Characteristic developmental expression of amyloid beta40, 42 and 43 in patients with Down syndrome

We immunohistochemically studied the expression of beta-amyloid precursor protein (APP), Abeta40, Abeta42, and Abeta43 in the frontal lobes of 20 Down syndrome (DS) patients and 13 controls. The immunoreactivity for each antibody was different in the degree of intensity and the chronological pattern of expression. APP and Abeta43 immunoreactivity was increased in neurons initially, and then Abeta43 and 42 immunoreactivity appeared in diffuse plaques from 32 years of age. APP and Abeta43 were characteristically observed in axons around senile plaques. Finally, Abeta40 immunoreactivity was detected in the cores of senile plaques. This time course of immunoreactive expression may be related to the pathogenetic process of Alzheimer-type dementia in DS, and the axonal damage in senile plaques may lead to the formation of neurofibrillary tangles (NFT) or neuronal death through axonal flow disturbance and accumulation of Abeta43 in cortical neurons.     

Distinctive,rapid, and easy labeling of diffuse plaques in the Alzheimer brains by a new methenamine silver stain

Summary We have developed a new methenamine silver (MS) stain for detecting diffuse plaques distinctively on paraffin-embedded tissue sections of Alzheimer-type dementia, Down'n syndrome, and mentally normal aged brains. This rapid and easy method selectively labels amyloid-related component of senile plaques, but not of kuru plaques found in Gerstmann-Sträussler syndrome. Our MS stain shows almost the same staining pattern as that of the protein immunostaining with formic acid pretreatment. Therefore, new MS stain is appropriate to routine or screening studies for senile plaques including diffuse plaques.     

An immunohistochemical study of β-protein in Alzheimer-type dementia brains

Summary An immunohistochemical study with a polyclonal anti--protein antiserum was performed in order to understand the mechanism of deposition of amyloid fibrils in senile plaques in Alzheimer-type dementia (ATD). Serial cortical sections cut from ATD brains were necessary to investigate the structural correlation between senile plaques and blood vessels. The senile plaques were stained well and a blood vessel or capillary-like structure was found in most of -protein-immunoreactive deposits. These findings may suggest an involvement of blood vessels in the formation of at least some of the amyloid deposits in ATD brains.     

Amyloid β protein (Aβ) deposition: Aβ42(43) precedes Aβ40 in down Syndrome

The chronological relationship regarding deposition of amyloid β protein (Aβ) species, Aβ40 and Aβ42(43), was investigated in 16 brains from Down syndrome patients aged 31 to 64 years. The frontal cortex was probed with two end-specific monoclonals that recognize Aβ40 or Aβ42(43). All senile plaques detected with an authentic β monoclonal were also Aβ42(43) positive, but only a varying proportion was Aβ40 positive. In young (≤ 50 years old) brains there were many Aβ42(43)-positive, Aβ40-negative diffuse plaques, but only few Aβ40-positive senile plaques (mean, 6.3% of total number of senile plaques). The 2 youngest Down syndrome brains showed only diffuse plaques that were all Aβ42(43) positive but Aβ40 negative. Old (≤ 50 years old) brains contained many mature senile plaques with amyloid cores in addition to diffuse and immature plaques and the proportion of Aβ40-positive senile plaques was increased (mean, 42% of total). Cerebral amyloid angiopathy was more abundant in old Down syndrome brains and was positive for both Aβ40 and Aβ42(43). In cerebral amyloid angiopathy, Aβ40 predominated over Aβ42(43) in both staining intensity and number of positive vessels. These results indicate that (1) the Aβ species intially deposited in the brain as senile plaques is Aβ42(43) and Aβ40 only appears a decade later, and (2) in cerebral amyloid angiopathy Aβ40 appears as early as Aβ42(43).     

Relationship between plaques, tangles, and dementia in Down syndrome

In patients with Down syndrome, senile plaques and neurofibrillary tangles accumulate in the cortex at an earlier age than in persons of normal karyotype. We studied 20 Down syndrome patients dying after age 30 (average age, 49); all had neocortical plaques and tangles, but only 3 of 20 had been demented. In 12 cases (average age, 53), tissue was available for quantitative study of plaque and tangle densities and estimation of cell loss in the hippocampus. Although at least 8 of these 12 cases had plaque and tangle densities comparable to those previously reported in demented old people, only 1 had dementia. The regional distribution of plaques and tangles in the hippocampus of these Down cases differed from the pattern in senile dementia. Although Alzheimer-like dementia occurs in Down disease, it is less prevalent than the plethoric plaques and tangles in the cortex.     

Immunoreactivity of cerebral amyloidosis is enhanced by protein denaturation treatments

Summary We investigated paraffin-embedded brain sections from three patients with Gerstmann-Sträussler syndrome and three patients with Alzheimer's disease or senile dementia of Alzheimer type using anti-human prion protein antisera and anti-/A4 protein antisera after protein denaturation treatments. After incubation with guanidine-thiocyanate, trichloroacetate, and phenol, the immunoreactivity of kuru plaques and senile plaques was enhanced to the same level as the formic acid treatment. These treatments revealed small compact amyloid deposits, amyloid deposits surrounding the plaque cores, and diffuse plaques. Most of these chemicals changed the congophilia of both amyloids. It is possible that these treatments denature amyloid fibril proteins and break down the structure of amyloid fibrils, thus revealing buried epitopes.Supported by grants (02454245, 03454171) from the Ministry of Education, Science and Culture, the Ministry of Health and Welfare, and the Science and Technology Agency, Japan     

Pathological alterations of the cerebral microvasculature in Alzheimer's disease and related dementing disorders

Alterations of the cerebral microvasculature have been reported in aging and in neurodegenerative disorders such as Alzheimer's disease. However, the exact role of microvascular alterations in the pathogenesis of neurodegeneration remains unknown. In the present report, the cerebral cortex microvasculature was studied by immunohistochemistry using a monoclonal antibody against vascular heparan sulfate proteoglycan protein core in normal aging controls, Alzheimer's disease, Down syndrome, Guam amyotrophic lateral sclerosis/parkinsonian dementia complex, Pick's disease and dementia pugilistica. In all dementing illnesses, increased microvascular pathology was evident compared to normal controls. Decreased microvascular density and numerous atrophic vessels were the primary abnormalities observed in all dementing disorders. These microvascular abnormalities demonstrated regional and laminar selectivity, and were primarly found in layers III and V of frontal and temporal cortex. Quantitative analysis employing computer-assisted microscopy demonstrated that the decrease in microvascular density in Alzheimer's disease was statistically significant compared to age-matched controls. In addition, extracellular heparan sulfate proteoglycan deposits were observed which colocalized with thioflavine S-positive senile plaques in Alzheimer's disease, Down syndrome and selected Guam dementia cases. In some cases, heparan sulfate proteoglycan was seen in senile plaques that appeared to be diffuse or primitive plaques that stained weakly with thioflavine. Heparan sulfate proteoglycan-containing neurons were also observed in Alzheimer's disease, as well as in Down syndrome and Guam cases. Glial staining for heparan sulfate proteoglycan was never observed. Our data support previous observations that microvascular pathology is found in aging and in Alzheimer's disease. The changes in Alzheimer's disease exceed those found in normal aging controls. We also found microvascular pathology in all other dementing disorders studied. Our studies further demonstrated that the microvascular pathology displays regional and laminar patterns which parallel patterns of neuronal loss. Finally, we also found that heparan sulfate proteoglycan is present in senile plaques and neurons not only as previously reported in Alzheimer's disease, but also in Down syndrome and Guam cases. Heparan sulfate proteoglycan in senile plaques may be derived from either the degenerating microvasculature or from degenerating neurons. Further studies are necessary to determine the role of microvascular disease in the progression of Alzheimer's disease and other dementing disorders.     

Ultrastructural studies of amyloid fibrils and senile plaques in human brain

Summary Amyloid fibrils and senile plaques in brains with Alzheimer's disease, senile dementia and Down's syndrome were examined by light and electron microscopy. In addition, replicas of amyloid fibrils, made by a quick freezing method from a brain with Down's syndrome, were examined. All amyloid masses forming the cores of senile plaques consisted of numerous amyloid fibrils spreading from the walls of small blood vessels to the surrounding parenchyma. The amyloid fibrils ran in various directions, forming bundle-like groups in a geometrical array. They appeared as rods with hollow structures consisting of an array of globular units in the replicas, while they showed bead-like structure in the tissue specimens of 500-nm thick sections. The ultrastructure of replicas reveals a new finding on the structure of amyloid fibrils in the human brain.     

Congophilia in cerebral amyloidosis is modified by inactivation procedures on slow transmissible pathogens

Cerebral tissues with amyloid deposits were treated by various chemicals which inactivated the agent of subacute spongiform encephalopathy (SSE). We discovered Congophilia in the amyloid plaques in cases of Creutzfeldt-Jakob disease (CJD) and Gerstmann-Str?ussler syndrome (GSS) correlated to the chemical inactivation profiles of SSE. After incubation with trichloroacetate, guanidine-SCN, guanidine-HCl, formic acid, phenol and autoclaving, amyloid plaques in unfixed frozen sections of human brains with CJD or GSS, lost the affinity of Congo red and green birefringence under polarized light. In formalin-fixed, paraffin-embedded tissue sections, amyloid plaques of CJD and GSS lost the affinity of Congo red after most of these treatments. On the other hand, senile plaques in the aged, patients with Alzheimer's disease and with senile dementia of the Alzheimer type did not lose the affinity of Congo red after most of these treatments. Therefore, the amyloid deposits in the amyloid plaques differ from those in senile plaques. The methods we used facilitate differentiation of amyloid and senile plaques in formalin-fixed, paraffin-embedded tissues.     

Lysosomal proteinase antigens are prominently localized within senile plaques of Alzheimer's disease: evidence for a neuronal origin

To investigate the role of proteolysis in amyloid formation, we studied the localization of the proteolytic enzymes, cathepsin D and cathepsin B, in the prefrontal cerebral cortex and hippocampus of human postmortem brains from patients with Alzheimer's disease and from individuals free of neurological disease. In control and Alzheimer brains, cathepsin immunoreactivity within cells was localized to lysosome-related structures, which were particularly abundant in neuronal perikarya. In Alzheimer brain, cathepsin immunoreactivity was also heavily concentrated extracellularly within senile plaques. Cathepsin immunoreactivity associated with plaques was not confined to lysosomes and was distributed throughout the plaque. Isolated amyloid cores, however, were not immunostained. Cathepsin-laden perikarya of degenerating neurons were frequently seen within senile plaques and, in the more advanced stages of degeneration, cathepsin immunoreactivity was present throughout the cytoplasm. Other identified constituents of senile plaques appeared to be less significant sources of cathepsin immunoreactivity, including astrocytes, degenerating neurites, microglia and macrophages. These results demonstrate that lysosomal proteinases are major constituents of the senile plaque and that degenerating neuronal perikarya are a principal source of the cathepsin immunoreactivity. We propose that the unregulated action of extracellular cathepsins liberated from degenerating neurons may lead to abnormal processing of the amyloid precursor protein and to the formation of amyloid locally within senile plaques in Alzheimer's disease.     

Permanganate oxidation of senile cerebral amyloid and its relationship to AA protein

Summary Immunoreactivity for AA protein was rarely detected in briefly fixed amyloid of senile plaques and dyshoric angiopathy, but was not observed in Congophilic angiopathy. Plaque and dyshoric amyloid exhibited variable sensitivity to permanganate oxidation; Congophilic angiopathy was resistant to oxidation. In contrast to systemic amyloid composed of AA protein, the rare immunoreactivity of senile cerebral amyloid was lost with prolonged fixation. This study demonstrates that the fibrillar protein of senile cerebral amyloid differs from that of systemic amyloid of AA type.     

Antiserum to scrapie-associated fibril protein reacts with amyloid plaques in familial transmissible dementia

Scrapie-associated fibrils (SAF) are disease-specific markers for the unconventional agent-induced, transmissible spongiform encephalopathies. Polyclonal rabbit antiserum to SAF protein was reacted with brain sections from scrapie-infected mice, two familial cases of transmissible dementia, and three cases of Alzheimer's disease (AD). Specific immunostaining of cerebral amyloid plaques occurred in the scrapie-infected mice and in the two familial cases of transmissible dementia. No immunoreactivity was detected in senile plaques or neurofibrillary tangles in the three cases of AD. Our results suggest that SAF, the causative pathogenic agent, and extracellular deposits of amyloid in the brain are closely related. Immunohistochemical detection of SAF protein could serve as a useful diagnostic adjunct in the postmortem evaluation of difficult cases of dementia. The identification of SAF protein in the brains of two affected members of a family combining the clinical and pathological features of Creutzfeldt-Jakob disease (CJD) and the Gerstmann-Straüssler syndrome (GSS) substantiates earlier conclusions of a nosological relationship between the two. Our study provides further evidence of the similarity of SAF protein to prion protein (PrP 27-30).     

Cerebral amyloid angiopathy in the aged

Summary Cerebral amyloid angiopathy (CAA) was found in 57% of 123 autopsy brains removed from patients aged 59–101 years. The incidence of CAA increased with age. CAA was seen most frequently in the occipital cortex. Immunohistochemically, amyloid of CAA was positive for amyloid P component and negative for human AA protein and human prealbumin. The presence and severity of CAA were significantly correlated with the number of senile plaques and neurofibrillary tangles. The incidence of CAA in 17 patients with dementia of Alzheimer type (DAT) was estimated to be 88% and was significantly higher than that in 26 patients with dementia of non-Alzheimer type. CAA had a pathogenetic relationship with both brain ageing and DAT. Lobar cerebral haemorrhage was found in 3 patients with CAA of marked or moderate degree. Lobar cerebral haemorrhage in the aged and in patients with DAT suggest the presence of CAA.     

Ultrastructural localization of argyrophilic substances in diffuse plaques of Alzheimer-type dementia demonstrated by methenamine silver staining

Summary The ultrastructure of argyrophilic substances in diffuse plaques of an Alzheimer-type dementia brain was examined using methenamine silver (MS) electron microscopy with the pre-embedding method. Electrondense substances, which were sparse aggregations of bundle-like structures with silver granules, were disseminated in the diffuse plaques. Comparison of serial MS and routine ultrathin sections revealed that diffuse plaques usually show scattered bundles of amyloid fibrils or amorphous materials, or both, between indistinct cell process membranes. Some of these processes were identified as astrocytic or dendritic in origin. A few degenerative neurites were frequently noted in large silver-positive areas but never in small areas. These findings suggest that the appearance of amyloid fibrils and amorphous materials between certain cell processes is a very morphological change in the process of senile plaque formation.     

Amyloid-P-component-like immunoreactivity in β/A4-immunoreactive deposits in Alzheimer-type dementia brains

An immunohistochemical study using the mirror-image technique was performed in order to establish whether amyloid P component is involved in the mechanism of deposition of amyloid fibrils in senile plaques (SPs) in Alzheimer-type dementia (ATD). Ninety percent of /A4 protein-immunoreactive SPs were also stained by the anti-amyloid P component immunchistochemistry, and this applied to all of the diffuse, primitive and classical types of /A4 deposits. These findings may suggest an involvement of amyloid P component in the formation of amyloid fibrils in senile plaques in ATD brains.     

Alzheimer's disease and hereditary cerebral hemorrhage with amyloidosis-Dutch type share a decrease in cerebrospinal fluid levels of amyloid beta-protein precursor.

The amyloid beta-protein is a 39-42 amino acid peptide that is deposited in senile plaques and in cerebral vessel walls in individuals with Alzheimer's disease, Down's syndrome, hereditary cerebral hemorrhage with amyloidosis-Dutch type (HCHWA-D), and, to a much lesser extent, normal aging. It is derived from abnormal proteolytic processing of its parent protein, the amyloid beta-protein precursor. Here we show that individuals with the HCHWA-D mutation and clinically manifesting the disease have markedly decreased cerebrospinal fluid levels of soluble amyloid beta-protein precursor (0.7 +/- 0.4 micrograms/ml) compared with age-matched normal subjects (3.0 +/- 0.2 micrograms/ml) as determined by quantitative immunoblotting and enzyme-linked immunosorbent assays. Similarly, age-matched patients diagnosed with probable Alzheimer's disease also have decreased cerebrospinal fluid levels of soluble amyloid beta-protein precursor (1.0 +/- 0.3 micrograms/ml). These parallel findings suggest a common biochemical marker for these two diseases and further establish the pathogenic relatedness of HCHWA-D and Alzheimer's disease.     

Immuno-electron microscopic localization of immunoglobulins in amyloid fibrils of senile plaques

Summary Amyloid fibrils in senile plaques of the brain of patients with senile dementia or Alzheimer's disease combined specifically with horseradish peroxidase (HRPO)-labeled rabbit anti-human IgG. Light and electron-microscopic immunoperoxidase technique was used to prove this. The fact may mean that immunological factors were involved in the pathogenesis of amyloid fibrils in the senile plaques, and probably also in that of senile dementia or Alzheimer's disease.     

An immunocytochemical study of alpha 1-antichymotrypsin in the senescent cerebral amyloid

An immunocytochemical study of alpha 1-antichymotrypsin (alpha 1ACT) was performed in order to demonstrate its localization and the relationship between alpha 1ACT and senescent cerebral amyloid. We examined 5 brains with dementia of the Alzheimer type (SDAT), a peripheral nerves of familial amyloidotic polyneuropathy (variant transthyretin type, FAP) and dorsal root ganglions of a primary amyloidosis with peripheral neuropathy (AL type, PA). Avidin-biotin-peroxidase complex method and double immunoenzymatic staining method (peroxidase-antiperoxidase method combined with avidin-biotin-alkaline phosphatase complex method) were used. Anti-beta protein serum was used as the marker of cerebral amyloid. About 98% of senile plaques had alpha 1ACT like-immunoreactivity (alpha 1ACTI). All types of plaques showed the immunoreactivity: Core and peripheral of typical plaques, primitive plaques, core plaques and amorphous cerebral amyloid deposits. Although, a part of a senile plaque showed beta protein like-immunoreactivity alone and the other part had alpha 1ACT, many remainder part of a senile plaque had both immunoreactivity. Of the other pathological changes of SDAT, eosinophilic tangles and cerebrovascular amyloid were positive, in contrast, intracellular tangles, granulovacuolar degeneration and Hirano body were negative. The amyloid from FAP had weak alpha 1ACTI and diffusely stained. alpha 1ACTI was seen in the peripheral margin of the amyloid from PA. These results indicate that alpha 1ACT is closely associated with senile plaques formation.     

Binding of vascular heparan sulfate proteoglycan to Alzheimer's amyloid precursor protein is mediated in part by the N-terminal region of A4 peptide

The exact mechanisms of deposition and accumulation of amyloid in senile plaques and in blood vessels in Alzheimer's disease remain unknown. Heparan sulfate proteoglycans may play an important role in amyloid deposition in Alzheimer's disease. Previous investigations have demonstrated high affinity binding between heparan sulfate proteoglycans and the amyloid precursor, as well as with the A4 peptide. In the current studies, a specific vascular heparan sulfate proteoglycan found in senile plaques bound with high affinity to two amyloid protein precursors (APP₆₉₅ and APP₇₇₀). Vascular heparan sulfate proteoglycan also bound the Alzheimer's amyloid A4 peptide, and not other amyloid protein precursor regions studied, with high affinity. Both heparan sulfate glycosaminoglycan chains and chemically deglycosylated vascular heparan sulfate proteoglycan protein core bound to A4. High affinity interactions between vascular heparan sulfate proteoglycan and the A4 peptide may play a role in the process of amyloidogenesis in Alzheimer's disease, by localizing the site of deposition of A4, protecting A4 from further proteolysis, or by promoting aggregation and fibril formation.