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Homanics GE, Park JE, Bailey L, Schaeffer DJ, Schaeffer L, He J, Li S, Zhang T, Haber A, Spruce C, Greenwood A, Murai T, Schultz L, Mongeau L, Ha S, Oluoch J, Stein B, Choi SH, Huhe H, Thathiah A, Strick PL, Carter GW, Silva AC, Sukoff Rizzo SJ. Early molecular events of autosomal-dominant Alzheimer's disease in marmosets with PSEN1 mutations. Alzheimers Dement 2024; 20:3455-3471. [PMID: 38574388 PMCID: PMC11095452 DOI: 10.1002/alz.13806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Fundamental questions remain about the key mechanisms that initiate Alzheimer's disease (AD) and the factors that promote its progression. Here we report the successful generation of the first genetically engineered marmosets that carry knock-in (KI) point mutations in the presenilin 1 (PSEN1) gene that can be studied from birth throughout lifespan. METHODS CRISPR/Cas9 was used to generate marmosets with C410Y or A426P point mutations in PSEN1. Founders and their germline offspring are comprehensively studied longitudinally using non-invasive measures including behavior, biomarkers, neuroimaging, and multiomics signatures. RESULTS Prior to adulthood, increases in plasma amyloid beta were observed in PSEN1 mutation carriers relative to non-carriers. Analysis of brain revealed alterations in several enzyme-substrate interactions within the gamma secretase complex prior to adulthood. DISCUSSION Marmosets carrying KI point mutations in PSEN1 provide the opportunity to study the earliest primate-specific mechanisms that contribute to the molecular and cellular root causes of AD onset and progression. HIGHLIGHTS We report the successful generation of genetically engineered marmosets harboring knock-in point mutations in the PSEN1 gene. PSEN1 marmosets and their germline offspring recapitulate the early emergence of AD-related biomarkers. Studies as early in life as possible in PSEN1 marmosets will enable the identification of primate-specific mechanisms that drive disease progression.
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Affiliation(s)
- Gregg E. Homanics
- Department of Anesthesiology & Perioperative MedicineUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
- Department of NeurobiologyUniversity of Pittsburgh Brain InstituteUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Jung Eun Park
- Department of NeurobiologyUniversity of Pittsburgh Brain InstituteUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Lauren Bailey
- Department of MedicineUniversity of Pittsburgh Aging Institute, University of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - David J. Schaeffer
- Department of NeurobiologyUniversity of Pittsburgh Brain InstituteUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Lauren Schaeffer
- Department of NeurobiologyUniversity of Pittsburgh Brain InstituteUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Jie He
- Department of StatisticsUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Shuoran Li
- Department of StatisticsUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Tingting Zhang
- Department of StatisticsUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | | | | | | | - Takeshi Murai
- Department of MedicineUniversity of Pittsburgh Aging Institute, University of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Laura Schultz
- Department of MedicineUniversity of Pittsburgh Aging Institute, University of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Lauren Mongeau
- Department of MedicineUniversity of Pittsburgh Aging Institute, University of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Seung‐Kwon Ha
- Department of NeurobiologyUniversity of Pittsburgh Brain InstituteUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Julia Oluoch
- Department of NeurobiologyUniversity of Pittsburgh Brain InstituteUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Brianne Stein
- Department of NeurobiologyUniversity of Pittsburgh Brain InstituteUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Sang Ho Choi
- Department of NeurobiologyUniversity of Pittsburgh Brain InstituteUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Hasi Huhe
- Department of MedicineUniversity of Pittsburgh Aging Institute, University of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Amantha Thathiah
- Department of NeurobiologyUniversity of Pittsburgh Brain InstituteUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Peter L. Strick
- Department of NeurobiologyUniversity of Pittsburgh Brain InstituteUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | | | - Afonso C. Silva
- Department of NeurobiologyUniversity of Pittsburgh Brain InstituteUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Stacey J. Sukoff Rizzo
- Department of NeurobiologyUniversity of Pittsburgh Brain InstituteUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
- Department of MedicineUniversity of Pittsburgh Aging Institute, University of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
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Korpela S, Sundblom J, Zetterberg H, Constantinescu R, Svenningsson P, Paucar M, Niemelä V. Cerebrospinal fluid glial fibrillary acidic protein, in contrast to amyloid beta protein, is associated with disease symptoms in Huntington's disease. J Neurol Sci 2024; 459:122979. [PMID: 38569376 DOI: 10.1016/j.jns.2024.122979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 02/07/2024] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Abstract
INTRODUCTION Huntington's disease (HD) is a hereditary neurodegenerative disease, currently lacking disease-modifying treatments. Biomarkers are needed for objective assessment of disease progression. Evidence supports both complex protein aggregation and astrocyte activation in HD. This study assesses the 42 amino acid long amyloid beta (Aβ42) and glial fibrillary acidic protein (GFAP) as potential biomarkers in the cerebrospinal fluid (CSF) of HD mutation carriers. METHODS CSF from participants was obtained from three sites in Sweden. Clinical symptoms were graded with the composite Unified Huntington's disease rating scale (cUHDRS). Protein concentrations were measured using ELISA. Pearson correlations were calculated to assess disease progression association. Results were adjusted for age and collection site. RESULTS The study enrolled 28 manifest HD patients (ManHD), 13 premanifest HD gene-expansion carriers (PreHD) and 20 controls. Aβ42 levels did not differ between groups and there was no correlation with measures of disease progression. GFAP concentration was higher in ManHD (424 ng/l, SD 253) compared with both PreHD (266 ng/l, SD 92.4) and controls (208 ng/l, SD 83.7). GFAP correlated with both cUHDRS (r = -0.77, p < 0.001), and 5-year risk of disease onset (r = 0.70, p = 0.008). CONCLUSION We provide evidence that indicates CSF Aβ42 has limited potential as a biomarker for HD. GFAP is a potential biomarker of progression in HD. Validation in larger cohorts measuring GFAP in blood and CSF would be of interest.
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Affiliation(s)
- Sara Korpela
- Department of Medicine, Neurology, Västerås Central Hospital, Västerås, Sweden
| | - Jimmy Sundblom
- Department of Medical Sciences, Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK; UK Dementia Research Institute at UCL, London, UK; Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
| | - Radu Constantinescu
- Institute of Neuroscience and Physiology, Clinical Neuroscience, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Per Svenningsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Martin Paucar
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Valter Niemelä
- Department of Medical Sciences, Neurology, Uppsala University, Uppsala, Sweden.
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Rafii MS, Aisen PS. Detection and treatment of Alzheimer's disease in its preclinical stage. NATURE AGING 2023; 3:520-531. [PMID: 37202518 PMCID: PMC11110912 DOI: 10.1038/s43587-023-00410-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/29/2023] [Indexed: 05/20/2023]
Abstract
Longitudinal multimodal biomarker studies reveal that the continuum of Alzheimer's disease (AD) includes a long latent phase, referred to as preclinical AD, which precedes the onset of symptoms by decades. Treatment during the preclinical AD phase offers an optimal opportunity for slowing the progression of disease. However, trial design in this population is complex. In this Review, we discuss the recent advances in accurate plasma measurements, new recruitment approaches, sensitive cognitive instruments and self-reported outcomes that have facilitated the successful launch of multiple phase 3 trials for preclinical AD. The recent success of anti-amyloid immunotherapy trials in symptomatic AD has increased the enthusiasm for testing this strategy at the earliest feasible stage. We provide an outlook for standard screening of amyloid accumulation at the preclinical stage in clinically normal individuals, during which effective therapy to delay or prevent cognitive decline can be initiated.
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Affiliation(s)
- Michael S Rafii
- Alzheimer's Therapeutic Research Institute, Keck School of Medicine University of Southern California, Los Angeles, CA, USA.
| | - Paul S Aisen
- Alzheimer's Therapeutic Research Institute, Keck School of Medicine University of Southern California, Los Angeles, CA, USA
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Dragović IR, Popović N, Ždralević M, Radulović L, Radunović M. Inflammation-Related microRNAs-146a and -155 Are Upregulated in Mild Cognitive Impairment Subjects Among Older Age Population in Montenegro. J Alzheimers Dis 2022; 90:625-638. [DOI: 10.3233/jad-220676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Pathological and clinical features of Alzheimer’s disease (AD) are in temporal discrepancy and currently accepted clinical tests provide the diagnosis decades after the initial pathophysiological events. In order to enable a more timely detection of AD, research efforts are directed to identification of biomarkers of the early symptomatic stage. Neuroinflammatory signaling pathways and inflammation-related microRNAs (miRNAs) could possibly have a crucial role in AD, making them promising potential biomarkers. Objective: We examined the expression of circulatory miRNAs with a documented role in AD pathophysiology: miR-29a/b, miR-101, miR-125b, miR-146a, and miR-155 in the plasma of AD patients (AD, n = 12), people with mild cognitive impairment (MCI, n = 9), and normocognitive group (CTRL, n = 18). We hypothesized that these miRNA expression levels could correlate with the level of participants’ cognitive decline. Methods: The study participants completed the standardized interview, neurological examination, neuropsychological assessment, and biochemical analyses. miRNA expression levels were assessed by RT-PCR. Results: Neurological and laboratory findings could not account for MCI, but miR-146a and -155 were upregulated in the MCI group compared to the control. miR-146a, known to mediate early neuroinflammatory AD events, was also upregulated in the MCI compared to AD group. ROC curve analysis for miRNA-146a showed 77.8% sensitivity and 94.4% specificity and 66.7% sensitivity and 88.9% specificity for miR-155. Conclusion: Determination of circulatory inflamma-miRs-146a and -155 expression, together with neuropsychological screening, could become a non-invasive tool for detecting individuals with an increased risk for AD, but research on a larger cohort is warranted.
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Affiliation(s)
| | - Nataša Popović
- University of Montenegro, Faculty of Medicine, Podgorica, Montenegro
| | - Maša Ždralević
- University of Montenegro, Faculty of Medicine, Podgorica, Montenegro
| | - Ljiljana Radulović
- Clinical Center of Montenegro, Department of Neurology, Podgorica, Montenegro
| | - Miodrag Radunović
- University of Montenegro, Faculty of Medicine, Podgorica, Montenegro
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Lloret A, Esteve D, Lloret MA, Cervera-Ferri A, Lopez B, Nepomuceno M, Monllor P. When Does Alzheimer's Disease Really Start? The Role of Biomarkers. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2021; 19:355-364. [PMID: 34690605 DOI: 10.1176/appi.focus.19305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
(Appeared originally in Int J Mol Sci 2019, 20 5536).
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Affiliation(s)
- Ana Lloret
- Department of Physiology, Faculty of Medicine, University of Valencia, Health Research Institute INCLIVA, Avda. Blasco Ibanez, 17, 46010 Valencia, Spain; Department of Clinic Neurophysiology. University Clinic Hospital of Valencia, Avda. Blasco Ibanez, 19, 46010 Valencia, Spain; Department of Human Anatomy and Embriology, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; Department of Neurology. University Clinic Hospital of Valencia, Avda. Blasco Ibanez, 19, 46010 Valencia, Spain
| | - Daniel Esteve
- Department of Physiology, Faculty of Medicine, University of Valencia, Health Research Institute INCLIVA, Avda. Blasco Ibanez, 17, 46010 Valencia, Spain; Department of Clinic Neurophysiology. University Clinic Hospital of Valencia, Avda. Blasco Ibanez, 19, 46010 Valencia, Spain; Department of Human Anatomy and Embriology, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; Department of Neurology. University Clinic Hospital of Valencia, Avda. Blasco Ibanez, 19, 46010 Valencia, Spain
| | - Maria-Angeles Lloret
- Department of Physiology, Faculty of Medicine, University of Valencia, Health Research Institute INCLIVA, Avda. Blasco Ibanez, 17, 46010 Valencia, Spain; Department of Clinic Neurophysiology. University Clinic Hospital of Valencia, Avda. Blasco Ibanez, 19, 46010 Valencia, Spain; Department of Human Anatomy and Embriology, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; Department of Neurology. University Clinic Hospital of Valencia, Avda. Blasco Ibanez, 19, 46010 Valencia, Spain
| | - Ana Cervera-Ferri
- Department of Physiology, Faculty of Medicine, University of Valencia, Health Research Institute INCLIVA, Avda. Blasco Ibanez, 17, 46010 Valencia, Spain; Department of Clinic Neurophysiology. University Clinic Hospital of Valencia, Avda. Blasco Ibanez, 19, 46010 Valencia, Spain; Department of Human Anatomy and Embriology, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; Department of Neurology. University Clinic Hospital of Valencia, Avda. Blasco Ibanez, 19, 46010 Valencia, Spain
| | - Begoña Lopez
- Department of Physiology, Faculty of Medicine, University of Valencia, Health Research Institute INCLIVA, Avda. Blasco Ibanez, 17, 46010 Valencia, Spain; Department of Clinic Neurophysiology. University Clinic Hospital of Valencia, Avda. Blasco Ibanez, 19, 46010 Valencia, Spain; Department of Human Anatomy and Embriology, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; Department of Neurology. University Clinic Hospital of Valencia, Avda. Blasco Ibanez, 19, 46010 Valencia, Spain
| | - Mariana Nepomuceno
- Department of Physiology, Faculty of Medicine, University of Valencia, Health Research Institute INCLIVA, Avda. Blasco Ibanez, 17, 46010 Valencia, Spain; Department of Clinic Neurophysiology. University Clinic Hospital of Valencia, Avda. Blasco Ibanez, 19, 46010 Valencia, Spain; Department of Human Anatomy and Embriology, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; Department of Neurology. University Clinic Hospital of Valencia, Avda. Blasco Ibanez, 19, 46010 Valencia, Spain
| | - Paloma Monllor
- Department of Physiology, Faculty of Medicine, University of Valencia, Health Research Institute INCLIVA, Avda. Blasco Ibanez, 17, 46010 Valencia, Spain; Department of Clinic Neurophysiology. University Clinic Hospital of Valencia, Avda. Blasco Ibanez, 19, 46010 Valencia, Spain; Department of Human Anatomy and Embriology, Faculty of Medicine, University of Valencia, 46010 Valencia, Spain; Department of Neurology. University Clinic Hospital of Valencia, Avda. Blasco Ibanez, 19, 46010 Valencia, Spain
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Forloni G. Alzheimer's disease: from basic science to precision medicine approach. BMJ Neurol Open 2020; 2:e000079. [PMID: 33681801 PMCID: PMC7903168 DOI: 10.1136/bmjno-2020-000079] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/24/2020] [Accepted: 10/16/2020] [Indexed: 12/14/2022] Open
Abstract
Alzheimer’s disease (AD) is the most common form of dementia in the elderly. Together with cerebral amyloid accumulation, several factors contribute to AD pathology including vascular alterations, systemic inflammation, genetic/epigenetic status and mitochondrial dysfunction. Much is now being devoted to neuroinflammation. However, anti-inflammatory drugs as numerous other therapies, mainly targeted on β-amyloid, have failed to show efficacious effects in AD. Timing, proper selection of patients, and the need for a multitarget approach appear to be the main weak points of current therapeutic efforts. The efficacy of a treatment could be better evaluate if efficient biomarkers are available. We propose here the application of precision medicine principles in AD to simultaneously verify the efficacy of a treatment and the reliability of specific biomarkers according to individually tailored biomarker-guided targeted therapies. People at risk of developing AD or in the very early phase of the disease should be stratified according to: (1) neuropsychological tests; (2) apolipoprotein E (ApoE) genotyping; (3) biochemical analysis of plasma and cerebrospinal fluid (CSF); (4) MRI and positron emission tomography and (5) assessment of their inflammatory profile by an integration of various genetic and biochemical parameters in plasma, CSF and an analysis of microbiota composition. The selected population should be treated with antiamyloidogenic and anti-inflammatory drugs in randomised, longitudinal, placebo-controlled studies using ad hoc profiles (eg, vascular profile, mitochondrial profile, etc…) If these criteria are adopted widely and the results shared, it may be possible to rapidly develop innovative and personalised drug treatment protocols with more realistic chances of being efficacious.
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Affiliation(s)
- Gianluigi Forloni
- Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri, Milano, Lombardia, Italy
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7
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Lowe AJ, Sjödin S, Rodrigues FB, Byrne LM, Blennow K, Tortelli R, Zetterberg H, Wild EJ. Cerebrospinal fluid endo-lysosomal proteins as potential biomarkers for Huntington's disease. PLoS One 2020; 15:e0233820. [PMID: 32804976 PMCID: PMC7430717 DOI: 10.1371/journal.pone.0233820] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/30/2020] [Indexed: 01/13/2023] Open
Abstract
Molecular markers derived from cerebrospinal fluid (CSF) represent an accessible means of exploring the pathobiology of Huntington's disease (HD) in vivo. The endo-lysosomal/autophagy system is dysfunctional in HD, potentially contributing to disease pathogenesis and representing a potential target for therapeutic intervention. Several endo-lysosomal proteins have shown promise as biomarkers in other neurodegenerative diseases; however, they have yet to be fully explored in HD. We performed parallel reaction monitoring mass spectrometry analysis (PRM-MS) of multiple endo-lysosomal proteins in the CSF of 60 HD mutation carriers and 20 healthy controls. Using generalised linear models controlling for age and CAG, none of the 18 proteins measured displayed significant differences in concentration between HD patients and controls. This was affirmed by principal component analysis, in which no significant difference across disease stage was found in any of the three components representing lysosomal hydrolases, binding/transfer proteins and innate immune system/peripheral proteins. However, several proteins were associated with measures of disease severity and cognition: most notably amyloid precursor protein, which displayed strong correlations with composite Unified Huntington's Disease Rating Scale, UHDRS Total Functional Capacity, UHDRS Total Motor Score, Symbol Digit Modalities Test and Stroop Word Reading. We conclude that although endo-lysosomal proteins are unlikely to have value as disease state CSF biomarkers for Huntington's disease, several proteins demonstrate associations with clinical severity, thus warranting further, targeted exploration and validation in larger, longitudinal samples.
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Affiliation(s)
- Alexander J. Lowe
- UCL Huntington’s Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Simon Sjödin
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Filipe B. Rodrigues
- UCL Huntington’s Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Lauren M. Byrne
- UCL Huntington’s Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Rosanna Tortelli
- UCL Huntington’s Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
| | - Henrik Zetterberg
- UCL Huntington’s Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- UK Dementia Research Institute at UCL, London, United Kingdom
| | - Edward J. Wild
- UCL Huntington’s Disease Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom
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When Does Alzheimer's Disease Really Start? The Role of Biomarkers. Int J Mol Sci 2019; 20:ijms20225536. [PMID: 31698826 PMCID: PMC6888399 DOI: 10.3390/ijms20225536] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/01/2019] [Accepted: 11/04/2019] [Indexed: 12/16/2022] Open
Abstract
While Alzheimer’s disease (AD) classical diagnostic criteria rely on clinical data from a stablished symptomatic disease, newer criteria aim to identify the disease in its earlier stages. For that, they incorporated the use of AD’s specific biomarkers to reach a diagnosis, including the identification of Aβ and tau depositions, glucose hypometabolism, and cerebral atrophy. These biomarkers created a new concept of the disease, in which AD’s main pathological processes have already taken place decades before we can clinically diagnose the first symptoms. Therefore, AD is now considered a dynamic disease with a gradual progression, and dementia is its final stage. With that in mind, new models were proposed, considering the orderly increment of biomarkers and the disease as a continuum, or the variable time needed for the disease’s progression. In 2011, the National Institute on Aging and the Alzheimer’s Association (NIA-AA) created separate diagnostic recommendations for each stage of the disease continuum—preclinical, mild cognitive impairment, and dementia. However, new scientific advances have led them to create a unifying research framework in 2018 that, although not intended for clinical use as of yet, is a step toward shifting the focus from the clinical symptoms to the biological alterations and toward changing the future diagnostic and treatment possibilities. This review aims to discuss the role of biomarkers in the onset of AD.
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Ryan L, Hay M, Huentelman MJ, Duarte A, Rundek T, Levin B, Soldan A, Pettigrew C, Mehl MR, Barnes CA. Precision Aging: Applying Precision Medicine to the Field of Cognitive Aging. Front Aging Neurosci 2019; 11:128. [PMID: 31231204 PMCID: PMC6568195 DOI: 10.3389/fnagi.2019.00128] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/16/2019] [Indexed: 12/13/2022] Open
Abstract
The current "one size fits all" approach to our cognitive aging population is not adequate to close the gap between cognitive health span and lifespan. In this review article, we present a novel model for understanding, preventing, and treating age-related cognitive impairment (ARCI) based on concepts borrowed from precision medicine. We will discuss how multiple risk factors can be classified into risk categories because of their interrelatedness in real life, the genetic variants that increase sensitivity to, or ameliorate, risk for ARCI, and the brain drivers or common mechanisms mediating brain aging. Rather than providing a definitive model of risk for ARCI and cognitive decline, the Precision Aging model is meant as a starting point to guide future research. To that end, after briefly discussing key risk categories, genetic risks, and brain drivers, we conclude with a discussion of steps that must be taken to move the field forward.
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Affiliation(s)
- Lee Ryan
- Department of Psychology, College of Science, University of Arizona, Tucson, AZ, United States
| | - Meredith Hay
- Department of Physiology, University of Arizona, Tucson, AZ, United States
| | - Matt J. Huentelman
- Neurobehavioral Research Unit, Division of Neurological Disorders, Translational Genomics Research Institute (TGen), Phoenix, AZ, United States
| | - Audrey Duarte
- Center for Advanced Brain Imaging, School of Psychology, Georgia Institute of Technology, Atlanta, GA, United States
| | - Tatjana Rundek
- Clinical and Translational Research Division, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Bonnie Levin
- Neuropsychology Division, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Anja Soldan
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Corinne Pettigrew
- Department of Neurology, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Matthias R. Mehl
- Department of Psychology, College of Science, University of Arizona, Tucson, AZ, United States
| | - Carol A. Barnes
- Department of Psychology, College of Science, University of Arizona, Tucson, AZ, United States
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Blennow K, Zetterberg H. Biomarkers for Alzheimer's disease: current status and prospects for the future. J Intern Med 2018; 284:643-663. [PMID: 30051512 DOI: 10.1111/joim.12816] [Citation(s) in RCA: 495] [Impact Index Per Article: 82.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Accumulating data from the clinical research support that the core Alzheimer's disease (AD) cerebrospinal fluid (CSF) biomarkers amyloid-β (Aβ42), total tau (T-tau), and phosphorylated tau (P-tau) reflect key elements of AD pathophysiology. Importantly, a large number of clinical studies very consistently show that these biomarkers contribute with diagnostically relevant information, also in the early disease stages. Recent technical developments have made it possible to measure these biomarkers using fully automated assays with high precision and stability. Standardization efforts have given certified reference materials for CSF Aβ42, with the aim to harmonize results between assay formats that would allow for uniform global reference limits and cut-off values. These encouraging developments have led to that the core AD CSF biomarkers have a central position in the novel diagnostic criteria for the disease and in the recent National Institute on Aging and Alzheimer's Association biological definition of AD. Taken together, this progress will likely serve as the basis for a more general introduction of these diagnostic tests in clinical routine practice. However, the heterogeneity of pathology in late-onset AD calls for an expansion of the AD CSF biomarker toolbox with additional biomarkers reflecting additional aspects of AD pathophysiology. One promising candidate is the synaptic protein neurogranin that seems specific for AD and predicts future rate of cognitive deterioration. Further, recent studies bring hope for easily accessible and cost-effective screening tools in the early diagnostic evaluation of patients with cognitive problems (and suspected AD) in primary care. In this respect, technical developments with ultrasensitive immunoassays and novel mass spectrometry techniques give promise of biomarkers to monitor brain amyloidosis (the Aβ42/40 or APP669-711/Aβ42 ratios) and neurodegeneration (tau and neurofilament light proteins) in plasma samples, but future studies are warranted to validate these promising results further.
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Affiliation(s)
- K Blennow
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
| | - H Zetterberg
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden
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Lista S, O'Bryant SE, Blennow K, Dubois B, Hugon J, Zetterberg H, Hampel H. Biomarkers in Sporadic and Familial Alzheimer's Disease. J Alzheimers Dis 2016; 47:291-317. [PMID: 26401553 DOI: 10.3233/jad-143006] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Most forms of Alzheimer's disease (AD) are sporadic (sAD) or inherited in a non-Mendelian fashion, and less than 1% of cases are autosomal-dominant. Forms of sAD do not exhibit familial aggregation and are characterized by complex genetic and environmental interactions. Recently, the expansion of genomic methodologies, in association with substantially larger combined cohorts, has resulted in various genome-wide association studies that have identified several novel genetic associations of AD. Currently, the most effective methods for establishing the diagnosis of AD are defined by multi-modal pathways, starting with clinical and neuropsychological assessment, cerebrospinal fluid (CSF) analysis, and brain-imaging procedures, all of which have significant cost- and access-to-care barriers. Consequently, research efforts have focused on the development and validation of non-invasive and generalizable blood-based biomarkers. Among the modalities conceptualized by the systems biology paradigm and utilized in the "exploratory biomarker discovery arena", proteome analysis has received the most attention. However, metabolomics, lipidomics, transcriptomics, and epigenomics have recently become key modalities in the search for AD biomarkers. Interestingly, biomarker changes for familial AD (fAD), in many but not all cases, seem similar to those for sAD. The integration of neurogenetics with systems biology/physiology-based strategies and high-throughput technologies for molecular profiling is expected to help identify the causes, mechanisms, and biomarkers associated with the various forms of AD. Moreover, in order to hypothesize the dynamic trajectories of biomarkers through disease stages and elucidate the mechanisms of biomarker alterations, updated and more sophisticated theoretical models have been proposed for both sAD and fAD.
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Affiliation(s)
- Simone Lista
- AXA Research Fund & UPMC Chair, Paris, France.,Sorbonne Universités, Université Pierre et Marie Curie, Paris 06, Institut de la Mémoire et de la Maladie d'Alzheimer (IM2A) & Institut du Cerveau et de la Moelle épinière (ICM), Département de Neurologie, Hôpital de la Pitié-Salpétrière, Paris, France
| | - Sid E O'Bryant
- Institute for Aging and Alzheimer's Disease Research & Department of Internal Medicine, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Bruno Dubois
- Sorbonne Universités, Université Pierre et Marie Curie, Paris 06, Institut de la Mémoire et de la Maladie d'Alzheimer (IM2A) & Institut du Cerveau et de la Moelle épinière (ICM), Département de Neurologie, Hôpital de la Pitié-Salpétrière, Paris, France
| | - Jacques Hugon
- Centre Mémoire de Ressources et de Recherche (CMRR) Paris Nord Ile-de-France, Groupe Hospitalier Saint Louis Lariboisière - Fernand Widal, Université Paris Diderot, Paris 07, Paris, France.,Institut du Fer à Moulin (IFM), Inserm UMR_S 839, Paris, France
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,University College London Institute of Neurology, Queen Square, London, UK
| | - Harald Hampel
- AXA Research Fund & UPMC Chair, Paris, France.,Sorbonne Universités, Université Pierre et Marie Curie, Paris 06, Institut de la Mémoire et de la Maladie d'Alzheimer (IM2A) & Institut du Cerveau et de la Moelle épinière (ICM), Département de Neurologie, Hôpital de la Pitié-Salpétrière, Paris, France
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13
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Advances in development of fluorescent probes for detecting amyloid-β aggregates. Acta Pharmacol Sin 2016; 37:719-30. [PMID: 26997567 DOI: 10.1038/aps.2015.155] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 12/25/2015] [Indexed: 12/17/2022] Open
Abstract
With accumulating evidence suggesting that amyloid-β (Aβ) deposition is a good diagnostic biomarker for Alzheimer's disease (AD), the discovery of active Aβ probes has become an active area of research. Among the existing imaging methods, optical imaging targeting Aβ aggregates (fibrils or oligomers), especially using near-infrared (NIR) fluorescent probes, is increasingly recognized as a promising approach for the early diagnosis of AD due to its real time detection, low cost, lack of radioactive exposure and high-resolution. In the past decade, a variety of fluorescent probes have been developed and tested for efficiency in vitro, and several probes have shown efficacy in AD transgenic mice. This review classifies these representative probes based on their chemical structures and functional modes (dominant solvent-dependent mode and a novel solvent-independent mode). Moreover, the pharmaceutical characteristics of these representative probes are summarized and discussed. This review provides important perspectives for the future development of novel NIR Aβ diagnostic probes.
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Soares HD, Gasior M, Toyn JH, Wang JS, Hong Q, Berisha F, Furlong MT, Raybon J, Lentz KA, Sweeney F, Zheng N, Akinsanya B, Berman RM, Thompson LA, Olson RE, Morrison J, Drexler DM, Macor JE, Albright CF, Ahlijanian MK, AbuTarif M. The γ-Secretase Modulator, BMS-932481, Modulates Aβ Peptides in the Plasma and Cerebrospinal Fluid of Healthy Volunteers. J Pharmacol Exp Ther 2016; 358:138-50. [PMID: 27189973 PMCID: PMC4931877 DOI: 10.1124/jpet.116.232256] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/05/2016] [Indexed: 11/22/2022] Open
Abstract
The pharmacokinetics, pharmacodynamics, safety, and tolerability of BMS-932481, a γ-secretase modulator (GSM), were tested in healthy young and elderly volunteers after single and multiple doses. BMS-932481 was orally absorbed, showed dose proportionality after a single dose administration, and had approximately 3-fold accumulation after multiple dosing. High-fat/caloric meals doubled the Cmax and area under the curve and prolonged Tmax by 1.5 hours. Consistent with the preclinical pharmacology of GSMs, BMS-932481 decreased cerebrospinal fluid (CSF) Aβ39, Aβ40, and Aβ42 while increasing Aβ37 and Aβ38, thereby providing evidence of γ-secretase enzyme modulation rather than inhibition. In plasma, reductions in Aβ40 and Aβ42 were observed with no change in total Aβ; in CSF, modest decreases in total Aβ were observed at higher dose levels. Increases in liver enzymes were observed at exposures associated with greater than 70% CSF Aβ42 lowering after multiple dosing. Although further development was halted due to an insufficient safety margin to test the hypothesis for efficacy of Aβ lowering in Alzheimer’s disease, this study demonstrates that γ-secretase modulation is achievable in healthy human volunteers and supports further efforts to discover well tolerated GSMs for testing in Alzheimer’s disease and other indications.
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Affiliation(s)
- Holly D Soares
- Bristol-Myers Squibb, Lawrence Township, New Jersey (H.D.S., J.R., K.A.L., N.Z., B.A., J.M., J.E.M., M.A.); Teva Pharmaceuticals, Frazer, Pennsylvania (M.G.); Bristol-Myers Squibb, Wallingford, Connecticut (J.H.T., L.A.T., R.E.O., D.M.D., C.F.A., M.K.A.); GSK Consumer Healthcare, Parsippany, New Jersey (J.-S.W.); Eisai, Woodcliff Lake, New Jersey (Q.H.); Kyowa Hakko Kirin Pharma, Princeton, New Jersey (F.B.); FORUM Pharmaceuticals, Waltham, Massachusetts (M.T.F.); Pfizer Worldwide Research and Development, Groton, Connecticut (F.S.); and Biohaven Medical Services, New Haven, Connecticut (R.M.B.)
| | - Maciej Gasior
- Bristol-Myers Squibb, Lawrence Township, New Jersey (H.D.S., J.R., K.A.L., N.Z., B.A., J.M., J.E.M., M.A.); Teva Pharmaceuticals, Frazer, Pennsylvania (M.G.); Bristol-Myers Squibb, Wallingford, Connecticut (J.H.T., L.A.T., R.E.O., D.M.D., C.F.A., M.K.A.); GSK Consumer Healthcare, Parsippany, New Jersey (J.-S.W.); Eisai, Woodcliff Lake, New Jersey (Q.H.); Kyowa Hakko Kirin Pharma, Princeton, New Jersey (F.B.); FORUM Pharmaceuticals, Waltham, Massachusetts (M.T.F.); Pfizer Worldwide Research and Development, Groton, Connecticut (F.S.); and Biohaven Medical Services, New Haven, Connecticut (R.M.B.)
| | - Jeremy H Toyn
- Bristol-Myers Squibb, Lawrence Township, New Jersey (H.D.S., J.R., K.A.L., N.Z., B.A., J.M., J.E.M., M.A.); Teva Pharmaceuticals, Frazer, Pennsylvania (M.G.); Bristol-Myers Squibb, Wallingford, Connecticut (J.H.T., L.A.T., R.E.O., D.M.D., C.F.A., M.K.A.); GSK Consumer Healthcare, Parsippany, New Jersey (J.-S.W.); Eisai, Woodcliff Lake, New Jersey (Q.H.); Kyowa Hakko Kirin Pharma, Princeton, New Jersey (F.B.); FORUM Pharmaceuticals, Waltham, Massachusetts (M.T.F.); Pfizer Worldwide Research and Development, Groton, Connecticut (F.S.); and Biohaven Medical Services, New Haven, Connecticut (R.M.B.)
| | - Jun-Sheng Wang
- Bristol-Myers Squibb, Lawrence Township, New Jersey (H.D.S., J.R., K.A.L., N.Z., B.A., J.M., J.E.M., M.A.); Teva Pharmaceuticals, Frazer, Pennsylvania (M.G.); Bristol-Myers Squibb, Wallingford, Connecticut (J.H.T., L.A.T., R.E.O., D.M.D., C.F.A., M.K.A.); GSK Consumer Healthcare, Parsippany, New Jersey (J.-S.W.); Eisai, Woodcliff Lake, New Jersey (Q.H.); Kyowa Hakko Kirin Pharma, Princeton, New Jersey (F.B.); FORUM Pharmaceuticals, Waltham, Massachusetts (M.T.F.); Pfizer Worldwide Research and Development, Groton, Connecticut (F.S.); and Biohaven Medical Services, New Haven, Connecticut (R.M.B.)
| | - Quan Hong
- Bristol-Myers Squibb, Lawrence Township, New Jersey (H.D.S., J.R., K.A.L., N.Z., B.A., J.M., J.E.M., M.A.); Teva Pharmaceuticals, Frazer, Pennsylvania (M.G.); Bristol-Myers Squibb, Wallingford, Connecticut (J.H.T., L.A.T., R.E.O., D.M.D., C.F.A., M.K.A.); GSK Consumer Healthcare, Parsippany, New Jersey (J.-S.W.); Eisai, Woodcliff Lake, New Jersey (Q.H.); Kyowa Hakko Kirin Pharma, Princeton, New Jersey (F.B.); FORUM Pharmaceuticals, Waltham, Massachusetts (M.T.F.); Pfizer Worldwide Research and Development, Groton, Connecticut (F.S.); and Biohaven Medical Services, New Haven, Connecticut (R.M.B.)
| | - Flora Berisha
- Bristol-Myers Squibb, Lawrence Township, New Jersey (H.D.S., J.R., K.A.L., N.Z., B.A., J.M., J.E.M., M.A.); Teva Pharmaceuticals, Frazer, Pennsylvania (M.G.); Bristol-Myers Squibb, Wallingford, Connecticut (J.H.T., L.A.T., R.E.O., D.M.D., C.F.A., M.K.A.); GSK Consumer Healthcare, Parsippany, New Jersey (J.-S.W.); Eisai, Woodcliff Lake, New Jersey (Q.H.); Kyowa Hakko Kirin Pharma, Princeton, New Jersey (F.B.); FORUM Pharmaceuticals, Waltham, Massachusetts (M.T.F.); Pfizer Worldwide Research and Development, Groton, Connecticut (F.S.); and Biohaven Medical Services, New Haven, Connecticut (R.M.B.)
| | - Michael T Furlong
- Bristol-Myers Squibb, Lawrence Township, New Jersey (H.D.S., J.R., K.A.L., N.Z., B.A., J.M., J.E.M., M.A.); Teva Pharmaceuticals, Frazer, Pennsylvania (M.G.); Bristol-Myers Squibb, Wallingford, Connecticut (J.H.T., L.A.T., R.E.O., D.M.D., C.F.A., M.K.A.); GSK Consumer Healthcare, Parsippany, New Jersey (J.-S.W.); Eisai, Woodcliff Lake, New Jersey (Q.H.); Kyowa Hakko Kirin Pharma, Princeton, New Jersey (F.B.); FORUM Pharmaceuticals, Waltham, Massachusetts (M.T.F.); Pfizer Worldwide Research and Development, Groton, Connecticut (F.S.); and Biohaven Medical Services, New Haven, Connecticut (R.M.B.)
| | - Joseph Raybon
- Bristol-Myers Squibb, Lawrence Township, New Jersey (H.D.S., J.R., K.A.L., N.Z., B.A., J.M., J.E.M., M.A.); Teva Pharmaceuticals, Frazer, Pennsylvania (M.G.); Bristol-Myers Squibb, Wallingford, Connecticut (J.H.T., L.A.T., R.E.O., D.M.D., C.F.A., M.K.A.); GSK Consumer Healthcare, Parsippany, New Jersey (J.-S.W.); Eisai, Woodcliff Lake, New Jersey (Q.H.); Kyowa Hakko Kirin Pharma, Princeton, New Jersey (F.B.); FORUM Pharmaceuticals, Waltham, Massachusetts (M.T.F.); Pfizer Worldwide Research and Development, Groton, Connecticut (F.S.); and Biohaven Medical Services, New Haven, Connecticut (R.M.B.)
| | - Kimberley A Lentz
- Bristol-Myers Squibb, Lawrence Township, New Jersey (H.D.S., J.R., K.A.L., N.Z., B.A., J.M., J.E.M., M.A.); Teva Pharmaceuticals, Frazer, Pennsylvania (M.G.); Bristol-Myers Squibb, Wallingford, Connecticut (J.H.T., L.A.T., R.E.O., D.M.D., C.F.A., M.K.A.); GSK Consumer Healthcare, Parsippany, New Jersey (J.-S.W.); Eisai, Woodcliff Lake, New Jersey (Q.H.); Kyowa Hakko Kirin Pharma, Princeton, New Jersey (F.B.); FORUM Pharmaceuticals, Waltham, Massachusetts (M.T.F.); Pfizer Worldwide Research and Development, Groton, Connecticut (F.S.); and Biohaven Medical Services, New Haven, Connecticut (R.M.B.)
| | - Francis Sweeney
- Bristol-Myers Squibb, Lawrence Township, New Jersey (H.D.S., J.R., K.A.L., N.Z., B.A., J.M., J.E.M., M.A.); Teva Pharmaceuticals, Frazer, Pennsylvania (M.G.); Bristol-Myers Squibb, Wallingford, Connecticut (J.H.T., L.A.T., R.E.O., D.M.D., C.F.A., M.K.A.); GSK Consumer Healthcare, Parsippany, New Jersey (J.-S.W.); Eisai, Woodcliff Lake, New Jersey (Q.H.); Kyowa Hakko Kirin Pharma, Princeton, New Jersey (F.B.); FORUM Pharmaceuticals, Waltham, Massachusetts (M.T.F.); Pfizer Worldwide Research and Development, Groton, Connecticut (F.S.); and Biohaven Medical Services, New Haven, Connecticut (R.M.B.)
| | - Naiyu Zheng
- Bristol-Myers Squibb, Lawrence Township, New Jersey (H.D.S., J.R., K.A.L., N.Z., B.A., J.M., J.E.M., M.A.); Teva Pharmaceuticals, Frazer, Pennsylvania (M.G.); Bristol-Myers Squibb, Wallingford, Connecticut (J.H.T., L.A.T., R.E.O., D.M.D., C.F.A., M.K.A.); GSK Consumer Healthcare, Parsippany, New Jersey (J.-S.W.); Eisai, Woodcliff Lake, New Jersey (Q.H.); Kyowa Hakko Kirin Pharma, Princeton, New Jersey (F.B.); FORUM Pharmaceuticals, Waltham, Massachusetts (M.T.F.); Pfizer Worldwide Research and Development, Groton, Connecticut (F.S.); and Biohaven Medical Services, New Haven, Connecticut (R.M.B.)
| | - Billy Akinsanya
- Bristol-Myers Squibb, Lawrence Township, New Jersey (H.D.S., J.R., K.A.L., N.Z., B.A., J.M., J.E.M., M.A.); Teva Pharmaceuticals, Frazer, Pennsylvania (M.G.); Bristol-Myers Squibb, Wallingford, Connecticut (J.H.T., L.A.T., R.E.O., D.M.D., C.F.A., M.K.A.); GSK Consumer Healthcare, Parsippany, New Jersey (J.-S.W.); Eisai, Woodcliff Lake, New Jersey (Q.H.); Kyowa Hakko Kirin Pharma, Princeton, New Jersey (F.B.); FORUM Pharmaceuticals, Waltham, Massachusetts (M.T.F.); Pfizer Worldwide Research and Development, Groton, Connecticut (F.S.); and Biohaven Medical Services, New Haven, Connecticut (R.M.B.)
| | - Robert M Berman
- Bristol-Myers Squibb, Lawrence Township, New Jersey (H.D.S., J.R., K.A.L., N.Z., B.A., J.M., J.E.M., M.A.); Teva Pharmaceuticals, Frazer, Pennsylvania (M.G.); Bristol-Myers Squibb, Wallingford, Connecticut (J.H.T., L.A.T., R.E.O., D.M.D., C.F.A., M.K.A.); GSK Consumer Healthcare, Parsippany, New Jersey (J.-S.W.); Eisai, Woodcliff Lake, New Jersey (Q.H.); Kyowa Hakko Kirin Pharma, Princeton, New Jersey (F.B.); FORUM Pharmaceuticals, Waltham, Massachusetts (M.T.F.); Pfizer Worldwide Research and Development, Groton, Connecticut (F.S.); and Biohaven Medical Services, New Haven, Connecticut (R.M.B.)
| | - Lorin A Thompson
- Bristol-Myers Squibb, Lawrence Township, New Jersey (H.D.S., J.R., K.A.L., N.Z., B.A., J.M., J.E.M., M.A.); Teva Pharmaceuticals, Frazer, Pennsylvania (M.G.); Bristol-Myers Squibb, Wallingford, Connecticut (J.H.T., L.A.T., R.E.O., D.M.D., C.F.A., M.K.A.); GSK Consumer Healthcare, Parsippany, New Jersey (J.-S.W.); Eisai, Woodcliff Lake, New Jersey (Q.H.); Kyowa Hakko Kirin Pharma, Princeton, New Jersey (F.B.); FORUM Pharmaceuticals, Waltham, Massachusetts (M.T.F.); Pfizer Worldwide Research and Development, Groton, Connecticut (F.S.); and Biohaven Medical Services, New Haven, Connecticut (R.M.B.)
| | - Richard E Olson
- Bristol-Myers Squibb, Lawrence Township, New Jersey (H.D.S., J.R., K.A.L., N.Z., B.A., J.M., J.E.M., M.A.); Teva Pharmaceuticals, Frazer, Pennsylvania (M.G.); Bristol-Myers Squibb, Wallingford, Connecticut (J.H.T., L.A.T., R.E.O., D.M.D., C.F.A., M.K.A.); GSK Consumer Healthcare, Parsippany, New Jersey (J.-S.W.); Eisai, Woodcliff Lake, New Jersey (Q.H.); Kyowa Hakko Kirin Pharma, Princeton, New Jersey (F.B.); FORUM Pharmaceuticals, Waltham, Massachusetts (M.T.F.); Pfizer Worldwide Research and Development, Groton, Connecticut (F.S.); and Biohaven Medical Services, New Haven, Connecticut (R.M.B.)
| | - John Morrison
- Bristol-Myers Squibb, Lawrence Township, New Jersey (H.D.S., J.R., K.A.L., N.Z., B.A., J.M., J.E.M., M.A.); Teva Pharmaceuticals, Frazer, Pennsylvania (M.G.); Bristol-Myers Squibb, Wallingford, Connecticut (J.H.T., L.A.T., R.E.O., D.M.D., C.F.A., M.K.A.); GSK Consumer Healthcare, Parsippany, New Jersey (J.-S.W.); Eisai, Woodcliff Lake, New Jersey (Q.H.); Kyowa Hakko Kirin Pharma, Princeton, New Jersey (F.B.); FORUM Pharmaceuticals, Waltham, Massachusetts (M.T.F.); Pfizer Worldwide Research and Development, Groton, Connecticut (F.S.); and Biohaven Medical Services, New Haven, Connecticut (R.M.B.)
| | - Dieter M Drexler
- Bristol-Myers Squibb, Lawrence Township, New Jersey (H.D.S., J.R., K.A.L., N.Z., B.A., J.M., J.E.M., M.A.); Teva Pharmaceuticals, Frazer, Pennsylvania (M.G.); Bristol-Myers Squibb, Wallingford, Connecticut (J.H.T., L.A.T., R.E.O., D.M.D., C.F.A., M.K.A.); GSK Consumer Healthcare, Parsippany, New Jersey (J.-S.W.); Eisai, Woodcliff Lake, New Jersey (Q.H.); Kyowa Hakko Kirin Pharma, Princeton, New Jersey (F.B.); FORUM Pharmaceuticals, Waltham, Massachusetts (M.T.F.); Pfizer Worldwide Research and Development, Groton, Connecticut (F.S.); and Biohaven Medical Services, New Haven, Connecticut (R.M.B.)
| | - John E Macor
- Bristol-Myers Squibb, Lawrence Township, New Jersey (H.D.S., J.R., K.A.L., N.Z., B.A., J.M., J.E.M., M.A.); Teva Pharmaceuticals, Frazer, Pennsylvania (M.G.); Bristol-Myers Squibb, Wallingford, Connecticut (J.H.T., L.A.T., R.E.O., D.M.D., C.F.A., M.K.A.); GSK Consumer Healthcare, Parsippany, New Jersey (J.-S.W.); Eisai, Woodcliff Lake, New Jersey (Q.H.); Kyowa Hakko Kirin Pharma, Princeton, New Jersey (F.B.); FORUM Pharmaceuticals, Waltham, Massachusetts (M.T.F.); Pfizer Worldwide Research and Development, Groton, Connecticut (F.S.); and Biohaven Medical Services, New Haven, Connecticut (R.M.B.)
| | - Charlie F Albright
- Bristol-Myers Squibb, Lawrence Township, New Jersey (H.D.S., J.R., K.A.L., N.Z., B.A., J.M., J.E.M., M.A.); Teva Pharmaceuticals, Frazer, Pennsylvania (M.G.); Bristol-Myers Squibb, Wallingford, Connecticut (J.H.T., L.A.T., R.E.O., D.M.D., C.F.A., M.K.A.); GSK Consumer Healthcare, Parsippany, New Jersey (J.-S.W.); Eisai, Woodcliff Lake, New Jersey (Q.H.); Kyowa Hakko Kirin Pharma, Princeton, New Jersey (F.B.); FORUM Pharmaceuticals, Waltham, Massachusetts (M.T.F.); Pfizer Worldwide Research and Development, Groton, Connecticut (F.S.); and Biohaven Medical Services, New Haven, Connecticut (R.M.B.)
| | - Michael K Ahlijanian
- Bristol-Myers Squibb, Lawrence Township, New Jersey (H.D.S., J.R., K.A.L., N.Z., B.A., J.M., J.E.M., M.A.); Teva Pharmaceuticals, Frazer, Pennsylvania (M.G.); Bristol-Myers Squibb, Wallingford, Connecticut (J.H.T., L.A.T., R.E.O., D.M.D., C.F.A., M.K.A.); GSK Consumer Healthcare, Parsippany, New Jersey (J.-S.W.); Eisai, Woodcliff Lake, New Jersey (Q.H.); Kyowa Hakko Kirin Pharma, Princeton, New Jersey (F.B.); FORUM Pharmaceuticals, Waltham, Massachusetts (M.T.F.); Pfizer Worldwide Research and Development, Groton, Connecticut (F.S.); and Biohaven Medical Services, New Haven, Connecticut (R.M.B.)
| | - Malaz AbuTarif
- Bristol-Myers Squibb, Lawrence Township, New Jersey (H.D.S., J.R., K.A.L., N.Z., B.A., J.M., J.E.M., M.A.); Teva Pharmaceuticals, Frazer, Pennsylvania (M.G.); Bristol-Myers Squibb, Wallingford, Connecticut (J.H.T., L.A.T., R.E.O., D.M.D., C.F.A., M.K.A.); GSK Consumer Healthcare, Parsippany, New Jersey (J.-S.W.); Eisai, Woodcliff Lake, New Jersey (Q.H.); Kyowa Hakko Kirin Pharma, Princeton, New Jersey (F.B.); FORUM Pharmaceuticals, Waltham, Massachusetts (M.T.F.); Pfizer Worldwide Research and Development, Groton, Connecticut (F.S.); and Biohaven Medical Services, New Haven, Connecticut (R.M.B.)
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15
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Rostgaard N, Waldemar G, Nielsen JE, Simonsen AH. Cerebrospinal Fluid Biomarkers in Familial Forms of Alzheimer's Disease and Frontotemporal Dementia. Dement Geriatr Cogn Disord 2016; 40:54-62. [PMID: 25998699 DOI: 10.1159/000381828] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2015] [Indexed: 11/19/2022] Open
Abstract
As dementia is a fast-growing health care problem, it is becoming an increasingly urgent need to provide an early diagnosis in order to offer patients the best medical treatment and care. Validated biomarkers which reflect the pathology and disease progression are essential for diagnosis and are important when developing new therapies. Today, the core protein biomarkers amyloid-β42, total tau and phosphorylated tau in the cerebrospinal fluid (CSF) are used to diagnose Alzheimer's disease (AD), because these biomarkers have shown to reflect the underlying amyloid and tau pathology. However, the biomarkers have proved insufficient predictors of dementias with a different pathology, e.g. frontotemporal dementia (FTD); furthermore, the biomarkers are not useful for early AD diagnosis. Familial dementias with a known disease-causing mutation can be extremely valuable to study; yet the biomarker profiles in patients with familial dementias are not clear. This review summarizes CSF biomarker findings from studies on symptomatic and presymptomatic individuals carrying a mutation in one of the genes known to cause early-onset familial AD or FTD. In conclusion, the biomarker profile of inherited AD is quite similar between carriers of different mutations as well as similar to the profile found in sporadic AD, whereas familial FTD does not seem to have a clear biomarker profile. Hence, new biomarkers are needed for FTD.
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Affiliation(s)
- Nina Rostgaard
- Danish Dementia Research Centre, Department of Neurology, Section 6911, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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16
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Shi L, Zhao L, Wong A, Wang D, Mok V. Mapping the Relationship of Contributing Factors for Preclinical Alzheimer's Disease. Sci Rep 2015; 5:11259. [PMID: 26190794 PMCID: PMC4507140 DOI: 10.1038/srep11259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 05/20/2015] [Indexed: 11/15/2022] Open
Abstract
While detecting and validating correlations among the contributing factors to the preclinical phase of Alzheimer’s disease (pAD) has been a focus, a potent meta-analysis method to integrate current findings is essential. The entity-relationship diagram with nodes as entities and edges as relationships is a graphical representation that summarizes the relationships among multiple factors in an intuitive manner. Based on this concept, a new meta-analysis approach with this type of diagram is proposed to summarize research about contributing factors of pAD and their interactions. To utilize the information for enriched visualization, width and color of the edges are encoded with reporting times, number of pAD subjects, correlation coefficient, and study design (cross-sectional or longitudinal). The proposed Probabilistic Entity-Relationship Diagram (PERD) demonstrated its effectiveness in this research for studying pAD. Another kind of diagram with occurrence order for some factors was also proposed to provide sequential information of the factors. In addition, PERD could potentially develop into an online application named PERD-online, which would help researchers to pool findings on the same relationships and guide further tests to validate uncertain relationships in PERD. PERD as a generic graphical meta-analysis tool can also be applied in studying other multifactorial diseases.
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Affiliation(s)
- Lin Shi
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR.,Chow Yuk Ho Center of Innovative Technology for Medicine, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Lei Zhao
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Adrian Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Defeng Wang
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR.,Research Center for Medical Image Computing, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
| | - Vincent Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR
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17
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Koper OM, Kaminska J, Kemona H, Dymicka-Piekarska V. Application of the Bead-Based Technique in Neurodegeneration: A Literature Review. NEURODEGENER DIS 2015; 15:281-93. [DOI: 10.1159/000433439] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 05/12/2015] [Indexed: 11/19/2022] Open
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Schindler SE, Fagan AM. Autosomal Dominant Alzheimer Disease: A Unique Resource to Study CSF Biomarker Changes in Preclinical AD. Front Neurol 2015; 6:142. [PMID: 26175713 PMCID: PMC4483518 DOI: 10.3389/fneur.2015.00142] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 06/12/2015] [Indexed: 12/27/2022] Open
Abstract
Our understanding of the pathogenesis of Alzheimer disease (AD) has been greatly influenced by investigation of rare families with autosomal dominant mutations that cause early onset AD. Mutations in the genes coding for amyloid precursor protein (APP), presenilin 1 (PSEN-1), and presenilin 2 (PSEN-2) cause over-production of the amyloid-β peptide (Aβ) leading to early deposition of Aβ in the brain, which in turn is hypothesized to initiate a cascade of processes, resulting in neuronal death, cognitive decline, and eventual dementia. Studies of cerebrospinal fluid (CSF) from individuals with the common form of AD, late-onset AD (LOAD), have revealed that low CSF Aβ42 and high CSF tau are associated with AD brain pathology. Herein, we review the literature on CSF biomarkers in autosomal dominant AD (ADAD), which has contributed to a detailed road map of AD pathogenesis, especially during the preclinical period, prior to the appearance of any cognitive symptoms. Current drug trials are also taking advantage of the unique characteristics of ADAD and utilizing CSF biomarkers to accelerate development of effective therapies for AD.
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Affiliation(s)
- Suzanne Elizabeth Schindler
- Department of Neurology, Knight Alzheimer's Disease Research Center, Hope Center for Neurological Disorders, Washington University School of Medicine , St. Louis, MO , USA
| | - Anne M Fagan
- Department of Neurology, Knight Alzheimer's Disease Research Center, Hope Center for Neurological Disorders, Washington University School of Medicine , St. Louis, MO , USA
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Xia D, Watanabe H, Wu B, Lee SH, Li Y, Tsvetkov E, Bolshakov VY, Shen J, Kelleher RJ. Presenilin-1 knockin mice reveal loss-of-function mechanism for familial Alzheimer's disease. Neuron 2015; 85:967-81. [PMID: 25741723 DOI: 10.1016/j.neuron.2015.02.010] [Citation(s) in RCA: 177] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 12/30/2014] [Accepted: 02/04/2015] [Indexed: 12/15/2022]
Abstract
Presenilins play essential roles in memory formation, synaptic function, and neuronal survival. Mutations in the Presenilin-1 (PSEN1) gene are the major cause of familial Alzheimer's disease (FAD). How PSEN1 mutations cause FAD is unclear, and pathogenic mechanisms based on gain or loss of function have been proposed. Here, we generated Psen1 knockin (KI) mice carrying the FAD mutation L435F or C410Y. Remarkably, KI mice homozygous for either mutation recapitulate the phenotypes of Psen1(-/-) mice. Neither mutation altered Psen1 mRNA expression, but both abolished γ-secretase activity. Heterozygosity for the KI mutation decreased production of Aβ40 and Aβ42, increased the Aβ42/Aβ40 ratio, and exacerbated Aβ deposition. Furthermore, the L435F mutation impairs hippocampal synaptic plasticity and memory and causes age-dependent neurodegeneration in the aging cerebral cortex. Collectively, our findings reveal that FAD mutations can cause complete loss of Presenilin-1 function in vivo, suggesting that clinical PSEN mutations produce FAD through a loss-of-function mechanism.
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Affiliation(s)
- Dan Xia
- Center for Neurologic Diseases, Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA; Center for Human Genetic Research, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Hirotaka Watanabe
- Center for Neurologic Diseases, Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Bei Wu
- Center for Neurologic Diseases, Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Sang Hun Lee
- Center for Neurologic Diseases, Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Yan Li
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA
| | - Evgeny Tsvetkov
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA
| | - Vadim Y Bolshakov
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA; Program in Neuroscience, Harvard Medical School, Boston, MA 02115, USA
| | - Jie Shen
- Center for Neurologic Diseases, Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA 02115, USA; Program in Neuroscience, Harvard Medical School, Boston, MA 02115, USA.
| | - Raymond J Kelleher
- Center for Human Genetic Research, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; Program in Neuroscience, Harvard Medical School, Boston, MA 02115, USA.
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Alzheimer disease cerebrospinal fluid biomarkers predict cognitive decline in healthy elderly over 2 years. Alzheimer Dis Assoc Disord 2015; 28:234-8. [PMID: 24632988 DOI: 10.1097/wad.0000000000000025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM : The aim of this study is to check the ability of cerebrospinal fluid biomarkers of Alzheimer disease (CSF-BMK-AD) to make a discrimination checklist within a healthy group, according to their cognitive development at 2 years of obtaining the sample. MATERIALS AND METHODS Between 2008 and 2010, 67 subjects without cognitive or behavioral disorders were included as a control group in a study on CSF-AD-BMK. Neuropsychological assessment at baseline and at follow-up had been carried out 2 years later. CSF was obtained at the inclusion. It was analyzed by Innotest reagents to measure amyloid-β (Aβ1-42), total-τ (T-τ), and phosphorylated τ181 (P-τ181p) protein levels, as well as T-τ/Aβ1-42 and P-τ181p/Aβ1-42 ratios. RESULTS Two years after inclusion, 28 subjects were not able to be checked for cognitive evolution. Of those who were seen for follow-up (n=39), 29 were cognitively stable and 10 showed cognitive impairment. We found significant differences in Aβ1-42 protein level (820 vs. 1359 pg/mL, P<0.003), in the T-τ/Aβ1-42 ratio (0.40 vs. 0.19, P<0.009), and in the P-τ181p/Aβ1-42 ratio (0.09 vs. 0.04, P<0.003) when both groups were compared. CONCLUSIONS CSF-BMK-AD are able to discriminate between subjects in a group initially asymptomatic depending on their cognitive evolution at the 2 years' follow-up. These results are consistent with the decrease of CSF Aβ1-42 protein levels as the first finding in preclinical AD showed.
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Humanin attenuates Alzheimer-like cognitive deficits and pathological changes induced by amyloid β-peptide in rats. Neurosci Bull 2014; 30:923-935. [PMID: 25391447 DOI: 10.1007/s12264-014-1479-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 05/12/2014] [Indexed: 12/20/2022] Open
Abstract
Amyloid β-peptide (Aβ) has been implicated as a key molecule in the neurodegenerative cascades of Alzheimer's disease (AD). Humanin (HN) is a secretory peptide that inhibits the neurotoxicity of Aβ. However, the mechanism(s) by which HN exerts its neuroprotection against Aβ-induced AD-like pathological changes and memory deficits are yet to be completely defined. In the present study, we provided evidence that treatment of rats with HN increases the number of dendritic branches and the density of dendritic spines, and upregulates pre- and post-synaptic protein levels; these effects lead to enhanced long-term potentiation and amelioration of the memory deficits induced by Aβ(1-42). HN also attenuated Aβ(1-42)-induced tau hyperphosphorylation, apparently by inhibiting the phosphorylation of Tyr307 on the inhibitory protein phosphatase-2A (PP2A) catalytic subunit and thereby activating PP2A. HN also inhibited apoptosis and reduced the oxidative stress induced by Aβ(1-42). These findings provide novel mechanisms of action for the ability of HN to protect against Aβ(1-42)-induced AD-like pathological changes and memory deficits.
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22
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CSF Biomarkers of Alzheimer’s Disease: Impact on Disease Concept, Diagnosis, and Clinical Trial Design. ACTA ACUST UNITED AC 2014. [DOI: 10.1155/2014/302712] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Data from clinicopathologic and biomarker studies have converged to support the view of Alzheimer’s disease (AD) as a continuum, with pathology developing decades prior to the onset of cognitive symptoms which culminate as dementia at the end stage of the disease. This concept is impacting disease nomenclature, diagnostic criteria, prognostic potential, and clinical trial design. Revisions to diagnostic criteria to incorporate biomarker results have recently been proposed in order to increase the confidence of AD as the underlying etiology of a clinical impairment and to permit a diagnosis of AD across the disease continuum, eventually perhaps in the asymptomatic period. Individuals in this preclinical stage are receiving intense focus as a targeted population for secondary prevention trials aimed at identifying disease-modifying therapies that have the best chance of preserving normal cognitive function. The goal is to bring validated biomarkers to clinical practice for the purpose of disease diagnosis, prognosis, and evaluation of therapeutic efficacy once disease-modifying treatments become available. Realization of this goal requires worldwide biomarker standardization efforts, consensus among researchers and clinicians regarding the clinical utility of assessing biomarkers in patient care settings, and eventually the endorsement and adoption of such procedures and practices into global health care systems.
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Kiuchi K, Kitamura S, Taoka T, Yasuno F, Tanimura M, Matsuoka K, Ikawa D, Toritsuka M, Hashimoto K, Makinodan M, Kosaka J, Morikawa M, Kichikawa K, Kishimoto T. Gray and white matter changes in subjective cognitive impairment, amnestic mild cognitive impairment and Alzheimer's disease: a voxel-based analysis study. PLoS One 2014; 9:e104007. [PMID: 25093415 PMCID: PMC4122459 DOI: 10.1371/journal.pone.0104007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2014] [Accepted: 07/05/2014] [Indexed: 11/19/2022] Open
Abstract
Subjective cognitive impairment may be a very early at-risk period of the continuum of dementia. However, it is difficult to discriminate at-risk states from normal aging. Thus, detection of the early pathological changes in the subjective cognitive impairment period is needed. To elucidate these changes, we employed diffusion tensor imaging and volumetry analysis, and compared subjective cognitive impairment with normal, mild cognitive impairment and Alzheimer's disease. The subjects in this study were 39 Alzheimer's disease, 43 mild cognitive impairment, 28 subjective cognitive impairment and 41 normal controls. There were no statistically significant differences between the normal control and subjective cognitive impairment groups in all measures. Alzheimer's disease and mild cognitive impairment had the same extent of brain atrophy and diffusion changes. These results are consistent with the hypothetical model of the dynamic biomarkers of Alzheimer's disease.
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Affiliation(s)
- Kuniaki Kiuchi
- Department of Psychiatry, Nara Medical University, Kashihara, Japan
- Medical Center for Dementia, Nara Medical University, Kashihara, Japan
- Sakai City Mental Health Center, Sakai, Japan
- * E-mail:
| | - Soichiro Kitamura
- Department of Psychiatry, Nara Medical University, Kashihara, Japan
- Medical Center for Dementia, Nara Medical University, Kashihara, Japan
- Molecular Imaging Center, National Institute of Radiological Sciences, Chiba, Japan
| | - Toshiaki Taoka
- Department of Radiology, Nara Medical University, Kashihara, Japan
| | - Fumihiko Yasuno
- Department of Psychiatry, Nara Medical University, Kashihara, Japan
- Medical Center for Dementia, Nara Medical University, Kashihara, Japan
| | | | - Kiwamu Matsuoka
- Department of Psychiatry, Nara Medical University, Kashihara, Japan
- Medical Center for Dementia, Nara Medical University, Kashihara, Japan
| | - Daisuke Ikawa
- Department of Psychiatry, Nara Medical University, Kashihara, Japan
| | | | | | - Manabu Makinodan
- Department of Psychiatry, Nara Medical University, Kashihara, Japan
| | - Jun Kosaka
- Department of Psychiatry, Nara Medical University, Kashihara, Japan
| | - Masayuki Morikawa
- Department of Psychiatry, Nara Medical University, Kashihara, Japan
- Mie Prefectural Mental Care Center, Tsu, Japan
| | | | - Toshifumi Kishimoto
- Department of Psychiatry, Nara Medical University, Kashihara, Japan
- Medical Center for Dementia, Nara Medical University, Kashihara, Japan
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Ferreira D, Perestelo-Pérez L, Westman E, Wahlund LO, Sarría A, Serrano-Aguilar P. Meta-Review of CSF Core Biomarkers in Alzheimer's Disease: The State-of-the-Art after the New Revised Diagnostic Criteria. Front Aging Neurosci 2014; 6:47. [PMID: 24715863 PMCID: PMC3970033 DOI: 10.3389/fnagi.2014.00047] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 03/02/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Current research criteria for Alzheimer's disease (AD) include cerebrospinal fluid (CSF) biomarkers into the diagnostic algorithm. However, spreading their use to the clinical routine is still questionable. OBJECTIVE To provide an updated, systematic and critical review on the diagnostic utility of the CSF core biomarkers for AD. DATA SOURCES MEDLINE, PreMedline, EMBASE, PsycInfo, CINAHL, Cochrane Library, and CRD. ELIGIBILITY CRITERIA (1a) Systematic reviews with meta-analysis; (1b) Primary studies published after the new revised diagnostic criteria; (2) Evaluation of the diagnostic performance of at least one CSF core biomarker. RESULTS The diagnostic performance of CSF biomarkers is generally satisfactory. They are optimal for discriminating AD patients from healthy controls. Their combination may also be suitable for mild cognitive impairment (MCI) prognosis. However, CSF biomarkers fail to distinguish AD from other forms of dementia. LIMITATIONS (1) Use of clinical diagnosis as standard instead of pathological postmortem confirmation; (2) variability of methodological aspects; (3) insufficiently long follow-up periods in MCI studies; and (4) lower diagnostic accuracy in primary care compared with memory clinics. CONCLUSION Additional work needs to be done to validate the application of CSF core biomarkers as they are proposed in the new revised diagnostic criteria. The use of CSF core biomarkers in clinical routine is more likely if these limitations are overcome. Early diagnosis is going to be of utmost importance when effective pharmacological treatment will be available and the CSF core biomarkers can also be implemented in clinical trials for drug development.
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Affiliation(s)
- Daniel Ferreira
- Section of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet , Stockholm , Sweden
| | - Lilisbeth Perestelo-Pérez
- Evaluation Unit of the Canary Islands Health Service , Santa Cruz de Tenerife , Spain ; Red de Investigación en Servicios de Salud en Enfermedades Crónicas , Santa Cruz de Tenerife , Spain
| | - Eric Westman
- Section of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet , Stockholm , Sweden
| | - Lars-Olof Wahlund
- Section of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet , Stockholm , Sweden
| | - Antonio Sarría
- Evaluation Unit of the Canary Islands Health Service , Santa Cruz de Tenerife , Spain ; Agency for Health Technology Assessment, Institute of Health Carlos III , Madrid , Spain
| | - Pedro Serrano-Aguilar
- Evaluation Unit of the Canary Islands Health Service , Santa Cruz de Tenerife , Spain ; Red de Investigación en Servicios de Salud en Enfermedades Crónicas , Santa Cruz de Tenerife , Spain
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25
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Cerebrospinal Fluid Biomarkers in Alzheimer’s Disease and Frontotemporal Dementia. NEURODEGENER DIS 2014. [DOI: 10.1007/978-1-4471-6380-0_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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26
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Hampel H, Lista S, Teipel SJ, Garaci F, Nisticò R, Blennow K, Zetterberg H, Bertram L, Duyckaerts C, Bakardjian H, Drzezga A, Colliot O, Epelbaum S, Broich K, Lehéricy S, Brice A, Khachaturian ZS, Aisen PS, Dubois B. Perspective on future role of biological markers in clinical therapy trials of Alzheimer's disease: a long-range point of view beyond 2020. Biochem Pharmacol 2013; 88:426-49. [PMID: 24275164 DOI: 10.1016/j.bcp.2013.11.009] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 11/13/2013] [Accepted: 11/13/2013] [Indexed: 10/26/2022]
Abstract
Recent advances in understanding the molecular mechanisms underlying various paths toward the pathogenesis of Alzheimer's disease (AD) has begun to provide new insight for interventions to modify disease progression. The evolving knowledge gained from multidisciplinary basic research has begun to identify new concepts for treatments and distinct classes of therapeutic targets; as well as putative disease-modifying compounds that are now being tested in clinical trials. There is a mounting consensus that such disease modifying compounds and/or interventions are more likely to be effectively administered as early as possible in the cascade of pathogenic processes preceding and underlying the clinical expression of AD. The budding sentiment is that "treatments" need to be applied before various molecular mechanisms converge into an irreversible pathway leading to morphological, metabolic and functional alterations that characterize the pathophysiology of AD. In light of this, biological indicators of pathophysiological mechanisms are desired to chart and detect AD throughout the asymptomatic early molecular stages into the prodromal and early dementia phase. A major conceptual development in the clinical AD research field was the recent proposal of new diagnostic criteria, which specifically incorporate the use of biomarkers as defining criteria for preclinical stages of AD. This paradigm shift in AD definition, conceptualization, operationalization, detection and diagnosis represents novel fundamental opportunities for the modification of interventional trial designs. This perspective summarizes not only present knowledge regarding biological markers but also unresolved questions on the status of surrogate indicators for detection of the disease in asymptomatic people and diagnosis of AD.
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Affiliation(s)
- Harald Hampel
- Université Pierre et Marie Curie, Département de Neurologie, Institut de la Mémoire et de la Maladie d'Alzheimer (IM2A), Pavillon François Lhermitte, Hôpital de la Salpêtrière, Paris, France.
| | - Simone Lista
- Department of Psychiatry, Psychotherapy and Psychosomatics, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany.
| | - Stefan J Teipel
- Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany; German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Rostock, Germany
| | - Francesco Garaci
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology, and Radiotherapy, University of Rome "Tor Vergata", Rome, Italy; IRCCS San Raffaele Pisana, Rome and San Raffaele Cassino, Cassino, Italy
| | - Robert Nisticò
- Department of Physiology and Pharmacology, University of Rome "La Sapienza", Rome, Italy; IRCSS Santa Lucia Foundation, Rome, Italy
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; University College London Institute of Neurology, Queen Square, London, UK
| | - Lars Bertram
- Department of Vertebrate Genomics, Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - Charles Duyckaerts
- Laboratoire de Neuropathologie Raymond-Escourolle, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - Hovagim Bakardjian
- IM2A - Institute of Memory and Alzheimer's Disease, Paris, France; IHU-A-ICM - Paris Institute of Translational Neurosciences Pitié-Salpêtrière University Hospital, Paris, France
| | - Alexander Drzezga
- Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany
| | - Olivier Colliot
- Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Épinière, UMR-S975 Paris, France; Inserm, U975, Paris, France; CNRS, UMR 7225, Paris, France; ICM - Institut du Cerveau et de la Moelle Épinière, Paris, France; INRIA, Aramis Team, Centre de Recherche Paris-Rocquencourt, France
| | - Stéphane Epelbaum
- Institut de la Mémoire et de la Maladie d'Alzheimer (IM2A), Département de Neurologie, Hôpital de la Pitié Salpêtrière, Paris, France; Université Pierre et Marie Curie, Paris, France
| | - Karl Broich
- Federal Institute of Drugs and Medical Devices (BfArM), Bonn, Germany
| | - Stéphane Lehéricy
- IHU-A-ICM - Paris Institute of Translational Neurosciences Pitié-Salpêtrière University Hospital, Paris, France; Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Épinière, UMR-S975 Paris, France; Inserm, U975, Paris, France; CNRS, UMR 7225, Paris, France; ICM - Institut du Cerveau et de la Moelle Épinière, Paris, France
| | - Alexis Brice
- Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Épinière, UMR-S975 Paris, France; Inserm, U975, Paris, France; CNRS, UMR 7225, Paris, France; ICM - Institut du Cerveau et de la Moelle Épinière, Paris, France; AP-HP, Hôpital de la Salpêtrière, Département de Génétique et Cytogénétique, Paris, France
| | | | - Paul S Aisen
- Department of Neurosciences, University of California, San Diego, San Diego, CA, USA
| | - Bruno Dubois
- Institut de la Mémoire et de la Maladie d'Alzheimer (IM2A), Département de Neurologie, Hôpital de la Pitié Salpêtrière, Paris, France; Université Pierre et Marie Curie, Paris, France
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Braak H, Zetterberg H, Del Tredici K, Blennow K. Intraneuronal tau aggregation precedes diffuse plaque deposition, but amyloid-β changes occur before increases of tau in cerebrospinal fluid. Acta Neuropathol 2013; 126:631-41. [PMID: 23756600 DOI: 10.1007/s00401-013-1139-0] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 05/23/2013] [Accepted: 06/03/2013] [Indexed: 02/06/2023]
Abstract
In comparison to the levels in age and gender-matched controls, reduced levels of pathological amyloid-β protein in cerebrospinal fluid routinely precede the onset of Alzheimer's disease-related symptoms by several years, whereas elevated soluble abnormal tau fractions (phosphorylated tau, total tau protein) in cerebrospinal fluid are detectable only with the onset and progression of clinical symptoms. This sequence of events in cerebrospinal fluid (amyloid-β changes detectable prior to abnormal tau changes) contrasts with that in which both proteins develop in the brain, where intraneuronal tau inclusions (pretangles, neurofibrillary tangles, neuropil threads) appear decades before the deposition of amyloid-β plaques (diffuse plaques, neuritic plaques). This viewpoint attempts to address questions arising in connection with this apparent sequential discrepancy-questions and issues for which there are currently no clear-cut answers.
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Affiliation(s)
- Heiko Braak
- Clinical Neuroanatomy Section, Department of Neurology, Center for Biomedical Research, University of Ulm, Helmholtzstrasse 8/1, 89081, Ulm, Germany,
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28
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Tagami S, Okochi M, Yanagida K, Kodama T, Arai T, Kuwano R, Ikeuchi T, Takeda M. Relative ratio and level of amyloid-β 42 surrogate in cerebrospinal fluid of familial Alzheimer disease patients with presenilin 1 mutations. NEURODEGENER DIS 2013; 13:166-70. [PMID: 24192669 DOI: 10.1159/000355258] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 08/23/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Presenilin 1 (PS1) mutations associated with familial Alzheimer disease (FAD) generally increase the amyloid-β 42 (Aβ42) to Aβ40 ratio secreted in cultured cells. Some of these mutants reduce the secretion of Aβ40 rather than increase that of Aβ42. Since it has been difficult to estimate Aβ42 secretion in brains of PS1-FAD patients due to substantial Aβ42 accumulation, it remains unknown whether the enhanced Aβ42 to Aβ40 ratio in brains of FAD patients is caused by elevated Aβ42 secretion or by reduced secretion of Aβ40. OBJECTIVE/METHODS Cerebrospinal fluids (CSF) of PS1-FAD patients and neurological control patients (controls) were collected. Levels of CSF amyloid precursor-like protein-1-derived Aβ-like peptide (APL1β), including APL1β28, an Aβ42 surrogate marker, were quantified by liquid chromatography tandem mass spectrometry, and Aβ42 secretion in the brain was estimated. RESULTS The relative ratio of CSF APL1β28 to total APL1β was higher in PS1-FAD patients than in controls. Importantly, CSF APL1β28 was not significantly higher. However, C-terminally shorter CSF APL1β25 and APL1β27 were significantly lower in PS1-FAD patients and, as expected, so were CSF Aβ40 and Aβ42. CONCLUSION A higher relative ratio of the CSF Aβ42 surrogate in PS1-FAD patients is not due to its increase in CSF, suggesting that massive Aβ42 accumulation in the PS1-FAD brain occurs without an apparent increase in Aβ42 secretion.
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Affiliation(s)
- Shinji Tagami
- Neuropsychiatry and Neurochemistry, Division of Internal Medicine, Department of Integrated Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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29
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Rosén C, Hansson O, Blennow K, Zetterberg H. Fluid biomarkers in Alzheimer's disease - current concepts. Mol Neurodegener 2013; 8:20. [PMID: 23800368 PMCID: PMC3691925 DOI: 10.1186/1750-1326-8-20] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 06/18/2013] [Indexed: 11/17/2022] Open
Abstract
The diagnostic guidelines of Alzheimer’s disease (AD) have recently been updated to include brain imaging and cerebrospinal fluid (CSF) biomarkers, with the aim of increasing the certainty of whether a patient has an ongoing AD neuropathologic process or not. The CSF biomarkers total tau (T-tau), hyperphosphorylated tau (P-tau) and the 42 amino acid isoform of amyloid β (Aβ42) reflect the core pathologic features of AD, which are neuronal loss, intracellular neurofibrillary tangles and extracellular senile plaques. Since the pathologic processes of AD start decades before the first symptoms, these biomarkers may provide means of early disease detection. The updated guidelines identify three different stages of AD: preclinical AD, mild cognitive impairment (MCI) due to AD and AD with dementia. In this review, we aim to summarize the CSF biomarker data available for each of these stages. We also review results from blood biomarker studies. In summary, the core AD CSF biomarkers have high diagnostic accuracy both for AD with dementia and to predict incipient AD (MCI due to AD). Longitudinal studies on healthy elderly and recent cross-sectional studies on patients with dominantly inherited AD mutations have also found biomarker changes in cognitively normal at-risk individuals. This will be important if disease-modifying treatment becomes available, given that treatment will probably be most effective early in the disease. An important prerequisite for this is trustworthy analyses. Since measurements vary between studies and laboratories, standardization of analytical as well as pre-analytical procedures will be essential. This process is already initiated. Apart from filling diagnostic roles, biomarkers may also be utilized for prognosis, disease progression, development of new treatments, monitoring treatment effects and for increasing the knowledge about pathologic processes coupled to the disease. Hence, the search for new biomarkers continues. Several candidate biomarkers have been found in CSF, and although biomarkers in blood have been harder to find, some recent studies have presented encouraging results. But before drawing any major conclusions, these results need to be verified in independent studies.
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Affiliation(s)
- Christoffer Rosén
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg Mölndal, S-431 80, Mölndal, Sweden.
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Potter R, Patterson BW, Elbert DL, Ovod V, Kasten T, Sigurdson W, Mawuenyega K, Blazey T, Goate A, Chott R, Yarasheski KE, Holtzman DM, Morris JC, Benzinger TLS, Bateman RJ. Increased in vivo amyloid-β42 production, exchange, and loss in presenilin mutation carriers. Sci Transl Med 2013; 5:189ra77. [PMID: 23761040 PMCID: PMC3838868 DOI: 10.1126/scitranslmed.3005615] [Citation(s) in RCA: 168] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Alzheimer's disease (AD) is hypothesized to be caused by an overproduction or reduced clearance of amyloid-β (Aβ) peptide. Autosomal dominant AD (ADAD) caused by mutations in the presenilin (PSEN) gene have been postulated to result from increased production of Aβ42 compared to Aβ40 in the central nervous system (CNS). This has been demonstrated in rodent models of ADAD but not in human mutation carriers. We used compartmental modeling of stable isotope labeling kinetic (SILK) studies in human carriers of PSEN mutations and related noncarriers to evaluate the pathophysiological effects of PSEN1 and PSEN2 mutations on the production and turnover of Aβ isoforms. We compared these findings by mutation status and amount of fibrillar amyloid deposition as measured by positron emission tomography (PET) using the amyloid tracer Pittsburgh compound B (PIB). CNS Aβ42 to Aβ40 production rates were 24% higher in mutation carriers compared to noncarriers, and this was independent of fibrillar amyloid deposits quantified by PET PIB imaging. The fractional turnover rate of soluble Aβ42 relative to Aβ40 was 65% faster in mutation carriers and correlated with amyloid deposition, consistent with increased deposition of Aβ42 into plaques, leading to reduced recovery of Aβ42 in cerebrospinal fluid (CSF). Reversible exchange of Aβ42 peptides with preexisting unlabeled peptide was observed in the presence of plaques. These findings support the hypothesis that Aβ42 is overproduced in the CNS of humans with PSEN mutations that cause AD, and demonstrate that soluble Aβ42 turnover and exchange processes are altered in the presence of amyloid plaques, causing a reduction in Aβ42 concentrations in the CSF.
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Affiliation(s)
- Rachel Potter
- Washington University School of Medicine, Department of Neurology
| | | | - Donald L. Elbert
- Washington University in St. Louis, Department of Biomedical Engineering
| | - Vitaliy Ovod
- Washington University School of Medicine, Department of Neurology
| | - Tom Kasten
- Washington University School of Medicine, Department of Neurology
| | - Wendy Sigurdson
- Washington University School of Medicine, Department of Neurology
- Knight Alzheimer’s Disease Research Center
| | - Kwasi Mawuenyega
- Washington University School of Medicine, Department of Neurology
| | - Tyler Blazey
- Knight Alzheimer’s Disease Research Center
- Washington University School of Medicine, Department of Radiology
| | - Alison Goate
- Knight Alzheimer’s Disease Research Center
- Hope Center for Neurological Disorders
- Washington University School of Medicine, Department of Psychiatry
| | - Robert Chott
- Washington University School of Medicine, Department of Medicine
| | | | - David M. Holtzman
- Washington University School of Medicine, Department of Neurology
- Knight Alzheimer’s Disease Research Center
- Hope Center for Neurological Disorders
| | - John C. Morris
- Washington University School of Medicine, Department of Neurology
- Knight Alzheimer’s Disease Research Center
- Hope Center for Neurological Disorders
| | - Tammie L. S. Benzinger
- Knight Alzheimer’s Disease Research Center
- Washington University School of Medicine, Department of Radiology
- Washington University School of Medicine, Department of Neurological Surgery
| | - Randall J. Bateman
- Washington University School of Medicine, Department of Neurology
- Knight Alzheimer’s Disease Research Center
- Hope Center for Neurological Disorders
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Blennow K, Zetterberg H. The application of cerebrospinal fluid biomarkers in early diagnosis of Alzheimer disease. Med Clin North Am 2013; 97:369-76. [PMID: 23642576 DOI: 10.1016/j.mcna.2012.12.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This article gives an updated account of the clinical application of cerebrospinal fluid (CSF) biomarkers for Alzheimer disease (AD). The clinically most relevant biomarkers, total tau, phospho-tau and Aβ42 are discussed, and how they may be used, together with other diagnostic investigations, to make a predementia diagnosis of AD. Recent findings in sporadic and genetic preclinical AD are also discussed and, more specifically, what the biomarkers have taught us on the sequence of events in the pathogenic process underlying AD.
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Affiliation(s)
- Kaj Blennow
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Mölndal Campus, Mölndal, Sweden.
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Lazarczyk MJ, Hof PR, Bouras C, Giannakopoulos P. Preclinical Alzheimer disease: identification of cases at risk among cognitively intact older individuals. BMC Med 2012; 10:127. [PMID: 23098093 PMCID: PMC3523068 DOI: 10.1186/1741-7015-10-127] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 10/25/2012] [Indexed: 01/08/2023] Open
Abstract
Since the first description of the case of Auguste Deter, presented in Tübingen in 1906 by Alois Alzheimer, there has been an exponential increase in our knowledge of the neuropathological, cellular, and molecular foundation of Alzheimer's disease (AD). The concept of AD pathogenesis has evolved from a static, binary view discriminating cognitive normality from dementia, towards a dynamic view that considers AD pathology as a long-lasting morbid process that takes place progressively over years, or even decades, before the first symptoms become apparent, and thus operating in a continuum between the two aforementioned extreme states. Several biomarkers have been proposed to predict AD-related cognitive decline, initially in cases with mild cognitive impairment, and more recently in cognitively intact individuals. These early markers define at-risk individuals thought to be in the preclinical phase of AD. However, the clinical relevance of this preclinical phase remains controversial. The fate of such individuals, who are cognitively intact, but positive for some early AD biomarkers, is currently uncertain at best. In this report, we advocate the point of view that although most of these preclinical cases will evolve to clinically overt AD, some appear to have efficient compensatory mechanisms and virtually never develop dementia. We critically review the currently available early AD markers, discuss their clinical relevance, and propose a novel classification of preclinical AD, designating these non-progressing cases as 'stable asymptomatic cerebral amyloidosis'.
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Affiliation(s)
- Maciej J Lazarczyk
- Department of Mental Health and Psychiatry, University Hospitals of Geneva and Faculty of Medicine of the University of Geneva, 1225 Geneva, Switzerland
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Abstract
Early-onset familial Alzheimer's disease (EOFAD) is a condition characterized by early onset dementia (age at onset < 65 years) and a positive family history for dementia. To date, 230 mutations in presenilin (PS1, PS2) and amyloid precursor protein (APP) genes have been identified in EOFAD. The mutations within these three genes (PS1/PS2/APP) affect a common pathogenic pathway in APP synthesis and proteolysis, which lead to excessive production of amyloid β. Compared with sporadic Alzheimer's disease (AD), EOFAD has some distinctive features including early age at onset, positive familial history, a variety of non-cognitive neurological symptoms and signs, and a more aggressive course. There is marked phenotypic heterogeneity among different mutations of EOFAD. Studies in presymptomatic mutation carriers reveal biomarkers abnormalities. EOFAD diagnosis is based on clinical and family history, neurological symptoms and examination, biomarker features, as well as genotyping in some cases. New therapeutic agents targeting amyloid formation may benefit EOFAD individuals.
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Abstract
Research progress has provided detailed understanding of the molecular pathogenesis of Alzheimer disease (AD). This knowledge has been translated into new drug candidates with putative disease-modifying effects, which are now being tested in clinical trials. The promise of effective therapy has created a great need for biomarkers able to detect AD in the predementia phase, because drugs will probably be effective only if neurodegeneration is not too advanced. In this chapter, cerebrospinal fluid (CSF) and plasma biomarkers are reviewed. The core CSF biomarkers total tau (T-tau), phosphorylated tau (P-tau) and the 42 amino acid form of β-amyloid (Aβ42) reflect AD pathology, and have high diagnostic accuracy to diagnose AD with dementia and prodromal AD in mild cognitive impairment cases. The rationale for the use of CSF biomarkers to identify and monitor the mechanism of action of new drug candidates is also outlined in this chapter.
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Affiliation(s)
- Kaj Blennow
- Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at University of Gothenburg, Sahlgrenska University Hospital, Mölndal, SE-431 80 Mölndal, Sweden.
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Cohn-Hokke PE, Elting MW, Pijnenburg YAL, van Swieten JC. Genetics of dementia: update and guidelines for the clinician. Am J Med Genet B Neuropsychiatr Genet 2012; 159B:628-43. [PMID: 22815225 DOI: 10.1002/ajmg.b.32080] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 06/28/2012] [Indexed: 12/12/2022]
Abstract
With increased frequency, clinical geneticists are asked for genetic advice on the heredity of dementia in families. Alzheimer's disease is in most cases a complex disease, but may be autosomal dominant inherited. Mutations in the PSEN1 gene are the most common genetic cause of early onset Alzheimer's disease, whereas APP and PSEN2 gene mutations are less frequent. Familial frontotemporal dementia may be associated with a mutation in the MAPT or GRN gene, or with a repeat expansion in the C9orf72 gene. All these genes show autosomal dominant inheritance with a high penetrance. Although Alzheimer's disease and frontotemporal dementia are clinically distinguishable entities, phenotypical overlap may occur. Rarely, dementia is caused by mutations in other autosomal dominant genes or by genetic defects with autosomal recessive, X-linked dominant or mitochondrial inheritance. The inherited forms of frontotemporal dementia and Alzheimer's disease show a large phenotypic variability also within families, resulting in many remaining uncertainties for mutation carriers. Therefore, genetic counseling before performing genetic testing is essential in both symptomatic individuals and healthy at risk relatives. This review provides an overview of the genetic causes of dementia and discusses all aspects relevant for genetic counseling and testing. Furthermore, based on current knowledge, we provide algorithms for genetic testing in patients with early onset Alzheimer's disease or frontotemporal dementia.
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Affiliation(s)
- Petra E Cohn-Hokke
- Department of Clinical Genetics, VU University Medical Center, Amsterdam, The Netherlands.
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Abstract
Neuropsychological assessment has featured prominently over the past 30 years in the characterization of dementia associated with Alzheimer disease (AD). Clinical neuropsychological methods have identified the earliest, most definitive cognitive and behavioral symptoms of illness, contributing to the identification, staging, and tracking of disease. With increasing public awareness of dementia, disease detection has moved to earlier stages of illness, at a time when deficits are both behaviorally and pathologically selective. For reasons that are not well understood, early AD pathology frequently targets large-scale neuroanatomical networks for episodic memory before other networks that subserve language, attention, executive functions, and visuospatial abilities. This chapter reviews the pathognomonic neuropsychological features of AD dementia and how these differ from "normal," age-related cognitive decline and from other neurodegenerative diseases that cause dementia, including cortical Lewy body disease, frontotemporal lobar degeneration, and cerebrovascular disease.
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Affiliation(s)
- Sandra Weintraub
- Cognitive Neurology and Alzheimer's Disease Center (CNADC), Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
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Ringman JM, Coppola G, Elashoff D, Rodriguez-Agudelo Y, Medina LD, Gylys K, Cummings JL, Cole GM. Cerebrospinal fluid biomarkers and proximity to diagnosis in preclinical familial Alzheimer's disease. Dement Geriatr Cogn Disord 2012; 33:1-5. [PMID: 22343824 PMCID: PMC3696356 DOI: 10.1159/000335729] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Biological markers of utility in tracking Alzheimer's disease (AD) during the presymptomatic prodromal phase are important for prevention studies. Changes in cerebrospinal fluid (CSF) levels of 42-amino-acid β-amyloid (Aβ(42)), total tau protein (t-tau) and phosphorylated tau at residue 181 (p-tau(181)) during this state are incompletely characterized. METHODS We measured CSF markers in 13 carriers of familial AD (FAD) mutations that are fully penetrant for causing AD (PSEN1 and APP) and in 5 non-mutation-carrying family members. RESULTS Even among the entirely presymptomatic mutation carriers (n = 9), Aβ(42) was diminished (388.7 vs. 618.4 pg/ml, p = 0.004), and t-tau (138.5 vs. 50.5 pg/ml, p = 0.002) and p-tau(181) (71.7 vs. 24.6 pg/ml, p = 0.003) were elevated. There was a negative correlation between Aβ(42) levels and age relative to the family-specific age of dementia diagnosis. CONCLUSIONS Our data are consistent with a decline in CSF Aβ(42) levels occurring at least 20 years prior to clinical dementia in FAD.
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Affiliation(s)
- John M. Ringman
- Mary S. Easton Center for Alzheimer's Disease Research at UCLA, Los Angeles, Calif., USA
| | - Giovanni Coppola
- Laboratory of Experimental Psychology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - David Elashoff
- Mary S. Easton Center for Alzheimer's Disease Research at UCLA, Los Angeles, Calif., USA
| | - Yaneth Rodriguez-Agudelo
- Laboratory of Experimental Psychology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Luis D. Medina
- Mary S. Easton Center for Alzheimer's Disease Research at UCLA, Los Angeles, Calif., USA
| | - Karen Gylys
- Mary S. Easton Center for Alzheimer's Disease Research at UCLA, Los Angeles, Calif., USA
| | - Jeffrey L. Cummings
- Mary S. Easton Center for Alzheimer's Disease Research at UCLA, Los Angeles, Calif., USA
| | - Greg M. Cole
- Mary S. Easton Center for Alzheimer's Disease Research at UCLA, Los Angeles, Calif., USA
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Rami L, Solé-Padullés C, Fortea J, Bosch B, Lladó A, Antonell A, Olives J, Castellví M, Bartres-Faz D, Sánchez-Valle R, Molinuevo JL. Applying the new research diagnostic criteria: MRI findings and neuropsychological correlations of prodromal AD. Int J Geriatr Psychiatry 2012; 27:127-34. [PMID: 21384432 DOI: 10.1002/gps.2696] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 01/04/2011] [Indexed: 11/10/2022]
Abstract
OBJECTIVE We describe the neuroimaging characteristics of prodromal AD (PrdAD) patients diagnosed using the new research criteria in a clinical setting. In order to further characterize these patients, we also study the relationship between neuropsychology, CSF biomarkers and magnetic resonance imaging (MRI) findings. METHODS/PATIENTS 76 participants--24 controls (CTR), 20 amnesic patients, and 32 Alzheimer's disease (AD) patients--were included in the study. PrdAD was defined on the basis of an objective episodic memory deficit and an AD CSF profile. Structural MRI was performed in all participants. RESULTS After FWE correction, voxel-based morphometry (VBM) analysis of PrdAD patients versus CTR showed significant clusters of decreased gray matter (GM) volume in the left hemisphere regions including the parahippocampal gyrus, uncus, precuneus, and middle frontal gyrus. We did not find differences in brain atrophy between PrdAD and mild AD patients. Some significant associations were found between CSF levels and episodic and semantic fluency tests in the PrdAD group. Correlations in the PrdAD group revealed that patients with higher scores on delayed free recall had significantly greater GM volume in the left superior temporal gyrus (t = 6.64, p < 0.0001). CONCLUSIONS PrdAD patients presented mainly medial temporal GM atrophy, which was related with significant episodic memory impairment. The cognitive deficit observed in PrdAD patients was also associated with CSF biomarker levels.
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Affiliation(s)
- Lorena Rami
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Hospital Clínic, Barcelona, Spain
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Lame ME, Chambers EE, Blatnik M. Quantitation of amyloid beta peptides Aβ1–38, Aβ1–40, and Aβ1–42 in human cerebrospinal fluid by ultra-performance liquid chromatography–tandem mass spectrometry. Anal Biochem 2011; 419:133-9. [DOI: 10.1016/j.ab.2011.08.010] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 08/04/2011] [Accepted: 08/05/2011] [Indexed: 10/17/2022]
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de Wilde MC, Kamphuis PJGH, Sijben JWC, Scheltens P. Utility of imaging for nutritional intervention studies in Alzheimer's disease. Eur J Pharmacol 2011; 668 Suppl 1:S59-69. [PMID: 21816137 DOI: 10.1016/j.ejphar.2011.07.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 07/01/2011] [Accepted: 07/07/2011] [Indexed: 11/24/2022]
Abstract
Alzheimer's disease (AD) is a multi-factorial neurodegenerative disorder and the leading cause of dementia, wherein synapse loss is the strongest structural correlate with cognitive impairment. Basic research has shown that dietary supply of precursors and co-factors for synthesis of neuronal membranes enhances the formation of synapses. Daily intake of a medical food containing a mix of these nutrients for 12 weeks in humans improved memory, measured as immediate and delayed verbal recall by the Wechsler Memory Scale-revised, in patients with very mild AD (MMSE 24-26). An improvement of immediate verbal recall was noted following 24 weeks of intervention in an exploratory extension of the study. These data suggest that the intervention may improve synaptic formation and function in early AD. Here we review emerging technologies that help identify changes in pathological hallmarks in AD, including synaptic function and loss of connectivity in the early stages of AD, before cognitive and behavioural symptoms are observable. These techniques include the detection of specific biomarkers in the cerebrospinal fluid, as well as imaging procedures such as fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET), amyloid PET, structural/functional magnetic resonance imaging, diffusion tensor imaging, magnetoencephalography (MEG) and electroencephalography (EEG). Such techniques can provide new insights into the functional and structural changes in the brain over time, and may therefore help to develop more effective AD therapies. In particular, nutritional intervention studies that target synapse formation and function may benefit from these techniques, especially FDG-PET and EEG/MEG employed in the preclinical or early stages of the disease.
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Affiliation(s)
- Martijn C de Wilde
- Nutricia Advanced Medical Nutrition, Danone Research, Centre for Specialised Nutrition, Wageningen, The Netherlands
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41
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Shim YS, Morris JC. Biomarkers predicting Alzheimer's disease in cognitively normal aging. J Clin Neurol 2011; 7:60-8. [PMID: 21779293 PMCID: PMC3131540 DOI: 10.3988/jcn.2011.7.2.60] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 01/31/2011] [Accepted: 01/31/2011] [Indexed: 02/07/2023] Open
Abstract
The pathophysiologic process of Alzheimer's disease (AD) begins years before the diagnosis of clinical dementia. This concept of preclinical AD has arisen from the observation of AD pathologic findings such as senile plaques and neurofibrillary tangles in the brains of people who at the time of death had normal cognitive function. Recent advances in biomarker studies now provide the ability to detect the pathologic changes of AD, which are antecedent to symptoms of the illness, in cognitively normal individuals. Functional and structural brain alterations that begin with amyloid-β accumulation already show the patterns of abnormality seen in individuals with dementia due to AD. The presence of preclinical AD provides a critical opportunity for potential interventions with disease-modifying therapy. This review focuses on the studies of antecedent biomarkers for preclinical AD.
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Affiliation(s)
- Yong S Shim
- Department of Neurology, Bucheon St. Mary's Hospital, The Catholic University of Korea College of Medicine, Bucheon, Korea
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Sperling RA, Aisen PS, Beckett LA, Bennett DA, Craft S, Fagan AM, Iwatsubo T, Jack CR, Kaye J, Montine TJ, Park DC, Reiman EM, Rowe CC, Siemers E, Stern Y, Yaffe K, Carrillo MC, Thies B, Morrison-Bogorad M, Wagster MV, Phelps CH. Toward defining the preclinical stages of Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimers Dement 2011; 7:280-92. [PMID: 21514248 DOI: 10.1016/j.jalz.2011.03.003] [Citation(s) in RCA: 4787] [Impact Index Per Article: 368.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The pathophysiological process of Alzheimer's disease (AD) is thought to begin many years before the diagnosis of AD dementia. This long "preclinical" phase of AD would provide a critical opportunity for therapeutic intervention; however, we need to further elucidate the link between the pathological cascade of AD and the emergence of clinical symptoms. The National Institute on Aging and the Alzheimer's Association convened an international workgroup to review the biomarker, epidemiological, and neuropsychological evidence, and to develop recommendations to determine the factors which best predict the risk of progression from "normal" cognition to mild cognitive impairment and AD dementia. We propose a conceptual framework and operational research criteria, based on the prevailing scientific evidence to date, to test and refine these models with longitudinal clinical research studies. These recommendations are solely intended for research purposes and do not have any clinical implications at this time. It is hoped that these recommendations will provide a common rubric to advance the study of preclinical AD, and ultimately, aid the field in moving toward earlier intervention at a stage of AD when some disease-modifying therapies may be most efficacious.
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Affiliation(s)
- Reisa A Sperling
- Center for Alzheimer Research and Treatment, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Kievit RA, Romeijn JW, Waldorp LJ, Wicherts JM, Scholte HS, Borsboom D. Mind the Gap: A Psychometric Approach to the Reduction Problem. PSYCHOLOGICAL INQUIRY 2011. [DOI: 10.1080/1047840x.2011.550181] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Koric L, Felician O, Ceccaldi M. [Use of CSF biomarkers in the diagnosis of Alzheimer's disease in clinical practice]. Rev Neurol (Paris) 2011; 167:474-84. [PMID: 21420704 DOI: 10.1016/j.neurol.2010.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 10/20/2010] [Accepted: 10/26/2010] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The diagnosis of Alzheimer's disease (AD) currently relies on clinical criteria that are primarily based on the presence of an amnestic syndrome of the mesial temporal lobe type. In recent years, new diagnostic tools have been developed, such as the possibility of measuring a set of proteins directly involved in the pathophysiological process of AD. A profile suggestive of AD has been defined, characterized by decreased beta-amyloid peptide, combined with increased Tau protein and phopho-Tau. STATE OF KNOWLEDGE According to current data available in the medical literature, the potential usefulness of CSF biomarkers in the common forms of AD fulfilling usual clinical criteria remains modest. In contrast however, they could be of significant help in the diagnosis of early-onset AD, in particular in atypical forms with prominent non-memory impairment (involving vision, language or behavior). In addition, due to their close relationship with the pathological process, they bring useful prognosis information upon the aggressiveness of the disease. CONCLUSION AND PERSPECTIVE Taken together, in the current state of knowledge, use of CSF biomarkers in clinical practice should first be recommended for the assessment of early-onset cognitive disturbances, in particular when initial symptoms are of a non-memory type. Their development, however, offers new avenues in the fields of clinical and pharmacological research.
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Affiliation(s)
- L Koric
- Service de Neurologie et Neuropsychologie, AP-HM, Hôpital de la Timone, 264 rue Saint-Pierre, 13385 Marseille cedex 5, France.
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Padovani A, Gilberti N, Borroni B. The usefulness of biological and neuroimaging markers for the diagnosis of early-onset Alzheimer's disease. Int J Alzheimers Dis 2011; 2011:296374. [PMID: 21559247 PMCID: PMC3087487 DOI: 10.4061/2011/296374] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Revised: 12/28/2010] [Accepted: 01/22/2011] [Indexed: 01/08/2023] Open
Abstract
The recent proposed criteria for Alzheimer's Disease (AD) have strongly claimed the usefulness of biological and neuroimaging markers for early identification AD. Cerebrospinal fluid (CSF) Tau/Abeta ratio, hippocampal atrophy, posterior cingulate, and neocortical associative area hypometabolism, or amyloid burden evaluated by PiB compound, held the premises to increase diagnostic accuracy in the preclinical disease stages. Despite many efforts to identify subjects at risk of developing AD, less attention has been paid to presenile AD diagnosis. A few data are already available in early onset AD, mainly obtained in cases of monogenic disorder. In this paper, we discuss the current literature on the role of biological and neuroimaging markers in presenile AD.
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Affiliation(s)
- Alessandro Padovani
- Centre for Ageing Brain and Neurodegenerative Disorders, Neurology Unit, University of Brescia, Piazza Spedali Civili 1, 25125 Brescia, Italy
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Bateman RJ, Aisen PS, De Strooper B, Fox NC, Lemere CA, Ringman JM, Salloway S, Sperling RA, Windisch M, Xiong C. Autosomal-dominant Alzheimer's disease: a review and proposal for the prevention of Alzheimer's disease. ALZHEIMERS RESEARCH & THERAPY 2011; 3:1. [PMID: 21211070 PMCID: PMC3109410 DOI: 10.1186/alzrt59] [Citation(s) in RCA: 337] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Autosomal-dominant Alzheimer's disease has provided significant understanding of the pathophysiology of Alzheimer's disease. The present review summarizes clinical, pathological, imaging, biochemical, and molecular studies of autosomal-dominant Alzheimer's disease, highlighting the similarities and differences between the dominantly inherited form of Alzheimer's disease and the more common sporadic form of Alzheimer's disease. Current developments in autosomal-dominant Alzheimer's disease are presented, including the international Dominantly Inherited Alzheimer Network and this network's initiative for clinical trials. Clinical trials in autosomal-dominant Alzheimer's disease may test the amyloid hypothesis, determine the timing of treatment, and lead the way to Alzheimer's disease prevention.
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Affiliation(s)
- Randall J Bateman
- Department of Neurology, Washington University School of Medicine, 660 S, Euclid, Campus Box 8111, St Louis, MO 63110, USA.
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Could clinical profile influence CSF biomarkers in early-onset Alzheimer disease? Alzheimer Dis Assoc Disord 2011; 24:278-83. [PMID: 20473135 DOI: 10.1097/wad.0b013e3181d712d9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In common forms of Alzheimer disease (AD), anterograde memory impairment is the first deficit to occur. However, the disease, especially in its presenile forms, may also manifest itself through initial deficits that are predominantly of a nonmemory type. These distinct clinical profiles, which reflect the distinct topography of the underlying pathologic processes, may also differ in terms of their cerebrospinal fluid (CSF) markers. The aim of this study was to assess the levels of total tau, phosphorylated tau, and amyloid-beta 42 peptide in the CSF of "atypical" (nonmemory) early-onset AD patients. CSF biomarkers were evaluated in 22 atypical patients, and compared with those from a group of 13 "typical" patients, with a memory onset form of the disease. Our results show that independently of age, disease duration, education level, and clinical severity indices, patients with an atypical onset have significantly higher levels of total tau in the CSF (P=0.023). These findings indicate that an assessment of CSF biomarkers may be of particular use in the clinical diagnosis of "atypical-onset" forms of early-onset AD in which the initial symptoms involve language and visuospatial abilities rather than memory. In addition, they highlight the heterogeneity of pathologic processes in AD, suggesting more intense degeneration in the forms of the disease that primarily involve neocortical structures.
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Fortea J, Lladó A, Bosch B, Antonell A, Oliva R, Molinuevo JL, Sánchez-Valle R. Cerebrospinal Fluid Biomarkers in Alzheimer’s Disease Families with PSEN1 Mutations. NEURODEGENER DIS 2011; 8:202-7. [DOI: 10.1159/000322229] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Accepted: 10/18/2010] [Indexed: 11/19/2022] Open
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Pollen DA, Baker S, Hinerfeld D, Swearer J, Evans BA, Evans JE, Caselli R, Rogaeva E, St George-Hyslop P, Moonis M. Prevention of Alzheimer's disease in high risk groups: statin therapy in subjects with PSEN1 mutations or heterozygosity for apolipoprotein E epsilon 4. ALZHEIMERS RESEARCH & THERAPY 2010; 2:31. [PMID: 21062519 PMCID: PMC2983440 DOI: 10.1186/alzrt55] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- Daniel A Pollen
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA 01655, USA.
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Abstract
Intense multidisciplinary research has provided detailed knowledge of the molecular pathogenesis of Alzheimer disease (AD). This knowledge has been translated into new therapeutic strategies with putative disease-modifying effects. Several of the most promising approaches, such as amyloid-beta immunotherapy and secretase inhibition, are now being tested in clinical trials. Disease-modifying treatments might be at their most effective when initiated very early in the course of AD, before amyloid plaques and neurodegeneration become too widespread. Thus, biomarkers are needed that can detect AD in the predementia phase or, ideally, in presymptomatic individuals. In this Review, we present the rationales behind and the diagnostic performances of the core cerebrospinal fluid (CSF) biomarkers for AD, namely total tau, phosphorylated tau and the 42 amino acid form of amyloid-beta. These biomarkers reflect AD pathology, and are candidate markers for predicting future cognitive decline in healthy individuals and the progression to dementia in patients who are cognitively impaired. We also discuss emerging plasma and CSF biomarkers, and explore new proteomics-based strategies for identifying additional CSF markers. Furthermore, we outline the roles of CSF biomarkers in drug discovery and clinical trials, and provide perspectives on AD biomarker discovery and the validation of such markers for use in the clinic.
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