Cerebral Amyloid Angiopathy Deposition Research Articles

Amyloid-β (Aβ) immunotherapy induced microhemorrhages are associated with activated perivascular macrophages and peripheral monocyte recruitment in Alzheimer’s disease mice

BackgroundAmyloid-related imaging abnormalities (ARIA) have been identified as the most common and serious adverse events resulting from pathological changes in the cerebral vasculature during several recent anti-amyloid-β (Aβ) immunotherapy trials. However, the precise cellular and molecular mechanisms underlying how amyloid immunotherapy enhances cerebral amyloid angiopathy (CAA)-mediated alterations in vascular permeability and microhemorrhages are not currently understood. Interestingly, brain perivascular macrophages have been implicated in regulating CAA deposition and cerebrovascular function however, further investigations are required to understand how perivascular macrophages play a role in enhancing CAA-related vascular permeability and microhemorrhages associated with amyloid immunotherapy.MethodsIn this study, we examined immune responses induced by amyloid-targeting antibodies and CAA-induced microhemorrhages using histology and gene expression analyses in Alzheimer’s disease (AD) mouse models and primary culture systems.ResultsIn the present study, we demonstrate that anti-Aβ (3D6) immunotherapy leads to the formation of an antibody immune complex with vascular amyloid deposits and induces the activation of CD169+ perivascular macrophages. We show that macrophages activated by antibody mediated Fc receptor signaling have increased expression of inflammatory signaling and extracellular matrix remodeling genes such as Timp1 and MMP9 in vitro and confirm these key findings in vivo. Finally, we demonstrate enhanced vascular permeability of plasma proteins and recruitment of inflammatory monocytes around vascular amyloid deposits, which are associated with hemosiderin deposits from cerebral microhemorrhages, suggesting the multidimensional roles of activated perivascular macrophages in response to Aβ immunotherapy.ConclusionsIn summary, our study establishes a connection between Aβ antibodies engaged at CAA deposits, the activation of perivascular macrophages, and the upregulation of genes involved in vascular permeability. However, the implications of this phenomenon on the susceptibility to microhemorrhages remain to be fully elucidated. Further investigations are warranted to determine the precise role of CD169 + perivascular macrophages in enhancing CAA-mediated vascular permeability, extravasation of plasma proteins, and infiltration of immune cells associated with microhemorrhages.

Elevated expression of urokinase plasminogen activator in rodent models and patients with cerebral amyloid angiopathy.

The aim of this work is to study the association of urokinase plasminogen activator (uPA) with development and progression of cerebral amyloid angiopathy (CAA). We studied the expression of uPA mRNA by quantitative polymerase chain reaction (qPCR) and co-localisation of uPA with amyloid-β (Aβ) using immunohistochemistry in the cerebral vasculature of rTg-DI rats compared with wild-type (WT) rats and in a sporadic CAA (sCAA) patient and control subject using immunohistochemistry. Cerebrospinal fluid (CSF) uPA levels were measured in rTg-DI and WT rats and in two separate cohorts of sCAA and Dutch-type hereditary CAA (D-CAA) patients and controls, using enzyme-linked immunosorbent assays (ELISA). The presence of uPA was clearly detected in the cerebral vasculature of rTg-DI rats and an sCAA patient but not in WT rats or a non-CAA human control. uPA expression was highly co-localised with microvascular Aβ deposits. In rTg-DI rats, uPA mRNA expression was highly elevated at 3months of age (coinciding with the emergence of microvascular Aβ deposition) and sustained up to 12 months of age (with severe microvascular CAA deposition) compared with WT rats. CSF uPA levels were elevated in rTg-DI rats compared with WT rats (p = 0.03), and in sCAA patients compared with controls (after adjustment for age of subjects, p = 0.05 and p = 0.03). No differences in CSF uPA levels were found between asymptomatic and symptomatic D-CAA patients and their respective controls (after age-adjustment, p = 0.09 and p = 0.44). Increased cerebrovascular expression of uPA in CAA correlates with increased quantities of CSF uPA in rTg-DI rats and human CAA patients, suggesting that uPA could serve as a biomarker for CAA.

Loss of clusterin shifts amyloid deposition to the cerebrovasculature via disruption of perivascular drainage pathways

Alzheimer's disease (AD) is characterized by amyloid-β (Aβ) peptide deposition in brain parenchyma as plaques and in cerebral blood vessels as cerebral amyloid angiopathy (CAA). CAA deposition leads to several clinical complications, including intracerebral hemorrhage. The underlying molecular mechanisms that regulate plaque and CAA deposition in the vast majority of sporadic AD patients remain unclear. The clusterin (CLU) gene is genetically associated with AD and CLU has been shown to alter aggregation, toxicity, and blood-brain barrier transport of Aβ, suggesting it might play a key role in regulating the balance between Aβ deposition and clearance in both brain and blood vessels. Here, we investigated the effect of CLU on Aβ pathology using the amyloid precursor protein/presenilin 1 (APP/PS1) mouse model of AD amyloidosis on a Clu+/+ or Clu-/- background. We found a marked decrease in plaque deposition in the brain parenchyma but an equally striking increase in CAA within the cerebrovasculature of APP/PS1;Clu-/- mice. Surprisingly, despite the several-fold increase in CAA levels, APP/PS1;Clu-/- mice had significantly less hemorrhage and inflammation. Mice lacking CLU had impaired clearance of Aβ in vivo and exogenously added CLU significantly prevented Aβ binding to isolated vessels ex vivo. These findings suggest that in the absence of CLU, Aβ clearance shifts to perivascular drainage pathways, resulting in fewer parenchymal plaques but more CAA because of loss of CLU chaperone activity, complicating the potential therapeutic targeting of CLU for AD.

LOSS OF CLUSTERIN SHIFTS AMYLOID DEPOSITION TO THE CEREBROVASCULATURE VIA DISRUPTION OF PERIVASCULAR DRAINAGE PATHWAYS

Alzheimer's disease (AD) is characterized by amyloid-β (Aβ) peptide deposition in brain parenchyma as plaques and in cerebral blood vessels as cerebral amyloid angiopathy (CAA). CAA deposition leads to several clinical complications, including intracerebral hemorrhage. The underlying molecular mechanisms that regulate plaque and CAA deposition in the vast majority of sporadic AD patients remain unclear. The clusterin (CLU) gene is genetically associated with AD and CLU has been shown to alter aggregation, toxicity and blood-brain barrier transport of Aβ, suggesting it might play a key role in regulating the balance between Aβ deposition and clearance in both brain and blood vessels. Here, we investigated the effect of CLU on Aβ pathology using the APP/PS1 mouse model of AD amyloidosis on a Clu+/+ or Clu-/- background. We measured amyloid pathology, neuritic dystrophy, microhemorrhage, and neuroinflammation. We also performed perivascular clearance experiments and ex vivo vessel binding assays. We found a marked decrease in plaque deposition in the brain parenchyma but an equally striking increase in CAA within the cerebrovasculature of APP/PS1; Clu-/- mice. Surprisingly, despite the several-fold increase in CAA levels, APP/PS1; Clu-/- mice had significantly less hemorrhage and inflammation. Clu-/- mice had impaired perivascular clearance of Aβ in vivo and exogenously added CLU significantly prevented Aβ binding to isolated vessels ex vivo. These findings indicate that in the absence of CLU, Aβ clearance shifts to perivascular drainage pathways resulting in fewer parenchymal plaques but more CAA due to loss of CLU chaperone activity, complicating the potential therapeutic targeting of CLU for AD.

CEREBRAL AMYLOID ANGIOPATHY TREATMENT VIA INNATE IMMUNITY STIMULATION IN AGED NON-HUMAN PRIMATES

Immunotherapeutic approaches for Alzheimer's disease (AD) are hampered by complications related to ineffectual clearance of cerebral amyloid angiopathy (CAA). Given the independent correlation of the degree of CAA pathology with the severity of cognitive impairment, as well as the key role of CAA in the pathophysiology leading to development of amyloid-related imaging abnormalities, our studies were designed to determine whether stimulation of innate immunity with TLR9 agonist CpG oligodeoxynucleotides (ODNs) could have beneficial effects in a non-human primate model of sporadic CAA, squirrel monkey (Saimiri Boliviensis). Our prior work has shown that treatment with CpG ODN is effective at improving cognitive deficits in aged monkeys without inducing adverse events. Elderly female monkeys with expected CAA deposits were subcutaneously injected with either predetermined non-toxic dosages of the class B CpG ODN or saline for a 25 month period. Animals were continuously examined for signs of toxicity. Plasma taken at specific times in the course of treatment was analyzed to identify immune responses and AD biomarkers. Histological and biochemical brain analyses commenced upon completion of the behavioral protocols. Long term treatment with CpG ODN significantly reduced total amyloid burden (6E10/4G8 immunohistochemistry), which in this model corresponds primarily to CAA. Histological evaluation of CpG ODN effect on pyroglutamate levels (AβpE3 immunohistochemistry) revealed region specific reduction in AβpE3 burden in monkeys treated with CpG ODN. These favorable histological data will be corroborated by measurements of Aβ levels in the brain homogenates. Our initial biomarker analyses exhibited a noticeable increase in AβpE3 plasma levels in CpG ODN-treated animals. Subsequent evaluation showed no increase in the extent of Iba1 microgliosis and GFAP astrogliosis in CpG ODN group at the end of the treatment. Additionally, there was no evidence of increased microhemorrhages or T cell infiltration in association with CpG ODN treatment, further supporting the viability of our approach. Concluding assessment of microglia/macrophage activation is currently in progress. Overall, the present findings together with our earlier experimental evidence validate this novel concept of immunomodulation as a safe method to successfully ameliorate AD related pathology, suggesting CpG ODN would have a significant potential of achieving clinical efficacy.

Neuropathology and biochemistry of Aβ and its aggregates in Alzheimer's disease.

Alzheimer's disease (AD) is characterized by β-amyloid plaques and intraneuronal τ aggregation usually associated with cerebral amyloid angiopathy (CAA). Both β-amyloid plaques and CAA deposits contain fibrillar aggregates of the amyloid β-peptide (Aβ). Aβ plaques and CAA develop first in neocortical areas of preclinical AD patients and, then, expand in a characteristic sequence into further brain regions with end-stage pathology in symptomatic AD patients. Aβ aggregates are not restricted to amyloid plaques and CAA. Soluble and several types of insoluble non-plaque- and non-CAA-associated Aβ aggregates have been described. Amyloid fibrils are products of a complex self-assembly process that involves different types of transient intermediates. Amongst these intermediate species are protofibrils and oligomers. Different variants of Aβ peptides may result from alternative processing or from mutations that lead to rare forms of familial AD. These variants can exhibit different self-assembly and aggregation properties. In addition, several post-translational modifications of Aβ have been described that result, for example, in the production of N-terminal truncated Aβ with pyroglutamate modification at position 3 (AβN3pE) or of Aβ phosphorylated at serine 8 (pSer8Aβ). Both AβN3pE and pSer8Aβ show enhanced aggregation into oligomers and fibrils. However, the earliest detectable soluble and insoluble Aβ aggregates in the human brain exhibit non-modified Aβ, whereas AβN3pE and pSer8Aβ are detected in later stages. This finding indicates the existence of different biochemical stages of Aβ aggregate maturation with pSer8Aβ being related mainly to cases with symptomatic AD. The conversion from preclinical to symptomatic AD could thereby be related to combined effects of increased Aβ concentration, maturation of aggregates and spread of deposits into additional brain regions. Thus, the inhibition of Aβ aggregation and maturation before entering the symptomatic stage of the disease as indicated by the accumulation of pSer8Aβ may represent an attractive treatment strategy for preventing disease progression.

Matrix metalloproteinase inhibition reduces oxidative stress associated with cerebral amyloid angiopathy in vivo in transgenic mice

Cerebral amyloid angiopathy (CAA), characterized by extracellular beta-amyloid peptide (Abeta) deposits in vessel walls, is present in the majority of cases of Alzheimer's disease and is a major cause of hemorrhagic stroke. Although the molecular pathways activated by vascular Abeta are poorly understood, extracellular matrix metalloproteinases (MMP) and Abeta-induced oxidative stress appear to play important roles. We adapted fluorogenic assays for MMP activity and reactive oxygen species generation for use in vivo. Using multiphoton microscopy in APPswe/PS1dE9 and Tg-2576 transgenic mice, we observed strong associations between MMP activation, oxidative stress, and CAA deposition in leptomeningeal vessels. Antioxidant treatment with alpha-phenyl-N-tert-butyl-nitrone reduced oxidative stress associated with CAA (approximately 50% reduction) without affecting MMP activation. Conversely, a selection of agents that inhibit MMP by different mechanisms of action, including minocycline, simvastatin, and GM6001, reduced not only CAA-associated MMP activation (approximately 30-40% reduction) but also oxidative stress (approximately 40% reduction). The inhibitors of MMP did not have direct antioxidant effects. Treatment of animals with alpha-phenyl-N-tert-butyl-nitrone or minocycline did not have a significant effect on CAA progression rates. These data suggest a close association between Abeta-related MMP activation and oxidative stress in vivo and raise the possibility that treatment with MMP inhibitors may have beneficial effects by indirectly reducing the oxidative stress associated with CAA.

Effect of Gelsolin on Cerebral Amyloid Angiopathy (CAA) in Transgenic Mice

Cerebral amyloid angiopathy (CAA), the deposition of cerebrovascular β‐amyloid (Aβ), is a cause of hemorrhagic stroke and is present in most cases of Alzheimer disease. We have previously developed a quantitative approach to measure CAA progression in mice and have shown that CAA can be reversed by passive immunotherapy. We now report the effect of peripheral administration of gelsolin, an agent with the ability to bind Aβ in the plasma and that may thus act as a peripheral sink for Aβ, on the rate of CAA progression. Cranial windows were placed in 11 month old mice, an age at which CAA deposition follows a mixed‐effects linear model. Seven days post‐craniotomy, mice were randomized to intraperitonal administration of either gelsolin (0.6 mg/kg) or vehicle every 2 days for 3 weeks. CAA in leptomeningeal arteries was imaged on day 0, 7, 14 and 21 post‐craniotomy using methoxy‐X04, with angiograms used to facilitate vessel alignment. Between day 0 and day 7 (prior to start of treatment) there was CAA progression as expected. Peripherally administrated gelsolin resulted in mild regression of CAA deposits. The effect of the peripherally administrated gelsolin was evident within a week after initial administration and this effect was sustained until day 21 (last imaging session). These data demonstrate that gelsolin, an agent with a peripherally acting effect on Aβ can cause regression of CAA in Tg2576. In addition, these data also suggest that plasma/brain Aβ dynamics may play a crucial role in the progression of CAA. Supported by NIH AG020570, EB00768 and AG21084, Caja Madrid fellowship (MG‐A), Lefler fellowship (CMP) and the Harvard NeuroDiscovery Center (RAB).

Human postmortem brain-derived cerebrovascular smooth muscle cells express all genes of the classical complement pathway: A potential mechanism for vascular damage in cerebral amyloid angiopathy and Alzheimer's disease

Deposition of amyloid around blood vessels, known as cerebral amyloid angiopathy (CAA), is a major pathological feature found in the majority of Alzheimer's disease (AD) cases, and activated complement fragments have been detected on CAA deposits in AD brains. In this study, we demonstrate for the first time that human cerebrovascular smooth muscle cells (HCSMC) isolated from cortical vessels derived from postmortem brains can express mRNAs for complement genes C1qB, C1r, C1s, C2, C3, C4, C5, C6, C7, C8 and C9, the components of the classical complement pathway. Secretion of the corresponding complement proteins for these genes was also demonstrated, except for C1q and C5. Of particular significance was the observation that treatment of HCSMC with aggregated amyloid beta (Aβ) 1–42 increased expression of complement C3 mRNA and increased release of C3 protein. Aβ treatment of HCSMC also increased expression of C6 mRNA. Interferon-γ induced expression and release of complement C1r, C1s, C2 and C4. As HCSMC are closely associated with Aβ deposits in vessels in the brain, their production of complement proteins could amplify the proinflammatory effects of amyloid in the perivascular environment, further compromising brain vascular integrity.

Antibody-Mediated Clearance of Amyloid-β Peptide from Cerebral Amyloid Angiopathy Revealed by QuantitativeIn VivoImaging

Cerebral amyloid angiopathy (CAA) is the accumulation of amyloid-beta peptide (Abeta) in the vessel wall of arteries in the brain. Because CAA is commonly associated with Alzheimer's disease (AD), characterized by parenchymal deposition of the same peptide in the form of senile plaques, there is considerable interest in the relationship of the two deposits in generating human disease. The study of CAA is of particular importance for immunotherapeutic approaches to AD, because reports of anti-Abeta immunotherapy in mice and humans have suggested that, whereas CAA appeared resistant to clearance, its response to this treatment promoted potential adverse effects, including meningoencephalitis. We used multiphoton microscopy and longitudinal imaging to monitor CAA in a mouse model of amyloid deposition to evaluate the effects of anti-Abeta passive immunotherapy. We found detectable clearance of CAA deposits within 1 week after a single administration of antibody directly to the brain, an effect that was short-lived. Chronic administration of antibody over 2 weeks led to more robust clearance without evidence of hemorrhage or other destructive changes. We found that the progressive clearance of Abeta from vessels follows distinct kinetics from what has been previously reported for clearance of plaques (parenchymal deposits of Abeta). This quantitative in vivo imaging approach directly demonstrates that CAA in a transgenic mouse model can be cleared with an optimized immunotherapy.

Progression of Cerebral Amyloid Angiopathy in Transgenic Mouse Models of Alzheimer Disease

Cerebral amyloid angiopathy (CAA), the deposition of beta-amyloid (Abeta3) in cerebral vessels, has been implicated as a common cause of hemorrhagic stroke and other forms of vascular disease. CAA is also a frequent concomitant of Alzheimer disease (AD). While the longterm consequences of CAA are well recognized from clinical and pathologic studies, numerous questions remain unanswered regarding the progression of the disease. Examination of CAA in traditional histologic sections does not easily allow for characterization of CAA, particularly in leptomeningeal vessels. In order to approach this topic, we used low magnification imaging of intact, postmortem brains from transgenic mouse models of AD-like pathology to define the spatial and temporal characteristics of CAA in leptomeningeal vessels. Imaging of brains from 10- to 26-month-old animals demonstrated a stereotypical pattern to the development of CAA, with vessels over the dorsal surface of the brain showing an anterior-to-posterior and large-to-small vessel gradient of involvement. High magnification imaging revealed that CAA deposition began with a banding pattern determined by the organization of the vascular smooth muscle cells. Further analysis of the pattern of amyloid deposits showed shrinkage and disappearance of the gaps between clusters of amyloid bands, gradually reaching a confluent pattern. These data led to a classification system to describe the severity of CAA deposition and demonstrate the potential of using intact brains to generate maps defining the progression and kinetics of CAA. This approach should lead to more informed analysis of the consequences of evolving therapeutic options for AD on this related form of vascular pathology.

Apolipoprotein E, smooth muscle cells and the pathogenesis of cerebral amyloid angiopathy: the potential role of impaired cerebrovascular A beta clearance.

Cerebral amyloid angiopathy (CAA) is caused by the deposition of beta-amyloid (A beta) in Alzheimer disease brains. It also occurs isolated, representing a major cause for cerebral hemorrhage in the elderly. The E4 genotype of apolipoprotein E (ApoE) is a risk factor for CAA; however, the molecular mechanism underlying this genetic association is unknown. Various findings suggest that cerebrovascular A beta is derived from the soluble A beta contained in the cortical extracellular space or the cerebrospinal fluid (CSF) that communicates and surrounds small cortical or leptomeningeal vessels. CAA deposits are always intimately associated with smooth muscle cells (SMCs) or SMC-derived pericytes. As we have previously reported, SMCs internalize A beta in vitro via a lipoprotein pathway involving ApoE and the low-density lipoprotein receptor family. Internalized A beta is subsequently located to lysosomes, suggesting its intracellular degradation. We show that A beta is internalized via multiple pathways, because class A and class B scavenger receptors are also colocalized to A beta-containing endosomes in SMCs, and A beta uptake is inhibited by various scavenger receptor antagonists. It has been recently shown for different cell types that the cellular uptake of ApoE is more efficient for the ApoE3 isoform when compared to ApoE4 and that this isoform-specific difference depends on the presence of heparan sulfate proteoglycan (HSPG). HSPG is produced by SMCs and promotes A beta fibrillogenesis. We propose a pathogenetic model of CAA, in which the ApoE- and HSPG-mediated clearance of CSF-derived A beta peptides by SMCs protects the vascular extracellular matrix against critical A beta concentrations. Impairment of this pathway or its reduced efficiency in carriers of the ApoE4 genotype may increase the risk of developing CAA.