Advances in developing novel therapeutic strategies for Alzheimer’s disease

Alzheimer’s Disease (AD), the most prevalent neurodegenerative disease of aging, affects one in eight older Americans. Nearly all drug treatments tested for AD today have failed to show any efficacy. There is a great need for therapies to prevent and/or slow the progression of AD. The major challenge in AD drug development is lack of clarity about the mechanisms underlying AD pathogenesis and pathophysiology. Several studies support the notion that AD is a multifactorial disease. While there is abundant evidence that amyloid plays a role in AD pathogenesis, other mechanisms have been implicated in AD such as tangle formation and spread, dysregulated protein degradation pathways, neuroinflammation, and loss of support by neurotrophic factors. Therefore, current paradigms of AD drug design have been shifted from single target approach (primarily amyloid-centric) to developing drugs targeted at multiple disease aspects, and from treating AD at later stages of disease progression to focusing on preventive strategies at early stages of disease development. Here, we summarize current strategies and new trends of AD drug development, including pre-clinical and clinical trials that target different aspects of disease (mechanism-based versus non-mechanism based, e.g. symptomatic treatments, lifestyle modifications and risk factor management).     

Is Alzheimer's disease a systemic disease?

Although Alzheimer's disease (AD) is the most common neurodegenerative disease, the etiology of AD is not well understood. In some cases, genetic factors explain AD risk, but a high percentage of late-onset AD is unexplained. The fact that AD is associated with a number of physical and systemic manifestations suggests that AD is a multifactorial disease that affects both the CNS and periphery. Interestingly, a common feature of many systemic processes linked to AD is involvement in energy metabolism. The goals of this review are to 1) explore the evidence that peripheral processes contribute to AD risk, 2) explore ways that AD modulates whole-body changes, and 3) discuss the role of genetics, mitochondria, and vascular mechanisms as underlying factors that could mediate both central and peripheral manifestations of AD. Despite efforts to strictly define AD as a homogeneous CNS disease, there may be no single etiologic pathway leading to the syndrome of AD dementia. Rather, the neurodegenerative process may involve some degree of baseline genetic risk that is modified by external risk factors. Continued research into the diverse but related processes linked to AD risk is necessary for successful development of disease-modifying therapies.     

阿尔茨海默病病理发生中的性别差异

阿尔茨海默病(Alzheimer's disease,AD)是一种神经退行性疾病,严重威胁着人类健康.流行病学研究表明,性别与AD发病风险密切相关,女性AD发病率显著高于同龄男性.了解AD病理发生中的性别差异,对于揭示AD发生的规律与特点具有重要的意义.本文就AD病理发生中的性别差异及社会学、生物学等相关原因进行了分析,并论述了针对性别差异的药物防治AD的研究进展,以期为基于性别差异的AD防治提供新思路.     

The Utility of Cerebral Blood Flow as a Biomarker of Preclinical Alzheimer’s Disease

There is accumulating evidence suggesting that changes in brain perfusion are present long before the clinical symptoms of Alzheimer’s disease (AD), perhaps even before amyloid-β accumulation or brain atrophy. This evidence, consistent with the vascular hypothesis of AD, implicates cerebral blood flow (CBF) in the pathogenesis of AD and suggests its utility as a biomarker of preclinical AD. The extended preclinical phase of AD holds particular significance for disease modification, as treatment would likely be most effective in this early asymptomatic stage of disease. This highlights the importance of identifying reliable and accurate biomarkers of AD that can differentiate normal aging from preclinical AD prior to clinical symptom manifestation. Cerebral perfusion, as measured by arterial spin labeling magnetic resonance imaging (ASL-MRI), has been shown to distinguish between normal controls and adults with AD. In addition to demonstrating diagnostic utility, CBF has shown usefulness as a tool for identifying those who are at risk for AD and for predicting subtle cognitive decline and conversion to mild cognitive impairment and AD. Taken together, this evidence not only implicates CBF as a useful biomarker for tracking disease severity and progression, but also suggests that ASL-measured CBF may be useful for identifying candidates for future AD treatment trials, especially in the preclinical, asymptomatic phases of the disease.     

阿尔茨海默病运动治疗研究进展

阿尔茨海默病(Alzheimer's disease,AD)是一种神经退行性疾病,目前对其发病机制尚未完全阐明,治疗效果也不佳。最近不少研究者根据运动对人体,特别是对脑的益处,提出运动治疗AD的可能。本文综述了运动治疗AD的研究进展及其可能机制,展望其可能的治疗前景。     

Redox proteomics identification of oxidatively modified proteins in Alzheimer's disease brain and in vivo and in vitro models of AD centered around Abeta(1-42)

Alzheimer's disease is a progressive neurodegenerative disease associated with loss of memory and cognition. One hallmark of AD is the accumulation of amyloid beta-peptide (Abeta), which invokes a cascade of oxidative damage to neurons that can eventually result in neuronal death. Several markers of oxidative stress have been identified in AD brain, thus providing greater understanding into potential mechanisms involved in the disease pathogenesis and progression. In the present article, we review the application of redox proteomics to the identification of oxidized proteins in AD brain and also our recent findings on amyloid beta-peptide (Abeta)-associated in vivo and in vitro models of AD. Our redox proteomics approach has made possible the identification of specifically oxidized proteins in Alzheimer's disease (AD) brain, providing for the first time evidence on how oxidative stress plays a crucial role in AD-related neurodegeneration. The information obtained has great potential to aid in determining the molecular pathogenesis in and detecting disease markers of AD, as well as identifying potential targets for drug therapy in AD. Application of redox proteomics to study cellular events, especially related to disease dysfunction, may provide an efficient tool to understand the main mechanisms involved in the pathogenesis and progression of oxidative stress-related neurodegenerative disorders.     

Copper dysfunction in Alzheimer's disease: from meta-analysis of biochemical studies to new insight into genetics

The involvement of body copper metabolism in the development of Alzheimer's disease (AD) - the most common form of dementia - is a deeply investigated issue in recent years. Copper is essential for life, but in excess it can be toxic. Recently, it has been hypothesized that copper toxicity may be a contributory factor in the etiology of the neurodegenerative disease AD. Studies on copper evaluation in AD vs. healthy controls collected in the latest 30 years and merged in a meta-analysis demonstrate that serum copper is slightly increased in AD. A specific form of copper, the copper non-bound to ceruloplasmin, or 'free' copper, seems to best characterize this increase in copper in AD patients. Clinical studies from us and other groups have demonstrated that free copper is associated with the typical deficits of AD, incipient AD and mild cognitive impairment, and specific cerebrospinal markers. Moreover, very recent data addressing molecular processes underlying copper dysfunction in AD have indicated that genetic variations of K832R and R952K Single Nucleotide Polymorphisms (SNPs) of the Wilson's disease gene ATP7B are associated also with sporadic AD. Specifically, ATP7B encodes for the protein ATPase 7B which controls free copper status in the body, and both R allele in K832R and K allele in R952K ATP7B SNPs are associated with an increased risk of having AD. Even though copper dysfunction cannot be assumed as a determinant of the disease, its causative, rather than associated, role in AD pathology as risk factor can be claimed.     

阿尔茨海默症诊断和监测的唾液生物标记物

阿尔茨海默症(Alzheimer's disease,AD)是全世界老年人群中最常见的神经退行性疾病,也是导致中枢神经系统不可逆和渐进性恶化的疾病.AD病发后尚无治愈手段,而AD的病理表现早于临床发病十多年,在显著的脑损伤出现前疾病修正疗法可能迟滞疾病的进程,因此迫切需要发掘适用的AD生物标记物从而利于早期诊断、预防及...     

综述:老年性痴呆早期的基因变异研究进展

阿尔茨海默病( Alzheimer's disease,AD)又称老年性痴呆,是老年人常见的神经系统变性疾病．AD包括痴呆前阶段和痴呆阶段,年龄老化与遗传因素为目前公认的发病因素．AD的病理生理过程在痴呆诊断前的5～10年就已开始了,这一漫长的AD痴呆前阶段是治疗干预的关键时期,因此目前痴呆前阶段已成为AD相关研究的热点．本文综述了近年来有关AD各主要阶段基因变异的研究进展．     

综述:阿尔茨海默病的神经影像学研究进展

阿尔茨海默病(Alzheimer's disease,AD)是以记忆和其他高级认知功能下降为特征的神经退行性疾病．早期的神经影像学研究通常是探索AD患者局部脑区的结构和功能变化．随着多模态神经影像技术和人脑连接组学研究方法的发展,研究者已经能够考察AD患者脑结构和功能连接通路．采用这些方法,最近的研究已经发现,AD患者脑网络的连接强度、网络效率、模块化组织和核心脑区连接的下降,并发现这些变化与患者的记忆评分等密切相关．这些新方法和新技术的出现不仅提供了新颖的观点来解释AD病的脑区失连接病理生理机制,而且发现的AD异常脑连接模式可能作为敏感特征应用于AD早期辅助诊断的影像标记物研究．特别重要的是,研究表明,在AD患者脑神经网络出现的异常连接模式,在AD前期即轻度认知障碍期患者中也已出现,表明了将AD影像学研究的重点前移到AD前期这一可治疗阶段的重要性和迫切性．     

Neuroinflammation,Gut Microbiome,and Alzheimer’s Disease

Alzheimer’s disease (AD) is a progressive neurodegenerative disease that develops insidiously and causes dementia finally. There are also clinical complications in advanced dementia, such as eating problems, infections, which will lead to the decline of patients’ life quality, and the rising cost of care for AD to our society. AD will be important public health challenge. Early detection of AD may be a key issue to prevent, delay, and stop the disease. Gut microbiome and neuroinflammation are closely related with nervous system diseases, although the specific mechanism is not clear. This review introduces the relationship between neuroinflammation, gut microbiome, and AD.     

阿尔采默氏病动物模型的研究进展

阿尔采默氏病（Alzheimer＇s Disease,AD）是一种病因不明的脑部退行性疾病。建立适合的AD动物模型对研究阿尔采默氏病的发病机理和相关药物筛选有十分重要的意义。本文将目前常用的AD动物模型分为两类,即以模拟AD症状为主的动物模型和以模拟AD病理改变为主的动物模型,并对相关文献加以综述。     

胰岛素降解酶与阿尔兹海默病的发生

阿尔兹海默病（AD）是以脑中β淀粉样蛋白（Aβ）累积和神经纤维缠绕（NFTs）为主要病理特征的神经退行性疾病,而胰岛素降解酶（IDE）是人体内最主要的Aβ降解酶之一。因此,IDE在AD进程中的作用受到了研究人员的广泛关注。大多数研究显示,AD的病理进程伴随着脑中IDE编码基因的表达和IDE活性的下降。IDE敲除动物也能够表现出AD样表型,同时已有研究尝试靶向于IDE进行AD的治疗。本文通过总结IDE在AD患者和AD模型动物脑中表达情况的变化,以及IDE敲除动物的表型,对近期IDE在AD发生中作用的研究进行了总结。     

Antioxidant clinical trials in mild cognitive impairment and Alzheimer's disease

Alzheimer's disease (AD) is a highly disabling progressive neurodegenerative disorder characterized by a steadily growing number of patients, by the absence of a cure for the disease and by great difficulties in diagnosing in the preclinical phase. Progresses in defining the complex etiopathogenesis of AD consider oxidative stress a core aspect as far as both AD onset and progression are concerned. However, clinical trials of antioxidants in AD have brought conflicting conclusions. In this review, we report the main results of clinical trials with antioxidants in mild cognitive impairment (MCI) and AD. Although available data do not warrant the doubtless use of antioxidants in AD, they are characterized by extremely poor comparability and the absence of a substantial clinical benefit of antioxidants in AD is not disproved to date. Furthermore, the role of vascular damage that contributes to oxidative stress in AD should be addressed in testing antioxidant treatments. This article is part of a Special Issue entitled: Antioxidants and Antioxidant Treatment in Disease.     

抗糖尿病药物治疗阿尔茨海默病的研究进展

阿尔茨海默病（Alzheimers disease, AD）是以认知缺陷为主要特征的慢性疾病,目前尚无有效根治药物。由于患者数量显著增长,探究治疗AD的药物成为国内外的研究热点。近年流行病学研究表明,2型糖尿病是AD的危险因素,两者具有共同的病理生理机制,如胰岛素抵抗、淀粉样蛋白沉积、Tau蛋白过度磷酸化、炎症反应和氧化应激等。因此,从现有的抗糖尿病药物中筛选AD的治疗药物是目前研究的一种趋势。越来越多的研究已证实降糖药物（如胰岛素、二甲双胍等）具有改善AD病变的有益作用。从AD与2型糖尿病的相关性、抗糖尿病药物治疗AD两个方面综述了抗糖尿病药物治疗AD的研究进展,以期为AD的治疗拓宽思路。     

Lyme Disease Associated with Alzheimer’s Disease

This case report discusses a patient with co-occurring neuroborreliosis and Alzheimer’s disease (AD). Although no claim is made for causality nor is there objective evidence that spirochetes are involved in AD, co-infection may exacerbate the symptoms of either neuroborreliosis or AD. Much is to be learned about the role of spirochetes in degenerative central nervous system disease.     

Genetics of Alzheimer's disease: new evidences for an old hypothesis?

Alzheimer's disease (AD) is the prime cause of dementia and presents a strong genetic predisposition (60-80% of the attributable risk). In addition to APOE, a major recognized genetic determinant of AD, systematic, high-throughput genomic approaches have recently allowed the characterization of four new genetic determinants: CLU, CR1, PICALM and BIN1. Even if the complete picture of AD genetics is still not fully understood, the characterization of these new AD genetic determinants is probably going to strongly modify our perception of the pathophysiological process involved in AD. The new AD genetic landscape suggests that the common and late-onset forms of the disease are associated with a defect in peripheral Aβ peptide clearance, implying that the amyloid cascade hypothesis could be relevant not only in the AD monogenic forms.     

Apoptosis in Alzheimer's disease—an update

Alzheimer's disease (AD) is the most common human neurodegenerative disorder characterized by the progressive deterioration of cognition and memory in association with the presence of senile plaques, neurofibrillary tangles, and massive loss of neurons. Most cases of AD are late-onset and sporadic, but in some cases the disease is inherited as an autosomal dominant trait. Four different genes, the amyloid precursor protein, apolipoprotein E, and presenilins 1 and 2 have been implicated in the etiology of familial AD. It is now generally accepted that massive neuronal death due to apoptosis is a commmon characteristic in the brains of patients suffering from neurodegenerative diseases, and apoptotic cell death has been found in neurons and glial cells in AD. This review summarizes the current findings regarding the evidence for apoptosis in AD and discusses the possible involvement of apoptosis-regulating factors in the pathology of AD. Modification of the apoptotic cascade could be considered as a primary therapeutic strategy for the disease.     

Genetic susceptibility to Alzheimer disease

Alzheimer disease (AD) is the leading cause of dementia in the elderly. Less than a decade ago, it was questioned as to whether or not genes were even involved in anything but rare early onset AD. Since that time, using a variety of genetic epidemiological and molecular biological techniques, four loci have been identified that play a role in the genetic susceptibility of AD, AD presents as a prototype of the power of genetic techniques in defining the etiology of a complex disease.     

Alzheimer's disease: synapses gone cold

Alzheimer's disease (AD) is a progressive neurodegenerative disease characterized by insidious cognitive decline and memory dysfunction. Synapse loss is the best pathological correlate of cognitive decline in AD and mounting evidence suggests that AD is primarily a disease of synaptic dysfunction. Soluble oligomeric forms of amyloid beta (Aβ), the peptide that aggregates to form senile plaques in the brain of AD patients, have been shown to be toxic to neuronal synapses both in vitro and in vivo. Aβ oligomers inhibit long-term potentiation (LTP) and facilitate long-term depression (LTD), electrophysiological correlates of memory formation. Furthermore, oligomeric Aβ has also been shown to induce synapse loss and cognitive impairment in animals. The molecular underpinnings of these observations are now being elucidated, and may provide clear therapeutic targets for effectively treating the disease. Here, we review recent findings concerning AD pathogenesis with a particular focus on how Aβ impacts synapses.