Alzheimer's Biomarkers are Correlated with Brain Connectivity in Older Adults Differentially during Resting and Task States

β-amyloid (Aβ) plaques and tau-related neurodegeneration are pathologic hallmarks of Alzheimer’s disease (AD). The utility of AD biomarkers, including those measured in cerebrospinal fluid (CSF), in predicting future AD risk and cognitive decline is still being refined. Here, we explored potential relationships between functional connectivity (FC) patterns within the default-mode network (DMN), age, CSF biomarkers (Aβ₄₂ and pTau₁₈₁), and cognitive status in older adults. Multiple measures of FC were explored, including a novel time series-based measure [total interdependence (TI)]. In our sample of 27 cognitively normal older adults, no significant associations were found between levels of Aβ₄₂ or pTau₁₈₁ and cognitive scores or regional brain volumes. However, we observed several novel relationships between these biomarkers and measures of FC in DMN during both resting-state and a short-term memory task. First, increased connectivity between bilateral anterior middle temporal gyri was associated with higher levels of CSF Aβ₄₂ and Aβ₄₂/pTau₁₈₁ ratio (reflecting lower AD risk) during both rest and task. Second, increased bilateral parietal connectivity during the short-term memory task, but not during rest, was associated with higher levels of CSF pTau₁₈₁ (reflecting higher AD risk). Third, increased connectivity between left middle temporal and left parietal cortices during the active task was associated with decreased global cognitive status but not CSF biomarkers. Lastly, we found that our new TI method was more sensitive to the CSF Aβ₄₂-connectivity relationship whereas the traditional cross-correlation method was more sensitive to levels of CSF pTau₁₈₁ and cognitive status. With further refinement, resting-state connectivity and task-driven connectivity measures hold promise as non-invasive neuroimaging markers of Aβ and pTau burden in cognitively normal older adults.

Abstract W P252: Amylin Vasculopathy, a Novel Mechanism of Cerebrovascular Injury and Neurologic Deficits in Diabetes

Human amylin is an amyloidogenic hormone that forms toxic oligomers that kill the insulin-producing β-cells in the pancreas of patients with type-2 diabetes. We recently showed that the pancreatic amylin pathology is also linked with cerebrovascular dementia and diabetic heart disease by increased circulating levels of toxic oligomerized amylin. Here, we tested the hypothesis that the cerebrovascular accumulation of oligomerized amylin injures the brain, leading to neurologic deficits independently of hyperglycemia.

A diabetic rat model overexpressing amyloidogenic human amylin in the pancreas (the HIP rat) and appropriate controls were used to investigate mechanistically cerebrovascular effects of amylin accumulation. As controls, we employed wild-type (WT) littermates and age- and glucose-matched diabetic rats expressing only non-amyloidogenic WT amylin, which does not accumulate in pancreas or other organs. Compared to controls, HIP rats showed reduced exploratory drive, vestibulomotor performance and recognition memory. Cortical arteries isolated from HIP rats displayed a ~40% higher myogenic tone (P<0.05), which correlates with an increased mean arterial blood pressure by ~20% (P<0.05). We also found elevated lipid peroxidation (by 18±3%; P<0.05) and activated Ca 2+ -mediated hypertrophy signaling in cortical smooth muscle cells from HIP rats compared to control rats. Serial staining with the ED1 antibody and amylin antibody indicates possible activated microglia/macrophages which are clustering in blood vessel areas positive for amylin infiltration. Multiple inflammatory markers are expressed in HIP rat brains compared to control rats, confirming that amylin deposition induces an inflammatory response.

Overall, our data suggest that cerebrovascular amylin deposition is associated with neurologic deficits via mechanisms of vascular dysfunction, oxidative stress and neuroinflammation.

Intraneuronal beta-amyloid aggregates, neurodegeneration, and neuron loss in transgenic mice with five familial Alzheimer's disease mutations: potential factors in amyloid plaque formation

Mutations in the genes for amyloid precursor protein (APP) and presenilins (PS1, PS2) increase production of beta-amyloid 42 (Abeta42) and cause familial Alzheimer's disease (FAD). Transgenic mice that express FAD mutant APP and PS1 overproduce Abeta42 and exhibit amyloid plaque pathology similar to that found in AD, but most transgenic models develop plaques slowly. To accelerate plaque development and investigate the effects of very high cerebral Abeta42 levels, we generated APP/PS1 double transgenic mice that coexpress five FAD mutations (5XFAD mice) and additively increase Abeta42 production. 5XFAD mice generate Abeta42 almost exclusively and rapidly accumulate massive cerebral Abeta42 levels. Amyloid deposition (and gliosis) begins at 2 months and reaches a very large burden, especially in subiculum and deep cortical layers. Intraneuronal Abeta42 accumulates in 5XFAD brain starting at 1.5 months of age (before plaques form), is aggregated (as determined by thioflavin S staining), and occurs within neuron soma and neurites. Some amyloid deposits originate within morphologically abnormal neuron soma that contain intraneuronal Abeta. Synaptic markers synaptophysin, syntaxin, and postsynaptic density-95 decrease with age in 5XFAD brain, and large pyramidal neurons in cortical layer 5 and subiculum are lost. In addition, levels of the activation subunit of cyclin-dependent kinase 5, p25, are elevated significantly at 9 months in 5XFAD brain, although an upward trend is observed by 3 months of age, before significant neurodegeneration or neuron loss. Finally, 5XFAD mice have impaired memory in the Y-maze. Thus, 5XFAD mice rapidly recapitulate major features of AD amyloid pathology and may be useful models of intraneuronal Abeta42-induced neurodegeneration and amyloid plaque formation.

Barriers to drug discovery and development for Alzheimer disease

Alzheimer disease (AD) is a neurodegenerative condition leading to progressive, irreversible loss of cognitive and behavioral function. Despite considerable investments in neuroscience research, only four drugs, all cholinesterase inhibitors, have been approved for the symptomatic management of AD in the United States. Although basically safe and modestly effective, these drugs are far from ideal, being neither universally efficacious nor disease modifying. AD exacts a considerable toll in direct medical costs, quality of life, and caregiver burden for persons and society. In addition to the obvious clinical benefit, therapeutic agents for AD and related dementias represent a considerable market opportunity for the pharmaceutical and biotechnology industries. There are currently 8-10 million AD sufferers in the seven major pharmaceutical markets. The market will grow rapidly in coming decades, as the developed world experiences an enormous increase in its elderly population. Given the great need for new therapeutic agents to manage and prevent AD, the Institute for the Study of Aging and the Fidelity Foundation organized a workshop, "Barriers to the Discovery and Development of Drugs for Alzheimer's Disease," to examine ways to expedite drug discovery and development. The identified barriers and potential solutions will be discussed here and in the accompanying articles in more detail.