Alzheimer's disease: a review concerning immune response and microischemia

Exploring the association between interleukin-1β and its interacting proteins in Alzheimer's disease

Alzheimer’s disease (AD) is an age-associated progressive neurodegenerative disorder which is of clinical concern. The association between the nervous and immune system is defined as an neuroimmunological theory that supports a model of pathology or treatment for AD. Interleukin (IL)-1β has a pro-inflammatory function in AD; however, the mechanism of its dysregulation in AD remains unknown. It is therefore of significance to understand the molecular mechanisms of IL-1β and how it may regulate AD. Proteins, which have been previously reported to be associated with IL-1β in AD, have been used in the present study as nodes to illustrate a net of protein interaction in Cytoscape. The Kyoto Encyclopedia of Genes and Genomes was used to further analyze the association of these proteins with the pathology of AD. The present study identified and subsequently compared two AD and six IL-1β pathways with the network produced in Cytoscape. The present study identified important mechanisms in the pathology of AD and constructed two novel networks using Cytoscape.

Elevated serum copper and ceruloplasmin levels in Alzheimer's disease

INTRODUCTION

Copper takes part in a variety of biological reduction-oxidation (redox) processes, and is an important cofactor of many redox enzymes. Ceruloplasmin, the copper-transporting protein, also possesses an important redox capacity.

METHODS

We assessed serum copper, ceruloplasmin and free-copper levels in 89 patients with Alzheimer's disease (AD) (mean age, 77.83 years; 41 men, 48 women) and in 118 healthy individuals (mean age, 69.93 years; 50 men, 68 women). High (≥75th percentile), medium, and low (≤25th percentile) copper, ceruloplasmin and free-copper groups were classified according to their serum level.

RESULTS

Serum copper (P = 0.026) and ceruloplasmin (P = 0.001) levels were significantly higher in the AD group than in the control group. There was no significant difference in serum free-copper levels between AD and healthy elderly groups (P = 0.975). After adjusting for age differences, serum copper (P = 0.049) was still significantly higher in the AD group. Furthermore, serum copper levels correlated with scores on the Boston naming test (r = -0.151, P = 0.037), indicating a close relationship between copper levels and cognitive abilities.

DISCUSSION

The significant association between the copper concentration in peripheral serum and AD with elevated copper levels found in patients with AD is likely linked to the evolution of AD. Serum copper levels were significantly negatively correlated with scores on cognitive test subscores. AD patients may have significantly more "defective" ceruloplasmin, that is, apo-ceruloplasmin lacking its copper, than in healthy controls.

New immunological approaches in treating and diagnosing CNS diseases

The immune system evolved to launch effective and specific responses against pathogens. A key feature of this defense mechanism is its ability to differentiate between self and nonself. However, in autoimmune diseases, the host's immune system fails to discriminate self versus foreign. The CNS is further protected by the blood-brain barrier. In spite of its 'immune privilege,' the brain is not protected from autoimmunity; perhaps paradoxically xenoantibodies can be used to treat neurological diseases. We describe patents covering treatment methods for CNS diseases with suspected or demonstrated autoimmune etiology. These include multiple sclerosis and, Alzheimer's and Parkinson's disease. The goal is to less invasively, yet efficiently, treat neurological diseases. Although autoimmune responses are often detrimental, recent studies have begun to harness, boost and induce immune responses as a mechanism of treatment. The patents discussed herein highlight new treatments for Alzheimer's and Parkinson's disease, multiple sclerosis, and seizure disorders.

AlzPathway: a comprehensive map of signaling pathways of Alzheimer's disease

Background

Alzheimer’s disease (AD) is the most common cause of dementia among the elderly. To clarify pathogenesis of AD, thousands of reports have been accumulating. However, knowledge of signaling pathways in the field of AD has not been compiled as a database before.

Description

Here, we have constructed a publicly available pathway map called “AlzPathway” that comprehensively catalogs signaling pathways in the field of AD. We have collected and manually curated over 100 review articles related to AD, and have built an AD pathway map using CellDesigner. AlzPathway is currently composed of 1347 molecules and 1070 reactions in neuron, brain blood barrier, presynaptic, postsynaptic, astrocyte, and microglial cells and their cellular localizations. AlzPathway is available as both the SBML (Systems Biology Markup Language) map for CellDesigner and the high resolution image map. AlzPathway is also available as a web service (online map) based on Payao system, a community-based, collaborative web service platform for pathway model curation, enabling continuous updates by AD researchers.

Conclusions

AlzPathway is the first comprehensive map of intra, inter and extra cellular AD signaling pathways which can enable mechanistic deciphering of AD pathogenesis. The AlzPathway map is accessible at http://alzpathway.org/.

Potentially modifiable risk factors for dementia in identical twins

BACKGROUND

The purpose of this study was to test nongenetic factors that might explain discordance for dementia in monozygotic twin pairs. Risk factors included education, engaged lifestyle in midlife, and early life circumstances indexed by tooth loss, short adult height, and parental social class.

METHODS

Data are from the HARMONY study, including members of the Swedish Twin Registry age 65 and older and alive in 1998, who were screened and assessed clinically for dementia. Analyses included a case-control design to evaluate the risk factors and a co-twin control design that permits testing nongenetic risk factors while controlling for genetic influences. Case-control analyses included 310 dementia cases and 3,063 nondemented controls. There were 106 monozygotic twin pairs discordant for dementia. Risk factors were assessed independently by the Swedish Twin Registry three decades previously.

RESULTS

Case-control findings showed that history of tooth loss before age 35 and low educational attainment were significant risk factors for Alzheimer's disease, with short adult height also contributing to risk for total dementia. In co-twin control analyses, only history of tooth loss before age 35 was a significant risk factor for Alzheimer's disease, whereas low educational attainment also contributed to risk for total dementia and lack of physical exercise to risk for non-Alzheimer's dementias.

CONCLUSIONS

Potentially modifiable risk factors from early and midlife, with a cumulative detrimental effect on the brain, contribute to risk of dementia. Based on the association with tooth loss, further investigation of inflammatory load as a risk factor for Alzheimer's disease is warranted.

Brain type carnosinase in dementia: a pilot study

Background

The pathological processes underlying dementia are poorly understood and so are the markers which identify them. Carnosinase is a dipeptidase found almost exclusively in brain and serum. Carnosinase and its substrate carnosine have been linked to neuropathophysiological processes.

Methods

Carnosinase activity was measured by a flourometric method in 37 patients attending a Geriatric Outpatient Clinic. There were 17 patients without dementia, 13 had Alzheimer's disease (AD) and 7 had mixed dementia (MD).

Results

The range of serum carnosinase activity for patients without dementia was 14.5 – 78.5 μmol/ml/h. There was no difference in carnosinase activity between patients without dementia (40.3 ± 15.2 μmol/ml/h) and patients with AD (44.4 ± 12.4 μmol/ml/h) or MD (26.6 ± 15 μmol/ml/h). However, levels in the MD group were significantly lower than the AD group (p = 0.01). This difference remained significant after adjusting for gender, MMSE score, exercise, but not age, one at a time and all combined. The effect of other medical conditions did not remove the significance between the AD and MD groups. The MD group, but not the AD group, demonstrated a significant trend with carnosinase activity decreasing with duration of disease (from first recorded date of diagnosis to date of blood collection) (r = -0.76, p = 0.049). There was no association with carnosinase activity and MMSE score in the AD or MD group. Both AD and MD patients on any dementia medication (donepezil, galantamine, memantine) had higher carnosinase activity compared to those not taking a dementia medication. Carnosinase activity was higher in patients who regularly exercised (n = 20) compared to those who did not exercise regularly (n = 17)(p = 0.006).

Conclusion

This exploratory study has shown altered activities of the enzyme carnosinase in patients with dementia.

Suppressive Effects of Melatonin on Amyloid-β-induced Glial Activation in Rat Hippocampus

BACKGROUND

Growing evidence indicates that activated glia, as a result of chronic inflammation, are associated with amyloid-beta peptide (Abeta) deposits in the brain of Alzheimer's disease (AD) patients. The purpose of the present study was to investigate, in vivo, the effects of melatonin on glia activation, which may contribute to improved learning and memory in amnesic rats induced by amyloid-beta peptide 25-35 (Abeta25-35).

METHODS

We examined cognitive function using the Morris water maze test. Expression of interleukin 1alpha (IL-1alpha) or complement 1q (C1q) in rat hippocampal tissue was determined by immunohistochemistry.

RESULTS

It was found that Abeta25-35 injected into rat hippocampus induced an impairment in learning and memory and a marked increase of positive glial cells expressing IL-1alpha and C1q in hippocampus, compared with the controls. This suggests that glial activation triggered by Abeta25-35 parallels the dysfunction of learning and memory. Melatonin, at doses of 0.01, 0.1, and 1 mg/kg (i.g. for 10 days), improved learning and memory of rats treated with Abeta25-35. Cells expressing IL-1alpha and C1q were significantly decreased in hippocampus by pretreatment with melatonin at doses of 0.1 mg/kg and 1 mg/kg, but not at the dose of 0.01 mg/kg.

CONCLUSIONS

Our data indicate that melatonin inhibited expressions of proinflammatory factors, which may contribute to improvement of learning and memory function in AD.

Identification of Aldolase as a Target Antigen in Alzheimer’s Disease

Alzheimer's disease (AD) is the most common human neurodegenerative disease, leading to progressive cognitive decline and eventually death. The prevailing paradigm on the pathogenesis of AD is that abnormally folded proteins accumulate in specific brain areas and lead to neuronal loss via apoptosis. In recent years it has become evident that an inflammatory and possibly autoimmune component exists in AD. Moreover, recent data demonstrate that immunization with amyloid-beta peptide is therapeutically effective in AD. The nature of CNS Ags that are the target of immune attack in AD is unknown. To identify potential autoantigens in AD, we tested sera IgG Abs of AD patients in immunoblots against brain and other tissue lysates. We identified a 42-kDa band in brain lysates that was detected with >50% of 45 AD sera. The band was identified by mass spectrometry to be aldolase A. Western blotting with aldolase using patient sera demonstrated a band of identical size. The Ab reactivity was verified with ELISAs using aldolase. One of 25 elderly control patients and 3 of 30 multiple sclerosis patients showed similar reactivity (p < 0.002). In enzymatic assays, anti-aldolase positive sera were found to inhibit the enzyme's activity, and the presence of the substrate (fructose 1,6-diphosphate) enhanced Ab binding. Immunization of rats and mice with aldolase in complete Freund's adjuvant was not pathogenic. These findings reveal an autoimmune component in AD, point at aldolase as a common autoantigen in this disease, and suggest a new target for potential immune modulation.

Theories of schizophrenia: a genetic-inflammatory-vascular synthesis

BACKGROUND

Schizophrenia, a relatively common psychiatric syndrome, affects virtually all brain functions yet has eluded explanation for more than 100 years. Whether by developmental and/or degenerative processes, abnormalities of neurons and their synaptic connections have been the recent focus of attention. However, our inability to fathom the pathophysiology of schizophrenia forces us to challenge our theoretical models and beliefs. A search for a more satisfying model to explain aspects of schizophrenia uncovers clues pointing to genetically mediated CNS microvascular inflammatory disease.

DISCUSSION

A vascular component to a theory of schizophrenia posits that the physiologic abnormalities leading to illness involve disruption of the exquisitely precise regulation of the delivery of energy and oxygen required for normal brain function. The theory further proposes that abnormalities of CNS metabolism arise because genetically modulated inflammatory reactions damage the microvascular system of the brain in reaction to environmental agents, including infections, hypoxia, and physical trauma. Damage may accumulate with repeated exposure to triggering agents resulting in exacerbation and deterioration, or healing with their removal. There are clear examples of genetic polymorphisms in inflammatory regulators leading to exaggerated inflammatory responses. There is also ample evidence that inflammatory vascular disease of the brain can lead to psychosis, often waxing and waning, and exhibiting a fluctuating course, as seen in schizophrenia. Disturbances of CNS blood flow have repeatedly been observed in people with schizophrenia using old and new technologies. To account for the myriad of behavioral and other curious findings in schizophrenia such as minor physical anomalies, or reported decreased rates of rheumatoid arthritis and highly visible nail fold capillaries, we would have to evoke a process that is systemic such as the vascular and immune/inflammatory systems.

SUMMARY

A vascular-inflammatory theory of schizophrenia brings together environmental and genetic factors in a way that can explain the diversity of symptoms and outcomes observed. If these ideas are confirmed, they would lead in new directions for treatments or preventions by avoiding inducers of inflammation or by way of inflammatory modulating agents, thus preventing exaggerated inflammation and consequent triggering of a psychotic episode in genetically predisposed persons.

Pharmacotherapeutic approaches to the prevention of Alzheimer's disease

BACKGROUND

Alzheimer's disease (AD) is the most common cause of cognitive impairment in older patients and is expected to increase greatly in prevalence. Interventions that could delay disease onset would have a major public health impact.

OBJECTIVE

The objective of this article is to review evidence from epidemiologic studies and controlled trials addressing whether AD can be prevented.

METHODS

Data were gathered through a comprehensive, systematic search of MEDLINE using focused search criteria and spanning a 6-year period from January 1998 through January 2004; a hand search of reference lists from these studies and reviews; a review of the Cochrane Database of Systematic Reviews; and a hand search of relevant journals. Selection of articles was based on the clinical focus. Additional inclusion criteria were used to select key articles that contained higher-level evidence in accordance with explicit, validated criteria.

RESULTS

Preventive interventions for AD include vitamins, nonsteroidal anti-inflammatory drugs, and agents that protect the endothelium (eg, statins). Good control of hypertension with angiotensin-converting enzyme inhibitors and long-acting dihydropyridines also confers neuroprotective benefits.

CONCLUSIONS

The paradigm that AD is pharmacologically unresponsive is shifting as more effective pharmacotherapies for prevention and treatment rapidly emerge. Our understanding of the molecular mechanisms of neurodegeneration will soon allow us to more specifically target and interrupt the processes that contribute to this progressive dementia.

Immunization with a cannabinoid receptor type 1 peptide results in experimental allergic meningocerebellitis in the Lewis rat: A model for cell-mediated autoimmune neuropathology

Neuronal elements are increasingly suggested as primary targets of an autoimmune attack in certain neurological and neuropsychiatric diseases. Type 1 cannabinoid receptors (CB1) were selected as autoimmune targets because they are predominantly expressed on neuronal surfaces in brain and display strikingly high protein levels in striatum, hippocampus, and cerebellum. Female Lewis rats were immunized with N-terminally acetylated peptides (50 or 400 microg per rat) of the extracellular domains of the rat CB1 and killed at various time points. Subsequent evaluation using immunohistochemistry and in situ hybridization showed dense infiltration of immune cells exclusively within the cerebellum, peaking 12-16 days after immunization with the CB1 peptide containing amino acids 9-25. The infiltrates clustered in meninges and perivascular locations in molecular and granular cell layers and were also scattered throughout the CB1-rich neuropil. They consisted primarily of CD4(+) and ED1(+) cells, suggestive of cell-mediated autoimmune pathology. There were no inflammatory infiltrates elsewhere in the brain or spinal cord. The results show that neuronal elements, such as neuronal cell-surface receptors, may be recognized as antigenic targets in a cell-mediated autoimmune attack and, therefore, support the hypothesis of cell-mediated antineuronal autoimmune pathology in certain brain disorders.

Activation of adenosine triphosphate-sensitive potassium channels confers protection against rotenone-induced cell death: therapeutic implications for Parkinson's disease

It is anticipated that further understanding of the protective mechanism induced by ischemic preconditioning will improve prognosis for patients of ischemic injury. It is not known whether preconditioning exerts beneficial actions in neurodegenerative diseases, in which ischemic injury plays a causative role. Here we show that transient activation of ATP-sensitive potassium channels, a trigger in ischemic preconditioning signaling, confers protection in PC12 cells and SH-SY5Y cells against neurotoxic effect of rotenone and MPTP, mitochondrial complex I inhibitors that have been implicated in the pathogenesis of Parkinson's disease. The degree of protection is in proportion to the bouts of exposure to an ATP-sensitive potassium channel opener, a feature reminiscent of ischemic tolerance in vivo. Protection is sensitive to a protein synthesis inhibitor, indicating the involvement of de novo protein synthesis in the protective processes. Pretreatment of PC12 cells with preconditioning stimuli FeSO(4) or xanthine/xanthine oxidase also confers protection against rotenone-induced cell death. Our results demonstrate for the first time the protective role of ATP-sensitive potassium channels in a dopaminergic neuronal cell line against rotenone-induced neurotoxicity and conceptually support the view that ischemic preconditioning-derived therapeutic strategies may have potential and feasibility in therapy for Parkinson's disease.