A survey of peptides with effective therapeutic potential in Alzheimer's disease rodent models or in human clinical studies

Alzheimer's disease (AD) is a devastating neurodegenerative disorder and the most common cause of dementia. Today, only palliative therapies are available. The pathological hallmarks of AD are the presence of neurofibrillary tangles and amyloid plaques, mainly composed of the amyloid-β peptide (Aβ), in the brains of the patients. Several lines of evidence suggest that the increased production and/or decreased cleavage of Aβ and subsequent accumulation of Aβ oligomers and aggregates play a fundamental role in the disease progress. Therefore, substances which bind to Aβ and influence aggregation thereof are of great interest. A wide range of Aβ binding peptides were investigated to date for therapeutic purposes. Only very few were shown to be effective in rodent AD models or in clinical studies. Here, we review those peptides and discuss their possible mechanisms of action.     

查尔酮衍生物在阿尔茨海默病治疗和诊断中的研究进展

阿尔茨海默病(Alzheimer's disease,AD)是老年人群中最常见的一种慢性神经退行性疾病。目前AD发病机制尚不明确,鉴于AD的复杂病因,多靶点药物是AD领域的重要研究方向;靶向β淀粉样蛋白(amyloid β-protein,Aβ)的分子荧光探针对AD早期诊断具有重要的临床和现实意义。查尔酮是一种天然产物,具有多种药理活性,值得进一步深入开发。根据公开发表的文献,从乙酰胆碱酯酶、氧化应激、单胺氧化酶B、Aβ聚集等方面对查尔酮及其衍生物作为多靶点AD治疗药物和诊断剂Aβ荧光探针进行总结,以期为AD的治疗和诊断提供重要线索和理论依据。     

Current status of PET-imaging probes of β-amyloid plaques

Alzheimer’s disease (AD) is the most common form of dementia and is characterized by progressive cognitive decline and memory loss. One of pathological hallmarks of AD is the accumulation and deposition of β-amyloid (Aβ) plaques which is a potential target for the early diagnosis of AD. Positron emission tomography (PET), a sensitive radionuclide imaging technique, has provided opportunities to detect Aβ plaques of AD. PET-imaging probes of Aβ plaques have been extensively developed during the last decade. [¹⁸F]Florbetapir, the ¹⁸F-labeled PET-imaging probe of Aβ plaques, was recently approved by US Food and Drug Administration. A number of follow-on PET-imaging probes are currently being developed in academia and pharmaceutical companies. This article will discuss the recent development of PET-imaging probes from [¹¹C]PIB to [¹⁸F]Florbetapir, which are in clinic trials, and several follow-on probes in preclinical stage.     

基于Asn27脱酰胺化修饰探究抑制Aβ42聚合的潜在作用位点

阿尔茨海默症(Alzheimer’s disease, AD)主要的病理特征表现为β-淀粉样蛋白(amyloid-βprotein, Aβ)在细胞外聚合形成斑块。抑止Aβ分子聚合,阻止Aβ分子聚合形成具有神经毒性的寡聚体是开发治疗AD药物的方向之一。研究表明当Aβ42中Asn27发生脱酰胺化修饰后,能够有效阻止Aβ单体发生聚合,但具体作用机制尚不清楚。针对此问题,本研究采用分子动力学模拟方法,探究Asn27发生脱酰胺修饰对Aβ42单体结构的改变和对聚合的影响。结果表明, Aβ42的Asn27发生脱酰胺化修饰会破坏D23～K28之间形成的盐桥,抑制Turn区域残基形成β转角结构,导致羧基末端(C-terminal region, CTR)与氨基末端(N-terminal region, NTR)区域不能形成反向平行的β折叠,使得Aβ42链内相互作用减弱。Asn27发生脱酰胺化修饰引起结构的改变,导致Aβ42单体间的聚合作用下降,这也与之前的实验结果相符合。D23～K28盐桥的形成对于促进Aβ42单体的聚合具有重要作用,将是针对抑制Aβ42聚合的潜在药物设计位点。     

Α-mangostin, a polyphenolic xanthone derivative from mangosteen, attenuates β-amyloid oligomers-induced neurotoxicity by inhibiting amyloid aggregation

Alzheimer's disease (AD) is a progressive neurodegenerative disease characterized by the accumulation of β-sheet-rich amyloid oligomers or fibrils which are associated with cellular toxicity in the brain. Inhibition of Aβ aggregation could be a viable therapeutic strategy for slowing and/or preventing the progress of AD. Here we reported that α-mangostin (α-M), a polyphenolic xanthone derivative from mangosteen, concentration-dependently attenuated the neurotoxicity induced by Aβ-(1-40) or Aβ-(1-42) oligomers (EC(50) = 3.89 nM, 4.14 nM respectively) as observed by decreased cell viability and impaired neurite outgrowth in primary rat cerebral cortical neurons. Molecular docking and dynamics simulations demonstrated that α-M could potentially bind to Aβ and stabilize α-helical conformation. α-M was found to directly dissociate Aβ-(1-40) and Aβ-(1-42) oligomers by blotting with oligomer-specific antibodies. ThioflavinT fluorescence assay and electron microscopy imaging further demonstrated that α-M blocked the fibril formation as well as disturbed the pre-formed fibrils. Taken together, our results indicate that α-M is capable to inhibit and dissociate the Aβ aggregation, which could contribute to its effect of attenuating Aβ oligomers-induced neurotoxicity. Thus, α-M could be a great potential candidate for AD treatment. This article is part of a Special Issue entitled 'Post-Traumatic Stress Disorder'.     

Novel aβ isoforms in Alzheimer's disease - their role in diagnosis and treatment

The last decades have witnessed an explosion in studies of the role of amyloid-β (Aβ) in the progress of the neurodegenerative disorder Alzheimer's disease (AD) and it is now widely accepted that Aβ is related to the pathogenesis of AD. For example, studies have shown that Aβ is neurotoxic and that the neurotoxicity of Aβ is related to its aggregation state. The concentration of the 42 amino acid form of Aβ (Aβ1-42) is reduced in the cerebrospinal fluid (CSF) from AD patients, which is believed to reflect the AD pathology with plaques in the brain acting as sinks. Less well investigated, however, is the ability of other Aβ isoforms to distinguish AD patients from controls and to identify treatment effects in clinical trials. Recently, novel C-truncated forms of Aβ (Aβ1-14, Aβ1-15, and Aβ1-16) were identified in human CSF. The presence of these small peptides is consistent with a catabolic amyloid precursor protein cleavage pathway by β- followed by α-secretase. It has been shown that Aβ1-14, Aβ1-15, and Aβ1-16 increase dose-dependently in response to γ-secretase inhibitor treatment while Aβ1-42 levels are unchanged. Here, we review the many aspects of Aβ and its isoforms with special focus on their potential role as diagnostic and theragnostic markers.     

Alzheimer's disease: emerging trends in small molecule therapies

Alzheimer's disease (AD) is a highly complex and rapidly progressive neurodegenerative disorder characterized by the systemic collapse of cognitive function and formation of dense amyloid plaques and neurofibrillary tangles. AD pathology is derived from the cholinergic, amyloid and tau hypotheses, respectively. Current pharmacotherapy with known anti-cholinesterases, such as Aricept? and Exelon?, only offer symptomatic relief without any disease-modifying effects. It is now clear that in order to prevent the rapid progression of AD, new therapeutic treatments should target multiple AD pathways as opposed to the traditional "one drug, one target" approach. This review will focus on the recent advances in medicinal chemistry aimed at the development of small molecule therapies that target various AD pathological routes such as the cholinesterases (AChE and BuChE), amyloidogenic secretases (β/γ- secretase), amyloid-β aggregation, tau phosphorylation and fibrillation and metal-ion redox/reactive oxygen species (ROS). Some notable ring templates will be discussed along with their structure-activity relationship (SAR) data and their multiple modes of action. These emerging trends signal a paradigm shift in anti-AD therapies aimed at the development of multifunctional small molecules as disease-modifying agents (DMAs).     

Molecular approaches to the treatment, prophylaxis, and diagnosis of Alzheimer's disease: tangle formation, amyloid-β, and microglia in Alzheimer's disease

Pathological hallmarks of Alzheimer's disease (AD) include senile plaques, neurofibrillary tangles (NFTs), synaptic loss, and neurodegeneration. Senile plaques are composed of amyloid-β (Aβ) and are surrounded by microglia, a primary immune effector cell in the central nervous system. NFTs are formed by the intraneuronal accumulation of hyperphosphorylated tau, and progressive synaptic and neuronal losses closely correlate with cognitive deficits in AD. Studies on responsible genes of familial AD and temporal patterns of pathological changes in brains of patients with Down's syndrome (Trisomy 21), who invariably develop neuropathology of AD, have suggested that Aβ accumulation is a primary event that influences other AD pathologies. Although details of the interaction between AD pathologies remain unclear, experimental evidences to discuss this issue have been accumulated. In this paper, we review and discuss recent findings that link the AD pathologies to each other. Further studies on the interaction between pathologies induced in AD brain may contribute to provide deep insight into the pathogenesis of AD and to develop novel therapeutic, prophylactic, and early diagnostic strategies for AD.     

Contributions of brain insulin resistance and deficiency in amyloid-related neurodegeneration in Alzheimer's disease

Alzheimer's disease (AD) is the most common cause of dementia in North America. Growing evidence supports the concept that AD is fundamentally a metabolic disease that results in progressive impairment in the brain's capacity to utilize glucose and respond to insulin and insulin-like growth factor (IGF) stimulation. Moreover, the heterogeneous nature of AD is only partly explained by the brain's propensity to accumulate aberrantly processed, misfolded and aggregated oligomeric structural proteins, including amyloid-β peptides and hyperphosphorylated tau. Evidence suggests that other factors, including impaired energy metabolism, oxidative stress, neuroinflammation, insulin and IGF resistance, and insulin/IGF deficiency in the brain should be incorporated into an overarching hypothesis to develop more realistic diagnostic and therapeutic approaches to AD. In this review, the interrelationship between impaired insulin and IGF signalling and amyloid-β pathology is discussed along with potential therapeutic approaches. Impairments in brain insulin/IGF signalling lead to increased expression of amyloid-β precursor protein (AβPP) and accumulation of AβPP-Aβ. In addition, they promote oxidative stress and deficits in energy metabolism, leading to the activation of pro-AβPP-Aβ-mediated neurodegeneration cascades. Although brain insulin/IGF resistance and deficiency can be induced by primary or secondary disease processes, the soaring rates of peripheral insulin resistance associated with obesity, diabetes mellitus and metabolic syndrome quite likely play major roles in the current AD epidemic. Both clinical and experimental data have linked chronic hyperinsulinaemia to cognitive impairment and neurodegeneration with increased AβPP-Aβ accumulation/reduced clearance in the CNS. Correspondingly, both the restoration of insulin responsiveness and the use of insulin therapy can lead to improved cognitive performance, although with variable effects on brain AβPP-Aβ load. On the other hand, experimental evidence supports the concept that the toxic effects of AβPP-Aβ can promote insulin resistance. Together, these findings suggest that a positive feedback loop of progressive neurodegeneration can develop whereby insulin resistance drives AβPP-Aβ accumulation, and AβPP-Aβ fibril toxicity drives brain insulin resistance. This phenomenon could explain why measuring AβPP-Aβ levels in cerebrospinal fluid or imaging of the brain has proven to be inadequate as a stand-alone biomarker for diagnosing AD, and why the clinical trial results of anti-AβPP-Aβ monotherapy have been disappointing. Instead, the aggregate data suggest that brain insulin resistance and deficiency must also be therapeutically targeted to halt AD progression or reverse its natural course. The positive therapeutic effects of different treatments that address the role of brain insulin/IGF resistance and deficiency, including the use of intranasal insulin delivery, incretins and insulin sensitizer agents are discussed along with potential benefits of lifestyle changes to modify risk for developing mild cognitive impairment or AD. Altogether, the data strongly support the notion that we must shift toward the implementation of multimodal rather than unimodal diagnostic and therapeutic strategies for AD.     

脑内β淀粉样蛋白水平的调节

β淀粉样蛋白（βamyloid protein,Aβ）是体内重要生物活性物质,主要包括Aβ40和Aβ42,它们在体内的利与害取决于其浓度高低。生理条件下脑内Aβ通过两个平衡维持在一定水平上,第一个平衡是Aβ的生成和降解,β分泌酶和γ分泌酶参与Aβ的生成,而脑啡肽酶和胰岛素降解酶参与Aβ的降解;第二个平衡是Aβ跨越血脑屏障的内向转运和外向转运,高级糖基化终产物受体（RAGE）是血脑屏障上Aβ内向转运体,而低密度脂蛋白受体相关蛋白1（LRP1）是血脑屏障上Aβ外向转运体。如果这两个平衡任何一个被破坏,将会导致脑内Aβ水平异常升高,继而Aβ聚集和沉淀,形成老年斑。本文综述生理条件下脑内Aβ水平的调节以及降低病理状态下脑内Aβ水平的策略。     

老年斑、神经元纤维缠结与硫酸多糖

老年斑 (senileplaques ,SP)、神经元纤维缠结 (neurofib rillarytangles,NFTs)是老年性痴呆最典型的病理特征 ,其中SP的主要成分为 β样淀粉蛋白 (Aβ) ,NFTs主要由异常修饰的tau蛋白组成。许多研究发现硫酸多糖与SP、NFTs的形成密切相关。大量文献报道硫酸多糖与淀粉样前体蛋白(APP)、Aβ以及tau蛋白具有高度亲和性 ,它不仅可以促进APP的异常代谢 ,导致Aβ的大量产生 ,诱导其形成纤丝并聚集、沉积于细胞外 ,而且还可促进tau蛋白发生高度磷酸化 ,形成成对螺旋丝 (PHF)并聚集成NFTs。但也有文献报道外源性硫酸多糖具有促进APP的神经营养作用 ,抑制Aβ纤丝的形成 ,并增强磷酸酯酶PP2B的活性 ,从而减少tau蛋白的磷酸化修饰。并且硫酸多糖的糖基组成、糖链长度、硫酸基的数目及位置不同 ,它在SP、NFTs的形成过程中扮演的作用也不同 ,所以可通过分子结构改造而使硫酸多糖表现抑制SP、NFTs形成的活性 ,从而达到抗老年性痴呆的作用     

β-Amyloid therapies in Alzheimer’s disease

Neurones in the brain produce β-amyloid (Aβ) fragments from a larger precursor molecule termed the amyloid precursor protein (APP). When released from the cell, these protein fragments may accumulate in extracellular amyloid plaques and consequently hasten the onset and progression of Alzheimer’s disease (AD). β-Amyloid fragments are generated through the action of specific proteases within the cell. Two of these enzymes, β- and γ-secretase, are particularly important in the formation of Aβ as they cleave within the APP protein to give rise to the N-terminal and C-terminal ends of the Aβ fragment, respectively. Consequently, many researchers are investigating therapeutic approaches that inhibit either β- or γ-secretase activity, with the ultimate goal of limiting Aβ production. An alternative AD therapeutic approach that is being investigated is to employ anti-Aβ antibodies to dissolve plaques that have already formed. Both of these approaches focus on the possibility that accrual of Aβ leads to neuronal degeneration and cognitive impairment characterised by AD and test the hypothesis that limiting Aβ deposition in neuritic plaques may be an effective treatment for AD.     

新型γ-分泌酶调节剂SPI-1865的研发历程概述

阿尔茨海默症(Alzheimer's disease,AD)为进行性的神经退行性疾病,目前缺乏有效的治疗手段.β淀粉样蛋白(β-amyloid,Aβ)在脑神经细胞外过度沉积形成的寡聚体和淀粉样斑块与阿尔茨海默症的发生、发展密切相关.γ-分泌酶是β淀粉样蛋白代谢过程中的关键酶,为研发阿尔茨海默症治疗药物的关键靶点.针对此靶点研发的γ-分泌酶调节剂(γ-secretase modulators,GSM)因对Notch等蛋白影响较小,有广阔的应用前景.本文总结了源于黑升麻(Black cohosh,Cimicifuga racemosa)的环阿尔廷型三萜为先导物的结构优化历程,最终获得γ-分泌酶调节剂药物候选物SPI-1865,以期为γ-分泌酶调节剂的开发与改造提供有价值的参考.     

Curcumin-conjugated nanoliposomes with high affinity for Aβ deposits: Possible applications to Alzheimer disease

Accumulation of amyloid peptide (Aβ) in senile plaques is a hallmark lesion of Alzheimer disease (AD). The design of molecules able to target the amyloid pathology in tissue is receiving increasing attention, both for diagnostic and for therapeutic purposes. Curcumin is a fluorescent molecule with high affinity for the Aβ peptide but its low solubility limits its clinical use. Curcumin-conjugated nanoliposomes, with curcumin exposed at the surface, were designed. They appeared to be monodisperse and stable. They were non-toxic in vitro, down-regulated the secretion of amyloid peptide and partially prevented Aβ-induced toxicity. They strongly labeled Aβ deposits in post-mortem brain tissue of AD patients and APPxPS1 mice. Injection in the hippocampus and in the neocortex of these mice showed that curcumin-conjugated nanoliposomes were able to specifically stain the Aβ deposits in vivo. Curcumin-conjugated nanoliposomes could find application in the diagnosis and targeted drug delivery in AD.From the Clinical EditorIn this preclinical study, curcumin-conjugated nanoliposomes were investigated as possible diagnostics and targeted drug delivery system in Alzheimer’s disease, demonstrating strong labeling of Aβ deposits both in human tissue and in mice, and in vitro downregulation of amyloid peptide secretion and prevention of Aβ-induced toxicity.     

Tau-targeted treatment strategies in Alzheimer's disease

With populations ageing worldwide, the need for treating and preventing diseases associated with high age is pertinent. Alzheimer's disease (AD) is reaching epidemic proportions, yet the currently available therapies are limited to a symptomatic relief, without halting the degenerative process that characterizes the AD brain. As in AD cholinergic neurons are lost at high numbers, the initial strategies were limited to the development of acetylcholinesterase inhibitors, and more recently the NMDA receptor antagonist memantine, in counteracting excitotoxicity. With the identification of the protein tau in intracellular neurofibrillary tangles and of the peptide amyloid-β (Aβ) in extracellular amyloid plaques in the AD brain, and a better understanding of their role in disease, newer strategies are emerging, which aim at either preventing their formation and deposition or at accelerating their clearance. Interestingly, what is well established to combat viral diseases in peripheral organs - vaccination - seems to work for the brain as well. Accordingly, immunization strategies targeting Aβ show efficacy in mice and to some degree also in humans. Even more surprising is the finding in mice that immunization strategies targeting tau, a protein that forms aggregates in nerve cells, ameliorates the tau-associated pathology. We are reviewing the literature and discuss what can be expected regarding the translation into clinical practice and how the findings can be extended to other neurodegenerative diseases with protein aggregation in brain.     

PP1 inhibition by Aβ peptide as a potential pathological mechanism in Alzheimer's disease

Abnormal protein phosphorylation has been associated with several neurodegenerative disorders, including Alzheimer's disease (AD). Aβ is the toxic peptide that results from proteolytic cleavage of the Alzheimer's amyloid precursor protein, a process where protein phosphatases are known to impact. The data presented here demonstrates that protein phosphatase 1 (PP1), an abundant neuronal serine/threonine-specific phosphatase highly enriched in dendritic spines, is specifically inhibited by Aβ peptides both in vitro and ex vivo. Indeed, the pathologically relevant Aβ_1–40 and Aβ_1–42 peptides, as well as Aβ_25–35, specifically inhibit PP1 with low micromolar potency, as compared to inactive controls and other disease related peptides (e.g. the prion related Pr_118–135 and Pr_106–126). Interestingly, PP1 inhibition is increased by Aβ aggregation, indicating a possible direct neurotoxic effect of the aggregated peptide. PP1 involvement in processes like long-term depression, memory and learning, and synaptic plasticity, prompt us to suggest that PP1 may constitute an important physiological target for Aβ and, therefore, increased Aβ production and/or aggregation may lead to abnormal PP1 activity and likely contribute to the progressive neuropsychiatric AD condition. Thus, PP1 activity and levels constitute potential biomolecular candidates for diagnostics and therapeutics.     

Nonhuman primate models of Alzheimer-like cerebral proteopathy

Nonhuman primates are useful for the study of age-associated changes in the brain and behavior in a model that is biologically proximal to humans. The Aβ and tau proteins, two key players in the pathogenesis of Alzheimer's disease (AD), are highly homologous among primates. With age, all nonhuman primates analyzed to date develop senile (Aβ) plaques and cerebral β-amyloid angiopathy. In contrast, significant tauopathy is unusual in simians, and only humans manifest the profound tauopathy, neuronal degeneration and cognitive impairment that characterize Alzheimer's disease. Primates thus are somewhat paradoxical models of AD-like pathology; on the one hand, they are excellent models of normal aging and naturally occurring Aβ lesions, and they can be useful for testing diagnostic and therapeutic agents targeting aggregated forms of Aβ. On the other hand, the resistance of monkeys and apes to tauopathy and AD-related neurodegeneration, in the presence of substantial cerebral Aβ deposition, suggests that a comparative analysis of human and nonhuman primates could yield informative clues to the uniquely human predisposition to Alzheimer's disease.     

Compounds for imaging amyloid-β deposits in an Alzheimer’s brain: a patent review

Introduction: β-amyloid (Aβ) plaques in the brain are regarded as a hallmark of Alzheimer’s disease (AD), and the imaging of Aβ is a critical step for early diagnosis. Extensive research has been done to develop probes for targeting Aβ with available imaging modalities.

Areas covered: In this review, the authors give an overview of published patents and papers about the discovery and development of compounds possessing potential utilization in imaging Aβ for the diagnosis of AD. SciFinder is the main electronic database for patent study in this review.

Expert opinion: Despite achievements in Aβ imaging, there is still a need to develop innovative compounds with selectivity and high affinity to Aβ. Positron emission tomography imaging agents will still be the trend in the field in the short term. Due to the low costs for single-photon emission computed tomography (SPECT) and the excellent nuclear properties of ^99mTc, substantial research should be conducted on the development of the probes for SPECT. Refining the current imaging techniques and in the meantime developing new efficient imaging multimodality and compounds would be a promising approach to imaging Aβ.     

Immunotherapy for Alzheimer's disease

Alzheimer's disease (AD) is the most common cause of dementia worldwide. In AD the normal soluble amyloid β (sAβ) peptide is converted into oligomeric/fibrillar Aβ. The oligomeric forms of Aβ are thought to be the most toxic, while fibrillar Aβ becomes deposited as amyloid plaques and congophilic angiopathy, which serve as neuropathological markers of the disease. In addition the accumulation of abnormally phosphorylated tau as soluble toxic oligomers and as neurofibrillary tangles is a critical part of the pathology. Numerous therapeutic interventions are under investigation to prevent and treat AD. Among the more exciting and advanced of these approaches is vaccination. Active and passive Immunotherapy targeting only Aβ has been successful in many AD model animal trials; however, the more limited human data has shown much less benefit so far, with encephalitis occurring in a minority of patients treated with active immunization and vasogenic edema or amyloid-related imaging abnormalities (ARIA) being a complication in some passive immunization trials. Therapeutic intervention targeting only tau has been tested only in mouse models; and no approaches targeting both pathologies concurrently has been attempted, until very recently. The immune approaches tried so far were targeting a self-protein, albeit in an abnormal conformation; however, effective enhanced clearance of the disease associated conformer has to be balanced with the potential risk of stimulating excessive toxic inflammation. The design of future more effective immunomodulatory approaches will need to target all aspects of AD pathology, as well as specifically targeting pathological oligomeric conformers, without the use of any self-antigen.     

治疗阿尔采末病的药物靶点:β-分泌酶

近年来的研究表明,β-淀粉样蛋白(Aβ)是老年斑的主要成分,有明显的神经细胞毒性作用,在阿尔采末病(AD)的发病过程中发挥了重要作用,因此降低脑中Aβ的生成量是治疗AD的策略。Aβ是由β-和γ-分泌酶裂解其前体蛋白(APP)而生成,其中β-分泌酶(BACE)是启动Aβ形成的关键限速酶,因此BACE是开发治疗AD药物的一个具有吸引力的作用靶点。该文就近来对β-分泌酶的研究作一综述。