tau proteina?

And why exactly do these abnormal proteins lead to such specific disease symptoms?

I zašto baš ove proteinske abnormalnosti uzrokuju specifičan skup simptoma?

To make matters more complex,

Da stvari budu još komplikovanije,

recent studies have found that Alzheimer's is closely linked to changes

skorija istraživanja su pokazala da je Alchajmerova bolest usko povezana

in the way immune cells, called microglia, function in the brain.

sa promenama u načinu rada imunskih ćelija u mozgu koje se zovu mikroglije.

Others have found that Alzheimer's may also be caused by problems

Druge studije su pokazale da je bolest možda takođe povezana sa problemima

in the junctions between neurons, called synapses.

u vezama između neurona, zvanim sinapse.

And alterations in the way the brain produces and burns energy

I promene u načinu na koji mozak proizvodi i troši energiju

may also be an underlying factor.

mogu biti doprinoseći faktor.

Together, all this suggests that Alzheimer's is likely caused

Sve ove teorije zajedno pretpostavljaju da je Alchajmerova bolest najverovatnije

by a complex cascade of events.

rezultat komplikovane kaskade događaja.

And teasing out the order of events, and how to stop it once it starts,

Razumevanje redosleda događaja i kako ih zaustaviti nakon započinjanja

will take more research.

zahteva još istraživanja.

But there are things patients can do to better manage symptoms.

Uprkos tome, i dalje postoje načini za usporavanje toka bolesti.

Staying active, learning new skills,

Održavanje akitvnosti, učenje novih veština,

and even participating in daily activities,

pa čak učestvovanje u svakodnevnim radnjama,

like household chores,

poput kućnih poslova,

seems to slow disease progression.

usporava progresiju bolesti.

Medications that target neurotransmitters, the brain's signaling molecules,

Lekovi koji utiču na neurotransmitere, tj. molekule moždane komunikacije,

can slow memory loss and help with learning and reasoning.

mogu usporiti gubitak pamćenja i pomoći u učenju i razmišljanju.

And scientists continue to develop new therapies.

Naučnici neprestano razvijaju nove vidove terapije.

For example, drugs that target beta-amyloid have shown promise

Na primer, lekovi koji napadaju beta-amiloid su se pokazali obećavajućim

in slowing the disease and reducing plaque accumulation in the brain.

u usporavanju bolesti i smanjenju akumulacije plakova u mozgu.

Alzheimer's disease won't go away anytime soon.

Alchajmerova bolest neće nestati u skorije vreme.

Dementia cases are expected to double in the next 20 years.

Očekuje se da će se broj pacijenata sa demencijom duplirati za 20 godina.

But continued research holds the promise of better treatment

Ali neprekidno istraživanje donosi nadu za bolje terapijske opcije

and perhaps one day, prevention,

i mogući razvoj metoda prevencije

as scientists piece the Alzheimer's puzzle together.

dok naučnici polako dobijaju kompletnu sliku o ovoj bolesti.