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Neves Briard J, Duquette A, Cayrol R, Lapalme-Remis S. Refractory Status Epilepticus in a Patient With Aducanumab-Induced Amyloid-Related Imaging Abnormalities. Neurology 2024; 103:e209582. [PMID: 39121445 DOI: 10.1212/wnl.0000000000209582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2024] Open
Abstract
OBJECTIVE To report a case of fatal super-refractory status epilepticus associated with amyloid-related imaging abnormalities (ARIA). METHODS We describe the history, neuroimaging, EEG, and brain pathology findings of a 75-year-old patient with mild cognitive impairment due to Alzheimer disease (homozygous ε4 apolipoprotein status) and a remote history of 3 asymptomatic ARIA episodes, who developed super-refractory status epilepticus related to severe ARIA. RESULTS The patient was participating in an extended open-label trial of aducanumab when she was admitted to hospital for focal seizures and ARIA in 2 noncontiguous regions of the left frontal and occipital lobes. Despite aggressive treatment with high-dose corticosteroids, sedation, and antiseizure medications, she died from refractory focal status epilepticus. In retrospect, routine surveillance brain magnetic resonance imaging performed 11 weeks before hospitalization had signs of ARIA, which had not been identified. DISCUSSION Clinicians should be aware that anti-amyloid therapies may cause rare serious adverse events. A high degree of vigilance is required in the interpretation of surveillance imaging for ARIA. Longitudinal studies are justified to further characterize the safety profile of anti-amyloid antibody therapies and identify participants at high risk of serious adverse events.
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Affiliation(s)
- Joel Neves Briard
- From the Department of Medicine (J.N.B.), Neuroscience (A.D., S.L.-R.), and Pathology and Cellular Biology (R.C.), Université de Montréal, Canada
| | - Antoine Duquette
- From the Department of Medicine (J.N.B.), Neuroscience (A.D., S.L.-R.), and Pathology and Cellular Biology (R.C.), Université de Montréal, Canada
| | - Romain Cayrol
- From the Department of Medicine (J.N.B.), Neuroscience (A.D., S.L.-R.), and Pathology and Cellular Biology (R.C.), Université de Montréal, Canada
| | - Samuel Lapalme-Remis
- From the Department of Medicine (J.N.B.), Neuroscience (A.D., S.L.-R.), and Pathology and Cellular Biology (R.C.), Université de Montréal, Canada
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Loomis SJ, Miller R, Castrillo-Viguera C, Umans K, Cheng W, O'Gorman J, Hughes R, Budd Haeberlein S, Whelan CD. Genome-Wide Association Studies of ARIA From the Aducanumab Phase 3 ENGAGE and EMERGE Studies. Neurology 2024; 102:e207919. [PMID: 38165296 PMCID: PMC11097767 DOI: 10.1212/wnl.0000000000207919] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/03/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Amyloid-related imaging abnormalities (ARIA) were the most common adverse events reported in the phase 3 ENGAGE and EMERGE trials of aducanumab, an anti-amyloid monoclonal antibody. APOE ε4 carrier status has been shown to increase risk of ARIA in prior trials of aducanumab and other anti-amyloid therapies; however, the remainder of the human genome has not been evaluated for ARIA risk factors. Therefore, we sought to determine in a hypothesis-free manner whether genetic variants beyond APOE influence risk of ARIA in aducanumab-treated patients. METHODS We performed genome-wide association studies (GWAS) of ARIA in participants in the ENGAGE and EMERGE trials. Participants had mild cognitive impairment due to Alzheimer disease or mild Alzheimer disease dementia and were amyloid-positive on PET scans. All participants underwent regular MRI monitoring to detect and diagnose ARIA. RESULTS Of the 3,285 participants in the intent-to-treat population, this analysis included 1,691 with genotyping array data who received at least one dose of aducanumab with at least one post-baseline MRI. All participants in the study cohort were of European ancestry; 51% were female. The mean age was 70.3 years. 31% had ARIA-E, 19% had ARIA-H microhemorrhage, and 14% had ARIA-H superficial siderosis. We identified one genome-wide significant (p < 5.0 × 10-8) association at the chromosome 19 locus encompassing APOE. The APOE association with ARIA was stronger in ε4/ε4 homozygotes (OR = 4.28, 4.58, 7.84; p < 2.9 × 10-14 for ARIA-E, ARIA-H microhemorrhage, and ARIA-H superficial siderosis, respectively) than in ε3/ε4 heterozygotes (OR = 1.74, 1.46, 3.14; p ≤ 0.03). We found greater odds of radiographically severe ARIA (OR = 7.04-24.64, p ≤ 2.72 × 10-5) than radiographically mild ARIA (OR = 3.19-5.00, p ≤ 1.37 × 10-5) among ε4/ε4 homozygotes. APOE ε4 was also significantly associated with both symptomatic (ε4/ε4 OR = 3.64-9.52; p < 0.004) and asymptomatic (ε4/ε4 OR = 4.20-7.94, p < 1.7 × 10-11) cases, although among ARIA cases, APOE did not appear to modulate symptomatic status. No other genome-wide significant associations were found. DISCUSSION We identified a strong, genome-wide significant association between APOE and risk of ARIA. Future, larger studies may be better powered to detect associations beyond APOE. These findings indicate that APOE is the strongest genetic risk factor of ARIA incidence, with implications for patient management and risk-benefit treatment decisions. TRIAL REGISTRATION INFORMATION Both trials (ENGAGE [221AD301]: NCT02477800 and EMERGE [221AD302]: NCT02484547) were registered in June 2015 at clinicaltrials.gov and enrolled patients from August 2015 to July 2018.
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Solopova E, Romero-Fernandez W, Harmsen H, Ventura-Antunes L, Wang E, Shostak A, Maldonado J, Donahue MJ, Schultz D, Coyne TM, Charidimou A, Schrag M. Fatal iatrogenic cerebral β-amyloid-related arteritis in a woman treated with lecanemab for Alzheimer's disease. Nat Commun 2023; 14:8220. [PMID: 38086820 PMCID: PMC10716177 DOI: 10.1038/s41467-023-43933-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
We report the case of a 79-year-old woman with Alzheimer's disease who participated in a Phase III randomized controlled trial called CLARITY-AD testing the experimental drug lecanemab. She was randomized to the placebo group and subsequently enrolled in an open-label extension which guaranteed she received the active drug. After the third biweekly infusion, she suffered a seizure characterized by speech arrest and a generalized convulsion. Magnetic resonance imaging revealed she had multifocal swelling and a marked increase in the number of cerebral microhemorrhages. She was treated with an antiepileptic regimen and high-dose intravenous corticosteroids but continued to worsen and died after 5 days. Post-mortem MRI confirmed extensive microhemorrhages in the temporal, parietal and occipital lobes. The autopsy confirmed the presence of two copies of APOE4, a gene associated with a higher risk of Alzheimer's disease, and neuropathological features of moderate severity Alzheimer's disease and severe cerebral amyloid angiopathy with perivascular lymphocytic infiltrates, reactive macrophages and fibrinoid degeneration of vessel walls. There were deposits of β-amyloid in meningeal vessels and penetrating arterioles with numerous microaneurysms. We conclude that the patient likely died as a result of severe cerebral amyloid-related inflammation.
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Affiliation(s)
- Elena Solopova
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Hannah Harmsen
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Emmeline Wang
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alena Shostak
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jose Maldonado
- Vanderbilt Neurovisualization Lab, Vanderbilt University, Nashville, TN, USA
| | - Manus J Donahue
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Daniel Schultz
- Final Diagnosis: Private Autopsy Florida - Forensic Pathology Lab, Tampa, FL, USA
| | - Thomas M Coyne
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL, USA
| | | | - Matthew Schrag
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
- The Vanderbilt Brain Institute, Vanderbilt University, Nashville, TN, USA.
- Vanderbilt Memory and Alzheimer's Center, Vanderbilt University Medical Center, Nashville, TN, USA.
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Alsufayan R, Hess C, Krings T. Monoclonal Antibodies: What the Diagnostic Neuroradiologist Needs to Know. AJNR Am J Neuroradiol 2023; 44:1358-1366. [PMID: 37591772 PMCID: PMC10714862 DOI: 10.3174/ajnr.a7974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023]
Abstract
Monoclonal antibodies have become increasingly popular as novel therapeutics against a variety of diseases due to their specificity, affinity, and serum stability. Due to the nearly infinite repertoire of monoclonal antibodies, their therapeutic use is rapidly expanding, revolutionizing disease course and management, and what is now considered experimental therapy may soon become approved practice. Therefore, it is important for radiologists, neuroradiologists, and neurologists to be aware of these drugs and their possible different imaging-related manifestations, including expected and adverse effects of these novel drugs. Herein, we review the most commonly used monoclonal antibody-targeted therapeutic agents, their mechanism of action, clinical applications, and major adverse events with a focus on neurologic and neurographic effects and discuss differential considerations, to assist in the diagnosis of these conditions.
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Affiliation(s)
- R Alsufayan
- From the Division of Neuroradiology, Department of Medical Imaging (R.A., T.K.), University of Toronto, Toronto Western Hospital, University Health Network and University Medical Imaging, Toronto, Ontario, Canada
- Department of Diagnostic Imaging (R.A.), Peterborough Regional Health Centre, Peterborough, Ontario, Canada
| | - C Hess
- Deartment of Radiology and Biomedical Imaging (C.H.), University of California, San Francisco, San Francisco, California
| | - T Krings
- From the Division of Neuroradiology, Department of Medical Imaging (R.A., T.K.), University of Toronto, Toronto Western Hospital, University Health Network and University Medical Imaging, Toronto, Ontario, Canada
- Division of Neurosurgery (T.K.), Sprott Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Hampel H, Elhage A, Cho M, Apostolova LG, Nicoll JAR, Atri A. Amyloid-related imaging abnormalities (ARIA): radiological, biological and clinical characteristics. Brain 2023; 146:4414-4424. [PMID: 37280110 PMCID: PMC10629981 DOI: 10.1093/brain/awad188] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 05/03/2023] [Accepted: 05/05/2023] [Indexed: 06/08/2023] Open
Abstract
Excess accumulation and aggregation of toxic soluble and insoluble amyloid-β species in the brain are a major hallmark of Alzheimer's disease. Randomized clinical trials show reduced brain amyloid-β deposits using monoclonal antibodies that target amyloid-β and have identified MRI signal abnormalities called amyloid-related imaging abnormalities (ARIA) as possible spontaneous or treatment-related adverse events. This review provides a comprehensive state-of-the-art conceptual review of radiological features, clinical detection and classification challenges, pathophysiology, underlying biological mechanism(s) and risk factors/predictors associated with ARIA. We summarize the existing literature and current lines of evidence with ARIA-oedema/effusion (ARIA-E) and ARIA-haemosiderosis/microhaemorrhages (ARIA-H) seen across anti-amyloid clinical trials and therapeutic development. Both forms of ARIA may occur, often early, during anti-amyloid-β monoclonal antibody treatment. Across randomized controlled trials, most ARIA cases were asymptomatic. Symptomatic ARIA-E cases often occurred at higher doses and resolved within 3-4 months or upon treatment cessation. Apolipoprotein E haplotype and treatment dosage are major risk factors for ARIA-E and ARIA-H. Presence of any microhaemorrhage on baseline MRI increases the risk of ARIA. ARIA shares many clinical, biological and pathophysiological features with Alzheimer's disease and cerebral amyloid angiopathy. There is a great need to conceptually link the evident synergistic interplay associated with such underlying conditions to allow clinicians and researchers to further understand, deliberate and investigate on the combined effects of these multiple pathophysiological processes. Moreover, this review article aims to better assist clinicians in detection (either observed via symptoms or visually on MRI), management based on appropriate use recommendations, and general preparedness and awareness when ARIA are observed as well as researchers in the fundamental understanding of the various antibodies in development and their associated risks of ARIA. To facilitate ARIA detection in clinical trials and clinical practice, we recommend the implementation of standardized MRI protocols and rigorous reporting standards. With the availability of approved amyloid-β therapies in the clinic, standardized and rigorous clinical and radiological monitoring and management protocols are required to effectively detect, monitor, and manage ARIA in real-world clinical settings.
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Affiliation(s)
- Harald Hampel
- Eisai Inc., Alzheimer’s Disease and Brain Health, Nutley, NJ 07110, USA
| | - Aya Elhage
- Eisai Inc., Alzheimer’s Disease and Brain Health, Nutley, NJ 07110, USA
| | - Min Cho
- Eisai Inc., Alzheimer’s Disease and Brain Health, Nutley, NJ 07110, USA
| | - Liana G Apostolova
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Department of Radiology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - James A R Nicoll
- Division of Clinical Neurosciences, Clinical and Experimental Sciences, University of Southampton, Southampton SO16 6YD, UK
- Department of Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
| | - Alireza Atri
- Banner Sun Health Research Institute, Banner Health, Sun City, AZ 85351, USA
- Center for Brain/Mind Medicine, Department of Neurology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
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Cogswell PM, Barakos JA, Barkhof F, Benzinger TS, Jack CR, Poussaint TY, Raji CA, Ramanan VK, Whitlow CT. Amyloid-Related Imaging Abnormalities with Emerging Alzheimer Disease Therapeutics: Detection and Reporting Recommendations for Clinical Practice. AJNR Am J Neuroradiol 2022; 43:E19-E35. [PMID: 35953274 PMCID: PMC9451628 DOI: 10.3174/ajnr.a7586] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Monoclonal antibodies are emerging disease-modifying therapies for Alzheimer disease that require brain MR imaging for eligibility assessment as well as for monitoring for amyloid-related imaging abnormalities. Amyloid-related imaging abnormalities result from treatment-related loss of vascular integrity and may occur in 2 forms. Amyloid-related imaging abnormalities with edema or effusion are transient, treatment-induced edema or sulcal effusion, identified on T2-FLAIR. Amyloid-related imaging abnormalities with hemorrhage are treatment-induced microhemorrhages or superficial siderosis identified on T2* gradient recalled-echo. As monoclonal antibodies become more widely available, treatment screening and monitoring brain MR imaging examinations may greatly increase neuroradiology practice volumes. Radiologists must become familiar with the imaging appearance of amyloid-related imaging abnormalities, how to select an appropriate imaging protocol, and report findings in clinical practice. On the basis of clinical trial literature and expert experience from clinical trial imaging, we summarize imaging findings of amyloid-related imaging abnormalities, describe potential interpretation pitfalls, and provide recommendations for a standardized imaging protocol and an amyloid-related imaging abnormalities reporting template. Standardized imaging and reporting of these findings are important because an amyloid-related imaging abnormalities severity score, derived from the imaging findings, is used along with clinical status to determine patient management and eligibility for continued monoclonal antibody dosing.
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Affiliation(s)
- P M Cogswell
- From the Departments of Radiology (P.M.C., C.R.J.)
| | - J A Barakos
- Department of Radiology (J.A.B.), California Pacific Medical Center, San Francisco, California
| | - F Barkhof
- Departments of Radiology (F.B.)
- Nuclear Medicine (F.B.), VU University Medical Center, Amsterdam, the Netherlands
- Queen Square Institute of Neurology and Centre for Medical Image Computing (F.B.), University College London, UK
| | - T S Benzinger
- Departments of Radiology (T.S.B., C.A.R.)
- Neurosurgery (T.S.B.)
| | - C R Jack
- From the Departments of Radiology (P.M.C., C.R.J.)
| | - T Y Poussaint
- Department of Radiology (T.Y.P.), Boston Children's Hospital, Boston, Massachusetts
| | - C A Raji
- Departments of Radiology (T.S.B., C.A.R.)
- Neurology (C.A.R.),Washington University School of Medicine, St. Louis, Missouri
| | - V K Ramanan
- Neurology (V.K.R.), Mayo Clinic, Rochester, Minnesota
| | - C T Whitlow
- Departments of Radiology (C.T.W.)
- Biomedical Engineering (C.T.W.), Wake Forest School of Medicine, Winston-Salem, North Carolina
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Scherlek AA, Kozberg MG, Nicoll JAR, Perosa V, Freeze WM, van der Weerd L, Bacskai BJ, Greenberg SM, Frosch MP, Boche D, van Veluw SJ. Histopathological correlates of haemorrhagic lesions on ex vivo magnetic resonance imaging in immunized Alzheimer's disease cases. Brain Commun 2022; 4:fcac021. [PMID: 35224489 PMCID: PMC8870423 DOI: 10.1093/braincomms/fcac021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/31/2021] [Accepted: 02/01/2022] [Indexed: 12/14/2022] Open
Abstract
Haemorrhagic amyloid-related imaging abnormalities on MRI are frequently observed adverse events in the context of amyloid β immunotherapy trials in patients with Alzheimer's disease. The underlying histopathology and pathophysiological mechanisms of haemorrhagic amyloid-related imaging abnormalities remain largely unknown, although coexisting cerebral amyloid angiopathy may play a key role. Here, we used ex vivo MRI in cases that underwent amyloid β immunotherapy during life to screen for haemorrhagic lesions and assess underlying tissue and vascular alterations. We hypothesized that these lesions would be associated with severe cerebral amyloid angiopathy. Ten cases were selected from the long-term follow-up study of patients who enrolled in the first clinical trial of active amyloid β immunization with AN1792 for Alzheimer's disease. Eleven matched non-immunized Alzheimer's disease cases from an independent brain brank were used as 'controls'. Formalin-fixed occipital brain slices were imaged at 7 T MRI to screen for haemorrhagic lesions (i.e. microbleeds and cortical superficial siderosis). Samples with and without haemorrhagic lesions were cut and stained. Artificial intelligence-assisted quantification of amyloid β plaque area, cortical and leptomeningeal cerebral amyloid angiopathy area, the density of iron and calcium positive cells and reactive astrocytes and activated microglia was performed. On ex vivo MRI, cortical superficial siderosis was observed in 5/10 immunized Alzheimer's disease cases compared with 1/11 control Alzheimer's disease cases (κ = 0.5). On histopathology, these areas revealed iron and calcium positive deposits in the cortex. Within the immunized Alzheimer's disease group, areas with siderosis on MRI revealed greater leptomeningeal cerebral amyloid angiopathy and concentric splitting of the vessel walls compared with areas without siderosis. Moreover, greater density of iron-positive cells in the cortex was associated with lower amyloid β plaque area and a trend towards increased post-vaccination antibody titres. This work highlights the use of ex vivo MRI to investigate the neuropathological correlates of haemorrhagic lesions observed in the context of amyloid β immunotherapy. These findings suggest a possible role for cerebral amyloid angiopathy in the formation of haemorrhagic amyloid-related imaging abnormalities, awaiting confirmation in future studies that include brain tissue of patients who received passive immunotherapy against amyloid β with available in vivo MRI during life.
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Affiliation(s)
- Ashley A. Scherlek
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Mariel G. Kozberg
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA,J. Philip Kistler Stroke Research Center, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - James A. R. Nicoll
- Clinical Neurosciences, Clinical and Experimental Sciences School, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Valentina Perosa
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Whitney M. Freeze
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Louise van der Weerd
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands,Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Brian J. Bacskai
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Steven M. Greenberg
- J. Philip Kistler Stroke Research Center, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Matthew P. Frosch
- Neuropathology Service, C.S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Delphine Boche
- Clinical Neurosciences, Clinical and Experimental Sciences School, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Susanne J. van Veluw
- MassGeneral Institute for Neurodegenerative Disease, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA,J. Philip Kistler Stroke Research Center, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA,Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands,Correspondence to: Susanne J. van Veluw MassGeneral Institute for Neurodegenerative Disease Massachusetts General Hospital 114 16th Street Charlestown, 02129 MA, USA E-mail:
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Aldea R, Grimm HP, Gieschke R, Hofmann C, Lott D, Bullain S, Delmar P, Klein G, Lyons M, Piazza F, Carare RO, Mazer NA. In silico exploration of amyloid‐related imaging abnormalities in the gantenerumab open‐label extension trials using a semi‐mechanistic model. ALZHEIMER'S & DEMENTIA: TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2022; 8:e12306. [PMID: 35676943 PMCID: PMC9169977 DOI: 10.1002/trc2.12306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/12/2022] [Accepted: 04/25/2022] [Indexed: 11/28/2022]
Abstract
Introduction Amyloid‐related imaging abnormalities with edema/effusion (ARIA‐E) are commonly observed with anti‐amyloid therapies in Alzheimer's disease. We developed a semi‐mechanistic, in silico model to understand the time course of ARIA‐E and its dose dependency. Methods Dynamic and statistical analyses of data from 112 individuals that experienced ARIA‐E in the open‐label extension of SCarlet RoAD (a study of gantenerumab in participants with prodromal Alzheimer's disease) and Marguerite RoAD (as study of Gantenerumab in participants with mild Alzheimer's disease) studies were used for model building. Gantenerumab pharmacokinetics, local amyloid removal, disturbance and repair of the vascular wall, and ARIA‐E magnitude were represented in the novel vascular wall disturbance (VWD) model of ARIA‐E. Results The modeled individual‐level profiles provided a good representation of the observed pharmacokinetics and time course of ARIA‐E magnitude. ARIA‐E dynamics were shown to depend on the interplay between drug‐mediated amyloid removal and intrinsic vascular repair processes. Discussion Upon further refinement and validation, the VWD model could inform strategies for dosing and ARIA monitoring in individuals with an ARIA‐E history.
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Affiliation(s)
- Roxana Aldea
- Roche Pharma Research and Early Development Roche Innovation Center Basel Switzerland
| | - Hans Peter Grimm
- Roche Pharma Research and Early Development Roche Innovation Center Basel Switzerland
| | - Ronald Gieschke
- Roche Pharma Research and Early Development Roche Innovation Center Basel Switzerland
| | - Carsten Hofmann
- Roche Pharma Research and Early Development Roche Innovation Center Basel Switzerland
| | - Dominik Lott
- Roche Pharma Research and Early Development Roche Innovation Center Basel Switzerland
| | - Szofia Bullain
- Roche Product Development Neuroscience Basel Switzerland
| | - Paul Delmar
- Roche Product Development Neuroscience Basel Switzerland
| | - Gregory Klein
- Roche Pharma Research and Early Development Roche Innovation Center Basel Switzerland
| | | | - Fabrizio Piazza
- School of Medicine Laboratory of CAA and AD Translational Research and Biomarkers University of Milano‐Bicocca Monza Italy
| | - Roxana O. Carare
- Faculty of Medicine Interdisciplinary Dementia and Aging Centre University of Southampton Southampton UK
| | - Norman A. Mazer
- Roche Pharma Research and Early Development Roche Innovation Center Basel Switzerland
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Salloway S, Chalkias S, Barkhof F, Burkett P, Barakos J, Purcell D, Suhy J, Forrestal F, Tian Y, Umans K, Wang G, Singhal P, Budd Haeberlein S, Smirnakis K. Amyloid-Related Imaging Abnormalities in 2 Phase 3 Studies Evaluating Aducanumab in Patients With Early Alzheimer Disease. JAMA Neurol 2021; 79:13-21. [PMID: 34807243 PMCID: PMC8609465 DOI: 10.1001/jamaneurol.2021.4161] [Citation(s) in RCA: 268] [Impact Index Per Article: 89.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Question What are the characteristics of amyloid-related imaging abnormalities (ARIA) during aducanumab treatment in individuals with early Alzheimer disease? Findings In an integrated safety data set of 2 phase 3 clinical trials (EMERGE and ENGAGE) including 3285 participants, 425 patients (41.3%) in the combined 10 mg/kg aducanumab group (n = 1029) experienced ARIA; ARIA-edema occurred in 362 patients (35.2%), and 94 of these patients (26.0%) experienced associated symptoms (eg, headache, confusion, dizziness, and nausea). ARIA-microhemorrhage and ARIA–superficial siderosis occurred in 197 patients (19.1%) and 151 patients (14.7%), respectively. Meaning Amyloid-related imaging abnormalities occurred in approximately 40% of participants in the phase 3 studies of aducanumab, and approximately one-quarter of these patients experienced symptoms. Importance The EMERGE and ENGAGE phase 3 randomized clinical trials of aducanumab provide a robust data set to characterize amyloid-related imaging abnormalities (ARIA) that occur with treatment with aducanumab, an amyloid-β (Aβ)–targeting monoclonal antibody, in patients with mild cognitive impairment due to Alzheimer disease or mild Alzheimer disease dementia. Objective To describe the radiographic and clinical characteristics of ARIA that occurred in EMERGE and ENGAGE. Design, Setting, and Participants Secondary analysis of data from the EMERGE and ENGAGE trials, which were 2 double-blind, placebo-controlled, parallel-group, phase 3 randomized clinical trials that compared low-dose and high-dose aducanumab treatment with placebo among participants at 348 sites across 20 countries. Enrollment occurred from August 2015 to July 2018, and the trials were terminated early (March 21, 2019) based on a futility analysis. The combined studies consisted of a total of 3285 participants with Alzheimer disease who received 1 or more doses of placebo (n = 1087) or aducanumab (n = 2198; 2752 total person-years of exposure) during the placebo-controlled period. Primary data analyses were performed from November 2019 to July 2020, with additional analyses performed through July 2021. Interventions Participants were randomly assigned 1:1:1 to high-dose or low-dose intravenous aducanumab or placebo once every 4 weeks. Dose titration was used as a risk-minimization strategy. Main Outcomes and Measures Brain magnetic resonance imaging was used to monitor patients for ARIA; associated symptoms were reported as adverse events. Results Of 3285 included participants, the mean (SD) age was 70.4 (7.45) years; 1706 participants (52%) were female, 2661 (81%) had mild cognitive impairment due to Alzheimer disease, and 1777 (54%) used symptomatic medications for Alzheimer disease. A total of 764 participants from EMERGE and 709 participants from ENGAGE were categorized as withdrawn before study completion, most often owing to early termination of the study by the sponsor. Unless otherwise specified, all results represent analyses from the 10-mg/kg group. During the placebo-controlled period, 425 of 1029 patients (41.3%) experienced ARIA, with serious cases occurring in 14 patients (1.4%). ARIA-edema (ARIA-E) was the most common adverse event (362 of 1029 [35.2%]), and 263 initial events (72.7%) occurred within the first 8 doses of aducanumab; 94 participants (26.0%) with an event exhibited symptoms. Common associated symptoms among 103 patients with symptomatic ARIA-E or ARIA-H were headache (48 [46.6%]), confusion (15 [14.6%]), dizziness (11 [10.7%]), and nausea (8 [7.8%]). Incidence of ARIA-E was highest in aducanumab-treated participants who were apolipoprotein E ε4 allele carriers. Most events (479 of 488 [98.2%]) among those with ARIA-E resolved radiographically; 404 of 488 (82.8%) resolved within 16 weeks. In the placebo group, 29 of 1076 participants (2.7%) had ARIA-E (apolipoprotein E ε4 carriers: 16 of 742 [2.2%]; noncarriers, 13 of 334 [3.9%]). ARIA-microhemorrhage and ARIA–superficial siderosis occurred in 197 participants (19.1%) and 151 participants (14.7%), respectively. Conclusions and Relevance In this integrated safety data set from EMERGE and ENGAGE, the most common adverse event in the 10-mg/kg group was ARIA-E, which occurred in 362 of the 1029 patients (35.2%) in the 10-mg/kg group with at least 1 postbaseline MRI scan, with 94 patients (26.0%) experiencing associated symptoms. The most common associated symptom was headache. Trial Registrations ClinicalTrials.gov Identifiers: NCT02484547, NCT02477800
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Affiliation(s)
- Stephen Salloway
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | | | - Frederik Barkhof
- Institutes of Healthcare Engineering and Neurology, University College London, London, United Kingdom.,Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | | | - Jerome Barakos
- California Pacific Medical Center, San Francisco.,Bioclinica, Newark, California
| | - Derk Purcell
- California Pacific Medical Center, San Francisco.,Bioclinica, Newark, California
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10
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Nimmo JT, Kelly L, Verma A, Carare RO, Nicoll JAR, Dodart JC. Amyloid-β and α-Synuclein Immunotherapy: From Experimental Studies to Clinical Trials. Front Neurosci 2021; 15:733857. [PMID: 34539340 PMCID: PMC8441015 DOI: 10.3389/fnins.2021.733857] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/13/2021] [Indexed: 11/28/2022] Open
Abstract
Alzheimer’s disease and Lewy body diseases are the most common causes of neurodegeneration and dementia. Amyloid-beta (Aβ) and alpha-synuclein (αSyn) are two key proteins involved in the pathogenesis of these neurodegenerative diseases. Immunotherapy aims to reduce the harmful effects of protein accumulation by neutralising toxic species and facilitating their removal. The results of the first immunisation trial against Aβ led to a small percentage of meningoencephalitis cases which revolutionised vaccine design, causing a shift in the field of immunotherapy from active to passive immunisation. While the vast majority of immunotherapies have been developed for Aβ and tested in Alzheimer’s disease, the field has progressed to targeting other proteins including αSyn. Despite showing some remarkable results in animal models, immunotherapies have largely failed final stages of clinical trials to date, with the exception of Aducanumab recently licenced in the US by the FDA. Neuropathological findings translate quite effectively from animal models to human trials, however, cognitive and functional outcome measures do not. The apparent lack of translation of experimental studies to clinical trials suggests that we are not obtaining a full representation of the effects of immunotherapies from animal studies. Here we provide a background understanding to the key concepts and challenges involved in therapeutic design. This review further provides a comprehensive comparison between experimental and clinical studies in Aβ and αSyn immunotherapy and aims to determine the possible reasons for the disconnection in their outcomes.
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Affiliation(s)
- Jacqui Taryn Nimmo
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Louise Kelly
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Ajay Verma
- Yumanity Therapeutics, Boston, MA, United States
| | - Roxana O Carare
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - James A R Nicoll
- Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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11
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Chee SEJ, Solito E. The Impact of Ageing on the CNS Immune Response in Alzheimer's Disease. Front Immunol 2021; 12:738511. [PMID: 34603320 PMCID: PMC8484764 DOI: 10.3389/fimmu.2021.738511] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/01/2021] [Indexed: 12/25/2022] Open
Abstract
Alzheimer's Disease (AD) is a progressive neurodegenerative disease strongly associated with increasing age. Neuroinflammation and the accumulation of amyloid protein are amongst the hallmarks of this disease and most translational research to date has focused on targeting these two processes. However, the exact etiology of AD remains to be fully elucidated. When compared alongside, the immune response in AD closely resembles the central nervous system (CNS) immune changes seen in elderly individuals. It is possible that AD is a pathological consequence of an aged immune system secondary to chronic stimulation by a previous or ongoing insult. Pathological changes like amyloid accumulation and neuronal cell death may reflect this process of immunosenescence as the CNS immune system fails to maintain homeostasis in the CNS. It is likely that future treatments designed to modulate the aged immune system may prove beneficial in altering the disease course. The development of new tests for appropriate biomarkers would also be essential in screening for patients most likely to benefit from such treatments.
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Affiliation(s)
- Stephan En Jie Chee
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Egle Solito
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Federico II University, Naples, Italy
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12
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Szu JI, Obenaus A. Cerebrovascular phenotypes in mouse models of Alzheimer's disease. J Cereb Blood Flow Metab 2021; 41:1821-1841. [PMID: 33557692 PMCID: PMC8327123 DOI: 10.1177/0271678x21992462] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/16/2020] [Accepted: 01/06/2021] [Indexed: 12/12/2022]
Abstract
Alzheimer's disease (AD) is a devastating neurological degenerative disorder and is the most common cause of dementia in the elderly. Clinically, AD manifests with memory and cognitive decline associated with deposition of hallmark amyloid beta (Aβ) plaques and neurofibrillary tangles (NFTs). Although the mechanisms underlying AD remains unclear, two hypotheses have been proposed. The established amyloid hypothesis states that Aβ accumulation is the basis of AD and leads to formation of NFTs. In contrast, the two-hit vascular hypothesis suggests that early vascular damage leads to increased accumulation of Aβ deposits in the brain. Multiple studies have reported significant morphological changes of the cerebrovasculature which can result in severe functional deficits. In this review, we delve into known structural and functional vascular alterations in various mouse models of AD and the cellular and molecular constituents that influence these changes to further disease progression. Many studies shed light on the direct impact of Aβ on the cerebrovasculature and how it is disrupted during the progression of AD. However, more research directed towards an improved understanding of how the cerebrovasculature is modified over the time course of AD is needed prior to developing future interventional strategies.
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Affiliation(s)
- Jenny I Szu
- Institute for Memory Impairments and Neurological Disorders, University of California Irvine, Irvine, CA, USA
| | - André Obenaus
- Department of Pediatrics, University of California Irvine, Irvine, CA, USA
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13
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Janssens J, Hermans B, Vandermeeren M, Barale-Thomas E, Borgers M, Willems R, Meulders G, Wintmolders C, Van den Bulck D, Bottelbergs A, Ver Donck L, Larsen P, Moechars D, Edwards W, Mercken M, Van Broeck B. Passive immunotherapy with a novel antibody against 3pE-modified Aβ demonstrates potential for enhanced efficacy and favorable safety in combination with BACE inhibitor treatment in plaque-depositing mice. Neurobiol Dis 2021; 154:105365. [PMID: 33848635 DOI: 10.1016/j.nbd.2021.105365] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/07/2021] [Indexed: 12/16/2022] Open
Abstract
The imbalance between production and clearance of amyloid β (Aβ) peptides and their resulting accumulation in the brain is an early and crucial step in the pathogenesis of Alzheimer's disease (AD). Therefore, Aβ is strongly positioned as a promising and extensively validated therapeutic target for AD. Investigational disease-modifying approaches aiming at reducing cerebral Aβ concentrations include prevention of de novo production of Aβ through inhibition of β-site amyloid precursor protein cleaving enzyme 1 (BACE1), and clearance of Aβ deposits via passive Aβ immunotherapy. We have developed a novel, high affinity antibody against Aβ peptides bearing a pyroglutamate residue at amino acid position 3 (3pE), an Aβ species abundantly present in plaque deposits in AD brains. Here, we describe the preclinical characterization of this antibody, and demonstrate a significant reduction in amyloid burden in the absence of microhemorrhages in different mouse models with established plaque deposition. Moreover, we combined antibody treatment with chronic BACE1 inhibitor treatment and demonstrate significant clearance of pre-existing amyloid deposits in transgenic mouse brain, without induction of microhemorrhages and other histopathological findings. Together, these data confirm significant potential for the 3pE-specific antibody to be developed as a passive immunotherapy approach that balances efficacy and safety. Moreover, our studies suggest further enhanced treatment efficacy and favorable safety after combination of the 3pE-specific antibody with BACE1 inhibitor treatment.
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Affiliation(s)
- Jonathan Janssens
- Department of Neuroscience, Janssen Research & Development, A Division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - Bart Hermans
- Department of Neuroscience, Janssen Research & Development, A Division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - Marc Vandermeeren
- Department of Neuroscience, Janssen Research & Development, A Division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - Erio Barale-Thomas
- Non-Clinical Science, Janssen Research & Development, A Division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - Marianne Borgers
- Department of Neuroscience, Janssen Research & Development, A Division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - Roland Willems
- Department of Neuroscience, Janssen Research & Development, A Division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - Greet Meulders
- Department of Neuroscience, Janssen Research & Development, A Division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - Cindy Wintmolders
- Department of Neuroscience, Janssen Research & Development, A Division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - Dries Van den Bulck
- Department of Neuroscience, Janssen Research & Development, A Division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - Astrid Bottelbergs
- Department of Neuroscience, Janssen Research & Development, A Division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - Luc Ver Donck
- Department of Neuroscience, Janssen Research & Development, A Division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - Peter Larsen
- Department of Neuroscience, Janssen Research & Development, A Division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - Dieder Moechars
- Department of Neuroscience, Janssen Research & Development, A Division of Janssen Pharmaceutica NV, Beerse, Belgium
| | | | - Marc Mercken
- Department of Neuroscience, Janssen Research & Development, A Division of Janssen Pharmaceutica NV, Beerse, Belgium
| | - Bianca Van Broeck
- Department of Neuroscience, Janssen Research & Development, A Division of Janssen Pharmaceutica NV, Beerse, Belgium.
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14
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Desai AA, Smith MD, Zhang Y, Makowski EK, Gerson JE, Ionescu E, Starr CG, Zupancic JM, Moore SJ, Sutter AB, Ivanova MI, Murphy GG, Paulson HL, Tessier PM. Rational affinity maturation of anti-amyloid antibodies with high conformational and sequence specificity. J Biol Chem 2021; 296:100508. [PMID: 33675750 PMCID: PMC8081927 DOI: 10.1016/j.jbc.2021.100508] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 02/05/2021] [Accepted: 03/02/2021] [Indexed: 01/01/2023] Open
Abstract
The aggregation of amyloidogenic polypeptides is strongly linked to several neurodegenerative disorders, including Alzheimer's and Parkinson's diseases. Conformational antibodies that selectively recognize protein aggregates are leading therapeutic agents for selectively neutralizing toxic aggregates, diagnostic and imaging agents for detecting disease, and biomedical reagents for elucidating disease mechanisms. Despite their importance, it is challenging to generate high-quality conformational antibodies in a systematic and site-specific manner due to the properties of protein aggregates (hydrophobic, multivalent, and heterogeneous) and limitations of immunization (uncontrolled antigen presentation and immunodominant epitopes). Toward addressing these challenges, we have developed a systematic directed evolution procedure for affinity maturing antibodies against Alzheimer's Aβ fibrils and selecting variants with strict conformational and sequence specificity. We first designed a library based on a lead conformational antibody by sampling combinations of amino acids in the antigen-binding site predicted to mediate high antibody specificity. Next, we displayed this library on the surface of yeast, sorted it against Aβ42 aggregates, and identified promising clones using deep sequencing. The resulting antibodies displayed similar or higher affinities than clinical-stage Aβ antibodies (aducanumab and crenezumab). Moreover, the affinity-matured antibodies retained high conformational specificity for Aβ aggregates, as observed for aducanumab and unlike crenezumab. Notably, the affinity-maturated antibodies displayed extremely low levels of nonspecific interactions, as observed for crenezumab and unlike aducanumab. We expect that our systematic methods for generating antibodies with unique combinations of desirable properties will improve the generation of high-quality conformational antibodies specific for diverse types of aggregated conformers.
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Affiliation(s)
- Alec A Desai
- Department of Chemical Engineering, University of Michigan, Ann Arbor, Michigan, USA; Biointerfaces Institute, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew D Smith
- Department of Chemical Engineering, University of Michigan, Ann Arbor, Michigan, USA; Biointerfaces Institute, University of Michigan, Ann Arbor, Michigan, USA
| | - Yulei Zhang
- Department of Chemical Engineering, University of Michigan, Ann Arbor, Michigan, USA; Biointerfaces Institute, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily K Makowski
- Biointerfaces Institute, University of Michigan, Ann Arbor, Michigan, USA; Department of Pharmaceutical Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Julia E Gerson
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Edward Ionescu
- Department of Chemical Engineering, University of Michigan, Ann Arbor, Michigan, USA; Biointerfaces Institute, University of Michigan, Ann Arbor, Michigan, USA
| | - Charles G Starr
- Department of Chemical Engineering, University of Michigan, Ann Arbor, Michigan, USA; Biointerfaces Institute, University of Michigan, Ann Arbor, Michigan, USA; Department of Pharmaceutical Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Jennifer M Zupancic
- Department of Chemical Engineering, University of Michigan, Ann Arbor, Michigan, USA; Biointerfaces Institute, University of Michigan, Ann Arbor, Michigan, USA
| | - Shannon J Moore
- Protein Folding Disease Initiative, University of Michigan, Ann Arbor, Michigan, USA; Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Alexandra B Sutter
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA; Biophysics Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Magdalena I Ivanova
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA; Biophysics Program, University of Michigan, Ann Arbor, Michigan, USA
| | - Geoffrey G Murphy
- Protein Folding Disease Initiative, University of Michigan, Ann Arbor, Michigan, USA; Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Henry L Paulson
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA; Protein Folding Disease Initiative, University of Michigan, Ann Arbor, Michigan, USA; Michigan Alzheimer's Disease Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Peter M Tessier
- Department of Chemical Engineering, University of Michigan, Ann Arbor, Michigan, USA; Biointerfaces Institute, University of Michigan, Ann Arbor, Michigan, USA; Department of Pharmaceutical Sciences, University of Michigan, Ann Arbor, Michigan, USA; Protein Folding Disease Initiative, University of Michigan, Ann Arbor, Michigan, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, Michigan, USA.
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15
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Zuo Z, Qi F, Xing Z, Yuan L, Yang Y, He Z, Zhou L, Yao Z. Bacille Calmette-Guérin attenuates vascular amyloid pathology and maximizes synaptic preservation in APP/PS1 mice following active amyloid-β immunotherapy. Neurobiol Aging 2021; 101:94-108. [PMID: 33610062 DOI: 10.1016/j.neurobiolaging.2021.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/20/2020] [Accepted: 01/02/2021] [Indexed: 01/08/2023]
Abstract
Despite effective clearance of parenchymal amyloid-β (Aβ) in patients with Alzheimer's disease, Aβ immunotherapy exacerbates the vascular Aβ (VAβ)-associated pathology in the brain. We have previously shown that BCG immunization facilitates protective monocyte recruitment to the brain of APP/PS1 mice. Here, we confirmed that the 4Aβ1-15 vaccine exacerbates VAβ deposits in this model, which coincides with a decrease in the number of cerebrovascular endothelial cells and pericytes, infiltration of neutrophils into the brain, and induction of cerebral microhemorrhage. Moreover, combined 4Aβ1-15/BCG treatment abrogates the development of the VAβ-associated pathology. In addition, BCG treatment is required for the upregulation of interleukin-10 in the brain. Notably, BCG treatment selectively enhances Aβ phagocytosis by recruited macrophages. Furthermore, combined 4Aβ1-15/BCG treatment is more effective than 4Aβ1-15 monotherapy in synaptic preservation and the enhancement of the learning efficiency. Overall, our study suggests that the combination of Aβ-targeted therapy with an immunomodulatory strategy may improve the efficacy of Aβ vaccine in Alzheimer's disease.
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Affiliation(s)
- Zejie Zuo
- Department of Anatomy and Neurobiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Fangfang Qi
- Department of Anatomy and Neurobiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Zhiwei Xing
- Department of Anatomy and Neurobiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Lifang Yuan
- Department of Anatomy and Neurobiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yunjie Yang
- Department of Anatomy and Neurobiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Zitian He
- Department of Anatomy and Neurobiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Lihua Zhou
- Department of Anatomy and Neurobiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People's Republic of China; Department of Anatomy, The School of Medicine, Sun Yat-sen University, Shenzhen, People's Republic of China
| | - Zhibin Yao
- Department of Anatomy and Neurobiology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People's Republic of China; Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, People's Republic of China.
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16
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Greenberg SM, Bacskai BJ, Hernandez-Guillamon M, Pruzin J, Sperling R, van Veluw SJ. Cerebral amyloid angiopathy and Alzheimer disease - one peptide, two pathways. Nat Rev Neurol 2020; 16:30-42. [PMID: 31827267 PMCID: PMC7268202 DOI: 10.1038/s41582-019-0281-2] [Citation(s) in RCA: 421] [Impact Index Per Article: 105.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2019] [Indexed: 12/22/2022]
Abstract
The shared role of amyloid-β (Aβ) deposition in cerebral amyloid angiopathy (CAA) and Alzheimer disease (AD) is arguably the clearest instance of crosstalk between neurodegenerative and cerebrovascular processes. The pathogenic pathways of CAA and AD intersect at the levels of Aβ generation, its circulation within the interstitial fluid and perivascular drainage pathways and its brain clearance, but diverge in their mechanisms of brain injury and disease presentation. Here, we review the evidence for and the pathogenic implications of interactions between CAA and AD. Both pathologies seem to be driven by impaired Aβ clearance, creating conditions for a self-reinforcing cycle of increased vascular Aβ, reduced perivascular clearance and further CAA and AD progression. Despite the close relationship between vascular and plaque Aβ deposition, several factors favour one or the other, such as the carboxy-terminal site of the peptide and specific co-deposited proteins. Amyloid-related imaging abnormalities that have been seen in trials of anti-Aβ immunotherapy are another probable intersection between CAA and AD, representing overload of perivascular clearance pathways and the effects of removing Aβ from CAA-positive vessels. The intersections between CAA and AD point to a crucial role for improving vascular function in the treatment of both diseases and indicate the next steps necessary for identifying therapies.
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Affiliation(s)
- Steven M Greenberg
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Brian J Bacskai
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mar Hernandez-Guillamon
- Neurovascular Research Laboratory, Institut de Recerca, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jeremy Pruzin
- Center for Alzheimer Research and Treatment, Brigham & Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Reisa Sperling
- Center for Alzheimer Research and Treatment, Brigham & Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Susanne J van Veluw
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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17
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Brashear HR, Ketter N, Bogert J, Di J, Salloway SP, Sperling R. Clinical Evaluation of Amyloid-Related Imaging Abnormalities in Bapineuzumab Phase III Studies. J Alzheimers Dis 2018; 66:1409-1424. [DOI: 10.3233/jad-180675] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- H. Robert Brashear
- Janssen Alzheimer Immunotherapy Research & Development, LLC, South San Francisco, CA, USA
| | - Nzeera Ketter
- Janssen Alzheimer Immunotherapy Research & Development, LLC, South San Francisco, CA, USA
| | | | - Jianing Di
- Janssen Alzheimer Immunotherapy Research & Development, LLC, South San Francisco, CA, USA
| | - Stephen P. Salloway
- Brown Medical School, Butler Hospital, Blackstone Blvd., Providence, RI, USA
| | - Reisa Sperling
- Center for Alzheimer Research and Treatment, Brigham and Women’s Hospital, MA, USA; General Hospital, Harvard Medical School, Boston, MA, USA
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18
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Gustafsson S, Gustavsson T, Roshanbin S, Hultqvist G, Hammarlund-Udenaes M, Sehlin D, Syvänen S. Blood-brain barrier integrity in a mouse model of Alzheimer's disease with or without acute 3D6 immunotherapy. Neuropharmacology 2018; 143:1-9. [DOI: 10.1016/j.neuropharm.2018.09.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/27/2018] [Accepted: 09/01/2018] [Indexed: 12/13/2022]
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19
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Villarreal S, Zhao F, Hyde LA, Holder D, Forest T, Sondey M, Chen X, Sur C, Parker EM, Kennedy ME. Chronic Verubecestat Treatment Suppresses Amyloid Accumulation in Advanced Aged Tg2576-AβPPswe Mice Without Inducing Microhemorrhage. J Alzheimers Dis 2018; 59:1393-1413. [PMID: 28800329 PMCID: PMC5611839 DOI: 10.3233/jad-170056] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Verubecestat is a potent BACE1 enzyme inhibitor currently being investigated in Phase III trials for the treatment of mild-to-moderate and prodromal Alzheimer's disease. Multiple anti-amyloid immunotherapies have been dose-limited by adverse amyloid related imaging abnormalities such as vasogenic edema (ARIA-E) and microhemorrhage (ARIA-H) observed in human trials and mice. Verubecestat was tested in a 12-week nonclinical study for the potential to exacerbate microhemorrhage (ARIA-H) profiles in 18-22-month-old post-plaque Tg2576-AβPPswe mice. Animals were treated with verubecestat or controls including the anti-Aβ antibody analog of bapineuzumab (3D6) as a positive control for ARIA induction. ARIA-H was measured using in-life longitudinal T2*-MRI and Prussian blue histochemistry at study end. Verubecestat reduced plasma and cerebrospinal fluid Aβ40 and Aβ42 by >90% and 62% to 68%, respectively. The ARIA-H profile of verubecestat-treated mice was not significantly different than controls. Anti-Aβ treatment significantly increased ARIA-H detected by Prussian blue staining; however, anti-Aβ antibody treatment did not impact plaque status. Verubecestat treatment significantly suppressed the accumulation of total levels of brain Aβ40 and Aβ42 and Thioflavin S positive plaque load. Stereological analysis of cortex and hippocampus plaque load similarly revealed significantly reduced area of Aβ immunoreactivity and reduced plaque number in verubecestat-treated animals compared to controls. The absence of elevated ARIA events in verubecestat-treated mice was associated with a significant reduction in the level of accumulated CNS amyloid pathology and brain Aβ peptides; effects consistent with the desired therapeutic mechanism of verubecestat in AD patients. These data will be compared with longitudinal MRI profiles from ongoing clinical trials.
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Affiliation(s)
| | | | | | | | - Thomas Forest
- Safety Assessment and Laboratory Animal Research, MRL, West Point, PA, USA
| | | | - Xia Chen
- Pharmacology, MRL, Kenilworth, NJ, USA
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Ketter N, Brashear HR, Bogert J, Di J, Miaux Y, Gass A, Purcell DD, Barkhof F, Arrighi HM. Central Review of Amyloid-Related Imaging Abnormalities in Two Phase III Clinical Trials of Bapineuzumab in Mild-To-Moderate Alzheimer's Disease Patients. J Alzheimers Dis 2018; 57:557-573. [PMID: 28269765 DOI: 10.3233/jad-160216] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Amyloid-related imaging abnormalities (ARIA) consist of ARIA-E (with effusion or edema) and ARIA-H (hemosiderin deposits [HDs]). OBJECTIVES To address accurate ascertainment of ARIA identification, a final magnetic resonance imaging (MRI) reading was performed on patients with mild-to-moderate Alzheimer's disease randomized to bapineuzumab IV or placebo during two Phase III trials (APOE ɛ4 allele carriers or noncarriers). METHODS Final MRI central review consisted of a systematic sequential locked, adjudicated read in 1,331 APOE ɛ4 noncarriers and 1,121 carriers by independent neuroradiologists. Assessment of ARIA-E, ARIA-H, intracerebral hemorrhages, and age-related white matter changes is described. RESULTS In the Final Read, treatment-emergent ARIA-E were identified in 242 patients including 76 additional cases not noted previously in real time. Overall, incidence proportion of ARIA-E was higher in carriers (active 21.2%; placebo 1.1%) than in noncarriers (pooled active 11.3%; placebo 0.6%), and was more often identified in homozygote APOE ɛ4 carriers than heterozygotes (34.5% versus 16.9%). Incidence rate of ARIA-E increased with increased dose in noncarriers. Frequency of ARIA-E first episodes was highest after the first and second bapineuzumab infusion and declined after repeated infusions. Incidence of total HDs <10 mm (cerebral microhemorrhages) was higher in active groups versus placebo. CONCLUSION ARIA was detected more often on MRI scans when every scan was reviewed by trained neuroradiologists and results adjudicated. There was increased incidence of ARIA-E in bapineuzumab-treated carriers who had a microhemorrhage at baseline. ARIA-E was a risk factor for incident ARIA-H and late onset ARIA-E was milder radiologically. Age-related white matter changes did not progress during the study.
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Affiliation(s)
- Nzeera Ketter
- Janssen Alzheimer Immunotherapy Research and Development, LLC, South San Francisco, CA, USA
| | - H Robert Brashear
- Janssen Alzheimer Immunotherapy Research and Development, LLC, South San Francisco, CA, USA
| | | | - Jianing Di
- Janssen Alzheimer Immunotherapy Research and Development, LLC, South San Francisco, CA, USA
| | - Yves Miaux
- BioClinica Inc. (formerly Synarc), Newtown, PA, USA
| | - Achim Gass
- BioClinica Inc. (formerly Synarc), Newtown, PA, USA
| | | | - Frederik Barkhof
- Department of Radiology, VU University Medical Center, Amsterdam, Netherlands
| | - H Michael Arrighi
- Janssen Alzheimer Immunotherapy Research and Development, LLC, South San Francisco, CA, USA
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21
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Hirt L, Price M, Benakis C, Badaut J. Aquaporins in neurological disorders. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2018. [DOI: 10.1177/2514183x17752902] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Lorenz Hirt
- Neurology service, department of clinical neurosciences, CHUV, Lausanne, Switzerland
- Centre de recherche en neurosciences (CRN), CHUV, Lausanne, Switzerland
| | - Melanie Price
- Neurology service, department of clinical neurosciences, CHUV, Lausanne, Switzerland
- Centre de recherche en neurosciences (CRN), CHUV, Lausanne, Switzerland
| | - Corinne Benakis
- Institute for Stroke and Dementia Research (ISD), Munich, Germany
| | - Jérôme Badaut
- CNRS UMR 5287, INCIA, University of Bordeaux, Bordeaux, France
- Department of Basic science, Loma Linda University, Loma Linda, CA, USA
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22
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Liu E, Wang D, Sperling R, Salloway S, Fox NC, Blennow K, Scheltens P, Schmidt ME, Streffer J, Novak G, Einstein S, Booth K, Ketter N, Brashear HR. Biomarker pattern of ARIA-E participants in phase 3 randomized clinical trials with bapineuzumab. Neurology 2018; 90:e877-e886. [PMID: 29429971 DOI: 10.1212/wnl.0000000000005060] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 11/21/2017] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To evaluate whether amyloid-related imaging abnormalities with edema/effusion (ARIA-E) observed in bapineuzumab clinical trials was associated with specific biomarker patterns. METHODS Bapineuzumab, an anti-β-amyloid monoclonal antibody, was evaluated in patients with mild to moderate Alzheimer disease. Amyloid PET imaging, CSF biomarkers, or volumetric MRI (vMRI) were assessed. RESULTS A total of 1,512 participants underwent one or more biomarker assessments; 154 developed incident ARIA-E. No differences were observed at baseline between ARIA-E and non-ARIA-E participants in brain amyloid burden by PET, the majority of vMRI measures, or CSF biomarkers, with the exception of lower baseline CSF Aβ42 in APOE ε4 noncarrier ARIA-E vs non-ARIA-E groups (bapineuzumab non-ARIA-E p = 0.027; placebo non-ARIA-E p = 0.012). At week 71, bapineuzumab-treated participants with ARIA-E vs non-ARIA-E showed greater reduction in brain amyloid PET, greater reductions in CSF phosphorylated tau (p-tau) (all comparisons p < 0.01), and total tau (t-tau) (all comparisons p < 0.025), and greater hippocampal volume reduction and ventricular enlargement (all p < 0.05). Greater reduction in CSF Aβ40 concentrations was observed for ARIA-E versus both non-ARIA-E groups (bapineuzumab/placebo non-ARIA-E p = 0.015/0.049). No group differences were observed at week 71 for changes in whole brain volume or CSF Aβ42. CONCLUSIONS Baseline biomarkers largely do not predict risk for developing ARIA-E. ARIA-E was associated with significant longitudinal changes in several biomarkers, with larger reductions in amyloid PET and CSF p-tau and t-tau concentrations, and paradoxically greater hippocampal volume reduction and ventricular enlargement, suggesting that ARIA-E in bapineuzumab-treated cases may be related to increased Aβ efflux from the brain and affecting downstream pathogenic processes.
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Affiliation(s)
- Enchi Liu
- From Janssen Research & Development, LLC (E.L.), La Jolla, CA; Janssen Research & Development, LLC (D.W., G.N., S.E.), Titusville, NJ; Brigham and Women's Hospital (R.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Brown University (S.S.), Providence, RI; UCL Institute of Neurology (N.C.F.), London, UK; Clinical Neurochemistry Lab, Department of Neuroscience and Physiology (K.B.), The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden; VUMC (P.S.), Amsterdam, the Netherlands; Janssen Pharmaceuticals (M.E.S., J.S.), NV, Beerse, Belgium; Reference Center for Biological Markers of Dementia (BIODEM) (J.S.), Institute Born-Bunge, University of Antwerp, Belgium; Pfizer, Inc. (K.B.), Collegeville, PA; and Janssen Research & Development, LLC (N.K., H.R.B.), Fremont, CA.
| | - Dai Wang
- From Janssen Research & Development, LLC (E.L.), La Jolla, CA; Janssen Research & Development, LLC (D.W., G.N., S.E.), Titusville, NJ; Brigham and Women's Hospital (R.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Brown University (S.S.), Providence, RI; UCL Institute of Neurology (N.C.F.), London, UK; Clinical Neurochemistry Lab, Department of Neuroscience and Physiology (K.B.), The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden; VUMC (P.S.), Amsterdam, the Netherlands; Janssen Pharmaceuticals (M.E.S., J.S.), NV, Beerse, Belgium; Reference Center for Biological Markers of Dementia (BIODEM) (J.S.), Institute Born-Bunge, University of Antwerp, Belgium; Pfizer, Inc. (K.B.), Collegeville, PA; and Janssen Research & Development, LLC (N.K., H.R.B.), Fremont, CA
| | - Reisa Sperling
- From Janssen Research & Development, LLC (E.L.), La Jolla, CA; Janssen Research & Development, LLC (D.W., G.N., S.E.), Titusville, NJ; Brigham and Women's Hospital (R.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Brown University (S.S.), Providence, RI; UCL Institute of Neurology (N.C.F.), London, UK; Clinical Neurochemistry Lab, Department of Neuroscience and Physiology (K.B.), The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden; VUMC (P.S.), Amsterdam, the Netherlands; Janssen Pharmaceuticals (M.E.S., J.S.), NV, Beerse, Belgium; Reference Center for Biological Markers of Dementia (BIODEM) (J.S.), Institute Born-Bunge, University of Antwerp, Belgium; Pfizer, Inc. (K.B.), Collegeville, PA; and Janssen Research & Development, LLC (N.K., H.R.B.), Fremont, CA
| | - Stephen Salloway
- From Janssen Research & Development, LLC (E.L.), La Jolla, CA; Janssen Research & Development, LLC (D.W., G.N., S.E.), Titusville, NJ; Brigham and Women's Hospital (R.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Brown University (S.S.), Providence, RI; UCL Institute of Neurology (N.C.F.), London, UK; Clinical Neurochemistry Lab, Department of Neuroscience and Physiology (K.B.), The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden; VUMC (P.S.), Amsterdam, the Netherlands; Janssen Pharmaceuticals (M.E.S., J.S.), NV, Beerse, Belgium; Reference Center for Biological Markers of Dementia (BIODEM) (J.S.), Institute Born-Bunge, University of Antwerp, Belgium; Pfizer, Inc. (K.B.), Collegeville, PA; and Janssen Research & Development, LLC (N.K., H.R.B.), Fremont, CA
| | - Nick C Fox
- From Janssen Research & Development, LLC (E.L.), La Jolla, CA; Janssen Research & Development, LLC (D.W., G.N., S.E.), Titusville, NJ; Brigham and Women's Hospital (R.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Brown University (S.S.), Providence, RI; UCL Institute of Neurology (N.C.F.), London, UK; Clinical Neurochemistry Lab, Department of Neuroscience and Physiology (K.B.), The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden; VUMC (P.S.), Amsterdam, the Netherlands; Janssen Pharmaceuticals (M.E.S., J.S.), NV, Beerse, Belgium; Reference Center for Biological Markers of Dementia (BIODEM) (J.S.), Institute Born-Bunge, University of Antwerp, Belgium; Pfizer, Inc. (K.B.), Collegeville, PA; and Janssen Research & Development, LLC (N.K., H.R.B.), Fremont, CA
| | - Kaj Blennow
- From Janssen Research & Development, LLC (E.L.), La Jolla, CA; Janssen Research & Development, LLC (D.W., G.N., S.E.), Titusville, NJ; Brigham and Women's Hospital (R.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Brown University (S.S.), Providence, RI; UCL Institute of Neurology (N.C.F.), London, UK; Clinical Neurochemistry Lab, Department of Neuroscience and Physiology (K.B.), The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden; VUMC (P.S.), Amsterdam, the Netherlands; Janssen Pharmaceuticals (M.E.S., J.S.), NV, Beerse, Belgium; Reference Center for Biological Markers of Dementia (BIODEM) (J.S.), Institute Born-Bunge, University of Antwerp, Belgium; Pfizer, Inc. (K.B.), Collegeville, PA; and Janssen Research & Development, LLC (N.K., H.R.B.), Fremont, CA
| | - Philip Scheltens
- From Janssen Research & Development, LLC (E.L.), La Jolla, CA; Janssen Research & Development, LLC (D.W., G.N., S.E.), Titusville, NJ; Brigham and Women's Hospital (R.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Brown University (S.S.), Providence, RI; UCL Institute of Neurology (N.C.F.), London, UK; Clinical Neurochemistry Lab, Department of Neuroscience and Physiology (K.B.), The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden; VUMC (P.S.), Amsterdam, the Netherlands; Janssen Pharmaceuticals (M.E.S., J.S.), NV, Beerse, Belgium; Reference Center for Biological Markers of Dementia (BIODEM) (J.S.), Institute Born-Bunge, University of Antwerp, Belgium; Pfizer, Inc. (K.B.), Collegeville, PA; and Janssen Research & Development, LLC (N.K., H.R.B.), Fremont, CA
| | - Mark E Schmidt
- From Janssen Research & Development, LLC (E.L.), La Jolla, CA; Janssen Research & Development, LLC (D.W., G.N., S.E.), Titusville, NJ; Brigham and Women's Hospital (R.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Brown University (S.S.), Providence, RI; UCL Institute of Neurology (N.C.F.), London, UK; Clinical Neurochemistry Lab, Department of Neuroscience and Physiology (K.B.), The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden; VUMC (P.S.), Amsterdam, the Netherlands; Janssen Pharmaceuticals (M.E.S., J.S.), NV, Beerse, Belgium; Reference Center for Biological Markers of Dementia (BIODEM) (J.S.), Institute Born-Bunge, University of Antwerp, Belgium; Pfizer, Inc. (K.B.), Collegeville, PA; and Janssen Research & Development, LLC (N.K., H.R.B.), Fremont, CA
| | - Johannes Streffer
- From Janssen Research & Development, LLC (E.L.), La Jolla, CA; Janssen Research & Development, LLC (D.W., G.N., S.E.), Titusville, NJ; Brigham and Women's Hospital (R.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Brown University (S.S.), Providence, RI; UCL Institute of Neurology (N.C.F.), London, UK; Clinical Neurochemistry Lab, Department of Neuroscience and Physiology (K.B.), The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden; VUMC (P.S.), Amsterdam, the Netherlands; Janssen Pharmaceuticals (M.E.S., J.S.), NV, Beerse, Belgium; Reference Center for Biological Markers of Dementia (BIODEM) (J.S.), Institute Born-Bunge, University of Antwerp, Belgium; Pfizer, Inc. (K.B.), Collegeville, PA; and Janssen Research & Development, LLC (N.K., H.R.B.), Fremont, CA
| | - Gerald Novak
- From Janssen Research & Development, LLC (E.L.), La Jolla, CA; Janssen Research & Development, LLC (D.W., G.N., S.E.), Titusville, NJ; Brigham and Women's Hospital (R.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Brown University (S.S.), Providence, RI; UCL Institute of Neurology (N.C.F.), London, UK; Clinical Neurochemistry Lab, Department of Neuroscience and Physiology (K.B.), The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden; VUMC (P.S.), Amsterdam, the Netherlands; Janssen Pharmaceuticals (M.E.S., J.S.), NV, Beerse, Belgium; Reference Center for Biological Markers of Dementia (BIODEM) (J.S.), Institute Born-Bunge, University of Antwerp, Belgium; Pfizer, Inc. (K.B.), Collegeville, PA; and Janssen Research & Development, LLC (N.K., H.R.B.), Fremont, CA
| | - Steve Einstein
- From Janssen Research & Development, LLC (E.L.), La Jolla, CA; Janssen Research & Development, LLC (D.W., G.N., S.E.), Titusville, NJ; Brigham and Women's Hospital (R.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Brown University (S.S.), Providence, RI; UCL Institute of Neurology (N.C.F.), London, UK; Clinical Neurochemistry Lab, Department of Neuroscience and Physiology (K.B.), The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden; VUMC (P.S.), Amsterdam, the Netherlands; Janssen Pharmaceuticals (M.E.S., J.S.), NV, Beerse, Belgium; Reference Center for Biological Markers of Dementia (BIODEM) (J.S.), Institute Born-Bunge, University of Antwerp, Belgium; Pfizer, Inc. (K.B.), Collegeville, PA; and Janssen Research & Development, LLC (N.K., H.R.B.), Fremont, CA
| | - Kevin Booth
- From Janssen Research & Development, LLC (E.L.), La Jolla, CA; Janssen Research & Development, LLC (D.W., G.N., S.E.), Titusville, NJ; Brigham and Women's Hospital (R.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Brown University (S.S.), Providence, RI; UCL Institute of Neurology (N.C.F.), London, UK; Clinical Neurochemistry Lab, Department of Neuroscience and Physiology (K.B.), The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden; VUMC (P.S.), Amsterdam, the Netherlands; Janssen Pharmaceuticals (M.E.S., J.S.), NV, Beerse, Belgium; Reference Center for Biological Markers of Dementia (BIODEM) (J.S.), Institute Born-Bunge, University of Antwerp, Belgium; Pfizer, Inc. (K.B.), Collegeville, PA; and Janssen Research & Development, LLC (N.K., H.R.B.), Fremont, CA
| | - Nzeera Ketter
- From Janssen Research & Development, LLC (E.L.), La Jolla, CA; Janssen Research & Development, LLC (D.W., G.N., S.E.), Titusville, NJ; Brigham and Women's Hospital (R.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Brown University (S.S.), Providence, RI; UCL Institute of Neurology (N.C.F.), London, UK; Clinical Neurochemistry Lab, Department of Neuroscience and Physiology (K.B.), The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden; VUMC (P.S.), Amsterdam, the Netherlands; Janssen Pharmaceuticals (M.E.S., J.S.), NV, Beerse, Belgium; Reference Center for Biological Markers of Dementia (BIODEM) (J.S.), Institute Born-Bunge, University of Antwerp, Belgium; Pfizer, Inc. (K.B.), Collegeville, PA; and Janssen Research & Development, LLC (N.K., H.R.B.), Fremont, CA
| | - H Robert Brashear
- From Janssen Research & Development, LLC (E.L.), La Jolla, CA; Janssen Research & Development, LLC (D.W., G.N., S.E.), Titusville, NJ; Brigham and Women's Hospital (R.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Brown University (S.S.), Providence, RI; UCL Institute of Neurology (N.C.F.), London, UK; Clinical Neurochemistry Lab, Department of Neuroscience and Physiology (K.B.), The Sahlgrenska Academy at University of Gothenburg, Mölndal, Sweden; VUMC (P.S.), Amsterdam, the Netherlands; Janssen Pharmaceuticals (M.E.S., J.S.), NV, Beerse, Belgium; Reference Center for Biological Markers of Dementia (BIODEM) (J.S.), Institute Born-Bunge, University of Antwerp, Belgium; Pfizer, Inc. (K.B.), Collegeville, PA; and Janssen Research & Development, LLC (N.K., H.R.B.), Fremont, CA
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Blockx I, Einstein S, Guns PJ, Van Audekerke J, Guglielmetti C, Zago W, Roose D, Verhoye M, Van der Linden A, Bard F. Monitoring Blood-Brain Barrier Integrity Following Amyloid-β Immunotherapy Using Gadolinium-Enhanced MRI in a PDAPP Mouse Model. J Alzheimers Dis 2018; 54:723-35. [PMID: 27567811 DOI: 10.3233/jad-160023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Amyloid-related imaging abnormalities (ARIA) have been reported with some anti-amyloid-β (Aβ) immunotherapy trials. They are detected with magnetic resonance imaging (MRI) and thought to represent transient accumulation of fluid/edema (ARIA-E) or microhemorrhages (ARIA-H). Although the clinical significance and pathophysiology are unknown, it has been proposed that anti-Aβimmunotherapy may affect blood-brain barrier (BBB) integrity. OBJECTIVE To examine vascular integrity in aged (12-16 months) PDAPP and wild type mice (WT), we performed a series of longitudinal in vivo MRI studies. METHODS Mice were treated on a weekly basis using anti-Aβimmunotherapy (3D6) and follow up was done longitudinally from 1-12 weeks after treatment. BBB-integrity was assessed using both visual assessment of T1-weighted scans and repeated T1 mapping in combination with gadolinium (Gd-DOTA). RESULTS A subset of 3D6 treated PDAPP mice displayed numerous BBB disruptions, whereas WT and saline-treated PDAPP mice showed intact BBB integrity under the conditions tested. In addition, the contrast induced decrease in T1 value was observed in the meningeal and midline area. BBB disruption events occurred early during treatment (between 1 and 5 weeks), were transient, and resolved quickly. Finally, BBB-leakages associated with microhemorrhages were confirmed by Perls'Prussian blue histopathological analysis. CONCLUSION Our preclinical findings support the hypothesis that 3D6 leads to transient leakage from amyloid-positive vessels. The current study has provided valuable insights on the time course of vascular alterations during immunization treatment and supports further research in relation to the nature of ARIA and the utility of in vivo repeated T1 MRI as a translational tool.
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Affiliation(s)
- Ines Blockx
- Bio-Imaging Lab, University of Antwerp, Antwerp, Belgium
| | | | - Pieter-Jan Guns
- Bio-Imaging Lab, University of Antwerp, Antwerp, Belgium.,Expert Group Antwerp Molecular Imaging (EGAMI), University of Antwerp, Antwerp, Belgium
| | | | | | - Wagner Zago
- Prothena Biosciences Inc, South San Francisco, CA, USA
| | - Dimitri Roose
- Bio-Imaging Lab, University of Antwerp, Antwerp, Belgium
| | | | | | - Frederique Bard
- Janssen Prevention Center, Janssen Pharmaceutical Companies of Johnson & Johnson, San Diego, CA, USA
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Mo J, Li J, Yang Z, Liu Z, Feng J. Efficacy and safety of anti-amyloid- β immunotherapy for Alzheimer's disease: a systematic review and network meta-analysis. Ann Clin Transl Neurol 2017; 4:931-942. [PMID: 29296624 PMCID: PMC5740249 DOI: 10.1002/acn3.469] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/18/2017] [Accepted: 08/22/2017] [Indexed: 01/14/2023] Open
Abstract
To review the optimality and safety of different anti-Amyloid-β(Aβ) immunotherapies for Alzheimer's disease (AD). Published randomized controlled trials were comprehensively reviewed from electronic databases (Cochrane library, Embase, Pubmed, and Google scholar). Pooled outcomes as mean difference or odds ratio values with 95% confidence interval were reported. The network estimates with confidence and predictive intervals for all pairwise relative effects was evaluated. Optimal intervention was ranked by benefit-risk ratio based on the surface under the cumulative ranking curve. Eleven eligible RCTs from 9 literatures, including 5141 patients and 5 interventions were included. The quality of evidence was rated low in comparisons. For efficacy, in terms of Mini-Mental State Examination, aducanumab and solanezumab are significantly effective than placebo. For safety, in terms of Amyloid-Related Imaging Abnormalities (ARIA), bapineuzumab and aducanumab are significantly worse than placebo. There were no significant differences in outcomes of Alzheimer's disease Assessment Scale-Cognitive subscale, Disability Assessment for Dementia, Adverse Events, and mortality. Given the clinical therapeutic effects of anti-Aβ immunotherapies for AD, aducanumab and solanezumab improve the cognitive function, while aducanumab and bapineuzumab may increase the risks of ARIA.
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Affiliation(s)
- Jia‐Jie Mo
- Department of Functional NeurosurgeryBeijing Tiantan HospitalCapital Medical UniversityBeijing100061China
| | - Jin‐yu Li
- Department of General Surgerythe Second Xiangya HospitalCentral South UniversityChangsha410011China
| | - Zheng Yang
- Department of PsychologyGuangdong Medical UniversityZhanjiang524023China
| | - Zhou Liu
- Department of NeurologyAffiliated Hospital of Guangdong Medical UniversityZhanjiang524023China
| | - Jin‐Shan Feng
- Scientific Research Center (Campus Zhanjiang)Guangdong Medical UniversityZhanjiang524023China
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Pardridge WM. Delivery of Biologics Across the Blood–Brain Barrier with Molecular Trojan Horse Technology. BioDrugs 2017; 31:503-519. [DOI: 10.1007/s40259-017-0248-z] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Morgan SJ, Couch J, Guzzie-Peck P, Keller DA, Kemper R, Otieno MA, Schulingkamp RJ, Jones TW. Regulatory Forum Opinion Piece *: Use and Utility of Animal Models of Disease for Nonclinical Safety Assessment: A Pharmaceutical Industry Survey. Toxicol Pathol 2017; 45:372-380. [PMID: 28351296 DOI: 10.1177/0192623317701004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
An Innovation and Quality (IQ) Consortium focus group conducted a cross-company survey to evaluate current practices and perceptions around the use of animal models of disease (AMDs) in nonclinical safety assessment of molecules in clinical development. The IQ Consortium group is an organization of pharmaceutical and biotechnology companies with the mission of advancing science and technology. The survey queried the utilization of AMDs during drug discovery in which drug candidates are evaluated in efficacy models and limited short-duration non-Good Laboratory Practices (GLP) toxicology testing and during drug development in which drug candidates are evaluated in GLP toxicology studies. The survey determined that the majority of companies used AMDs during drug discovery primarily as a means for proactively assessing potential nonclinical safety issues prior to the conduct of toxicology studies, followed closely by the use of AMDs to better understand toxicities associated with exaggerated pharmacology in traditional toxicology models or to derisk issues when the target is only expressed in the disease state. In contrast, the survey results indicated that the use of AMDs in development is infrequent, being used primarily to investigate nonclinical safety issues associated with targets expressed only in disease states and/or in response to requests from global regulatory authorities.
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Affiliation(s)
- Sherry J Morgan
- 1 AbbVie, Inc., Preclinical Safety, North Chicago, Illinois, USA
| | - Jessica Couch
- 2 Genentech, Inc., Department of Safety Assessment, South San Francisco, California, USA
| | - Peggy Guzzie-Peck
- 3 Janssen Research and Development, Preclinical Development and Safety, Spring House, Pennsylvania, USA
| | | | - Ray Kemper
- 5 Vertex Pharmaceuticals, Inc., Preclinical Safety Assessment, Boston, Massachusetts, USA
| | - Monicah A Otieno
- 3 Janssen Research and Development, Preclinical Development and Safety, Spring House, Pennsylvania, USA
| | | | - Thomas W Jones
- 7 Eli Lilly and Company, Toxicology and Pathology, Indianapolis, Indiana, USA
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Hubbard JA, Szu JI, Binder DK. The role of aquaporin-4 in synaptic plasticity, memory and disease. Brain Res Bull 2017; 136:118-129. [PMID: 28274814 DOI: 10.1016/j.brainresbull.2017.02.011] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/27/2017] [Accepted: 02/28/2017] [Indexed: 12/25/2022]
Abstract
Since the discovery of aquaporins, it has become clear that the various mammalian aquaporins play critical physiological roles in water and ion balance in multiple tissues. Aquaporin-4 (AQP4), the principal aquaporin expressed in the central nervous system (CNS, brain and spinal cord), has been shown to mediate CNS water homeostasis. In this review, we summarize new and exciting studies indicating that AQP4 also plays critical and unanticipated roles in synaptic plasticity and memory formation. Next, we consider the role of AQP4 in Alzheimer's disease (AD), amyotrophic lateral sclerosis (ALS), Parkinson's disease (PD), multiple sclerosis (MS), neuromyelitis optica (NMO), epilepsy, traumatic brain injury (TBI), and stroke. Each of these conditions involves changes in AQP4 expression and/or distribution that may be functionally relevant to disease physiology. Insofar as AQP4 is exclusively expressed on astrocytes, these data provide new evidence of "astrocytopathy" in the etiology of diverse neurological diseases.
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Affiliation(s)
- Jacqueline A Hubbard
- Center for Glial-Neuronal Interactions, Division of Biomedical Sciences, School of Medicine, University of California, Riverside, United States
| | - Jenny I Szu
- Center for Glial-Neuronal Interactions, Division of Biomedical Sciences, School of Medicine, University of California, Riverside, United States
| | - Devin K Binder
- Center for Glial-Neuronal Interactions, Division of Biomedical Sciences, School of Medicine, University of California, Riverside, United States.
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Pankiewicz JE, Baquero-Buitrago J, Sanchez S, Lopez-Contreras J, Kim J, Sullivan PM, Holtzman DM, Sadowski MJ. APOE Genotype Differentially Modulates Effects of Anti-Aβ, Passive Immunization in APP Transgenic Mice. Mol Neurodegener 2017; 12:12. [PMID: 28143566 PMCID: PMC5282859 DOI: 10.1186/s13024-017-0156-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 01/24/2017] [Indexed: 11/11/2022] Open
Abstract
Background APOE genotype is the foremost genetic factor modulating β-amyloid (Aβ) deposition and risk of sporadic Alzheimer’s disease (AD). Here we investigated how APOE genotype influences response to anti-Aβ immunotherapy. Methods APPSW/PS1dE9 (APP) transgenic mice with targeted replacement of the murine Apoe gene for human APOE alleles received 10D5 anti-Aβ or TY11-15 isotype control antibodies between the ages of 12 and 15 months. Results Anti-Aβ immunization decreased both the load of fibrillar plaques and the load of Aβ immunopositive plaques in mice of all APOE backgrounds. Although the relative reduction in parenchymal Aβ plaque load was comparable across all APOE genotypes, APP/ε4 mice showed the greatest reduction in the absolute Aβ plaque load values, given their highest baseline. The immunization stimulated phagocytic activation of microglia, which magnitude adjusted for the post-treatment plaque load was the greatest in APP/ε4 mice implying association between the ε4 allele and impaired Aβ phagocytosis. Perivascular hemosiderin deposits reflecting ensued microhemorrhages were associated with vascular Aβ (VAβ) and ubiquitously present in control mice of all APOE genotypes, although in APP/ε3 mice their incidence was the lowest. Anti-Aβ immunization significantly reduced VAβ burden but increased the number of hemosiderin deposits across all APOE genotypes with the strongest and the weakest effect in APP/ε2 and APP/ε3 mice, respectively. Conclusions Our studies indicate that APOE genotype differentially modulates microglia activation and Aβ plaque load reduction during anti-Aβ immunotherapy. The APOE ε3 allele shows strong protective effect against immunotherapy associated microhemorrhages; while, conversely, the APOE ε2 allele increases risk thereof. Electronic supplementary material The online version of this article (doi:10.1186/s13024-017-0156-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joanna E Pankiewicz
- Department of Neurology, New York University School of Medicine, New York, NY, 10016, USA.,Department of Biochemistry and Molecular Pharmacology, New York University School of Medicine, New York, NY, 10016, USA
| | - Jairo Baquero-Buitrago
- Department of Neurology, New York University School of Medicine, New York, NY, 10016, USA
| | - Sandrine Sanchez
- Department of Neurology, New York University School of Medicine, New York, NY, 10016, USA
| | | | - Jungsu Kim
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63110, USA.,Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, 63110, USA.,Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO, 63110, USA.,Department of Neuroscience, Mayo Clinic College of Medicine, Jacksonville, FL, 32224, USA
| | - Patrick M Sullivan
- Department of Medicine (Geriatrics), Duke University School of Medicine, Durham, NC, 27710, USA.,Durham VA Medical Center's Geriatric Research, Education, and Clinical Center, Durham, NC, 27710, USA
| | - David M Holtzman
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, 63110, USA.,Knight Alzheimer's Disease Research Center, Washington University School of Medicine, St. Louis, MO, 63110, USA.,Hope Center for Neurological Disorders, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Martin J Sadowski
- Department of Neurology, New York University School of Medicine, New York, NY, 10016, USA. .,Department of Biochemistry and Molecular Pharmacology, New York University School of Medicine, New York, NY, 10016, USA. .,Department of Psychiatry, New York University School of Medicine, New York, NY, 10016, USA.
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Sevigny J, Chiao P, Bussière T, Weinreb PH, Williams L, Maier M, Dunstan R, Salloway S, Chen T, Ling Y, O’Gorman J, Qian F, Arastu M, Li M, Chollate S, Brennan MS, Quintero-Monzon O, Scannevin RH, Arnold HM, Engber T, Rhodes K, Ferrero J, Hang Y, Mikulskis A, Grimm J, Hock C, Nitsch RM, Sandrock A. The antibody aducanumab reduces Aβ plaques in Alzheimer’s disease. Nature 2016; 537:50-6. [DOI: 10.1038/nature19323] [Citation(s) in RCA: 1608] [Impact Index Per Article: 201.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 07/21/2016] [Indexed: 12/11/2022]
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Abstract
Although the prevalence of dementia continues to increase worldwide, incidence in the western world might have decreased as a result of better vascular care and improved brain health. Alzheimer's disease, the most prevalent cause of dementia, is still defined by the combined presence of amyloid and tau, but researchers are gradually moving away from the simple assumption of linear causality as proposed in the original amyloid hypothesis. Age-related, protective, and disease-promoting factors probably interact with the core mechanisms of the disease. Amyloid β42, and tau proteins are established core cerebrospinal biomarkers; novel candidate biomarkers include amyloid β oligomers and synaptic markers. MRI and fluorodeoxyglucose PET are established imaging techniques for diagnosis of Alzheimer's disease. Amyloid PET is gaining traction in the clinical arena, but validity and cost-effectiveness remain to be established. Tau PET might offer new insights and be of great help in differential diagnosis and selection of patients for trials. In the search for understanding the disease mechanism and keys to treatment, research is moving increasingly into the earliest phase of disease. Preclinical Alzheimer's disease is defined as biomarker evidence of Alzheimer's pathological changes in cognitively healthy individuals. Patients with subjective cognitive decline have been identified as a useful population in whom to look for preclinical Alzheimer's disease. Moderately positive results for interventions targeting several lifestyle factors in non-demented elderly patients and moderately positive interim results for lowering amyloid in pre-dementia Alzheimer's disease suggest that, ultimately, there will be a future in which specific anti-Alzheimer's therapy will be combined with lifestyle interventions targeting general brain health to jointly combat the disease. In this Seminar, we discuss the main developments in Alzheimer's research.
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Affiliation(s)
- Philip Scheltens
- Department of Neurology & Alzheimer Center, VU University Medical Center, Amsterdam, Netherlands.
| | - Kaj Blennow
- Clinical Neurochemistry Lab, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Monique M B Breteler
- German Center for Neurodegenerative diseases (DZNE), and Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany
| | - Bart de Strooper
- VIB Center for the Biology of Disease, VIB-Leuven, Leuven, Belgium; KU Leuven Center for Human Genetics, LIND en Universitaire ziekenhuizen, Leuven, Belgium; Institute of Neurology, University College London, London, UK
| | - Giovanni B Frisoni
- University Hospitals and University of Geneva, Geneva, Switzerland; IRCCS Fatebenefratelli, Brescia, Italy
| | - Stephen Salloway
- Warren Alpert Medical School, Brown University, Providence, RI, USA
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31
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Jewells VL. Commentary on “Multimodality Review of Amyloid-related Diseases of the Central Nervous System”. Radiographics 2016; 36:1163-5. [DOI: 10.1148/rg.2016160093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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32
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Longitudinal noninvasive magnetic resonance imaging of brain microhemorrhages in BACE inhibitor-treated APP transgenic mice. Neurobiol Aging 2016; 45:50-60. [PMID: 27459925 DOI: 10.1016/j.neurobiolaging.2016.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/12/2016] [Accepted: 05/10/2016] [Indexed: 12/16/2022]
Abstract
Currently, several immunotherapies and BACE (Beta Site APP Cleaving Enzyme) inhibitor approaches are being tested in the clinic for the treatment of Alzheimer's disease. A crucial mechanism-related safety concern is the exacerbation of microhemorrhages, which are already present in the majority of Alzheimer patients. To investigate potential safety liabilities of long-term BACE inhibitor therapy, we used aged amyloid precursor protein (APP) transgenic mice (APP23), which robustly develop cerebral amyloid angiopathy. T2*-weighted magnetic resonance imaging (MRI), a translational method applicable in preclinical and clinical studies, was used for the detection of microhemorrhages throughout the entire brain, with subsequent histological validation. Three-dimensional reconstruction based on in vivo MRI and serial Perls' stained sections demonstrated a one-to-one matching of the lesions thus allowing for their histopathological characterization. MRI detected small Perls' positive areas with a high spatial resolution. Our data demonstrate that volumetric assessment by noninvasive MRI is well suited to monitor cerebral microhemorrhages in vivo. Furthermore, 3 months treatment of aged APP23 with the potent BACE-inhibitor NB-360 did not exacerbate microhemorrhages in contrast to Aβ-antibody β1. These results substantiate the safe use of BACE inhibitors regarding microhemorrhages in long-term clinical studies for the treatment of Alzheimer's disease.
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Wes PD, Sayed FA, Bard F, Gan L. Targeting microglia for the treatment of Alzheimer's Disease. Glia 2016; 64:1710-32. [DOI: 10.1002/glia.22988] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 03/22/2016] [Accepted: 03/24/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Paul D. Wes
- Neuroinflammation Department; Lundbeck Research USA; Paramus New Jersey
| | - Faten A. Sayed
- Gladstone Institute for Neurodegeneration; San Francisco California
| | | | - Li Gan
- Gladstone Institute for Neurodegeneration; San Francisco California
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Carlson C, Siemers E, Hake A, Case M, Hayduk R, Suhy J, Oh J, Barakos J. Amyloid-related imaging abnormalities from trials of solanezumab for Alzheimer's disease. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2016; 2:75-85. [PMID: 27239538 PMCID: PMC4879647 DOI: 10.1016/j.dadm.2016.02.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Introduction Solanezumab, a humanized monoclonal antibody that binds soluble amyloid beta peptide, is being developed for treatment of Alzheimer's disease (AD). Methods Patients (n = 2042) with mild and moderate AD were randomized 1:1 to 400-mg solanezumab or placebo infusion every 4 weeks for 80 weeks and 1457 patients entered an open-label extension. Magnetic resonance imaging scans monitored for amyloid-related imaging abnormalities-edema/effusion (ARIA-E) and amyloid-related imaging abnormalities-hemorrhage/hemosiderin deposition. Results Sixteen patients (solanezumab, n = 11; placebo, n = 5) developed ARIA-E during the double-blind phase, and 7 patients developed ARIA-E during the open-label extension as of July 31, 2014. Unique cases are discussed including solanezumab patients who were given solanezumab, while ARIA-E was present and a patient who developed ARIA-E during placebo treatment and again during solanezumab treatment. Discussion Asymptomatic ARIA-E was detected in solanezumab-treated and placebo-treated AD patients. ARIA-E occurs infrequently during solanezumab and placebo treatments but may occur repeatedly in some patients.
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Affiliation(s)
- Christopher Carlson
- Lilly Bio-medicines, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Eric Siemers
- Lilly Bio-medicines, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Ann Hake
- Lilly Bio-medicines, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Michael Case
- Lilly Bio-medicines, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN, USA
| | - Roza Hayduk
- Neurology, CNS Medical Strategy & Science, Therapeutic Science & Strategy Unit, Quintiles, Durham, NC, USA
| | - Joyce Suhy
- Medical Imaging, Neuroscience, Bioclinica, Newark, CA, USA
| | - Joonmi Oh
- Medical Imaging, Neuroscience, Bioclinica, Newark, CA, USA
| | - Jerome Barakos
- Medical Imaging, Neuroscience, Bioclinica, Newark, CA, USA; Department of Radiology, California Pacific Medical Center, San Francisco, CA, USA
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35
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Arrighi HM, Barakos J, Barkhof F, Tampieri D, Jack C, Melançon D, Morris K, Ketter N, Liu E, Brashear HR. Amyloid-related imaging abnormalities-haemosiderin (ARIA-H) in patients with Alzheimer's disease treated with bapineuzumab: a historical, prospective secondary analysis. J Neurol Neurosurg Psychiatry 2016; 87:106-12. [PMID: 25669746 PMCID: PMC4717448 DOI: 10.1136/jnnp-2014-309493] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 01/19/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Amyloid-related imaging abnormalities due to haemosiderin deposition (ARIA-H) occur in patients with mild to moderate dementia due to Alzheimer's disease (AD) and have been reported with increased incidence in clinical trials of amyloid-lowering therapies under development for AD. OBJECTIVE Our objective was to explore the relationship between the incidences of ARIA-H during treatment with placebo and different doses of bapineuzumab, a humanised monoclonal antibody directed against amyloid β. METHODS Two neuroradiologists independently reviewed 2572 GRE/T2* MRI sequences from 262 participants in two phase two clinical trials of bapineuzumab and an open-label extension study. Readers were blinded to the participant's therapy, APOE ε4 genotype and medical history. RESULTS Several risk factors for small ARIA-H <10 mm (microhaemorrhages) were identified: APOE ε4, bapineuzumab treatment, pre-existing small ARIA-H and use of antithrombotics. The HR (95%CI) for incident ARIA-H <10 mm associated with the number of APOE ε4 alleles was 11.9 (3.3 to 42.5) for 2 versus no alleles and 3.5 (1.0 to 12.0) for 1 versus no allele. The HR for bapineuzumab therapy was 3.5 (1.0 to 12.0); for the presence of baseline ARIA-H <10 mm, it was 3.5 (1.6 to 7.8), and for the use of antithrombotic agents it was 2.2 (1.0 to 4.8). The incidence rate for ARIA-H <10 mm was elevated only in the initial 6 months of active treatment and declined after this interval to a rate similar to that observed in the group treated with placebo. CONCLUSIONS ARIA-H represents a spectrum of MRI findings due to haemosiderin deposition that appears to be related to impaired vascular integrity. The increased risk for ARIA-H associated with APOE ε4 allele frequency, pre-existing ARIA-H, treatment with bapineuzumab and use of antithrombotic agents provides additional support for this hypothesis of loss of integrity of cerebral vessels due to amyloid burden. TRIAL REGISTRATION NCT00112073 and NCT00606476.
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Affiliation(s)
- H Michael Arrighi
- Janssen Research & Development, South San Francisco, California, USA
| | - Jerome Barakos
- California Pacific Medical Center, San Francisco, California, USA Synarc, Newark, California, USA
| | - Frederik Barkhof
- Department of Radiology, Image Analysis Centre, VU University Medical Center, Amsterdam, The Netherlands Department of Diagnostic Radiology, VU University Medical Center, Amsterdam, The Netherlands
| | | | | | | | - Kristen Morris
- Janssen Alzheimer Immunotherapy R&D, South San Francisco, California, USA BioMarin, San Rafael, California, USA
| | - Nzeera Ketter
- Janssen Research & Development, South San Francisco, California, USA
| | - Enchi Liu
- Janssen Research & Development, South San Francisco, California, USA
| | - H Robert Brashear
- Janssen Research & Development, South San Francisco, California, USA
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36
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Novak G, Fox N, Clegg S, Nielsen C, Einstein S, Lu Y, Tudor IC, Gregg K, Di J, Collins P, Wyman BT, Yuen E, Grundman M, Brashear HR, Liu E. Changes in Brain Volume with Bapineuzumab in Mild to Moderate Alzheimer’s Disease. J Alzheimers Dis 2015; 49:1123-34. [DOI: 10.3233/jad-150448] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Gerald Novak
- Janssen Research and Development, Titusville, NJ, USA
| | - Nick Fox
- Dementia Research Centre, University College London Institute of Neurology, London, UK
| | - Shona Clegg
- Dementia Research Centre, University College London Institute of Neurology, London, UK
| | - Casper Nielsen
- Dementia Research Centre, University College London Institute of Neurology, London, UK
| | | | - Yuan Lu
- Jazz Pharmaceuticals, Palo Alto, CA, USA
| | | | - Keith Gregg
- Janssen Alzheimer Immunotherapy, South San Francisco, CA, USA
| | - Jianing Di
- Janssen Research and Development, San Diego, CA, USA
| | | | | | - Eric Yuen
- Janssen Alzheimer Immunotherapy, South San Francisco, CA, USA
| | | | | | - Enchi Liu
- Janssen Research and Development, San Diego, CA, USA
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Planque SA, Nishiyama Y, Sonoda S, Lin Y, Taguchi H, Hara M, Kolodziej S, Mitsuda Y, Gonzalez V, Sait HBR, Fukuchi KI, Massey RJ, Friedland RP, O'Nuallain B, Sigurdsson EM, Paul S. Specific amyloid β clearance by a catalytic antibody construct. J Biol Chem 2015; 290:10229-41. [PMID: 25724648 DOI: 10.1074/jbc.m115.641738] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Indexed: 11/06/2022] Open
Abstract
Classical immunization methods do not generate catalytic antibodies (catabodies), but recent findings suggest that the innate antibody repertoire is a rich catabody source. We describe the specificity and amyloid β (Aβ)-clearing effect of a catabody construct engineered from innate immunity principles. The catabody recognized the Aβ C terminus noncovalently and hydrolyzed Aβ rapidly, with no reactivity to the Aβ precursor protein, transthyretin amyloid aggregates, or irrelevant proteins containing the catabody-sensitive Aβ dipeptide unit. The catabody dissolved preformed Aβ aggregates and inhibited Aβ aggregation more potently than an Aβ-binding IgG. Intravenous catabody treatment reduced brain Aβ deposits in a mouse Alzheimer disease model without inducing microgliosis or microhemorrhages. Specific Aβ hydrolysis appears to be an innate immune function that could be applied for therapeutic Aβ removal.
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Affiliation(s)
- Stephanie A Planque
- From the Chemical Immunology Research Center, Department of Pathology and Laboratory Medicine, University of Texas-Houston Medical School, Houston, Texas 77030
| | - Yasuhiro Nishiyama
- From the Chemical Immunology Research Center, Department of Pathology and Laboratory Medicine, University of Texas-Houston Medical School, Houston, Texas 77030
| | - Sari Sonoda
- From the Chemical Immunology Research Center, Department of Pathology and Laboratory Medicine, University of Texas-Houston Medical School, Houston, Texas 77030
| | - Yan Lin
- the Departments of Neuroscience, Physiology, and Psychiatry, New York University School of Medicine, New York, New York 10016
| | - Hiroaki Taguchi
- From the Chemical Immunology Research Center, Department of Pathology and Laboratory Medicine, University of Texas-Houston Medical School, Houston, Texas 77030
| | - Mariko Hara
- From the Chemical Immunology Research Center, Department of Pathology and Laboratory Medicine, University of Texas-Houston Medical School, Houston, Texas 77030
| | - Steven Kolodziej
- From the Chemical Immunology Research Center, Department of Pathology and Laboratory Medicine, University of Texas-Houston Medical School, Houston, Texas 77030
| | - Yukie Mitsuda
- From the Chemical Immunology Research Center, Department of Pathology and Laboratory Medicine, University of Texas-Houston Medical School, Houston, Texas 77030
| | - Veronica Gonzalez
- the Departments of Neuroscience, Physiology, and Psychiatry, New York University School of Medicine, New York, New York 10016
| | - Hameetha B R Sait
- the Departments of Neuroscience, Physiology, and Psychiatry, New York University School of Medicine, New York, New York 10016
| | - Ken-ichiro Fukuchi
- the Department of Cancer Biology and Pharmacology, University of Illinois College of Medicine, Peoria, Illinois 61605
| | | | - Robert P Friedland
- the Department of Neurology, University of Louisville School of Medicine, Louisville, Kentucky 40202, and
| | - Brian O'Nuallain
- the Center for Neurologic Diseases, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Einar M Sigurdsson
- the Departments of Neuroscience, Physiology, and Psychiatry, New York University School of Medicine, New York, New York 10016,
| | - Sudhir Paul
- From the Chemical Immunology Research Center, Department of Pathology and Laboratory Medicine, University of Texas-Houston Medical School, Houston, Texas 77030,
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Esiri M, Chance S, Joachim C, Warden D, Smallwood A, Sloan C, Christie S, Wilcock G, Smith AD. Cerebral amyloid angiopathy, subcortical white matter disease and dementia: literature review and study in OPTIMA. Brain Pathol 2015; 25:51-62. [PMID: 25521177 PMCID: PMC8028928 DOI: 10.1111/bpa.12221] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 10/08/2014] [Indexed: 12/23/2022] Open
Abstract
Cerebral amyloid angiopathy (CAA) is of increasing clinical and research interest as the ability to detect it and its consequences by neuroimaging in living subjects has advanced. There is also increasing interest in understanding its possible role in the development of intracerebral hemorrhage, Alzheimer's disease (AD) and vascular dementia. In this article, the literature on this subject is reviewed and novel findings relating CAA to subcortical white matter damage in 224 subjects in the Oxford project to Investigate Memory and Ageing (OPTIMA) are reported. The relationship between CAA and subcortical tissue damage in the OPTIMA subjects was found to be critically dependent on ApoE genotype, there being a positive relationship between measures of CAA and subcortical small vessel disease in ApoEε4 carriers and a significant negative relationship in ApoEε2 carriers. These findings draw attention, as have many other studies, to the importance of ApoE genotype as a major risk factor not only for dementia but also for damage to blood vessels in the aging brain.
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Affiliation(s)
- Margaret Esiri
- Neuropathology DepartmentNuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Steven Chance
- Neuropathology DepartmentNuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Catharine Joachim
- Neuropathology DepartmentNuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Donald Warden
- Department of PharmacologyUniversity of OxfordOxfordUK
| | | | - Carolyn Sloan
- Neuropathology DepartmentNuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | - Sharon Christie
- Nuffield Department of Clinical NeurosciencesOPTIMAUniversity of OxfordOxfordUK
| | - Gordon Wilcock
- Nuffield Department of Clinical NeurosciencesOPTIMAUniversity of OxfordOxfordUK
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Aβ immunotherapy for Alzheimer's disease: effects on apoE and cerebral vasculopathy. Acta Neuropathol 2014; 128:777-89. [PMID: 25195061 DOI: 10.1007/s00401-014-1340-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 08/28/2014] [Accepted: 08/30/2014] [Indexed: 12/30/2022]
Abstract
Aβ immunotherapy for Alzheimer's disease (AD) results in the removal of Aβ plaques and increased cerebral amyloid angiopathy (CAA). In current clinical trials, amyloid-related imaging abnormalities (ARIAs), putatively due to exacerbation of CAA, are concerning side effects. We aimed to assess the role of the Aβ transporter apolipoprotein E (apoE) in the exacerbation of CAA and development of CAA-associated vasculopathy after Aβ immunotherapy. 12 Aβ42-immunized AD (iAD; AN1792, Elan Pharmaceuticals) cases were compared with 28 unimmunized AD (cAD) cases. Immunohistochemistry was quantified for Aβ42, apoE, apoE E4 and smooth muscle actin, and CAA-associated vasculopathy was analyzed. Aβ immunotherapy was associated with redistribution of apoE from cortical plaques to cerebral vessel walls, mirroring the altered distribution of Aβ42. Concentric vessel wall splitting was increased threefold in leptomeningeal vessels after immunotherapy (cAD 6.3 vs iAD 20.6 %, P < 0.001), but smooth muscle cell abnormalities did not differ. The findings suggest that apoE is involved in the removal of plaques and transport of Aβ to the cerebral vasculature induced by Aβ immunotherapy. Immunotherapy was not associated with CAA-related vascular smooth muscle damage, but was accompanied by increased splitting of the vessel wall, perhaps reflecting enhanced deposition and subsequent removal of Aβ. ARIA occurring in some current trials of Aβ immunotherapy may reflect an extreme form of these vascular changes.
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40
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Nishiyama Y, Taguchi H, Hara M, Planque SA, Mitsuda Y, Paul S. Metal-dependent amyloid β-degrading catalytic antibody construct. J Biotechnol 2014; 180:17-22. [PMID: 24698848 DOI: 10.1016/j.jbiotec.2014.03.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 03/05/2014] [Accepted: 03/21/2014] [Indexed: 01/29/2023]
Abstract
Catalytic antibodies (catabodies) that degrade target antigens rapidly are rare. We describe the metal-dependence of catabody construct 2E6, an engineered heterodimer of immunoglobulin light chain variable domains that hydrolyzes amyloid β peptides (Aβ) specifically. In addition to the electrophilic phosphonate inhibitor of serine proteases, the metal chelators ethylenediaminetetraacetic acid (EDTA) and 1,10-phenanthroline completely inhibited the hydrolysis of Aβ by catabody 2E6. Formation of catabody-electrophilic phosphonate inhibitor adducts was unaffected by EDTA, suggesting that the metal exerts a favorable effect on a catalytic step after the initial catabody nucleophilic attack on Aβ. The EDTA inactivated catabody failed to disaggregate fibrillar Aβ, indicating the functional importance of the Aβ hydrolytic activity. Treating the EDTA-inactivated catabody with Zn(2+) or Co(2+) restored the Aβ hydrolytic activity, and Zn(2+)-induced catabody conformational transitions were evident by fluorescence emission spectroscopy. The studies reveal the absolute catabody dependence on a metal cofactor.
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Affiliation(s)
- Yasuhiro Nishiyama
- Chemical Immunology Research Center, Department of Pathology and Laboratory Medicine, University of Texas-Houston Medical School, Houston, TX 77030, USA
| | - Hiroaki Taguchi
- Chemical Immunology Research Center, Department of Pathology and Laboratory Medicine, University of Texas-Houston Medical School, Houston, TX 77030, USA
| | - Mariko Hara
- Chemical Immunology Research Center, Department of Pathology and Laboratory Medicine, University of Texas-Houston Medical School, Houston, TX 77030, USA
| | - Stephanie A Planque
- Chemical Immunology Research Center, Department of Pathology and Laboratory Medicine, University of Texas-Houston Medical School, Houston, TX 77030, USA
| | - Yukie Mitsuda
- Chemical Immunology Research Center, Department of Pathology and Laboratory Medicine, University of Texas-Houston Medical School, Houston, TX 77030, USA
| | - Sudhir Paul
- Chemical Immunology Research Center, Department of Pathology and Laboratory Medicine, University of Texas-Houston Medical School, Houston, TX 77030, USA.
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Salloway S, Sperling R, Fox NC, Blennow K, Klunk W, Raskind M, Sabbagh M, Honig LS, Porsteinsson AP, Ferris S, Reichert M, Ketter N, Nejadnik B, Guenzler V, Miloslavsky M, Wang D, Lu Y, Lull J, Tudor IC, Liu E, Grundman M, Yuen E, Black R, Brashear HR. Two phase 3 trials of bapineuzumab in mild-to-moderate Alzheimer's disease. N Engl J Med 2014; 370:322-33. [PMID: 24450891 PMCID: PMC4159618 DOI: 10.1056/nejmoa1304839] [Citation(s) in RCA: 1335] [Impact Index Per Article: 133.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Bapineuzumab, a humanized anti-amyloid-beta monoclonal antibody, is in clinical development for the treatment of Alzheimer's disease. METHODS We conducted two double-blind, randomized, placebo-controlled, phase 3 trials involving patients with mild-to-moderate Alzheimer's disease--one involving 1121 carriers of the apolipoprotein E (APOE) ε4 allele and the other involving 1331 noncarriers. Bapineuzumab or placebo, with doses varying by study, was administered by intravenous infusion every 13 weeks for 78 weeks. The primary outcome measures were scores on the 11-item cognitive subscale of the Alzheimer's Disease Assessment Scale (ADAS-cog11, with scores ranging from 0 to 70 and higher scores indicating greater impairment) and the Disability Assessment for Dementia (DAD, with scores ranging from 0 to 100 and higher scores indicating less impairment). A total of 1090 carriers and 1114 noncarriers were included in the efficacy analysis. Secondary outcome measures included findings on positron-emission tomographic amyloid imaging with the use of Pittsburgh compound B (PIB-PET) and cerebrospinal fluid phosphorylated tau (phospho-tau) concentrations. RESULTS There were no significant between-group differences in the primary outcomes. At week 78, the between-group differences in the change from baseline in the ADAS-cog11 and DAD scores (bapineuzumab group minus placebo group) were -0.2 (P=0.80) and -1.2 (P=0.34), respectively, in the carrier study; the corresponding differences in the noncarrier study were -0.3 (P=0.64) and 2.8 (P=0.07) with the 0.5-mg-per-kilogram dose of bapineuzumab and 0.4 (P=0.62) and 0.9 (P=0.55) with the 1.0-mg-per-kilogram dose. The major safety finding was amyloid-related imaging abnormalities with edema among patients receiving bapineuzumab, which increased with bapineuzumab dose and APOE ε4 allele number and which led to discontinuation of the 2.0-mg-per-kilogram dose. Between-group differences were observed with respect to PIB-PET and cerebrospinal fluid phospho-tau concentrations in APOE ε4 allele carriers but not in noncarriers. CONCLUSIONS Bapineuzumab did not improve clinical outcomes in patients with Alzheimer's disease, despite treatment differences in biomarkers observed in APOE ε4 carriers. (Funded by Janssen Alzheimer Immunotherapy and Pfizer; Bapineuzumab 301 and 302 ClinicalTrials.gov numbers, NCT00575055 and NCT00574132, and EudraCT number, 2009-012748-17.).
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Affiliation(s)
- Stephen Salloway
- From Butler Hospital, Providence, RI (S.S.); Brigham and Women's Hospital, Boston (R.S.); University College London, Institute of Neurology, London (N.C.F.); University of Göteborg, Sahlgrenska University Hospital, Mölndal, Sweden (K.B.); University of Pittsburgh, Pittsburgh (W.K.); Veterans Affairs Medical Center, Seattle (M.R.); Cleo Roberts Center for Clinical Research/Sun Health Research Institute, Sun City, AZ (M.S.); Columbia University (L.S.H.) and New York University Langone Medical Center (S.F.), New York; University of Rochester School of Medicine and Dentistry, Rochester, NY (A.P.P.); Janssen Alzheimer Immunotherapy Research and Development, South San Francisco, CA (M.R., N.K., B.N., V.G., M.M., D.W., Y.L., I.C.T., E.L., E.Y., H.R.B.); Janssen Research and Development, Titusville, NJ (J.L.); Global R&D Partners and the University of California, San Diego - both in San Diego (M.G.); and Pfizer, Collegeville, PA (R.B.)
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Castillo-Carranza DL, Guerrero-Muñoz MJ, Kayed R. Immunotherapy for the treatment of Alzheimer's disease: amyloid-β or tau, which is the right target? Immunotargets Ther 2013; 3:19-28. [PMID: 27471697 PMCID: PMC4918231 DOI: 10.2147/itt.s40131] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Alzheimer's disease (AD) is characterized by the presence of amyloid plaques composed mainly of amyloid-β (Aβ) protein. Overproduction or slow clearance of Aβ initiates a cascade of pathologic events that may lead to formation of neurofibrillary tangles, neuronal cell death, and dementia. Although immunotherapy in animal models has been demonstrated to be successful at removing plaques or prefibrillar forms of Aβ, clinical trials have yielded disappointing results. The lack of substantial cognitive improvement obtained by targeting Aβ raises the question of whether or not this is the correct target. Another important pathologic process in the AD brain is tau aggregation, which seems to become independent once initiated. Recent studies targeting tau in AD mouse models have displayed evidence of cognitive improvement, providing a novel therapeutic approach for the treatment of AD. In this review, we describe new advances in immunotherapy targeting Aβ peptide and tau protein, as well as future directions.
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Affiliation(s)
- Diana L Castillo-Carranza
- Mitchell Center for Neurodegenerative Diseases, University of Texas Medical Branch, Galveston, TX, USA; Departments of Neurology, Neuroscience, and Cell Biology, University of Texas Medical Branch, Galveston, TX, USA
| | - Marcos J Guerrero-Muñoz
- Mitchell Center for Neurodegenerative Diseases, University of Texas Medical Branch, Galveston, TX, USA; Departments of Neurology, Neuroscience, and Cell Biology, University of Texas Medical Branch, Galveston, TX, USA
| | - Rakez Kayed
- Mitchell Center for Neurodegenerative Diseases, University of Texas Medical Branch, Galveston, TX, USA; Departments of Neurology, Neuroscience, and Cell Biology, University of Texas Medical Branch, Galveston, TX, USA; Sealy Center for Vaccine Development, University of Texas Medical Branch, Galveston, TX, USA
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Goñi F, Herline K, Peyser D, Wong K, Ji Y, Sun Y, Mehta P, Wisniewski T. Immunomodulation targeting of both Aβ and tau pathological conformers ameliorates Alzheimer's disease pathology in TgSwDI and 3xTg mouse models. J Neuroinflammation 2013; 10:150. [PMID: 24330773 PMCID: PMC3878790 DOI: 10.1186/1742-2094-10-150] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 11/23/2013] [Indexed: 12/20/2022] Open
Abstract
Background Central to the pathogenesis of Alzheimer’s disease (AD) and many other neurodegenerative diseases is the conformational change of a normal self-protein into toxic oligomeric species and amyloid deposits. None of these disorders have an effective therapy, but immunization approaches hold great promise. We have previously shown that active immunization with a novel peptide when polymerized into a stable oligomeric conformation, pBri, induced a humoral immune response to toxic Aβ species in an AD model, APP/PS1 transgenic (Tg) mice, reducing plaque deposits. pBri is a glutaraldehyde polymerized form of the carboxyl fragment of an amyloidogenic protein, which is deposited in the brains of patients with a rare autosomal dominant disease due to a missense mutation in a stop codon, resulting in the translation of an intronic sequence, with no known sequence homology to any mammalian protein. Methods In the current study we tested whether pBri-peptide-based immunomodulation is effective at reducing both vascular amyloid deposits and tau-related pathology using TgSwDI mice with extensive congophilic angiopathy and 3xTg mice with tau pathology. Results Our results indicate that this immunomodulation approach, which produces a humoral response to proteins in a pathological conformation, is effective at reducing both Aβ and tau-related pathologies. Conclusions This immunomodulatory approach has the advantage of using a non-self-immunogen that is less likely to be associated with autoimmune toxicity. Furthermore we found that it is able to target all the cardinal features of AD concurrently.
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Affiliation(s)
| | | | | | | | | | | | | | - Thomas Wisniewski
- Department of Neurology, New York University School of Medicine, 550 First Avenue, New York, NY 10016, USA.
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