Metabolism of amyloid-beta peptide and Alzheimer's disease

The accumulation of amyloid-beta peptide (Abeta), a physiological peptide, in the brain is a triggering event leading to the pathological cascade of Alzheimer's disease (AD) and appears to be caused by an increase in the anabolic activity, as seen in familial AD cases or by a decrease in catabolic activity. Neprilysin is a rate-limiting peptidase involved in the physiological degradation of Abeta in the brain. As demonstrated by reverse genetics studies, disruption of the neprilysin gene causes elevation of endogenous Abeta levels in mouse brain in a gene-dose-dependent manner. Thus, the reduction of neprilysin activity will contribute to Abeta accumulation and consequently to AD development. Evidence that neprilysin in the hippocampus and cerebral cortex is down-regulated with aging and from an early stage of AD development supports a close association of neprilysin with the etiology and pathogenesis of AD. Therefore, the up-regulation of neprilysin represents a promising strategy for therapy and prevention. Recently, somatostatin, which acts via a G-protein-coupled receptor (GPCR), has been identified as a modulator that increases brain neprilysin activity, resulting in a decrease of Abeta levels. Thus, it may be possible to pharmacologically control brain Abeta levels with somatostatin receptor agonists.     

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.     

Secretases as targets for drug design in Alzheimer's disease

Alzheimer's disease accounts for the majority of dementia in the elderly. Worldwide, approximately 20 million people are suffering from this devastating disease, with no effective treatment currently available. For efficient drug design, it is important to identify the molecular mechanisms underlying the pathology of the disease. An invariant feature in the pathology of Alzheimer's disease is the amyloid-beta peptide. Amyloid-beta is produced by endoproteolytic cleavage of the amyloid precursor protein by beta- and gamma-secretase. In the past 2 years, the protein responsible for beta-secretase activity has been isolated and researchers are close to identifying gamma-secretase. These recent achievements in Alzheimer's disease research have provided helpful tools for the development of therapeutics.     

Adverse effects and drugs for Alzheimer's disease]

Molecules currently available or in late phases of development for the treatment of Alzheimer's disease have modest and apparently equivalent efficacies. Thus, the choice will depend on the safety profile of these drugs and on the patient characteristics. The aim of this review is to undertake an inventory of adverse effects and interactions reported in the literature for anticholinesterasics (the only ones approved by authorities). As most of the molecules described in this article are still in early phases of development, data reported here mainly issued from clinical trials carried out on specific populations. Most of these reported adverse effects have not been attributed according to the rules of pharmacovigilance. Nevertheless, we believe that the data presented in this review will be of great interest to clinicians and pharmacovigilance specialists as the compounds concerned become available on the market.     

阿尔茨海默病患者甲状腺激素水平与抑郁症状及生活能力相关性研究

目的 探讨阿尔茨海默病患者甲状腺素水平与抑郁症状、生活能力、认知功能的相关性.方法 将32例伴有抑郁症状的阿尔茨海默病患者设为研究组,将27例无抑郁症状的阿尔茨海默病患者设为对照组,两组均予以阿尔茨海默病常规治疗,研究组在此基础上联合抗抑郁剂治疗,观察8周.于治疗前后采用汉密顿抑郁量表、日常生活能力量表、简易精神状态量表、长谷川痴呆量表评定患者疾病状况,同时测定甲状腺激素水平.结果 治疗前后两组甲状腺激素T4水平均在正常范围内,FT3水平均低于正常范围;研究组治疗后T4水平较治疗前有显著下降(P＜0.01),但治疗前后均显著高于对照组(P＜0.01),FT3水平治疗前后无显著变化,但显著低于对照组(P＜0.05).研究组汉密顿抑郁量表评分治疗前显著高于对照组(P＜0.01),治疗后较治疗前显著下降(P＜0.01),且与对照组差异无显著性(P＞0.05);日常生活能力量表评分治疗后较治疗前显著下降,但治疗前后均显著高于对照组(P＜0.01);简易精神状态量表及长谷川痴呆量表评分治疗前后无显著变化(P＞0.05),且与对照组差异无显著性(P＞0.05).结论阿尔茨海默病患者的甲状腺激素T4水平与抑郁症状、日常生活能力有关,FT3水平与认知功能衰退有关;抗抑郁治疗能有效降低T4水平,提高患者日常生活能力.     

The cell cycle as a therapeutic target for Alzheimer's disease

Alzheimer's disease (AD) is the most prevalent neurodegenerative disease worldwide. It is a progressive, incurable disease whose predominant clinical manifestation is memory loss, and which always ends in death. The classic neuropathological diagnostic markers for AD are amyloid plaques and neurofibrillary tangles, but our understanding of the role that these features of AD play in the etiology and progression of the disease remains incomplete. Research over the last decade has revealed that cell cycle abnormalities also represent a major neuropathological feature of AD. These abnormalities appear very early in the disease process, prior to the appearance of plaques and tangles. Growing evidence suggests that neuronal cell cycle regulatory failure, leading to apoptosis, may be a significant component of the pathogenesis of AD. A number of signaling pathways with the potential to activate aberrant cell cycle re-entry in AD have been described. The relationships among these signaling cascades, which involve the amyloid precursor protein (APP), cyclin-dependent kinases (cdks), and the cell cycle protein Pin1, have not yet been fully elucidated, but details of the individual pathways are beginning to emerge. This review summarizes the current state of knowledge with respect to specific neuronal signaling events that are thought to underlie cell cycle regulatory failure in AD brain. The elements of these pathways that represent potential new therapeutic targets for AD are described. Drugs and peptides that can inhibit molecular steps leading to AD neurodegeneration by intervening in the activation of cell cycle re-entry in neurons represent an entirely new approach to the development of treatments for AD.     

β淀粉样蛋白1～42诱导原代皮质神经元损伤过程中的淀粉样前体蛋白信号通路

背景:近年有研究表明纤维状β淀粉样蛋白能够促进细胞表面淀粉样前体蛋白在细胞外的积聚,导致神经损伤。目的:分析淀粉样前体蛋白信号通路在纤维状β淀粉样蛋白1～42诱导神经元损伤机制中的作用。方法:体外分离培养孕17.0～18.0d SD大鼠皮质神经元,培养7d后加入0(正常对照),0.05,0.5,5mol/L纤维状β淀粉样蛋白1～42,孵育8h建立毒性损伤模型,采用生化方法检测神经元细胞培养上清中的Calcein释放,分别用免疫荧光双标、Western blotting方法检测淀粉样前体蛋白和Fe65的表达。结果与结论:与正常对照组比较,加入不同浓度纤维状β淀粉样蛋白1～42诱导损伤8h后,神经元培养上清中Calcein释放增加(P<0.05或P<0.01),Western blotting和免疫荧光方法分别检测到淀粉样前体蛋白和Fe65的表达及共定位增加。说明纤维状β淀粉样蛋白1～42可诱导原代培养皮质神经元的毒性损伤,淀粉样前体蛋白-Fe65信号通路可能是其损伤机制之一。     

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)     

The significance of elevated brain natriuretic peptide levels in chronic obstructive pulmonary disease

We investigated the clinical significance of brain natriuretic peptide (BNP), a cardiac hormone, in chronic obstructive pulmonary disease (COPD). Subjects were 38 patients with stable COPD, of whom 20 had cor pulmonale (CP), and 22 were healthy individuals. Plasma BNP levels were measured and pulmonary arterial pressure (PAP) was estimated by echocardiography. Arterial blood gas analysis, forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were also recorded. BNP levels of patients with COPD were higher than those of controls (48.2 +/- 37.5 and 9.3 +/- 3.0 pg/ml). Patients with CP had a higher mean BNP level with respect to those without CP (73.9 +/- 35.8 and 21.0 +/- 10.2 pg/ml, respectively). BNP levels correlated with PAP (r = 0.68), partial arterial oxygen pressure (r = -0.70), FEV1 (r = -0.65) and FVC (r = -0.52). We have concluded that BNP determination has a role in the diagnosis of CP in patients with COPD.     

Valsartan lowers brain beta-amyloid protein levels and improves spatial learning in a mouse model of Alzheimer disease

Recent epidemiological evidence suggests that some antihypertensive medications may reduce the risk for Alzheimer disease (AD). We screened 55 clinically prescribed antihypertensive medications for AD-modifying activity using primary cortico-hippocampal neuron cultures generated from the Tg2576 AD mouse model. These agents represent all drug classes used for hypertension pharmacotherapy. We identified 7 candidate antihypertensive agents that significantly reduced AD-type beta-amyloid protein (Abeta) accumulation. Through in vitro studies, we found that only 1 of the candidate drugs, valsartan, was capable of attenuating oligomerization of Abeta peptides into high-molecular-weight (HMW) oligomeric peptides, known to be involved in cognitive deterioration. We found that preventive treatment of Tg2576 mice with valsartan significantly reduced AD-type neuropathology and the content of soluble HMW extracellular oligomeric Abeta peptides in the brain. Most importantly, valsartan administration also attenuated the development of Abeta-mediated cognitive deterioration, even when delivered at a dose about 2-fold lower than that used for hypertension treatment in humans. These preclinical studies suggest that certain antihypertensive drugs may have AD-modifying activity and may protect against progressive Abeta-related memory deficits in subjects with AD or in those at high risk of developing AD.     

Updating the role of natriuretic peptide levels in cardiovascular disease

Heart disease affects 1 in 3 individuals in the United States, and the prevalence of heart failure (HF) is increasing exponentially. Although our understanding of the disease progression of congestive HF (CHF) has advanced, refining the areas of diagnosis, risk stratification, prognosis, and treatment is still needed. The natriuretic peptides, specifically B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), have shown promise in clinical practice. Brain natriuretic peptide is released from cardiac ventricular myocytes in response to volume or pressure overload. Rapid measurement of plasma BNP or NT-proBNP has been shown to increase the diagnostic accuracy of HF exacerbations. A cutoff value of 100 pg/mL has a sensitivity and specificity of 90% and 73%, respectively, according to the Breathing Not Properly Study. In addition, BNP and NT-proBNP have been considered independent predictors of adverse outcome. One study calculated a 35% increase in risk of death due to HF for every 100-pg/mL increase in BNP level. Lastly, natriuretic peptides have been known to decrease following medical therapy of HF, suggesting the role of their measurement in monitoring inpatient disease progression and outpatient medical programs. The future of natriuretic peptides lies in risk stratification in other cardiac diseases, such as acute coronary syndrome, and possibly determining severity of valvular disease. Although there is substantial work done in elucidating the power of natriuretic peptides in clinical practice, more research is necessary to reach a consensus regarding how to appropriately utilize them in treatment regimens.     

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.     

Atrial natriuretic peptide: blood levels in human disease and their measurement

The atrial hormonal system consists of 126 amino acid-containing prohormone (proANP) stored in the secretory granules of atrial myocytes and 28 amino acid-containing hormone (ANP) that is secreted into the bloodstream in response to raised atrial pressure. ANP participates in the homeostasis of body fluid volume through its main receptor-mediated effects; natriuresis, inhibition of renin and aldosterone secretion, and vasodilation. It counteracts the renin-angiotensin system with the putative primary role of regulating the circulating blood volume. Although in man, the physiologic volume stimuli lead to relatively modest increases of ANP secretion, its plasma level undergoes striking changes in pathology. Marked elevations in conditions accompanied by fluid retention, most conspicuously in heart failure and renal failure, have been explained as a compensatory reaction to volume overload. The recent data suggest a decreased target organ responsiveness as one of the causes of a relative inefficiency of the high circulating levels of ANP in inducing an appropriate natriuresis in these volume overload conditions. The well established radioimmunoassay and the more recent methods of plasma ANP measurement are reviewed, and the authors' results with a commercial RIA are presented.     

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.     

Animal models in the development of symptomatic and preventive drug therapies for Alzheimer's disease

Dementia of the Alzheimer type (AD) is clinically characterized by a progressive deterioration of intellect, memory, judgment, and abstract thinking. It is incurable, and causal therapy is not yet available. For the development of therapeutic drugs, valid animal models are needed that mimic the pathophysiological change in brain functions and the concomitant behavioural deterioration seen in AD patients. This article provides an overview of the animal models that are used most often to study the substrates and mechanisms of the pathological changes underlying AD and to identify, characterize and develop putative neuroprotective, antidegenerative, revalidation-supporting and/or cognition-enhancing compounds or treatments. The first generation of agents for the symptomatic treatment of the disease has been developed on the basis of results obtained with these models. These drugs are presently undergoing clinical testing or are already used therapeutically. There is, however, no single animal model that can mimic the full range of pathophysiological alterations and key symptoms of AD. New, genetically engineered mouse models that mimic at least some of the key pathological changes of AD are expected to provide tools that will facilitate the development of symptomatic and preventive drug therapies.     

自组装多肽纳米纤维水凝胶在细胞三维培养中的应用及特征

背景：自组装多肽类材料因其独特的设计及良好的生物相容性和可降解性在众多三维支架材料中脱颖而出。目的：综述RADA类离子互补型自组装多肽支架材料的结构和功能化设计,从细胞三维培养方面探讨多肽类材料作为细胞载体材料在细胞治疗中的应用前景。方法：由作者通过PubMed、Web of science数据库及CNKI数据库检索有关自组装多肽水凝胶的相关文献,检索词为“self-assembly peptide, tissue engineering;自组装多肽,组织工程”,检索文献量总计224篇,纳入包含多肽材料设计、功能化多肽材料、多肽材料用于细胞三维培养方面的研究,最终纳入48篇。结果与结论：从物理结构角度讲,多肽材料可以在生理环境中自组装成具有纳米级纤维和较高孔隙率的水凝胶,最大程度上模拟细胞外基质的结构,保障细胞生存在一个真正的三维环境中。从生物功能角度讲,多肽材料可以根据不同需求复合特异性的生物活性短肽片断,赋予材料一定的细胞特异性,可以促进细胞的黏附、增殖或分化。     

Alpha2-macroglobulin deletion polymorphism and plasma levels in late onset Alzheimer's disease.

The acute-phase "panproteinase" inhibitor alpha2-macroglobulin (alpha2M), a protein involved in inflammatory reactions, has been identified in amyloid plaques in Alzheimer's disease (AD). In addition, alpha2M is involved in AD susceptibility at the genetic level, and a deletion polymorphism at the a2M gene has been found to be associated with sporadic AD. We analyzed the deletion polymorphism and alpha2M plasma levels in 93 ultraoctuagenarian patients with late-onset sporadic AD and in controls (n=157). alpha2M allele frequencies did not differ between AD patients (alpha2M*2=0.169) and controls (alpha2M*2=0.146). The mean plasma concentrations of alpha2M were similar in patients (271.8+/-79 mg/dl) and controls (269.5+/-81.2 mg/dl). No difference was found in the alpha2M mean plasma levels associated with the three alpha2M genotypes, indicating that the deletion has no effect on alpha2M protein level. However, in AD patients alpha2M mean plasma values differed significantly according to apolipoprotein E genotypes (p=0.03), with E3/E3 homozygotes showing the highest levels. Since in a previous work E3/E3 were found to be associated with the highest plasma levels of alpha1-antichymotrypsin, another acute-phase protein, the present findings seem to support the hypothesis that inflammation may be a relevant factor in AD pathogenesis peculiar to E3/E3 subjects.