The immune system plays a major part in neurodegenerative diseases. In some, such as multiple sclerosis, it is the primary driver of the disease. In others, such as Alzheimer disease, amyotrophic lateral sclerosis and Parkinson disease, it has an amplifying role. Immunotherapeutic approaches that target the adaptive and innate immune systems are being explored for the treatment of almost all neurological diseases, and the targets and approaches are often common across diseases. Microglia are the primary immune cells in the brain that contribute to disease pathogenesis, and are consequently a common immune target for therapy. Other therapeutic approaches target components of the peripheral immune system, such as regulatory T cells and monocytes, which in turn act within the CNS. This Review considers in detail how microglia, monocytes and T cells contribute to the pathogenesis of multiple sclerosis, Alzheimer disease, amyotrophic lateral sclerosis and Parkinson disease, and their potential as shared therapeutic targets across these diseases. The microbiome is also highlighted as an emerging therapeutic target that indirectly modulates the immune system. Therapeutic approaches being developed to target immune function in neurodegenerative diseases are discussed, highlighting how immune-based approaches developed to treat one disease could be applicable to multiple other neurological diseases.

免疫系统在神经退行性疾病中起着重要作用。在某些疾病中，例如多发性硬化症，它是该疾病的主要驱动因素。在其他疾病中，如阿尔茨海默病、肌萎缩侧索硬化症和帕金森病，它具有放大作用。针对适应性和先天免疫系统的免疫治疗方法正在被探索用于治疗几乎所有神经系统疾病，并且这些靶点和方法通常在疾病中很常见。小胶质细胞是大脑中促成疾病发病机制的主要免疫细胞，因此是治疗的常见免疫靶点。其他治疗方法针对外周免疫系统的组成部分，例如调节性 T 细胞和单核细胞，它们反过来又在 CNS 内起作用。本综述详细考虑了小胶质细胞、单核细胞和 T 细胞如何促进多发性硬化症、阿尔茨海默病、肌萎缩侧索硬化症和帕金森病的发病机制，以及它们作为这些疾病共同治疗靶点的潜力。微生物组也被强调为间接调节免疫系统的新兴治疗靶点。讨论了正在开发的针对神经退行性疾病免疫功能的治疗方法，强调了为治疗一种疾病而开发的基于免疫的方法如何适用于多种其他神经系统疾病。