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Alois Alzheimer (1864-1915)

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Alzheimer’s disease. Epidemiology 1-AD is the most common form of dementia, accounting for >60% of all the cases. 2- Most of the cases of AD ARE SPORADIC . The prevalence of inherited forms of AD is
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Alois Alzheimer (1864-1915) Epidemiology 1-AD is the most common form of dementia, accounting for >60% of all the cases. 2-Most of the cases of AD ARE SPORADIC . The prevalence of inherited forms of AD is <0.1%. 3-Risk factors for sporadic AD: -aging -head injuries -hormonal changes -vascular diseases -inflammation -ApoE e4 allele polymorphism -exposure to metals, like Cu ++ and Zn ++ Alzheimer’s disease
  • Alois Alzheimer(1864-1915)Epidemiology 1-AD is the most common form of dementia, accounting for >60% of all the cases.

    2-Most of the cases of AD ARE SPORADIC. The prevalence of inherited forms of AD is

  • http://scienceblogs.com/neurophilosophy/AlzheimerA nissl stain tissue section (left) and a Bielkhowskys stain section from Augustine Deters brain (right)First description of tangle and plaque pathology by Alois Alzheimer (1901)

  • Alzheimers diseaseAD is a progressive neurodegenerative disorder affecting the elderly population. Once it starts, it progresses with aging.

    It is characterized by the presence of lesions both at an extracellular level (the b-amyloid plaques), and at an intracellular levels (the Neurofibrillary tangles, NFT).

    The presence of the lesions correlates with both reduction in the volume of the brain (as a consequence of the neurodegenerative phenomena), and with cognitive decline associated to loss of memory.

    AD is a form of Dementia.

  • The loss of intellectual functions (such as thinking, remembering, and reasoning) of sufficient severity to interfere with a persons daily functioning.

    Dementia is not a disease itself but rather a group of symptoms that may accompany certain diseases or conditions. Symptoms may also include changes in personality, mood, and behavior.

    Dementia is irreversible when caused by disease or injury but may be reversible when caused by drugs, alcohol, hormone or vitamin imbalances, or depression.Definition of Dementia

  • Increasing and persistent forgetfulness

    Difficulty performing familiar tasks

    Problems with finding the right words to express your thoughts

    Disorientation with time and place

    Poor or impaired judgment

    Problems with abstract thinking

    Putting everyday items in illogical places

    Mood, behavior or personality changes.

    Symptoms in AD

  • Comparison between AD signs and age-related memory changes

    Someone with Alzheimer's disease symptoms

    Someone with normal age-related memory changes

    Forgets entire experiences

    Forgets part of an experience

    Rarely remembers later

    Often remembers later

    Is gradually unable to follow written/spoken directions

    Is usually able to follow written/spoken directions

    Is gradually unable to use notes as reminders

    Is usually able to use notes as reminders

    Is gradually unable to care for self

    Is usually able to care for self

  • NormalADMRIwww.elements4health.comPETAnatomy of the Alzheimers disease brain

  • Alzheimers disease: characterized by extracellular depositions, the b-amyloid plaque, and intracellular depositions, the Neurofibrillary Tangles (NFT) comprised of Paired Helical Filaments (PHF), aggregates of hyperphosphorylated protein tau.Deposition of fibrillar proteinacious material in Alzheimers disease

  • Origin of NFTs and the mechanism of tau pathology1- Tau is a microtubule-associated protein that regulates cytoskeleton structure.

    2- Tau is hyperphosphorylated in AD.

    3- When highly phosphorylated, tau is sequestered into aggregates (PHF and NFT) and causes disruption of microtubules, that ultimately leads to cell death.


  • Origin of the b-amyloid plaque1-Amyloidogenic processing of the Amyloid Precursor Protein APP, and generation of the the b-amyloid peptides (Ab37-43).

    The b-Amyloid Plaqueamyloidogenic processing pathwayAbAPPTMDNH2


  • The b-amyloid plaque1- b-amyloid is DIFFERENT from amyloid. b-amyloid contains specifically the b-amyloid peptide, an approximately 4kDa peptide (Ab40, Ab42) deriving from the amyloid precursor protein APP when it undergoes the so called amyloidogenic pathway. b-amyloid plaque contains also ubiquitin and other proteins coming from degenerative neurons and glial cells.

    2- The b-amyloid peptide is insoluble in water. When released from the precursor protein it assumes a b-sheet conformation that makes it hydrophobic.

    3- b-amyloid peptides forms oligomers that may affect neurotransmitter release and synaptic plasticity. Oligomers will further aggregates in larger structures called fibrils, that will form the core of the b-amyloid plaque, depositing in the extracellular matrix.

    4- The size of the plaque will increase following the progression of the disease. Scientific clear evidences are still missing in order to understand whether the plaque is a consequence or a cause of AD. Indeed, Ab and plaques formation are associated to neuronal death. Inherited forms of AD lead to substantial increase of Ab production.

  • Where do b-Amyloid peptides come from?From the processing so called AMYLOIDOGENIC of the larger precursor APP (Amyloid Precursor Protein)

  • APP processing and formation of aggregates of beta-amyloid

  • Structure of the b-Amyloid peptide

  • Genetic of AD-Depending on the kind of mutation and on the gene that carries it, the onset of the disease is SIGNIFICANTLY EARLIER than in sporadic cases (
  • Mutations on APPChromosome 21. Relation to Downs syndrome (Trisomy 21; excess of APP transcript induces plaque formation already at early age, and progresses with aging).

    Swedish mutation: K670M/N671L, facilitates the amyloidogenic processing of APP by increasing the affinity for and the cleavage by b-secretase of ~100 times.Dutch Mutation: E693Q, induces cerebral amyloidosis Arctic Mutation:E693G enhances b-Amyloid protofibril formationLondon Mutation: V717I, Affects the cleavage of g-secretaseK670M/N671LSwedish MutationV717ILondon MutationE693GArctic Mutation

  • K670M/N671LV717IE693G

  • Mutations on PresenilinsPS1 (on chromosome 14) PS2 (on chromosome 1) are ~450 aa long aspartyl proteases comprised of 7- to 8- transmembrane spanning domains. They are the catalytic part of a tetrameric protein complex called g-secretase, able to cleave APP at the end of the sequence for b-Amyloid peptides, generating b-Amyloid species.

    More than 70 mutations on PS1 gene account for inherited AD.

    Two mutations on PS2 gene account for inherited AD.

  • Hardy and Selkoe, 2002PS1 mutations and APP

  • sbAPPAbb-secretaseg-secretase/mutantPS1C99 TMDAPPb-secretaseg-secretaseAmyloidogenic processing of APPNH2COOHCOOHNH2

  • The b-Amyloid PlaqueAlois Alzheimer: miliary bodies (the plaques) and dense bundles of fibrils (NFT)

  • Characteristic of the b-amyloid plaque

    -is extracellular

    -normally, it has a core composed of the b-amyloid peptide

    -it can be cored (with an intensely stained core with a weak periphery stain-halo) or diffused, which do not have a core and the immunoreactivity is uniform over the plaque.

    -aggregation is massive in the center, and diffused at the sides (disaggregation hypothesis?)

    -diameter ranges between 20mm and 90mm

    -is composed of dystrophic neurites, b-amyloid peptides (40/42/43), ubiquitin, tau protein and other proteins, some involved in the generation of b-amyloid, like the secretases.

  • Amyloid: definitionInsoluble fibrous protein aggregations sharing specific structural traits:-Insolubility in water-b-sheet conformation-largest aggregates deposit extracellularly-positive to the staining with specific dyes, such as Congo Red -associated with tissue degeneration (cause or consequence?)

    b-AmyloidAre formations of amyloid characterized by a core specifically formed by b-amyloid peptides, a product of the so called amyloidgenic processing of a larger precursor, the protein APP (Amyloid Precursor Protein)

  • Congo red staining of amyloid plaquesUnder polarized lightUnder unpolarized light

  • Prions diseaseUnpolarized lightPolarized lightADCongophylic plaques

  • How to specifically detect b-Amyloid plaques?Using antibodies that specifically recognize the different b-Amyloid peptides, Ab 1-40, Ab 1-42, Ab 1-43

  • b-Amyloid plaques depositions follow the progression of AD

  • Ab40, Ab42 and Ab43 are part of the b-amyloid plaque in AD

  • Levels of deposited Ab40, Ab42 and Ab43 follow the progression of the disease

  • Diagnosis of ADAt the moment, the exact diagnosis for AD can be performed only post-mortem by means of immunohistochemistry, verifying the presence of the b-amyloid plaques in the patients brain section using specific anti b-amyloid antibodies.

    However, a clinical diagnosis for AD is based on

    Neuropsycologic evaluation: behavioral and cognitive tests (MMSE, CDR). Diagnosis of a possible or probable AD (Dementia of AD type).

    Imaging techniques:MRI to detect changes in the volume of the brainPET analysis to identify areas of the brain with reduced glucose utilization

    Progress has been done in the direction of using dyes/compounds that specifically recognize the b-amyloid structure in both MRI and PET analysis. This would improve the quality of the diagnosis, identifying the structures (b-amyloid plaques) that are specific for AD.

  • MRIComputer graphicMRI in Alzheimers disease (AD)

  • Study on age-related morphologic neuronal changes

  • Cortical thickness decreases with age

  • Number of cortical neurons does not decrease with age

  • Cerebral volume loss is associated with aging, but not necessarily with neuronal death and/or with AD.Need for diagnostic tools more specific than MRI.

  • Characteristics of a biomarker for diagnostic purposes -It should be already changed in the initial steps of the disease: implications for an early diagnosis of the disease, with deep impact in the success of the treatment.

    -The method to access the biomarker must not be invasive

    -The molecule used as a biomarker must be specific for that disease, and not be involved in other diseases. The mechanisms behind the specific changes in the disease must be clear.

    -The method of analysis must be reproducible :-) and must not be expensive

    -Ideally, the levels of the biomarker, once identified, should follow the progression of the disease (linear progression).

  • Possible biomarkers in AD-Levels of b-amyloid peptides in the CSF of patients. Concerns regarding:

    The method used to take the sample of CSF (spinal injection, which is invasive).

    In the CSF of AD patients, the levels of the different species of b-amyloid peptides, in particular the most aggressive Ab42, do not always follow the progression of the disease. In fact, levels of Ab42 raise in the early stages of the diseases, but drop in the late, advanced stages of the disease, maybe indicating increased deposition of secreted Ab42 into plaques in the brain.

    It is very difficult to correlate the amount of biomarker (in particular Ab42) to the amount of deposited plaques in the different stages of the disease.

    Cerebrospinal levels of hyperphoshorylated tau. However, since tau is involved also in other neurodegenerative phenomena called taupaties, it is questionable how it could be considered as a biomarker specific for AD.

  • Immune responseApoptosisHematopoiesis18 predictive AD-related plasma signaling molecules

  • Ray et al.,Probable AD diagnosis via identification of changes in the 18 markers

  • The Pittsburgh Compound B PIB is specifically up-taken in AD brains

  • PIB is differentially retained in brain areas more susceptible to AD

  • ControlControlADADTopography of PIB retention in AD brain

  • In AD brains, PIB uptake correlates with the progression of the disease

  • ?Are plaques a CAUSE or a CONSEQUENCE of neurite dysfunction?

  • Appearance of a novel plaque is a fast process that takes 1 weekMeyer-Luehamnn et al., Nature, 2008, 451:720

  • Meyer-Luehamnn et al., Nature, 2008, 451:720Formation of a plaque can occur within 24 hours

  • Meyer-Luehamnn et al., Nature, 2008, 451:720Plaques recruit activated microglia: a possible role of microglia limiting the size of the plaque

  • Meyer-Luehamnn et al., Nature, 2008, 451:720Plaque formation induces neurites curvature

  • Soluble beta-Amyloid critically contributes to the formation of the plaquesSoluble and insoluble beta-Amyloid and toxic functions

  • Beta-Amyloid peptides can be detected in the ISF

  • Amyloid plaques develop in J20APPTg mice without changes in the precursor APP

  • Levels of soluble ISF Abeta decrease with disease progressing

  • whereas levels of insoluble Abeta increase

  • Higher levels of exogenous, NOT newly synthesized Abeta are sequestered from the ISF in plaque-rich animals

  • Demonstration that the plaque attracts soluble Abeta

    Explanation why levels of Abeta 42 in the CSF DO NOT follow the progression of the disease

  • The many ways the system tries to get rid of the Abeta peptides

  • Insulin Degrading Enzyme (IDE) is crucial for Abeta degradation

  • IDE levels are reduced in brain areas affected by AD

  • Decreased Ab plaque burden in animals overexpressing Insulin Degrading Enzyme (IDE) and NeprilysinLeissring et al.,

  • Is there anything we can do to help the system get rid of the plaques?Y E S ! H E A L T H Y L I F E S T Y L E !!

  • Abeta plaques are reduced in APPTg mice in enriched environment

  • Abeta plaques are reduced in APPTg mice in enriched environment

  • Environmental enrichment reduces the amyloid load

  • Both levels of soluble and insoluble Abeta decrease with environmental enrichment

  • Activity of IDE and neprilysin are increased with environmental enrichment:Abeta clearance is favored

  • Exercise reduces the levels of markers of AD in CFS:Reduced levels of Abeta42

  • and tau, phosphorylated tau

  • Decreased exercise associates with increased risk of AD