Clinical and biomarker profiling of prodromal Alzheimer's disease in workpackage 5 of the Innovative Medicines Initiative PharmaCog project: a 'European ADNI study'

BACKGROUND

In the field of Alzheimer's disease (AD), the validation of biomarkers for early AD diagnosis and for use as a surrogate outcome in AD clinical trials is of considerable research interest.

OBJECTIVE

To characterize the clinical profile and genetic, neuroimaging and neurophysiological biomarkers of prodromal AD in amnestic mild cognitive impairment (aMCI) patients enrolled in the IMI WP5 PharmaCog (also referred to as the European ADNI study).

METHODS

A total of 147 aMCI patients were enrolled in 13 European memory clinics. Patients underwent clinical and neuropsychological evaluation, magnetic resonance imaging (MRI), electroencephalography (EEG) and lumbar puncture to assess the levels of amyloid β peptide 1-42 (Aβ42), tau and p-tau, and blood samples were collected. Genetic (APOE), neuroimaging (3T morphometry and diffusion MRI) and EEG (with resting-state and auditory oddball event-related potential (AO-ERP) paradigm) biomarkers were evaluated.

RESULTS

Prodromal AD was found in 55 aMCI patients defined by low Aβ42 in the cerebrospinal fluid (Aβ positive). Compared to the aMCI group with high Aβ42 levels (Aβ negative), Aβ positive patients showed poorer visual (P = 0.001), spatial recognition (P < 0.0005) and working (P = 0.024) memory, as well as a higher frequency of APOE4 (P < 0.0005), lower hippocampal volume (P = 0.04), reduced thickness of the parietal cortex (P < 0.009) and structural connectivity of the corpus callosum (P < 0.05), higher amplitude of delta rhythms at rest (P = 0.03) and lower amplitude of posterior cingulate sources of AO-ERP (P = 0.03).

CONCLUSION

These results suggest that, in aMCI patients, prodromal AD is characterized by a distinctive cognitive profile and genetic, neuroimaging and neurophysiological biomarkers. Longitudinal assessment will help to identify the role of these biomarkers in AD progression.

Yawning in depression: worth looking into

Yawning often occurs during states of increased sleep propensity. Depression is associated with sleep problems and tiredness. The aim of this paper is to review the present knowledge about possible changes of yawning during an episode of major depression (MD) and to report data on yawning from an online depression forum comprising of 450,000 postings. A literature search did not reveal any study about yawning in people with MD when compared to controls. However, there is evidence for an increased frequency of yawning under the influence of antidepressants. Analysis of the depression forum postings revealed 63 people writing about increased yawning in the context of depression. However, all but one of them were treated with antidepressants; and yawning was not reported as a symptom of depression, but in most cases (N=56) as occurring as a result of treatment with antidepressants. These findings are in agreement with a tonic hyperarousal in typical depression which is reduced by all standard antidepressants. For clinicians, it would be of interest to know whether yawning is reduced in untreated depression and whether it predicts treatment outcome.

Serotonin transporter gene variation impacts innate fear processing: Acoustic startle response and emotional startle

Anxiety-related behaviors are closely linked to neural circuits relaying fear-specific information to the amygdala. Many of these circuits, like those underlying processing of innate fear, are remarkably well understood. Recent imaging studies have contributed to this knowledge by discriminating more detailed corticoamygdalar associations mediating processing fear and anxiety. However, little is known about the underlying molecular mechanisms. We used the acoustic startle paradigm to investigate the impact of molecular genetic variation of serotonergic function on the acoustic startle response and its fear potentiation. Startle magnitudes to noise bursts as measured with the eye blink response were recorded in 66 healthy volunteers under four conditions: presenting unpleasant and pleasant affective pictures as well as neutral pictures, and presenting the startle stimulus without additional stimuli as a baseline. Subjects were genotyped for functional polymorphism in the transcriptional control region of the serotonin transporter gene (5-hydroxytryptamine transporter gene-linked region: 5-HTTLPR). Analyses of variance revealed a significant effect of 5-HTTLPR on overall startle responses across conditions. Carriers of the short (s) allele exhibited stronger startle responses than l/l homozygotes. However, we could not confirm our hypothesis of enhanced fear potentiation of the startle in s allele carriers. In conclusion, the results provide first evidence that the startle response is sensitive to genetic variation in the serotonin pathway. Despite some issues remaining to be resolved, the startle paradigm may provide a valuable endophenotype of fear processing and underlying serotonergic influences.

Specific GABAA circuits in brain development and therapy

GABAergic interneurons are highly diverse and operate with a corresponding diversity of GABA(A) receptor subtypes in controlling behaviour. In this article, we review the significance of GABA(A) receptor heterogeneity for neural circuit development and central nervous system pharmacology. GABA(A) receptor subtypes were identified as selective targets for behavioural actions of benzodiazepines and of selected intravenous anesthetic agents using point mutations which render a specific receptor subtype insensitive to the action of the respective drugs and also by novel subtype-selective ligands. The pharmacological separation of anxiolysis and sedation guides the development of novel anxiolytics, while inverse agonism at extrasynaptic GABA(A) receptors involved in learning and memory is currently being evaluated as a novel therapeutic principle for symptomatic memory enhancement.

Calcium-induced long-term depression in the visual cortex of the rat in vitro

1. In many brain areas, including neocortex and hippocampus, excitatory synapses can undergo both long-term potentiation (LTP) and long-term depression (LTD). It is established that a change in the postsynaptic calcium concentration ([Ca2+]i) is critical for the induction of both LTP and LTD. Protocols that induce these long-term synaptic modifications typically involve afferent stimulation. But, in hippocampus, LTP can also be induced by a transient increase of the extracellular calcium concentration ([Ca2+]o). The purpose of the present study was to determine whether raising [Ca2+]o also induces long-term modifications of excitatory synaptic transmission in the neocortex. 2. Intracellular recordings were obtained from regular spiking cells in layers II-III of slices of the rat visual cortex. Test stimuli were evoked with stimulation electrodes located in the white matter (w.m.) below the recorded cell and intracortically (i.c.) adjacent to the cell. Both the depolarizing slope and the amplitude of excitatory postsynaptic potentials (EPSPs) were measured. For exposure to elevated [Ca2+]o, the normal medium ([Ca2+]o = 2 mM) was exchanged for a period of 10 min against a medium containing 4 mM [Ca2+]o. 3. Elevated [Ca2+]o leads, after return to normal medium, to a long-lasting decrease of intracellularly recorded synaptic responses to both w.m. and i.c. stimulation even if activation of these two pathways is discontinued or N-methyl-D-aspartate (NMDA) receptors are blocked during elevated [Ca2+]o. This decrease is due to reduced efficacy of excitatory transmission because it is observed in the presence of the gamma-aminobutyric acid-A (GABAA) receptor antagonist, bicuculline. 4. Induction of LTD by raising [Ca2+]o is voltage dependent. First, elevated [Ca2+]o elicits LTD only in cells whose resting membrane potential (Vmr) is less polarized than -79 mV (and more polarized than -70 mV, which is the Vmr of the least polarized cell). Second, hyperpolarizing cells whose Vmr is in this susceptible range by 20 mV below Vmr during exposure to high [Ca2+]o prevents Ca2+-induced LTD. Third, when elevated [Ca2+]o is associated with postsynaptic depolarizing pulses, LTD is readily induced in cells whose Vmr is more polarized than -79 mV. This voltage dependence implies that the depression is induced by a postsynaptic process and hence that it occurs at synapses formed by excitatory terminals on the recorded neuron. 5. Assuming that a transient elevation of [Ca2+]o leads to an increase of [Ca2+]i, the results of this study suggest that a transient increase of [Ca2+]i is sufficient to elicit LTD. This may provide a mechanism for the induction of heterosynaptic LTD, a depression that occurs in afferents that are silent while the postsynaptic neuron is activated by other inputs.

Differential blocking action of Joro spider toxin analog on parallel fiber and climbing fiber synapses in cerebellar Purkinje cells

Synaptic potentials were recorded intracellularly from Purkinje cells in guinea pig cerebellar slices. EPSPs evoked by stimulation of parallel fibers were effectively blocked by perfusion of a slice with the synthetic analog of Joro spider toxin, 1-naphthylacetyl-spermine (NAS) at 250 microM. However, it did not influence those responses evoked by stimulation of climbing fibers. This action of NAS is in contrast to other commonly used glutamate antagonists, CNQX or APV: CNQX (5 microM) blocked both parallel fiber- and climbing fiber-induced responses, while APV (up to 1 mM) did not influence either except for a weak reduction observed in climbing fiber responses. NAS thus provides a useful tool for pharmacologically distinguishing parallel fiber and climbing fiber synapses.

The role of cerebellar flocculus in adaptive gain control of ocular reflexes

Sustained oscillation of the head of an alert animal with inphase or outphase combination of screen oscillation in the horizontal plane induced marked adaptive changes in the gain of the horizontal vestibulo-ocular reflex (HVOR). These changes are assumed to be a prototype of motor learning by the cerebellar flocculus. Several lines of experimental evidence, using rabbits or monkeys as experimental material, have consistently suggested that the plastic changes of neuronal activities of a particular group of floccular Purkinje cells (H-cells) are the sources of the HVOR adaptation.