Alzheimer's disease as a systems-level timing disorder: Circadian disruption of glial immunometabolism, brain clearance, and therapeutic responsiveness

Alzheimer's disease (AD) is the leading cause of dementia, affecting approximately 45.0 million people worldwide and ranking as the fifth leading cause of mortality. AD is identified by neurofibrillary tangles (NFTs), which include abnormally phosphorylated tau-protein and amyloid protein (amyloid plaques). Peptide dysregulation is caused by an imbalance between the production and clearance of the amyloid-beta (Aβ) and NFT. AD begins to develop when these peptides are not cleared from the body. As a result, understanding the processes that control both normal and pathological protein recycling in neuronal cells is critical. Insufficient Aβ and NFT clearance are important factors in the development of AD. Autophagy, lysosomal dysfunction, and ubiquitin-proteasome dysfunction have potential roles in the pathogenesis of many neurodegenerative disorders, particularly in AD. Modulation of these pathways may provide a novel treatment strategy for AD. Non-coding RNAs (ncRNAs) have recently emerged as important biological regulators, with particular relevance to the emergence and development of neurodegenerative disorders such as AD. ncRNAs can be used as potential therapeutic targets and diagnostic biomarkers due to their critical regulatory functions in several biological processes involved in disease development, such as the aggregation and accumulation of Aβ and NFT. It is evident that ncRNAs play a role in the pathophysiology of AD. In this communication, we explored the link between ncRNAs and AD and their regulatory mechanisms that may help in finding new therapeutic targets and AD medications.

Synaptosome microRNAs: emerging synapse players in aging and Alzheimer’s disease

Intrinsic Connectivity Identifies the Hippocampus as a Main Crossroad between Alzheimer’s and Semantic Dementia-Targeted Networks

How far is arterial spin labeling MRI from a clinical reality? Insights from arterial spin labeling comparative studies in Alzheimer's disease and other neurological disorders.

Purpose of Review Alzheimer’s disease (AD) is multifactorial, and it is believed that several factors, including genetic, metabolic, bioenergetics, and environmental factors, have a role in the onset and development of this disease. Obstructive sleep apnea (OSA) has a high prevalence in patients with AD and is considered a risk factor for the development of AD. Besides, several features, including shared comorbidities, the induction of cognitive impairment and neurodegeneration make both pathologies highly interconnected. We reviewed the existing knowledge about the possible OSA-induced brain alterations that can potentially participate in the development and progression of AD. Recent Findings Intermittent hypoxia and sleep fragmentation have been considered as the most important OSA-induced alterations that can trigger dysregulation of multiple pathways at the cerebral tissue. Although both events can act synergistically, here we discussed the possible role of each event in development and progression of AD individually. Intermittent hypoxia has been linked to increased oxidative stress, systemic and neuroinflammation, and consequently cerebrovascular dysfunctionality. On the other hand, sleep fragmentation and deprivation can challenge memory consolidation and the brain clearance. Summary OSA-induced pathophysiological alterations in AD patients can lead to synaptic damage, neurodegeneration and increased AD-related brain pathology that will manifest by progressive cognitive impairment in this disease.

Oxidative stress and inflammation are important pathologic factors for the progression of Alzheimer’s disease (AD). The alleviation of oxidative stress and inflammation is regarded as an effective strategy for the treatment of AD. Herein, benefiting from the strong anti-oxidative and anti-inflammatory capability of quercetin (QC), we fabricate QC-loaded nanoparticles (QC NPs) for potential treatment of AD. QC is conjugated to phenylboronic acid modified hyaluronic acid by the formation of phenylboronate ester bonds, which is further assembled into QC NPs owing to the amphiphilic property. QC can be efficiently released from QC NPs under the stimulation of acidic pH or H 2 O 2 , due to the cleavage of dynamic phenylboronate ester bonds. The released QC from QC NPs significantly reduces intracellular ROS level and down-regulates pro-inflammatory cytokines (TNF- α and IL-6) in model AD cells, thereby alleviating Aβ25-35 induced cytotoxicity. This research brings up an effective strategy for potential treatment of AD.

The prion protein (PrP) is best known for its association with prion diseases. However, a controversial new role for PrP in Alzheimer disease (AD) has recently emerged. In vitro studies and mouse models of AD suggest that PrP may be involved in AD pathogenesis through a highly specific interaction with amyloid-β (Aβ42) oligomers. Immobilized recombinant human PrP (huPrP) also exhibited high affinity and specificity for Aβ42 oligomers. Here we report the novel finding that aggregated forms of huPrP and Aβ42 are co-purified from AD brain extracts. Moreover, an anti-PrP antibody and an agent that specifically binds to insoluble PrP (iPrP) co-precipitate insoluble Aβ from human AD brain. Finally, using peptide membrane arrays of 99 13-mer peptides that span the entire sequence of mature huPrP, two distinct types of Aβ binding sites on huPrP are identified in vitro. One specifically binds to Aβ42 and the other binds to both Aβ42 and Aβ40. Notably, Aβ42-specific binding sites are localized predominantly in the octapeptide repeat region, whereas sites that bind both Aβ40 and Aβ42 are mainly in the extreme N-terminal or C-terminal domains of PrP. Our study suggests that iPrP is the major PrP species that interacts with insoluble Aβ42 in vivo. Although this work indicated the interaction of Aβ42 with huPrP in the AD brain, the pathophysiological relevance of the iPrP/Aβ42 interaction remains to be established.

BackgroundLittle is known about the genetic factors and downstream molecular pathways determining individual variability in fluid and imaging biomarkers associated with Alzheimer’s disease(AD). We studied polygenic risk scores (PRS) and pathway‐specific PRS in relationship with AD fluid and imaging biomarkers, in non‐demented individuals from the European Prevention of Alzheimer’s Dementia (EPAD) cohort.MethodEPAD inclusion criteria were age>50 and Clinical Dementia Rating = 0.5 (n = 1886, Table 1). AD‐PRS was based on 85 previously identified loci, including and excluding APOE (PRSAPOE, PRSnoAPOE)[1]. Using gene‐variant and variant‐pathway mapping[2], six pathway‐specific PRSnoAPOE were identified:1) immune‐activation, 2) signal‐transduction, 3) inflammatory‐response, 4) migration, 5) amyloid‐production, and 6) clearance. Linear models were used to assess the relationship of all PRS with fluid AD biomarkers, including Aß1‐42, p‐Tau181, and t‐tau; and several imaging biomarkers, including hippocampal volume, global and lobar white matter hyperintensities (WMH) volumes, fractional anisotropy (FA) in 14 regions of interest from diffusion tensor imaging, and 10 resting‐state network connectivity from functional MRI. Models were adjusted for age, sex, site, and multiple comparisons.ResultModels’ coefficients are reported in Table 2. PRSAPOE was significantly associated with decreased Aß1‐42, and increased p‐Tau181 and t‐Tau. PRSnoAPOE showed a weaker, but still significant, negative association with Aß1‐42 levels, and a significant positive association with p‐Tau181 and t‐Tau. Aß1‐42 was only significantly associated with the migration, amyloid, and clearance pathways, while all pathways were significantly positively associated with p‐Tau181 and t‐Tau. Hippocampal volume was only significantly associated with PRSAPOE. Regarding WMH load, PRSAPOE showed a positive association with global, frontal periventricular, and parietal deep lobes. Furthermore, the clearance pathway was related to WMH load in all regions, most strongly in periventricular areas. Only the migration pathway was related to increases in FA in the splenium, body, and genu of the corpus callosum. Only the PRSAPOE was related to reduced functional connectivity (FC) in the default mode, control, and visual networks.ConclusionWe show that genetic risk beyond APOE facilitates the manifestation of AD related pathologies. Moreover, clearance and migration pathways were associated with neuroimaging measures of white matter integrity, while FC and hippocampal volume were associated with overall AD genetic risk.

BackgroundLittle is known about the genetic factors and downstream molecular pathways determining individual variability in fluid and imaging biomarkers associated with Alzheimer’s disease(AD). We studied polygenic risk scores (PRS) and pathway‐specific PRS in relationship with AD fluid and imaging biomarkers, in non‐demented individuals from the European Prevention of Alzheimer’s Dementia (EPAD) cohort.MethodEPAD inclusion criteria were age>50 and Clinical Dementia Rating≤0.5 (n = 1886, Table 1). AD‐PRS was based on 85 previously identified loci, including and excluding APOE (PRSAPOE, PRSnoAPOE)[1]. Using gene‐variant and variant‐pathway mapping[2], six pathway‐specific PRSnoAPOE were identified:1) immune‐activation, 2) signal‐transduction, 3) inflammatory‐response, 4) migration, 5) amyloid‐production, and 6) clearance. Linear models were used to assess the relationship of all PRS with fluid AD biomarkers, including Aβ1‐42, p‐Tau181, and t‐tau; and several imaging biomarkers, including hippocampal volume, global and lobar white matter hyperintensities (WMH) volumes, fractional anisotropy (FA) in 14 regions of interest from diffusion tensor imaging, and 10 resting‐state network connectivity from functional MRI. Models were adjusted for age, sex, site, and multiple comparisons.ResultModels’ coefficients are reported in Table 2. PRSAPOE was significantly associated with decreased Aβ1‐42, and increased p‐Tau181 and t‐Tau. PRSnoAPOE showed a weaker, but still significant, negative association with Aβ1‐42 levels, and a significant positive association with p‐Tau181 and t‐Tau. Aβ1‐42 was only significantly associated with the migration, amyloid, and clearance pathways, while all pathways were significantly positively associated with p‐Tau181 and t‐Tau.Hippocampal volume was only significantly associated with PRSAPOE. Regarding WMH load, PRSAPOE showed a positive association with global, frontal periventricular, and parietal deep lobes. Furthermore, the clearance pathway was related to WMH load in all regions, most strongly in periventricular areas.Only the migration pathway was related to increases in FA in the splenium, body, and genu of the corpus callosum. Only the PRSAPOE was related to reduced functional connectivity (FC) in the default mode, control, and visual networks.ConclusionWe show that genetic risk beyond APOE facilitates the manifestation of AD related pathologies. Moreover, clearance and migration pathways were associated with neuroimaging measures of white matter integrity, while FC and hippocampal volume were associated with overall AD genetic risk.

BackgroundComplement contributes significantly to pathophysiology in many neurodegenerative diseases (NDDs) including Alzheimer's Disease (AD); yet, the source of complement in the brain is poorly understood. Even multiple small changes to individual complement components can compound into significant dysregulation of the whole system. Targeting complement effectively in NDDs requires understanding complement expression in the healthy brain and how it changes in pathology.MethodWe integrated single‐nucleus RNA sequencing datasets, including over 600,000 cells from 97 donor frontal cortices, 60 AD donors (36 male, 24 female) and 37 control donors (23 male, 14 female). Complement expression across nine cell types, and the impact of AD pathology, sex and age on complement gene expression was examined.ResultsMicroglia are the principle source of C1Q/A/B/C and C3 expression in both the healthy and AD brain, with more microglia expressing higher levels observed in AD. Increases in C1R, C1S, C5 and C7 expression are seen in AD, predominately in fibroblasts, pericytes and astrocytes. Endothelial cells strongly expressed most complement regulators including, CD46, CD55, CD59 and CFH with greater expression observed in AD. The AD risk gene CLU demonstrated significantly higher expression in multiple cell types however, remains predominantly expressed in astrocytes. Expression of the novel complement regulator SRPX2 was markedly increased in AD in pericytes and fibroblasts, while slightly elevated expression of CSMD1/2/3 is seen in neurons. No significant differences in complement expression between sexes was observed in control donors. However, in AD donors sex‐based differences were seen with female donors typically demonstrating a greater percentage of cells expressing complement. This data suggests that AD alters the normal pattern of changes in complement gene expression with age, in particular, significantly higher expression of C1R, C1S and CLU are seen in the youngest age group.ConclusionOur comprehensive complement expression atlas for the AD and control frontal cortex reveals profound complement dysregulation in AD. There are sex specific trends in this dysregulation with females demonstrating greater dysregulation. Finally, most severe complement dysregulation in AD is observed in the youngest individuals highlighting a significant age‐dependent factor that could inform the timing and design of therapeutic interventions.

In Alzheimer's disease (AD), accumulation of brain amyloid-β (Aβ) depends on imbalance between production and clearance of Aβ. Several pathways for Aβ clearance have been reported including transport across the blood-brain barrier (BBB) and hepatic clearance. The incidence of AD increases with age and failure of Aβ clearance correlates with AD. The cholinesterase inhibitors (ChEIs) donepezil and rivastigmine are used to ease the symptoms of dementia associated with AD. Besides, both drugs have been reported to provide neuroprotective and disease-modifying effects. Here, we investigated the effect of ChEIs on age-related reduced Aβ clearance. Findings from in vitro and in vivo studies demonstrated donepezil and rivastigmine to enhance (125)I-Aβ40 clearance. Also, the increase in brain and hepatic clearance of (125)I-Aβ40 was more pronounced in aged compared to young rats, and was associated with significant reduction in brain Aβ endogenous levels determined by ELISA. Furthermore, the enhanced clearance was concomitant with up-regulation in the expression of Aβ major transport proteins P-glycoprotein and LRP1. Collectively, our findings that donepezil and rivastigmine enhance Aβ clearance across the BBB and liver are novel and introduce an additional mechanism by which both drugs could affect AD pathology. Thus, optimizing their clinical use could help future drug development by providing new drug targets and possible mechanisms involved in AD pathology.

Cross-sectional studies suggest that sleep fragmentation is associated with cognitive performance in older adults. We tested the hypothesis that sleep fragmentation is associated with incident Alzheimer's disease (AD) and the rate of cognitive decline in older adults. Prospective cohort study. Community-based. 737 community dwelling older adults without dementia. Sleep fragmentation was quantified from up to 10 consecutive days of actigraphy. Subjects underwent annual evaluation for AD with 19 neuropsychological tests. Over a follow-up period of up to 6 years (mean 3.3 years), 97 individuals developed AD. In a Cox proportional hazards model controlling for age, sex, and education, a higher level of sleep fragmentation was associated with an increased risk of AD (HR = 1.22, 95%CI 1.03-1.44, P = 0.02 per 1SD increase in sleep fragmentation). An individual with high sleep fragmentation (90th percentile) had a 1.5-fold risk of developing AD as compared with someone with low sleep fragmentation (10th percentile). The association of sleep fragmentation with incident AD did not vary along demographic lines and was unchanged after controlling for potential confounders including total daily rest time, chronic medical conditions, and the use of common medications which can affect sleep. In a linear mixed effect analysis, a 0.01 unit increase in sleep fragmentation was associated with a 22% increase in the annual rate of cognitive decline relative to the average rate of decline in the cohort (Estimate = -0.016, SE = 0.007, P = 0.03). Sleep fragmentation in older adults is associated with incident AD and the rate of cognitive decline. Lim ASP; Kowgier M; Yu L; Buchman AS; Bennett DA. Sleep fragmentation and the risk of incident alzheimer's disease and cognitive decline in older persons. SLEEP 2013;36(7):1027-1032.

This cross-sectional study examined associations between multiple fluid biomarkers of neuronal and glial dysfunction (plasma neurofilament light chain, CSF growth-associated protein 43 and CSF soluble triggering receptor expressed on myeloid cells 2), total white matter hyperintensity volume and episodic memory and executive function performance in the context of Alzheimer's disease biomarker status. A total of 563 participants (mean age = 71.9 years, standard deviation = 7.2) from the Alzheimer's Disease Neuroimaging Initiative were classified by the amyloid-β/tau/neurodegeneration framework into no Alzheimer's disease pathology (n = 176), suspected non-Alzheimer's disease pathophysiology (n = 87) or Alzheimer's disease continuum (n = 300) groups. Participants completed baseline neuropsychological assessment, plasma/CSF biomarker collection and MRI. Analyses explored the relative contributions of biomarkers to episodic memory and executive function performance and whether relationships varied by amyloid-β/tau/neurodegeneration group status. Across all participants, neurofilament light chain ( = -0.14, P < 0.001) and growth-associated protein 43 ( = -0.13, P < 0.001) were the strongest biomarkers associated with episodic memory performance, such that greater levels were associated with worse episodic memory. There was a group by growth-associated protein 43 interaction with episodic memory: greater growth-associated protein 43 was associated with lower episodic memory performance in participants classified as Alzheimer's disease continuum relative to the no Alzheimer's disease pathology group ( = -0.26, P < 0.001). No robust associations between biomarkers and executive function performance or between soluble triggering receptor expressed on myeloid cells 2, white matter hyperintensity volume and cognition were observed. Biomarkers of neuro-axonal injury and synaptic dysfunction may independently contribute to episodic memory performance across participants with differing amyloid-β/tau/neurodegeneration profiles. Growth-associated protein 43 may predict worse episodic memory performance in participants with greater Alzheimer's disease pathology. These biomarkers of neuronal dysfunction may serve as domain-specific cognitive correlates in the context of Alzheimer's disease biomarker status.

10 - Protein aggregation disorders

Genetic Ablation of Apolipoprotein A-IV Accelerates Alzheimer's Disease Pathogenesis in a Mouse Model