Extraneuronal manifestations of Alzheimer's disease

Altered proteolysis in fibroblasts of Alzheimer patients with predictive implications for subjects at risk of disease

There is great interest in developing reliable biomarkers to support antemortem diagnosis of late-onset Alzheimer's disease (AD). Early prediction and diagnosis of AD might be improved by the detection of a proteolytic dysfunction in extracts from cultured AD fibroblasts, producing altered isoelectrophoretic forms of the enzyme transketolase (TK-alkaline bands). The TK profile and apolipoprotein E (APOE) genotype were examined in fibroblasts from 36 clinically diagnosed probable late-onset sporadic AD patients and 38 of their asymptomatic relatives, 29 elderly healthy individuals, 12 neurological non-AD patients, and 5 early-onset AD patients. TK alterations occurred in (i) several probable AD patients regardless of age-of-onset and severity of disease; (ii) all early-onset AD patients and APOE ε 4/4 carriers; and (iii) nearly half of asymptomatic AD relatives. Normal subjects and non-AD patients were all negative. Notably, culture conditions promoting TK alterations were also effective in increasing active BACE1 levels. Overall, the TK assay might represent a low-cost laboratory tool useful for supporting AD differential diagnosis and identifying asymptomatic subjects who are at greater risk of AD and who should enter a follow-up study. Moreover, the cultured fibroblasts were confirmed as a useful in vitro model for further studies on the pathogenetic process of AD.

Towards a whole-body systems [multi-organ] lipidomics in Alzheimer's disease

Preclinical and clinical evidence suggests that docosahexaenoic acid (DHA), an omega-3 fatty acid derived from diet or synthesized in the liver, decreases the risk of developing Alzheimer's disease (AD). DHA levels are reduced in the brain of subjects with AD, but it is still unclear whether human dementias are associated with dysregulations of DHA metabolism. A systems biological view of omega-3 fatty acid metabolism offered unexpected insights on the regulation of DHA homeostasis in AD [1]. Results of multi-organ lipidomic analyses were integrated with clinical and gene-expression data sets to develop testable hypotheses on the functional significance of lipid abnormalities observed and on their possible mechanistic bases. One surprising outcome of this integrative approach was the discovery that the liver of AD patients has a limited capacity to convert shorter chain omega-3 fatty acids into DHA due to a deficit in the peroxisomal d-bifunctional protein. This deficit may contribute to the decrease in brain DHA levels and contribute to cognitive impairment.

An update on clinical proteomics in Alzheimer's research

Alzheimer's disease (AD) is a pathologically complex and aetiologically multifactorial dementing disorder affecting millions of people worldwide. The pathological brain changes are assumed to occur decades prior to the onset of clinical symptoms. The diagnosis of early AD remains problematic and is mainly based on clinical and neuropsychological findings after the onset of symptoms. Currently available drugs are able to delay the symptom progression of the disease but not to attenuate the progression of pathological brain changes. Many studies exploring AD proteomes have been conducted as the middle of 1990s as a consequence of recent advances in the development of both gel-based and gel-free proteomics approaches. It is hoped that proteomics can contribute to improving the understanding, diagnosis, and follow-up of the progression of AD. In this review, we summarise the present status of proteome alterations, with emphasis on quantitative approaches, in AD brain, CSF and blood, and their relevance to dementia research.

TNF-related apoptosis-inducing ligand level in Alzheimer's disease

In the present study, we determined the significance of tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) in Alzheimer's disease (AD). We characterized the expression of TRAIL protein in the cerebrospinal fluid (CSF) and serum with ELISA and TRAIL mRNA in the peripheral blood mononuclear cells (PBMCs) with real-time PCR in 22 patients with AD and 20 control cases. We could not find TRAIL protein in the CSF samples. The concentration of TRAIL protein in sera from patients with AD was not different from controls. However, there was an inverse correlation between serum TRAIL levels and Mini-Mental State Examination scores in AD patients. Also we did not find significant difference in TRAIL mRNA in the PBMCs of patients with AD when compared with control group. Our data indicate that TRAIL serum level decreases in the late stage of disease.

Two-dimensional protein electrophoresis: from molecular pathway discovery to biomarker discovery in neurological disorders

Two-dimensional protein electrophoresis (2-DE) has undergone many technical improvements in the past 30 years, resulting in an analytical method that is unparalleled in the resolution of complex protein mixtures and capable of quantifying changes in protein expression from a wide variety of tissues and samples. The technique has been applied in many studies of neurologic disease to identify changes in spot patterns that correlate with disease. The true power of the technique emerges when it is coupled to state-of-the-art methods in mass spectrometry, which enable identification of the protein or proteins contained within a spot of interest on a 2-DE map. Investigators have successfully applied the technique to gain improved understanding of neurologic disease mechanisms in humans and in animal models and to discover biomarkers that are useful in the clinical setting. An important extension to these efforts that has not been realized thus far is the desire to profile changes in protein expression that result from therapy to help relate disease-modifying effects at the molecular level with clinical outcomes. Here we review the major advances in 2-DE methods and discuss specific examples of its application in the study of neurologic diseases.

Problems associated with biological markers of Alzheimer's disease

The etiopathogenesis of Alzheimer's disease (AD) is still unclear, although clinical diagnostic criteria exist and the neuropathology of AD has been studied in great detail during the last 20 years. The present study addresses certain problems in the search for biological markers for the diagnosis, as well as in the follow-up of the course of AD and its differential diagnosis and reports some of our own observations in comparison with other studies. These include protein, genetic and neuroimaging markers. The definitions of biological markers and search strategies are also discussed.

Abnormal erythrocyte anion exchange in Alzheimer disease

CONTEXT

Several abnormalities have been described in red blood cells of patients with Alzheimer disease (AD), but to date none of these has been confirmed by a second, independent study. Erythrocyte anion exchange has been reported to be abnormal in AD; we have developed a new technique for measuring anion exchange.

OBJECTIVES

To confirm the abnormality of erythrocyte anion exchange in AD and to determine whether the phenomenon has potential for clinical utility.

DESIGN

Comparison of patients with probable AD to age-matched controls.

SETTING

University hospital and ambulatory clinic.

METHODS

Chloride-bicarbonate exchange was measured in erythrocyte ghosts resealed with a fluorescent probe of chloride concentration.

RESULTS

Erythrocyte anion exchange is abnormal in AD. This difference appears in citrate but not EDTA anticoagulant. Mahalanobis's generalized distance between the 2 populations is 1.7, and a discriminant function derived from our technique classifies 82% of the study population in accordance with the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria. Receiver operating characteristic analysis demonstrates the possibility of choosing cutoffs with high sensitivity and specificity.

CONCLUSIONS

Measurement of red blood cell anion exchange may be useful in classifying patients with AD. The dependence of this phenomenon on anticoagulant suggests the involvement of platelet activation or complement fixation.

Ionic and signal transduction alterations in Alzheimer's disease: relevance of studies on peripheral cells

Several lines of evidence indicate that Alzheimer's disease (AD) has systemic expression. Systemic changes are manifested as alterations in a number of molecular and cellular processes. Although, these alterations appear to have little or no consequence in peripheral systems, their parallel expression in the central nervous system (CNS) could account for the principal clinical manifestations of the disease. Recent research seems to indicate that alterations in ion channels, calcium homeostasis, and protein kinase C (PKC) can be linked and thereby constitute a model of pathophysiological relevance. Considering the difficulties of studying dynamic pathophysiological processes in the disease-ridden postmortem AD brain, peripheral tissues such as fibroblasts provide a suitable model to study molecular and cellular aspects of the disease.

Restoration of TEA-induced calcium responses in fibroblasts from Alzheimer's disease patients by a PKC activator

Several alterations in fibroblasts of Alzheimer's disease (AD) patients have been described, including alterations in calcium regulation, protein kinase C (PKC), and potassium (K+) channels. Studies have also found reduced levels of the alpha isoform of PKC in brains and fibroblasts of AD patients. Since PKC is known to regulate ion channels, we studied K+ channel activity in fibroblasts from AD patients in the presence of (2S, 5S)-8-(1-decynyl)benzolactam (BL), a novel activator of PKC with improved selectivity for the alpha, beta, and gamma isoforms. We present evidence for restoration of normal K+ channel function, as measured by TEA-induced [Ca2+]i elevations, due to activation of PKC by BL. Representative patch-clamp data further substantiate the effect of BL on restoration of 113pS K+ channel activity. Immunoblotting analyses using an alpha-isozyme-specific PKC antibody confirm that BL-treated fibroblasts of AD patients show increased PKC activation. The present study suggests that PKC activator-based restoration of K+ channels may offer another approach to the investigation of AD pathophysiology, which in turn could lead to the development of a useful model for AD therapeutics.

Distinct pH homeostatic features in lymphoblasts from Alzheimer's disease patients

Epstein-Barr-transformed lymphocytes from Alzheimer's disease patients showed the following distinct features in controlling the intracellular pH compared with cells from normal age-matched controls: (1) The alphaIgM-induced intracellular acidification was more pronounced in Alzheimer's disease than control cells and this effect appears to be associated with a loss of effectiveness of a Ca2+/calmodulin-dependent mechanism in controlling the activity of the Na+/H+ exchanger; and (2) the intracellular H+-buffering capacity and the rate of proton efflux in response to an acid load were both decreased in Alzheimer's disease cells. It is concluded that the amplitude of the intracellular pH changes under acid-loading conditions will always be greater in Alzheimer's disease than in control cells.

Calcium responses in fibroblasts from asymptomatic members of Alzheimer's disease families

We have previously identified alterations of K+ channel function, IP3-mediated calcium release, and Cp20 (a memory-associated GTP binding protein) in fibroblasts from Alzheimer's disease (AD) patients vs controls. Some of these alterations can be integrated into an index that distinguishes AD patients from controls with both high specificity and high sensitivity. We report here that alterations in IP3-mediated calcium responses are present in a large proportion of AD family members (i.e., individuals at high risk) before clinical symptoms of Alzheimer's disease are present. This was not the case if such members later "escaped" AD symptoms. This preclinical calcium signal correlate of later AD does not reflect, however, the presence of the PS1 familial AD gene.

Cysteine proteinases are responsible for characteristic transketolase alterations in Alzheimer fibroblasts

Cultured fibroblasts from patients affected by Alzheimer's disease (AD) exhibited peculiar alterations of the enzyme transketolase (TK). Abnormalities (dubbed alkaline bands, ab) consisted of enzyme forms having unusually high pl and were proposed as a marker of the disease in living patients. The mechanisms of TK-ab expression were investigated with the use of cysteine proteinase inhibitors and purified preparations of either rat liver or human cysteine proteinases. The cysteine proteinase inhibitors N-acetyl-leu-leu-norleucinal (ALLN), L-trans-Epoxy-succinyl-leucylamido(4-guanidino)butane (E-64), and egg white cystatin added to AD cells just prior to extraction abolished TK abnormalities. Moreover, 1 day incubation of AD cultures with either ALLN (10 micrograms/ml), NH4Cl (10 mM), or KCl (30 mM) prevented TK-ab generation, due, presumably, to an impairment of lysosomal functions. Isolated rat liver cysteine proteinases were able to degrade TK in normal extracts and reproduce the characteristic TK-ab of AD fibroblasts. Moreover, pure human cathepsin H was also shown to partially induce an Alzheimer-like TK pattern and cleave normal TK to a 35 kDa fragment as spontaneously occurring in AD fibroblasts. The explanation of mechanisms of TK-ab formation provided evidence for an underlying imbalance of proteolysis in AD fibroblasts due to a relative increase/derangement of the cysteine proteinases cathepsins which might be also involved in the reported abnormal processing of multiple cellular components.

Calcium responses in human fibroblasts: a diagnostic molecular profile for Alzheimer's disease

We have previously identified alterations of K+ channel function, IP3-mediated calcium release, and Cp20 (a memory-associated GTP binding protein) in fibroblasts from AD patients vs. controls. In the present study we introduce a scoring system based on these response alterations that integrates two or more alterations (and their degree) in AD vs. control fibroblasts. This scoring system generates an index that distinguishes AD patients from controls with both high specificity and sensitivity. We also show that low doses of bradykinin elicit intracellular calcium release almost exclusively in AD cell lines in an all or none fashion that provide a clear measurement of enhanced IP3-mediated function in AD vs. controls.

Soluble beta-amyloid induces Alzheimer's disease features in human fibroblasts and in neuronal tissues

It has been shown that K+ channels, Cp20 (a 20kD GTP-binding protein), and intracellular calcium release, play a key role in associative memory storage. These same elements have been shown to be altered in fibroblasts from Alzheimer's Disease (AD) patients. In addition, it has been shown that PKC, also implicated in memory storage and closely related to the above mentioned components, is also altered in AD fibroblasts. Moreover, beta-amyloid was capable of inducing an AD-like phenotype for K+ channels and Cp20 in otherwise normal fibroblasts, providing additional evidence for the potential involvement of these components in AD and suggesting a possible pathological consequence of soluble beta-amyloid elevation in AD. Preliminary evidence shows that comparable changes in potassium channel function are also present in human olfactory neuroblasts from AD patients. These results indicate that the observed changes not only occur in peripheral tissues such as fibroblasts, but also in neural tissue, the primary site of AD pathology.

Breakdown of membrane phospholipids in Alzheimer disease. Involvement of excitatory amino acid receptors

Membrane phospholipids are not only essential membrane constituents but also determine many membrane functions and integrity. Normal receptor function, signal transduction, and transport of essential substrates depend strongly on normal membrane phospholipid metabolism. Studies of plasma membrane phospholipid composition have indicated that ethanolamine glycerophospholipids decrease, whereas serine glycerophospholipids increase significantly, in Alzheimer disease (AD). The release of arachidonate from the sn-2 position of glycerophospholipids is catalyzed by phospholipases and lipases. These enzymes are coupled to EAA receptors. Overstimulation of these receptors may be involved in abnormal calcium homeostasis, degradation of membrane phospholipids, and the accumulation of free fatty acids, prostaglandins, and lipid peroxides. Accumulation of the mentioned metabolites, as well as abnormalities in signal transduction owing to stimulation of lipases and phospholipases, may be involved in the pathogenesis of the neurodegeneration in AD.

Differential electrophoretic behavior in aqueous polymer solutions of red blood cells from Alzheimer patients and from normal individuals

The recently reported phenomenon that red blood cells (RBC) from Alzheimer disease (AD) patients and normal individuals, which have identical electrophoretic mobilities (EPM) in phosphate-buffered saline (PBS), have different EPM in appropriately selected polymer solutions, has been further explored. Of a number of in vitro treatments to which AD and normal RBC were subjected prior to EPM measurements in bottom phase (from a dextran-poly(ethylene glycol) (PEG) aqueous phase system) only trypsin eliminated the difference. Thus, the differential polymer interaction between AD and normal RBC, thought to be the basis for their dissimilar EPM, can be abolished by appropriate proteolytic modification of the cell surfaces and suggests protein as a source of difference. Because young and old RBC from normal individuals, which have the same EPM in PBS, have different EPM in certain polymer solutions, and the RBC from AD patients have been reported to age abnormally, we also compared the young and old RBC subpopulations from these two sources. By the criterion of cell electrophoresis in polymer solutions the differences between AD and normal RBC and between young and old RBC are distinct. The EPM of AD and normal RBC differ in bottom phase or PEG but not in dextran solution; while the EPM of young and old RBC differ predominantly in dextran. We speculate that since the observed difference in EPM of RBC from AD patients and normals depends on protein(s) yet is anticoagulant-related (being obtained only when blood is collected in citrate or oxalate) it might be the result of an interaction (Ca(2+)-mediated?) between the surfaces of these cells and protein component(s) of their respective, compositionally differing sera.

Muscarinic receptors on human eccrine sweat gland in aging and Alzheimer's disease

Age and Alzheimer's disease-related changes have been reported in the peripheral cholinergic system controlling sweating. We present (1) evidence of a high affinity muscarinic receptor localized on human eccrine sweat gland and (2) muscarinic receptor concentrations on eccrine gland samples from 22 patients with probable Alzheimer's disease of various degrees of dementia, 8 age-matched controls, and 11 young controls. Muscarinic receptors were measured using autoradiography with 3H-NMS as ligand. We found no evidence of changes related to aging or Alzheimer's disease in the overall concentration of receptors or in the amount of gland showing binding. Nor was there any correlation between the degree of dementia as measured by the Global Deterioration Scale or the Mini-Mental State Exam and 3H-NMS binding. In conclusion, we find no evidence that previously reported sweat gland functional changes associated with aging and Alzheimer's disease are reflected in changes in eccrine gland muscarinic receptor density.

Molecular mechanisms of memory and the pathophysiology of Alzheimer's disease

Research on molecular and biophysical mechanisms of associative learning and memory storage identified a number of key elements that are phylogenetically conserved. In both vertebrates and invertebrates, K+ channels, PKC, Cp20, and intracellular Ca2+ regulation play a fundamental role in memory mechanisms. Because memory loss is the hallmark and perhaps the earliest sign of Alzheimer's disease, we hypothesized that these normal memory mechanisms might be altered in AD. With the use of a variety of experimental methodologies, our results revealed that one of the critical elements in memory storage, K+ channels, are dysfunctional in AD fibroblasts. Moreover, beta-amyloid induced the same K+ dysfunction in normal cells. Intracellular Ca2+ release, also associated with molecular memory mechanisms, was found altered in fibroblasts from patients with AD. The results therefore strongly suggest that biophysical and molecular mechanisms of associative learning could be altered in AD and that they may contribute to the memory loss observed early in the disease.

Tau-like immunoreactivity in Alzheimer and control skin fibroblasts

The presence of the microtubule-associated protein tau in skin fibroblasts derived from Alzheimer patients and normal controls was investigated using a panel of well-characterized anti-tau antibodies against epitopes spanning the tau protein from the amino to the carboxyl end. The antibodies immunolabeled a fine, fibrillar cytoplasmic network in all skin fibroblasts. Disruption of the microtubule network with colchicine did not affect the immunolabeling of the fibrillar network nor did treatment with cytochalasin B known to disrupt the microfilament network. Immunoelectron microscopy with the anti-tau antibodies revealed colocalization of the label with the 10 nm intermediate filaments. Furthermore, immunoblots found no reactivity against purified vimentin, suggesting that the antibodies recognize an intermediate filament-associated protein. The findings indicate the presence of tau or a protein with considerable homology to tau in fibroblasts associated with intermediate filaments and not microtubules.

Alzheimer's disease and Down syndrome: leukocyte membrane fluidity alterations

Down Syndrome (DS) patients over the age of 40 have brain lesions identical to those of patients with Alzheimer's Disease (AD). We have earlier shown that with some membrane probes, the plasma membranes of circulating leukocytes had increased fluidity in AD compared to the normally more rigid membranes in similarly aged subjects. We next questioned whether the occurrence of AD-like pathological lesions in older DS subjects would be associated with a similar increase in membrane fluidity. Fluidity was assessed by measurements of steady-state fluorescence anisotropy using TMA-DPH, which anchors at the plasma membrane surface, and a series of 9-anthroyloxy fatty acids substituted with the fluorescent moiety at different positions on the fatty acid, which permit measurement of fluidity at different depths of the plasma membrane. This was done simultaneously in neutrophils, lymphocytes, and monocytes utilizing flow cytometry. In older DS subjects (average age 52.6), plasma membrane fluidity was indeed increased, a finding similar to that with AD leukocytes. Membrane fluidity of leukocytes of young DS subjects (average age 23.6 years) was less than that seen in older subjects. Membrane changes may result from lipophilic substances released from the central nervous system, or may reflect intrinsic differences in membrane structure unique in DS.