Human antibodies to neurofibrillary tangles and astrocytes in Alzheimer's disease

Inflammation, Autoimmunity and Neurodegenerative Diseases, Therapeutics and Beyond

Neurodegenerative disease (ND) incidence has recently increased due to improved life expectancy. Alzheimer's (AD) or Parkinson's disease (PD) are the most prevalent NDs. Both diseases are poly genetic, multifactorial and heterogenous. Preventive medicine, a healthy diet, exercise, and controlling comorbidities may delay the onset. After the diseases are diagnosed, therapy is needed to slow progression. Recent studies show that local, peripheral and age-related inflammation accelerates NDs' onset and progression. Patients with autoimmune disorders like inflammatory bowel disease (IBD) could be at higher risk of developing AD or PD. However, no increase in ND incidence has been reported if the patients are adequately diagnosed and treated. Autoantibodies against abnormal tau, β amyloid and α- synuclein have been encountered in AD and PD and may be protective. This discovery led to the proposal of immune-based therapies for AD and PD involving monoclonal antibodies, immunization/ vaccines, pro-inflammatory cytokine inhibition and anti-inflammatory cytokine addition. All the different approaches have been analysed here. Future perspectives on new therapeutic strategies for both disorders are concisely examined.

The Complexity of Microglial Interactions With Innate and Adaptive Immune Cells in Alzheimer's Disease

In the naïve mouse brain, microglia and astrocytes are the most abundant immune cells; however, there is a complexity of other immune cells present including monocytes, neutrophils, and lymphocytic cells, such as natural killer (NK) cells, T cells, and B cells. In Alzheimer’s disease (AD), there is high inflammation, reactive microglia, and astrocytes, leaky blood–brain barrier, the buildup of amyloid-beta (Aβ) plaques, and neurofibrillary tangles which attract infiltrating peripheral immune cells that are interacting with the resident microglia. Limited studies have analyzed how these infiltrating immune cells contribute to the neuropathology of AD and even fewer have analyzed their interactions with the resident microglia. Understanding the complexity and dynamics of how these immune cells interact in AD will be important for identifying new and novel therapeutic targets. Thus, this review will focus on discussing our current understanding of how macrophages, neutrophils, NK cells, T cells, and B cells, alongside astrocytes, are altered in AD and what this means for the disorder, as well as how these cells are affected relative to the resident microglia.

The Fox and the Rabbits-Environmental Variables and Population Genetics (1) Replication Problems in Association Studies and the Untapped Power of GWAS (2) Vitamin A Deficiency, Herpes Simplex Reactivation and Other Causes of Alzheimer's Disease

Classical population genetics shows that varying permutations of genes and risk factors permit or disallow the effects of causative agents, depending on circumstance. For example, genes and environment determine whether a fox kills black or white rabbits on snow or black ash covered islands. Risk promoting effects are different on each island, but obscured by meta-analysis or GWAS data from both islands, unless partitioned by different contributory factors. In Alzheimer's disease, the foxes appear to be herpes, borrelia or chlamydial infection, hypercholesterolemia, hyperhomocysteinaemia, diabetes, cerebral hypoperfusion, oestrogen depletion, or vitamin A deficiency, all of which promote beta-amyloid deposition in animal models—without the aid of gene variants. All relate to risk factors and subsets of susceptibility genes, which condition their effects. All are less prevalent in convents, where nuns appear less susceptible to the ravages of ageing. Antagonism of the antimicrobial properties of beta-amyloid by Abeta autoantibodies in the ageing population, likely generated by antibodies raised to beta-amyloid/pathogen protein homologues, may play a role in this scenario. These agents are treatable by diet and drugs, vitamin supplementation, pathogen detection and elimination, and autoantibody removal, although again, the beneficial effects of individual treatments may be tempered by genes and environment.

Humoral immunity in brain aging and Alzheimer's disease

Although the contribution of inflammatory processes in the etiology of late-onset Alzheimer's disease (AD) has been suspected for years, most studies were confined to the analysis of cell-mediated immunological reactions thought to represent an epiphenomenon of AD lesion development. Based on the traditional view of the "immunological privilege" of the brain, which excludes a direct access of human immunoglobulins (Ig) to the central nervous system under normal conditions, little attention has been paid to a possible role of humoral immunity in AD pathogenesis. In the first part of this review, we summarize evidences for a blood-brain barrier (BBB) dysfunction in this disorder and critically comment on earlier observations supporting the presence of anti-brain autoantibodies and immunoglobulins (Ig) in AD brains. Current concepts regarding the Ig turnover in the central nervous system and the mechanisms of glial and neuronal Fc receptors activation are also discussed. In the second part, we present new ex vivo and in vitro data suggesting that human immunoglobulins can interact with tau protein and alter both the dynamics and structural organization of microtubules. Subsequent experiments needed to test this new working hypothesis are addressed at the end of the review.

Human immunoglobulins and Fc fragments promote microtubule assembly via tau proteins and induce conformational changes of neuronal microtubules in vitro

The influence of human immunoglobulins (Ig) in neuronal cytoskeleton stability was studied in vitro. Here we show that human Ig and Fc fragments stimulate animal and human microtubule assembly by binding to microtubules via tau isoforms. In presence of Ig, microtubules show increased aggregation, twisting and rigidity. Non-immune Ig and Fc fragments promote microtubule assembly in temperature-dependent manner and stabilize microtubules at a molecular ratio of 1 Ig per 4 tubulin dimers. These in vitro data provide an experimental support for an immuno-mediated modulation of the cytoskeleton. In conjunction with previous neuropathological data, they suggest that Ig could participate in early stages of neurodegeneration by affecting the microtubule stability in vivo.

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.

Autoantibodies in neurodegenerative diseases: antigen-specific frequencies and intrathecal analysis

The frequency of autoantibodies (AAbs) was surveyed in several neurodegenerative diseases, other neurological diseases, and controls using antigen-specific EIAs for neurofilament heavy subunit, tubulin, glial fibrillary acidic protein, S100 protein, tau, beta-amyloid peptide, myelin basic protein, and heparan sulfate proteoglycan. High frequencies of sera and cerebrospinal fluid tubulin AAbs were found in Alzheimer disease (62% and 69%, respectively), Parkinson disease (27% and 70%), amyotrophic lateral sclerosis (54% and 67%), and in sera from multiple sclerosis (50% and 67%), optic neuritis (85%), Guillain-Barré syndrome (88%), and vascular dementia (52%). High frequencies of neurofilament heavy subunit AAbs were detected in Guillain-Barré syndrome, chronic peripheral neuropathy (88%) and optic neuritis (62%); whereas, some Alzheimer's disease (33%) and vascular dementia (44%) patients had glial fibrillary acidic protein AAbs. Lower frequencies of other AAbs were found in patient groups. AAb results were also compared to functional assessment of blood-brain barrier integrity in Parkinson's disease and Alzheimer's disease. The relevance of these AAbs to pathogenesis and/or course of neurologic diseases merits further study with particular reference to subgrouping and prognosis.

Increased incidence of anti-beta-amyloid autoantibodies secreted by Epstein-Barr virus transformed B cell lines from patients with Alzheimer's disease

During the past several years, evidence has been accumulated to support the thesis that immunological factors may play some role in Alzheimer's disease (AD). We have characterized the reactive antigens detected by certain monoclonal antibodies secreted by Epstein-Barr virus (EBV)-transformed B cell lines from the peripheral blood of AD patients and controls. Autoantibodies against beta-amyloid protein beta-amyloid protein (beta-A) in amyloid plaques and blood vessels and in enzyme-linked immunosorbent assays (ELISA) have been reported in four cell lines derived from an AD patient. In this study, over 3300 EBV-transformed B cell lines from thirteen individuals were tested in ELISAs for antibodies against beta-A peptides. Significantly more autoantibodies against beta-A (1-40) were found in the AD group, 2.26 +/- 0.62% (39/1794 cell lines) than in the control group, 0.28 +/- 0.36% (5/1552 cell lines) with P < 0.005. These new antibodies did not react with plaques or amyloid deposits in blood vessels. In contrast to the four plaque-reactive autoantibodies which reacted better with beta-A (1-40) than with beta-A (1-28), 70% of these anti-beta-A (1-40) antibodies reacted as well or better with beta-A (1-28). Many of them were also reactive with beta-A (1-16). Tested against a panel of cytoskeletal proteins and Hela cells, many of these anti-beta-A (1-40) antibodies appear to be polyreactive. The higher incidence of anti-beta-A antibody secreting B cells in AD patients provides further evidence that autoimmunity may play a role in AD.

Antihistone and anti-dsDNA autoantibodies in Alzheimer's disease and vascular dementia

In order to evaluate their prevalence in senile dementias, serum titer of antibodies against histones and double stranded deoxyribonucleic acid (dsDNA) were measured by means of the ELISA test in patients suffering from vascular dementia (VD), presenile Alzheimer's disease (AD), and senile dementia of the Alzheimer's type (SDAT). Only three subjects out of 87 had dsDNA autoantibodies. On the contrary, VD and SDAT showed high titers of antibodies against histones when compared to healthy controls. A significant relationship was also found between antihistone serum titer and degree of dementia in AD. Results were not influenced by gender, age, or duration of illness. Presence of antihistone antibodies in dementias might reflect an alteration of membrane fluidity and integrity with leakage of nuclear immunogens or disturbances of immune functions, as frequently observed in dementia disorders.

Human antibodies reactive with beta-amyloid protein in Alzheimer's disease

Four human B cell lines established by Epstein-Barr viral transformation of B cells from a patient with a clinical diagnosis of Alzheimer's disease (AD) were found to secrete antibodies that react with plaques and cerebrovascular blood vessels in AD brain in a staining profile characteristic of beta-amyloid protein (beta-AP) in AD brain. Two of these antibodies were shown to be reactive with a rare plaque in a normal brain. In these studies, immunofluorescence and avidin-biotin complex immunoperoxidase methodology were used to determine antibody reaction, and thioflavine S was used to double label amyloid and neurofibrillary tangles. The four antibodies also reacted with neurons in normal and AD brain. Absorption studies, dot immunoblots, and enzyme-linked immunosorbent assays with beta-amyloid peptides 1-28 (beta-A1-28) and 1-40 (beta-A1-40) indicate the major determinant of the reactive epitope is located in the region of amino acids 1-28 of beta-AP. However, inhibition studies demonstrate a significant contribution to the antigenic determinant by the 29-40 region of the beta-A1-40. These antibodies represent the first human autoantibodies against beta-AP. The pathological significance of these autoantibodies is discussed.

Characteristics of Epstein-Barr virus transformed B cell lines from patients with Alzheimer's disease and age-matched controls

The characteristics of B cell lines isolated from patients with Alzheimer's disease (AD) and age-matched controls were investigated after having been transformed by Epstein-Barr virus (EBV). After isolation of mononuclear blood cells and in vivo or in vitro EBV infection, 35 and 21 lymphoblastoid cell lines (LCLs) were generated from 19 patients with AD (mean age 79.4 years) and 21 age-matched controls (mean age 80.0 years), respectively. B lymphocytes from AD patients were immortalised more easily than those from controls; the percentage of in vitro EBV infected LCLs (B95-LCLs) obtained in the AD group was significantly higher (76.2% versus 33.3% in the control group) and the mean time required for establishment was significantly lower (20.2 and 21.9 days versus 26.7 and 60.9 days in the control group). The EBV receptor and surface immunoglobulin (Ig) analyses showed no difference between the two groups. The expression of Epstein-Barr early antigens (EA) and viral capsid antigens (VCAs) revealed a tendency to higher viral replication in LCLs from AD patients; however, VCA expression remained limited to a small number of cells and did not affect overall cell growth. Finally, qualitative and quantitative differences were observed in the pattern of Ig production. Whereas spontaneously established LCLs from AD patients were generally monoclonal (80% of LCLs versus 33% in the control group), B95-LCLs were all polyclonal and secreted more IgM and IgA than those from controls; the mean IgM level was significantly higher in B95-LCLs from the AD group. These results suggest that B cells derived from AD patients seemed to be less differentiated than cells from age-matched controls.

The decrease of CD8-positive lymphocytes in Alzheimer's disease

The aim of this study was to analyze the possible association of the changes in systemic immunity in the neurodegenerative diseases and in brain atrophy per se. Therefore we enumerated the numbers and proportions of the CD3-, CD4- and CD8-positive cells and B-lymphocytes in peripheral blood of 136 patients with various neurodegenerative disorders of the brain and 58 healthy age-matched controls. The selective decrease of the CD8-positive lymphocytes was demonstrated in the patients with Alzheimer's disease. In contrast, in the patients with brain atrophy of unknown origin and in the patients with vascular dementia the number of the CD8-positive cells tended to increase. The results suggest that brain degenerative changes are associated with changes in the systemic immunity and the changes are linked with the underlying disorder more than brain degeneration per se.

Substance P and neurodegenerative disorders. A speculative review

The causes of the neurodegenerative disorders of Parkinson's disease (PD), Alzheimer's disease (AD) and amyotrophic lateral sclerosis (ALS) are unknown. It is proposed that all these disorders result primarily from a loss of trophic peptidergic neurotransmitter, possibly Substance P (SP). This loss in turn produces the classical neuronal degeneration seen in each of these diseases and occurs due to a combination of natural aging and chronic autoimmune destruction following a viral infection of the CNS, early in life. The loss is therefore slow and by the time of clinical presentation the inflammatory process is disappearing as the antigenic stimulus lessens with its removal. The implications of the theory in terms of future research and therapy are briefly discussed.

Antibodies to viral antigens, xenoantigens, and autoantigens in Alzheimer's disease

Sera from 19 patients with Alzheimer's disease (AD) and 21 control subjects were studied by immunofluorescence and enzyme immunoassay for antibody activity against various viruses and 12 self- and non-self-antigens. Total IgG mean level was significantly higher in the AD group; the IgG level was above 15 g/L in 52.8% of AD patients versus 14.3% of control subjects. Antiviral antibody titers showed no significant differences except for antibodies to herpes simplex virus-1, which were increased in control group. In contrast, autoantibodies were more frequently found in AD patients, and the prevalence of antibodies to spectrin, peroxidase, and thyroglobulin was significantly increased. Thus, in our series, autoimmune but not antiviral responses were heightened in at least 42% of AD patients (versus 9% of the control group) suggesting the existence of two subpopulations in the AD group.

Enzyme-linked immunosorbent assay for human autoantibody to glial fibrillary acidic protein: higher titer of the antibody is detected in serum of patients with Alzheimer's disease

We have developed an enzyme-linked immunosorbent assay (ELISA) to detect anti-glial fibrillary acidic protein (GFAP) autoantibody in human sera. The ELISA was prepared by coating microtest plates with purified GFAP from bovine spinal cord. The autoantibody activities were assayed in the serum from 219 control subjects, 39 Alzheimer's disease patients and 39 cerebrovascular dementia patients. Higher titer of the antibody was observed in the serum of Alzheimer's disease patients. Since the titer showed no significant change with aging or with sex in the control serum, we could determine a certain normal value of the antibody titer. The percentage of abnormal subjects whose antibody levels were over the normal value was 53.8% in Alzheimer's disease (presenile onset) patients, 30.8% in Alzheimer's disease (senile onset) patients, 10.3% in cerebrovascular dementia patients and 5.5% in control subjects. We discuss the relationship between the anti-GFAP autoantibody and the pathogenesis of Alzheimer's disease and suggest that the evaluation of anti-GFAP autoantibody level may be useful in diagnosing Alzheimer's disease.