Beta A4 amyloid protein and its precursor in Alzheimer's disease.

The beta A4 amyloid protein is now understood to play a pivotal role in the development of Alzheimer's disease. This protein is generated by the abnormal processing of the amyloid protein precursor, a large membrane glycoprotein. Insights into the mechanisms of this abnormal processing will give information relevant to the design of new therapeutic strategies for Alzheimer's disease.     

Production and catabolism of amyloid peptides in Alzheimer's disease

Senile plaques that accumulate in cortical and sub-cortical areas of Alzheimer's disease (AD)-affected brains are mainly composed of a set of hydrophobic and aggregated peptides referred to as amyloid β-peptides (Aβ). These peptides derive from the proteolytic processing of a transmembrane precursor, the β-amyloid precursor protein (βAPP) that undergoes subsequent cleavages by β- and γ-secretases, respectively. Another enzyme called α-secretase cleaves βAPP in the middle of its Aβ sequence and thereby, lowers its production. Once produced, Aβ peptides can be cleared off by neuropeptidases, mainly insulin-degrading enzyme and neprilysin, or, alternatively, can be biotransformed upon N-terminal truncation by exopeptidases and subsequent cyclisation of the glutamate in position 3. Here, we will describe the nature of the various proteolytic activities documented above and we will discuss briefly their advantages and drawbacks as putative therapeutic targets in AD.     

Neuropsychological correlates of amyloid precursor protein in Alzheimer's disease

The comprehensive cognitive screens for dementia, the Cambridge Cognitive screen (CAMCOG) and the Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE) were used for assessing use of the putative Alzheimer's disease biological marker, plasma amyloid precursor protein (APP), in Alzheimer's disease and Down syndrome. The analysis suggested that there were significant correlations between amyloid precursor protein and cognitive decline as assessed by the IQCODE. Preliminary investigations of Down syndrome suggest amyloid precursor protein levels are associated with duration of dementia in the group. The findings imply circulating amyloid precursor protein has a more central role in the pathogenesis of Alzheimer's disease.     

The role of amyloid beta peptide 42 in Alzheimer's disease

During the last 20 years, an expanding body of research has elucidated the central role of amyloid precursor protein (APP) processing and amyloid beta peptide (Abeta) production in the risk, onset, and progression of the neurodegenerative disorder Alzheimer's disease (AD), the most common form of dementia. Ongoing research is establishing a greater level of detail for our understanding of the normal functions of APP, its proteolysis products, and the mechanisms by which this processing occurs. The importance of this processing machinery in normal cellular function, such as Notch processing, has revealed specific concerns about targeting APP processing for therapeutic purposes. Aspects of AD that are now well studied include direct and indirect genetic and other risk factors for AD, APP processing, and Abeta production. Emerging from these studies is the particular importance of the long form of Abeta, Abeta42. Elevated Abeta42 levels, as well as particularly the elevation of the ratio of Abeta42 to the shorter major form Abeta40, has been identified as important in early events in the pathogenesis of AD. The specific pathological importance of Abeta42 has drawn attention to seeking drugs that will selectively lower the levels of this peptide through reduced production or increased clearance while allowing normal protein processing to remain substantially intact. An increasing variety of compounds that modulate APP processing to reduce Abeta levels are being identified, some with Abeta42 selectivity. Such compounds are now reaching clinical evaluation to determine how they may be of benefit in the treatment of AD.     

Development of amyloid imaging PET probes for an early diagnosis of Alzheimer's disease.

Progressive accumulation of senile plaques (SPs) is one of the major neuropathological features of Alzheimer's Disease (AD) that precedes cognitive decline. Noninvasive detection of SPs could, therefore, be a potential diagnostic test for early or presymptomatic detection of AD patients. For this purpose, many attempts have been made to visualize AD-specific pathological changes in the living brain. Currently, a most practical method for the in vivo measurement of SP depositions is using positron emission tomography (PET) and contrast agent that specifically label SPs. We have developed a novel compound 2-[2-(2-dimethylaminothiazol-5-yl) ethenyl]-6-[2-(fluoro)ethoxy] benzoxazole (BF-227) as a candidate for an amyloid imaging probe for PET. BF-227 displayed high affinity to synthetic amyloid beta fibrils and clearly stained both SPs and diffuse plaques in AD brain sections. Intravenous administration of [11C]BF-227 into normal mice indicated that this labeled tracer readily penetrated the blood brain barrier (BBB) and was washed out quickly from brain tissue. Currently, we have investigated the clinical trial of [11C]BF-227 in healthy subjects and AD patients.     

Molecular genetics of Alzheimer's disease and the amyloid beta peptide precursor gene

Alzheimer's disease is a neurodegenerative disorder characterized by global cognitive decline. An autopsy of the Alzheimer patient's brain reveals two major neuropathological lesions: neurofibrillary tangles, and amyloid deposits in the form of senile plaques and cerebrovascular accumulations. While tangles appear to be a universal hallmark of dying neurons in several neurodegenerative diseases, amyloid plaques occur in only three conditions including Alzheimer's disease, Down syndrome, and to a limited extent, normal aging. The frequency of senile plaques appears to correlate well with the degree of dementia in the Alzheimer's patient. It remains unclear, however, whether amyloid formation represents one of the final stages of a long neuropathological process in the brain, or initially participates in promoting neuronal dysfunction. To address this question, we have isolated the gene encoding the precursor of the principle component of the plaque, the amyloid beta peptide. We have mapped this gene to chromosome 21, the same chromosome in which we have detected linkage between anonymous DNA markers and the familial form of Alzheimer's disease. Employing direct genetic linkage analysis, we have shown that the amyloid gene and the familial Alzheimer's disease gene represent two separate and distinct genetic loci. Here we present further information on the location of the familial Alzheimer's disease gene on chromosome 21. We also discuss the recent discovery of an alternate form of the amyloid beta peptide precursor gene which encodes a serine protease inhibitor in the Kunitz family. The presence of a protease inhibitor domain within the amyloid beta peptide precursor, itself, has profound implications for its possible role in the process of amyloid formation.(ABSTRACT TRUNCATED AT 250 WORDS)     

Multitracer PET imaging of amyloid plaques and neurofibrillary tangles in Alzheimer's disease

Recently developed positron emission tomography (PET) tracers, such as PIB and FDDNP, help to visualize amyloid plaques and neurofibrillary tangles in living subjects. FDDNP binds to both amyloid plaques and tangles, whereas PIB selectively labels amyloid plaques. Therefore, it will be interesting to see a direct comparison of the regional binding of the two radiotracers for plaques (PIB) and plaques and tangles (FDDNP) using multitracer PET imaging for both PIB and FDDNP in the same subjects with and without Alzheimer's disease. Here we report that multitracer PET images of PIB and FDDNP in the same Alzheimer subjects show negligible PIB but strong FDDNP binding in the medial temporal cortex (hippocampus, amygdala, and parahippocampal gyrus), whereas there are significant quantities of both PIB and FDDNP binding in neocortical areas. These results suggest that tangles rather than amyloid plaques are the dominant pathology in the medial temporal cortex of living Alzheimer patients. In nondemented elderly normal subjects, PIB binding shows a significant increase in the posterior cingulate cortex compared with other brain regions, whereas in the same normal subjects we found significant FDDNP binding in the medial temporal cortex. Interestingly, the medial temporal FDDNP uptake values in normal elderly subjects were inversely correlated with long delay recall scores in the California Verbal Learning Test, a measure of episodic memory performance. We conclude that multitracer PET imaging of amyloid plaques and tangles using FDDNP and PIB in both nondemented and demented subjects provides important insight into these complicated pathological processes in living subjects.     

The pathology of the amyloid A4 precursor of Alzheimer's disease

The A4 amyloid protein is the major subunit present in the amyloid of Alzheimer's disease. It is derived by proteolytic cleavage from a larger precursor (PreA4) which is a neuronal membrane glycoprotein. Whereas in Down's syndrome, over-expression of the gene coding for PreA4 is likely to be responsible for the premature development of cerebral amyloidosis, a similar mechanism is yet to be demonstrated in Alzheimer's disease.     

Mutations of amyloid precursor protein in early-onset familial Alzheimer's disease]

Genetic linkage studies of familial Alzheimer's disease (FAD) have suggested that some form of early-onset FAD is linked to proximal long arm of chromosome 21. It has been also suggested that some form of late-onset FAD is linked to long arm of chromosome 19. Goate et al have identified a mis-sense mutation (Val to Ile) in exon 17 of the amyloid precursor protein (APP) gene in 2 of 16 early-onset FAD families, and have shown that the FAD locus in an FAD family is tightly linked to the mis-sense mutation. To determine if the mis-sense mutation is observed in different ethnic origine, we have studied some early-onset FAD families. Two early-onset FAD families showed the existence of the mutation. As the mutation has been identified in different ethnic origine and the mutation has not been observed in normal individuals, it strengthen hypothesis that the mutation is pathogenic. Recently, Val to Phe and Val to Gly mutations have been also identified at the same codon (Codon 717) of the APP gene.     

Homocysteine, vascular dementia and Alzheimer's disease.

There is some evidence from recent observational studies that hyperhomocysteinemia is a risk factor for cognitive dysfunction, including Alzheimer's disease and vascular dementia. There are only a few intervention studies, and the results are disappointing for such a frequent disease. Prospective double-blind and placebo-controlled intervention studies are not available. If homocysteine-lowering therapy will be in the running for the prevention and treatment of dementia, we must be able to diagnose the disease at a preclinical stage (i.e. 5 or 10 or 20 years before the disease becomes clinically overt for Alzheimer's disease). At the moment, there are insufficient data to support a vitamin B12, B6 or folate therapy in the prevention or treatment of patients with dementia.     

Alzheimer's disease.

Alzheimer's disease is one of the most severe and most common chronic diseases of older persons. Because occurrence of the disease is strongly related to age, its public health impact is likely to continue to increase as the population ages. As with many other diseases, a diagnosis of Alzheimer's disease is made through a combination of clinical history, physical, and neurologic examination, and laboratory evaluation. Because the dominant feature of this disease is its effect on cognition, its diagnosis requires careful evaluation of cognitive function usually with formal neuropsychological performance testing. Clinical evaluation of persons for Alzheimer's disease has four objectives: (1) to determine as accurately as possible if the person has dementia; (2) if dementia is present, to determine whether its presentation and course are consistent with a diagnosis of Alzheimer's disease; (3) to assess evidence for any alternate diagnoses, especially if the presentation and course are atypical for Alzheimer's disease; and (4) to evaluate evidence of other, coexisting, diseases that may contribute to the dementia, with strong emphasis on conditions that might respond to treatment. There is no reliable antemortem diagnostic test for Alzheimer's disease; the main purpose of laboratory testing is to identify other conditions that might cause or exacerbate dementia. Pathologically, Alzheimer's disease is characterized by the presence of two lesions on microscopic examination of the brain: neuritic plaques and neurofibrillary tangles. Both lesions can be seen in the brains of older persons without dementia. However, they are found in greater numbers in the neocortex and hippocampus with Alzheimer's disease. Caring for patients with Alzheimer's disease is demanding and requires compassion and skills that go beyond the choices among sophisticated and effective therapies that characterize much of modern medical practice. The current lack of effective pharmacotherapy for cognitive dysfunction in Alzheimer's disease should not obscure that there are many areas in which intervention can improve quality of life for both the patient and the caregiver. Achieving success in these areas typically requires that the physician work effectively with providers of many other medical and nonmedical services. Community resources, advocacy, behavior management, and experimental therapies and procedures, should be discussed with the family of each patient. In addition, persons with mild disease should be promptly informed of their diagnosis in order to obtain their wishes regarding life prolonging measures and extended care options.     

Plasma amyloid beta levels and platelet mitochondrial respiration in patients with Alzheimer's disease

ObjectivesAltered amyloid metabolism and mitochondrial dysfunction play key roles in the development of Alzheimer's disease (AD). We asked whether an association exists between disturbed platelet mitochondrial respiration and the plasma concentrations of Aβ₄₀ and Aβ₄₂ in patients with AD.Design and methodsPlasma Aβ₄₀ and Aβ₄₂ concentrations and mitochondrial respiration in intact and permeabilized platelets were measured in 50 patients with AD, 15 patients with vascular dementia and 25 control subjects. A pilot longitudinal study was performed to monitor the progression of AD in a subgroup 11 patients with AD.ResultsThe mean Aβ₄₀, Aβ₄₂ and Aβ₄₂/Aβ₄₀ levels were not significantly altered in patients with AD compared with controls. The mitochondrial respiratory rate in intact platelets was significantly reduced in patients with AD compared to controls, particularly the basal respiratory rate, maximum respiratory capacity, and respiratory reserve; however, the flux control ratio for basal respiration was increased. A correlation between the plasma Aβ₄₂ concentration and mitochondrial respiration in both intact and permeabilized platelets differs in controls and patients with AD.ConclusionsBased on our data, (1) mitochondrial respiration in intact platelets, but not the Aβ level itself, may be included in a panel of biomarkers for AD; (2) dysfunctional mitochondrial respiration in platelets is not explained by changes in plasma Aβ concentrations; and (3) the association between mitochondrial respiration in platelets and plasma Aβ levels differs in patients with AD and controls. The results supported the hypothesis that mitochondrial dysfunction is the primary factor contributing to the development of AD.     

Imaging of amyloid plaques and cerebral glucose metabolism in semantic dementia and Alzheimer's disease

Semantic dementia (SD) is a rare clinical syndrome, assigned to the group of frontotemporal lobar degenerations (FTLD). Histopathological analysis has not revealed the deposition of amyloid plaques in the majority of SD cases, in contrast to dementia of the Alzheimer type (AD). However, based on clinical examination alone a reliable differentiation of the underlying pathology cannot be guaranteed, i.e. AD and SD may be confused in some cases. Our aim was to determine, whether AD and SD can be differentiated in vivo by means of amyloid plaque PET imaging. In groups of AD and SD patients, matched for gender, age and overall degree of cognitive impairment, cerebral glucose metabolism was examined with [(18)F]Fluorodeoxyglucose (FDG)-PET and cerebral amyloid plaque density was assessed using [(11)C]6-OH-BTA-1 (PIB)-PET. A volume-of-interest analysis (VOI), using the cerebellum as a reference region, and voxel-based statistical group comparisons (SPM2) were carried out between the patient groups and matched groups of healthy controls. To control for a potential influence of atrophy on the PET findings, a correction of partial volume effects was performed. Characteristic patterns of hypometabolism could be demonstrated in both clinically defined AD and SD with some regional overlap and subtle differences (AD: bilateral posterior cingulate, temporoparietal and frontal cortex; SD: left>right polar temporal, frontal mesial cortex). Compared with healthy controls, significant [(11)C]PIB amyloid plaque tracer binding was observed only in patients with AD (in bilateral temporoparietal, frontal and posterior cingulate cortex and the precuneus) but not in SD. This difference in amyloid plaque deposition could be reproduced in direct statistical comparison of AD and SD and clearly extended the metabolic differences between the patient groups. These findings support the notion that SD can be diagnosed in vivo as a separate entity from AD using amyloid plaque imaging. In general, amyloid plaque PET may complement neuropsychological assessment regarding reliable differential diagnosis of AD and FTLD dementias based on characterization of underlying pathology and may improve the definition of individual prognosis and the selection of patients for scientific trials.     

Peripheral transgene expression of plasma gelsolin reduces amyloid in transgenic mouse models of Alzheimer's disease.

The accumulation and deposition of the 40-42-amino acid peptide amyloid beta (Abeta) is thought to be a critical event in the pathology of Alzheimer's disease (AD). Both passive and active immunizations against Abeta in amyloid-depositing transgenic mice have reduced Abeta pathology and improved memory-related behavior. Peripheral treatments with other amyloid-binding agents have also reduced Abeta pathology. The present study demonstrates that peripheral delivery of plasmid DNA coding for the amyloid-binding protein plasma gelsolin reduces brain Abeta in two separate amyloid-depositing transgenic mouse models of AD when inter-litter variability is accounted for. The reduction in Abeta pathology observed is accompanied by an apparent increase in activated and reactive microglia and soluble oligomeric forms of amyloid. These findings demonstrate that peripheral expression of plasma gelsolin may be a suitable gene-therapeutic approach for the prevention or treatment of AD.