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.     

Ischemic heart disease as deficiency disease.

Four classes of agents capable of producing human illness have been identified: toxicity, heredity, infection and deficiency. The leading paradigm for the etiology and pathophysiology of ischemic heart disease in the 20th century was that of intoxication by too much of the wrong kind of dietary fat. This overemphasis on lipid metabolism persists because important data are neglected and because of inattention to details. For example, heart disease risk does not correlate with fat intake within nations in contrast to between nations. Also development of ischemic heart disease involves inter alia arterial spasm, cardiac rhythm, metabolism of connective tissue, glucose and homocysteine, plus paraoxonase activity and thrombus formation which generally are unaffected by dietary fat. Homocysteine thiolactone accumulates when homocysteine is high. This lactone specifically inhibits lysyl oxidase which depends on copper to catalyze cross linking of collagen and elastin in arteries and bone. The lactone is hydrolyzed by paraoxonase, activity of which can be decreased by copper deficiency. Just as cholesterol was an important focus for heart disease as intoxication, homocysteine can become an excellent focus for a paradigm shift to heart disease as deficiency because supplementation with several nutrients can alter homocysteine metabolism and decrease its plasma concentration. These supplements include betaine, copper, folate, pyridoxine and vitamin B-12. Opportunities for research on ischemic heart disease as deficiency disease are plentiful.     

Strategies for disease modification in Alzheimer's disease

Treating Alzheimer's disease (AD) is the biggest unmet medical need in neurology. Current drugs improve symptoms, but do not have profound disease-modifying effects. Three main classes of disease-modification approaches can be defined: one that is broadly neurotrophic or neuroprotective, one that targets specific aspects of AD pathology, and one that is based on epidemiological observation. This review discusses all three approaches, with particular emphasis on anti-amyloid strategies - currently the most active area of investigation. The approaches that are reviewed include secretase inhibition, amyloid-beta aggregation inhibition, immunotherapy and strategies that might indirectly affect the amyloid pathway.     

Borna disease: virus-induced neurobehavioral disease pathogenesis

Studies of the pathogenesis of neurobehavioral diseases following Borna disease virus infections have been increasing rapidly over the past ten years. Recent major advances have included a report of vertical transmission of the virus in its natural host, the horse, and a report of isolation of a novel variant, No/98, in that same species. In rats infected neonatally with the Borna disease virus that lack blood-borne inflammation in the brain, evidence of an "endogenous" brain inflammatory response is abundant, with elevated expression of cytokine and chemokine mRNA. Infection in these rats is also associated with abnormal levels of neurotransmitters, including serotonin and norepinephrine. Data and debate continue to be forthcoming about the role of Borna disease virus in human infection and psychiatric disease.     

NIH disease funding levels and burden of disease

Background

An analysis of NIH funding in 1996 found that the strongest predictor of funding, disability-adjusted life-years (DALYs), explained only 39% of the variance in funding. In 1998, Congress requested that the Institute of Medicine (IOM) evaluate priority-setting criteria for NIH funding; the IOM recommended greater consideration of disease burden. We examined whether the association between current burden and funding has changed since that time.

Methods

We analyzed public data on 2006 NIH funding for 29 common conditions. Measures of US disease burden in 2004 were obtained from the World Health Organization''s Global Burden of Disease study and national databases. We assessed the relationship between disease burden and NIH funding dollars in univariate and multivariable log-linear models that evaluated all measures of disease burden. Sensitivity analyses examined associations with future US burden, current and future measures of world disease burden, and a newly standardized NIH accounting method.

Results

In univariate and multivariable analyses, disease-specific NIH funding levels increased with burden of disease measured in DALYs (p = 0.001), which accounted for 33% of funding level variation. No other factor predicted funding in multivariable models. Conditions receiving the most funding greater than expected based on disease burden were AIDS ($2474 M), diabetes mellitus ($390 M), and perinatal conditions ($297 M). Depression ($719 M), injuries ($691 M), and chronic obstructive pulmonary disease ($613 M) were the most underfunded. Results were similar using estimates of future US burden, current and future world disease burden, and alternate NIH accounting methods.

Conclusions

Current levels of NIH disease-specific research funding correlate modestly with US disease burden, and correlation has not improved in the last decade.     

Environmental disease: environmental alteration and infectious disease

Humans have changed their environment to survive and to achieve a safer and more comfortable life. For example, drinking water and wastewater infrastructures are indispensable for civilized societies to flourish and to prevent water-borne infectious diseases. However, excessive loading on environments might disturb microbial ecosystems, resulting in outbreaks of pathogenic microbes and the expansion of infectious diseases. Clarifying the relationship between environmental alterations and changes in microbial ecosystems is thus important to prevent further outbreaks of infectious diseases. The present study aims to understand the links between the following factors: environmental alterations; ecosystem disturbance and the occurrence of infectious disease; and impact on society. We focus on legionellosis and nontuberculous mycobacterial diseases from the viewpoint of their environmental linkage. While Legionella spp. are ubiquitous in aquatic environments, Legionella pneumophila often increases in anthropogenic environments, such as cooling towers or spas, and can cause outbreaks of legionellosis. Recently, travel-associated Legionnaires’ disease has caused concern in many countries. The numbers of patients infected with nontuberculous Mycobacteria (NTM) have increased worldwide since the 1990s. Disturbances to microbial ecosystems caused by changes in water usage might be one cause of NTM diseases. Clarifying the dynamics of Legionella pneumophila and NTM in aquatic environments should help prevent outbreaks of diseases associated with these bacteria.     

Developing disease

When pathways vital for development go awry, the consequences can be disastrous. This collection of reviews highlights emerging translational aspects of developmental biology at a time when the first clinical applications are taking shape.