A new strategy for Alzheimer’s disease: low‐dose combination of radiotherapy and pharmacological epigenetic perturbation

Abstract

AbstractBackgroundMost Alzheimer’s disease (AD) drug discovery studies focus exclusively on one specific target. This approach has to date shown limited success in AD, mainly because this complex disease is multifactorial and involves numerous pathways. In light of the large number of disappointing clinical trials, the National Institute on Aging (NIA) and the Alzheimer’s Association (AA) published, in 2018, new guidelines recommending focusing on biomarkers of the AD continuum. These guidelines advise targeting Amyloid‐β (A), neurofibrillary tangles (T) and neurodegeneration markers (N), designated “ATN”, to advance AD research. Using 2 different approaches, we have been able to both reverse and prevent ATN burden in mouse models of AD. Indeed, our group has previously demonstrated that histone deacetylase inhibition (HDACi) and cranial radiotherapy (RT) independently improve (AD)‐like pathogenesis in cell and animal models. In the present study, we investigate the synergistic potential of using both RT and HDACi as a low‐dose combination therapy (LDCT) to further improve molecular and behavioral AD‐like phenotypes in AD models.MethodLDCT consisted of daily administration of the HDAC3 inhibitor RGFP‐966 and/or bi‐weekly cranial x‐irradiation. Behavioral analyses, real‐time qPCR, NanoString technology, ELISAs and Western blots were used to assess the effects of RT, RGFP‐966 and LDCT on AD‐like pathogenesis in AD models. Additionally, innate immune response to LDCT was also assessed in vitro and in vivo using human and murine cell models and 3xTg‐AD mice.ResultLDCT induced a tolerant, anti‐inflammatory innate immune response in microglia and increased non‐amyloidogenic APP processing. Both RT and LDCT improved spatial learning and memory in the Barnes maze test. No sensorimotor deficits were observed. LDCT induced a unique anti‐AD gene expression profile in the brain, that included upregulation of neurotrophic genes and downregulation of inflammation‐related genes. Brain region specific observations included lowered Aβ42/40 ratio, decreased Bace1, and reduced p‐tau181 levels.ConclusionThis work shows that it is possible to attenuate AD‐related pathologies through the synergy of low doses of RT and HDACi treatment. This project supports a paradigm shift to a multipronged approach to AD therapeutics.