Is Alzheimer's disease an immunological disorder? Observations and speculations

Inflammatory pathogenesis in Alzheimer's disease: biological mechanisms and cognitive sequeli

Experimental evidence from molecular biology, biochemistry, epidemiology and behavioral research support the conclusion that brain inflammation contributes to the pathogenesis of Alzheimer's disease and other types of human dementias. Aspects of neuroimmunology relating to the pathogenesis of Alzheimer's disease are briefly reviewed. The effects of brain inflammation, mediated through cytokines and other secretory products of activated glial cells, on neurotransmission (specifically, nitric oxide, glutamate, and acetylcholine), amyloidogenesis, proteolysis, and oxidative stress are discussed within the context of the pathogenesis of learning and memory dysfunction in Alzheimer's disease. Alzheimer's disease is proposed to be an etiologically heterogeneous syndrome with the common elements of amyloid deposition and inflammatory neuronal damage.

Importance of immunological and inflammatory processes in the pathogenesis and therapy of Alzheimer's disease

The contribution of autoimmune processes or inflammatory components in the etiology and pathogenesis of Alzheimer's disease (AD) has been suspected for many years. The presence of antigen-presenting, HLA-DR-positive and other immunoregulatory cells, components of complement, inflammatory cytokines and acute phase reactants have been established in tissue of AD neuropathology. Although these data do not confirm the immune response as a primary cause of AD, they indicate involvement of immune processes at least as a secondary or tertiary reaction to the preexisting pathogen and point out its driving-force role in AD pathogenesis. These processes may contribute to systemic immune response. Thus, experimental and clinical studies indicate impairments in both humoral and cellular immunity in an animal model of AD as well as in AD patients. On the other hand, anti-inflammatory drugs applied for the treatment of some chronic inflammatory diseases have been shown to reduce risk of AD in these patients. Therefore, it seems that anti-inflammatory drugs and other substances which can control the activity of immunocompetent cells and the level of endogenous immune response can be valuable in the treatment of AD patients.

Humoral and cell-mediated immune responses following lesions of the nucleus basalis magnocellularis in the rat

The present study was undertaken to elucidate whether electrolytic lesions of nucleus basalis magnocellularis--NBM (an animal model of Alzheimer's disease--AD) may influence humoral and cellular immune responses in adult male Wistar rats. For this purpose intact control (IC), sham-operated (SO) and NBM-lesioned rats were divided into two main groups: (1) rats immunized with sheep red blood cells (SRBC) for plaque-forming cell (PFC) response and anti-SRBC agglutinins, and (2) rats immunized with bovine serum albumin in complete Freund's adjuvant (BSA-CFA) for anti-BSA antibody production, Arthus and delayed hypersensitivity skin reaction to BSA. PFC responses and anti-SRBC agglutinins as well as diameter and expression of edema/induration of Arthus/delayed skin reaction and titer of anti-BSA antibody were significantly lower in NBM lesioned rats (compared to IC and SO). The results showed that in NBM-lesioned rats both the humoral and cellular immune responses were suppressed.

Autoantibody reactivity in serum of patients with Alzheimer's disease and other age-related dementias

Serum antibodies against a series of antigens, including an organ-specific central nervous system (CNS) antigen and the neurotransmitter serotonin, were investigated in 22 patients with Alzheimer's Disease (n=15) and other age-related dementias (n=7) by indirect immunofluorescence assay and enzyme-linked immunosorbent assay. Patients with dementia showed an increase of antibody-positive sera against nuclear antigen, gastric parietal cells, CNS antigen, gangliosides (Gm1), laminin, and keratin. Alzheimer's Disease patients alone exhibited antibodies against CNS antigen. However, the results do not show sufficient specificity and sensitivity for use as a diagnostic indicator.

Intracellular calcium response is reduced in CD4+ lymphocytes in Alzheimer's disease and in older persons with Down's syndrome

Abnormalities in intracellular free calcium ([Ca2+]i) regulation are likely to play a role in brain aging and have been described in cells from patients with Alzheimer's disease (AD). [Ca2+]i acts as a second messenger in transmembrane signaling and regulates diverse functions in many cell types. Therefore, abnormalities in [Ca2+]i response may have far-ranging effects. Using flow cytometric assay for [Ca2+]i, we examined whether mitogen-induced increases in [Ca2+]i are abnormal in CD4+ T-lymphocytes from patients with familial AD (FAD), other AD, and Down's syndrome (DS) compared to age-matched controls. We observed that the peak [Ca2+]i responses were significantly decreased in CD4+ cells from 6 FAD patients (59% of control), 34 other AD patients (69% of age-matched control), and 6 older persons with DS (> 25 years old, 47% of control), after stimulation with 10 micrograms/ml anti-CD3 monoclonal antibody (mAb). The number of CD3 receptors on T lymphocytes of the AD patients was not decreased. In contrast, lymphocytes from subjects with FAD, other AD and older DS patients had no decrease in response to phytohemagglutinin (30 micrograms/ml). CD3 and related classes of membrane receptors are present on many cells of the central nervous system. Therefore, receptor signaling defects via this receptor in T lymphocytes of AD patients may be relevant to the central nervous system pathology seen in AD and DS.

Abnormal expression of actin in lymphocytes of Alzheimer's disease and Down's syndrome patients

Alzheimer's disease (AD) is a degenerative disorder of the central nervous system accompanied by several immunological disturbances and a number of common features exist between AD and Down's syndrome (DS). High resolution two-dimensional electrophoresis of lymphocyte proteins demonstrates an actin abnormality in AD and DS: a double actin spot instead of the single spot observed in controls. This dual form was studied by pulse-chase experiments and seems to be related to extracellular factors which influence the post-translational modification of actin. These results agree with the immunological disturbances observed in AD and DS, and with the well established hypothesis that AD is a systemic as well as cerebral disease.

Zinc and thymic hormone-dependent immunity in normal ageing and in patients with senile dementia of the Alzheimer type

Plasma zinc levels were measured in young controls, aged controls, patients with dementia of the Alzheimer type and patients with non-Alzheimer type dementia. Zinc levels decreased with age; however, no difference was found between patients with dementia and age-matched controls. Plasma levels of active or inactive thymulin, a nonapeptide produced and released by the thymus gland, were also determined in young controls, aged controls, patients with dementia of the Alzheimer type and patients with non-Alzheimer type dementia. Basal levels of active thymulin were decreased in aged controls and in patients with dementia. In vitro reactivation of thymulin after zinc addition to plasma samples was decreased in aged controls. A further impairment of thymulin reactivation was present in patients with dementia. A significant age-dependent decrease in lymphocyte proliferation after mitogen stimulation was found; however, no difference was present between aged controls and patients with dementia of the Alzheimer type. Interleukin-2-induced cell activation and its effect on mitogen-induced proliferation were also measured; once again only an age-associated decrease was found. The endocrine function of the thymus of patients with dementia appears to be more compromised than that from aged controls.

Altered post-receptorial signal transduction mechanism under various stimulation in polymorphonuclear granulocytes of Alzheimer's disease

The cyclic nucleotide changes were studied under 10(-6) M isoproterenol (IP), 10(-6) M carbachol and 10(-8) M Met-enkephalin (Met-enk) stimulations in polymorphonuclear granulocytes (PMNLs) of middle-aged (aged 35-52 years) and elderly (aged 61-97 years) healthy subjects, as well as of patients with Alzheimer's disease (AD) (aged 58-65 years). From our results we can conclude that in the case of middle-aged healthy subjects only the IP caused a marked cAMP elevation while in elderly and AD all the applied substances stimulated the cAMP at different degrees. Concerning the cGMP levels in PMNLs, we observed a marked increase under carbachol and Met-enk stimulation, in middle-aged subjects, while in the elderly a weak change was obtained by carbachol. In AD practically no change of cGMP levels could be obtained. Thus, the main features of AD are a cAarP response to Met-enk and an abolition of a GarP response to carbachol. We can conclude that in PMNLs of elderly and patients with AD we assist to an altered post-receptorial signal transduction mechanism, which seems to be even more marked in the case of AD comparing to normal aging.

Cerebrospinal fluid corticotropin-releasing factor levels and stimulation test in dementia of the Alzheimer type

Experimental findings have recently suggested a toxic role for glucocorticoids in hippocampus, the main brain target for the adrenocortical hormones. In this study, we explored the activity of the hypothalamus-pituitary-adrenal (HPA) axis in a group of patients with dementia of the Alzheimer's type (DAT) and in a control group of age-matched subjects. We measured the corticotropin-releasing factor (CRF) levels in cerebrospinal fluid (CSF) and evaluated the plasma cortisol response to a CRF stimulation test. While no differences were observed in the results of the CRF test for two groups, CSF CRF values in DAT patients were found to be significantly higher than in controls. Bearing in mind the bidirectional relationships between the neuroendocrine and immune systems and the changes in some immunological parameters reported in DAT, the possible role of HPA axis hyperactivity in the pathogenesis of primary dementia is discussed.

The brain and the immune system: a psychosomatic network

The central nervous system (CNS) and the immune system, communicating through the neuroendocrine system, are closely involved in the individual's adaptation to the environment. The data from basic science research and clinical observations are overviewed, and more recent studies are summarized. As changes in immune function may mediate the effects of psychosocial factors in psychosomatic disorders, it is important for all biopsychosocially oriented physicians to understand the network that connects the central nervous and immune systems.

Functional study of T lymphocyte responsiveness in patients with dementia of the Alzheimer type

The autologous mixed lymphocyte reaction (AMLR) was used to study T lymphocytes in a group of patients with dementia of the Alzheimer type (DAT) in order to confirm the observation that their T cell proliferation in AMLR was greater than in age-matched controls, and to investigate other pathways of T cell activation, searching for correlations between immunologic and clinical findings in DAT. The mean proliferative response in AMLR was increased in patients with DAT. No differences between patients and age-matched controls were detected when other pathways of T cell activation were investigated. The degree of response in the AMLR varied among patients with DAT. This fits with the suggestion that the disorder may be a heterogeneous syndrome.

Lymphopenia in primary degenerative dementia

The central nervous and immune systems share a number of common properties, e.g. neurotransmitter receptors. In contrast to age matched healthy and/or hypertensive controls, the total lymphocyte count in 25 carefully diagnosed and staged patients with primary degenerative dementia were significantly reduced and also correlated with the severity of their dementia. Subjects' age, age of dementia onset, or duration of illness were unrelated. Total leukocyte counts were similar between groups. Nutritional status, ACTH, or plasma cortisol in dementia cohort were also not explanatory of their lymphopenia. These results are potentially significant in light of an immune hypothesis for primary degenerative dementia: Alzheimer's type and/or that population's high concomitant risk of infection.

Autoimmunity and age-associated cognitive decline

It is suggested that the immune system may play a role in the etiology of age-associated cognitive decline and/or Alzheimer's disease. The relationship between brain-reactive antibodies (BRA) and age-associated cognitive dysfunction is reviewed and discussed. A parallel relationship between BRA increases with age and decline of avoidance learning capacity is described in mouse models. Transfer of immunity from old to young mice was found to accelerate both age-related formation of brain-reactive antibodies and age-related decline of avoidance learning capacity. Short-lived mouse genotypes with accelerated autoimmunity were found to show accelerated age-related declines in their ability to acquire an avoidance response when compared with nonautoimmune mice. Overall, these findings suggest that the immune system could be an important target for development of intervention strategies aimed at extending the intellectually competent period of life. Mice in which autoimmunity is accelerated may be useful as models for the development of such interventions.

Phagocytic cell function in aged subjects

In order to study the activity of phagocytic cells in normal and pathological aging, we compared normal young and aged subjects and patients with Alzheimer's (AD) or Parkinson's (PD) disease. Blood granulocytes and monocytes were separately assayed for ingestion of three different particle species (opsonized zymosan, immunoglobulin-coated sheep red cells (IgG-SRC) and glutaraldehyde-treated sheep red cells (G-SRC]. The superoxide anion production induced by these particles was also measured. All granulocyte responses to zymosan and IgG-SRC were depressed in the three aged groups as compared to young controls. Hence, only functions involving a specific receptor (Fc or C3b receptor) seemed affected. Monocyte activity was slightly decreased in the same groups. No difference was found between AD or PD patients and normal aged subjects. Hence the phagocytic and oxidative defects we found were a consequence of aging.

Age differences in acquisition and retention of one-way avoidance learning in C57BL/6NNia and autoimmune mice

Acquisition and 48-h retention of a step-up active avoidance response were studied in separate age groups of C57BL/6NNia mice (aged 1.5, 3.5, 6, 12, or 26 months) and five strains of genetically autoimmune mice differing in life span. The C57BL/6NNia mice showed no change in ability to acquire the avoidance response between 1.5 and 3.5 months, but showed a steady decline in that ability thereafter. Mouse strains with early-onset autoimmune disorder (NZB/B1NJ, MRL/MpJ-lpr, and BXSB/MpJ) showed declines in acquisition capability between 1.5 and 3.5 months of age, whereas mouse strains with mild, late-onset autoimmune disorder (MRL/MpJ- + and NZBWF1/J) showed stable or improved acquisition during that period. Both the C57BL/6NNia and NZB/B1NJ mice showed age-dependent declines in 48-h retention performance by 12 months of age. These findings suggested that while 48-h retention performance deficits were most related to chronological age, avoidance acquisition deficits were related to development of autoimmunity.

Molecular form of human lymphocyte membrane-bound acetylcholinesterase

The membrane-bound acetylcholinesterase (AchE) from human peripheral blood lymphocyte gives only one symmetrical peak on sucrose density gradient centrifugation in the presence of Triton X-100 detergent, with the calculated sedimentation coefficient of 6.5 S. However, this dimeric form of AchE was converted to a monomeric 3.8 S form when treated with 2-mercaptoethanol and iodoacetic acid. The results are consistent with studies which have shown by sodium dodecyl sulfate gel electrophoresis that the enzyme is built up of two identical monomers inter-linked by disulfide bond(s). Under reducing conditions, revealed a single species of 70,000 molecular weight, whereas under non-reducing conditions, another species of 140,000 molecular weight of the AchE was found. Polyacrylamide gel electrophoresis indicated a single band with AchE activity in the presence of Triton X-100. In contrast, in the absence of the same detergent multiple band pattern could be observed. These results suggest that membrane-bound AchE enzyme is present in homogenous dimeric form on human lymphocyte membrane.

Altered lymphocyte acetylcholinesterase activity in patients with senile dementia

Reductions in the acetylcholinesterase (AChE) activity of certain brain areas in patients with senile dementia of Alzheimer type (SDAT) have been found to correlate with the severity of the disease, suggesting a central cholinergic lesion. Since AChE is expressed on the surface of various blood cells too, the AChE activity of lymphocytes and erythrocytes was determined to test the possibility whether the cholinergic lesion is also reflected on these readily available cells. The AChE activity of lymphocytes in SDAT and in alcoholic dementia (AD) were significantly lower as compared to those of the age-matched healthy volunteers. In contrast, there was no significant difference in the activity of lymphocyte AChE between age-matched healthy controls and patients with multi-infarct dementia of vascular origin (MID). No changes could be demonstrated in the erythrocyte AChE activities of the patients studied, and the age-matched healthy individuals, when comparing them to the healthy blood donors. The AChE activity of lymphocytes may thus be a useful marker to follow the alterations in the metabolism of acetylcholine (ACh) in the central nervous system (CNS) of different types of dementia.

Impaired coupling of naloxone sensitive opiate receptors to adenylate cyclase in PMNLs of aged male subjects

Met-enkephalin (Met-enk) in 10(-9)-10(-7) M concentrations enhanced the extracellular cytotoxicity of polymorphonuclear leukocytes (PMNL) of young adult humans partly by stimulation of the "respiratory burst" in these cells. Meanwhile adenylate cyclase was inhibited and guanylate cyclase was stimulated. All the observed effects were abolished by 10(-5) M naloxone. On the other hand, a positive receptor coupling to adenylate cyclase was found when Met-enk was added in higher (10(-6)-10(-5) M) concentrations to PMNLs. The elevated cAMP level resulted in decreased extracellular cytotoxicity of PMNLs by a naloxone insensitive way. In PMNLs obtained from healthy aged male subjects, Met-enk induced in all of the applied concentrations an increased cAMP level and no change in cGMP level, with subsequent decrease of cytotoxicity, i.e. an impaired negative coupling of naloxone sensitive opiate receptors was detected with aging.

Does normal lymphocyte DNA synthesis in response to PHA exclude cell-mediated immunodepression?

PHA stimulation assay was the first in vitro method for evaluating the T-cell function, and this T-cell proliferative response has been routinely used to discriminate between normal subjects and patients with deficiency in cell-mediated immunity. However, [3H]thymidine incorporation into lymphocyte DNA can be studied by using additional in vitro assay methods since they measure different lymphocyte activation pathways. In the present study we selected three different tests to investigate the reliability of this single approach: PHA induced lymphocyte DNA synthesis; T lymphocyte DNA synthesis to anti-T3 monoclonal antibody (OKT3); autologous mixed lymphocyte reaction (AMLR). In addition, IL-2 receptor expression on the membrane of T-cell stimulated in AMLR both with PHA and anti-T3 was evaluated. This study was performed in various groups of subjects: normal young controls, aged healthy individuals, and patients with Alzheimer's disease (AD), Retinitis Pigmentosa (RP), and with cell-mediated immunodeficiency and clinical evidence of recurrent viral infections (ID). The data reported herein show heterogeneity of results in each group studied and demonstrate the necessity of employing more than one laboratory test for the routine evaluation of T-cell-mediated immunity.

Detection of brain autoantibodies in the serum of patients with Alzheimer's disease but not Down's syndrome

The immunofluorescent staining of antibodies specifically binding to rat brain tissue sections was investigated in 95 human sera including 30 cases of Alzheimer's disease. A high incidence of specific antibrain antibody was found among Alzheimer's patients (57% positive) compared to other neurological disease controls (only 8% positive) or normal young and aged healthy controls (none positive).

Evidence of T-lymphocyte functional impairment in Huntington's disease

Huntington's Disease (HD) is a degenerative neurological disorder with autosomal dominant transmission. Although immunological defect(s) have been postulated, no confirmed laboratory evidence for this exists. In the present study we observed activated T cells in the peripheral blood of HD patients (using 4F2 monoclonal antibody), whereas the percentage of T cells bearing T-cell activation markers such as HLA-DR and MLR4 antigens was normal. We then studied T cells of HD patients in some functional assays. Since it has been suggested that autologous mixed lymphocyte reaction (AMLR) includes several immune mechanisms in which distinct cell subsets interact and perform distinct regulatory functions, it is conceivable that the remarkable deficiency of AMLR herein observed in HD patients results from some abnormal immune regulation which may contribute to the pathology of this condition. Additional experiments demonstrated a defect of AMLR in three asymptomatic young sibs of HD patients, and coculture experiments between T cells of patients (as responders) and non-T cells of their sibs (as stimulators), and vice versa, produced no proliferative response. Subnormal responsiveness in allogeneic MLR was also observed. Normal or enhanced PHA-induced production of both IL-2 and IFN-gamma in vitro was detected. These experimental data suggest a cellular branch of the immune system in HD; however, they do not indicate if this defect is primary or secondary to the disease itself.

Immunological dysfunction in Alzheimer's disease

Peripheral blood lymphocytes from Alzheimer's patients and apparently healthy elderly individuals were examined for interleukin-1 (IL-1) production. Our results indicate severely low production of IL-1 by patient's peripheral blood monocytes. The low production of IL-1 in vitro correlated with patients' symptoms and therapy with 1-acetamide,2-pyrrolidone (1a,2p). In addition to low IL-1 production, the number of autologous rosette forming cells (ARFC) was significantly decreased in all Alzheimer's patients whereas B-cell glucose metabolism was significantly higher than age-matched healthy individuals.