Parenchymal Amyloid Research Articles

Loss of TREM2 diminishes CAA despite an overall increase of amyloid load in Tg‐SwDI mice

AbstractINTRODUCTIONThe microglial receptor triggering receptor expressed on myeloid cells 2 (TREM2) is a major risk factor for Alzheimer's disease (AD). Experimentally, Trem2 deficiency affects parenchymal amyloid beta (Aβ) deposition. However, the role of TREM2 in cerebrovascular amyloidosis, especially cerebral amyloid angiopathy (CAA), remains unexplored.METHODSTg‐SwDI (SwDI) mice, a CAA‐prone model of AD, and Trem2 knockout mice were crossed to generate SwDI/TWT, SwDI/THet, and SwDI/TKO mice, followed by pathological and biochemical analyses at 16 months of age.RESULTSLoss of Trem2 led to a dramatic decrease in CAA and microglial association, despite a marked increase in overall brain Aβ load. Single nucleus RNA sequencing analysis revealed that in the absence of Trem2, microglia were activated but trapped in transition to the fully reactive state, with distinct responses of vascular cells.DISCUSSIONOur study provides the first evidence that TREM2 differentially modulates parenchymal and vascular Aβ pathologies, offering significant implications for both TREM2‐ and Aβ‐targeting therapies for AD.Highlights Triggering receptor expressed on myeloid cells 2 (TREM2) differentially modulates brain parenchymal and vascular amyloidosis. Loss of Trem2 markedly reduces cerebral amyloid angiopathy despite an overall increase of amyloid beta load in Tg‐SwDI mice. Microglia are trapped in transition to the fully reactive state without Trem2. Perivascular macrophages and other vascular cells have distinct responses to Trem2 deficiency. Balanced TREM2‐targeting therapies may be required for optimal outcomes.

TPA supplementation preserves neurovascular and cognitive function in Tg2576 mice.

Amyloid beta (Aβ) impairs the cerebral blood flow (CBF) increase induced by neural activity (functional hyperemia). Tissue plasminogen activator (tPA) is required for functional hyperemia, and in mouse models of Aβ accumulation tPA deficiency contributes to neurovascular and cognitive impairment. However, it remains unknown if tPA supplementation can rescue Aβ-induced neurovascular and cognitive dysfunction. Tg2576 mice and wild-type littermates received intranasal tPA (0.8mg/kg/day) or vehicle 5 days a week starting at 11 to 12 months of age and were assessed 3 months later. Treatment of Tg2576 mice with tPA restored resting CBF, prevented the attenuation in functional hyperemia, and improved nesting behavior. These effects were associated with reduced cerebral atrophy and cerebral amyloid angiopathy, but not parenchymal amyloid. These findings highlight the key role of tPA deficiency in the neurovascular and cognitive dysfunction associated with amyloid pathology, and suggest potential therapeutic strategies involving tPA reconstitution. Amyloid beta (Aβ) induces neurovascular dysfunction and impairs the increase of cerebral blood flow induced by neural activity (functional hyperemia). Tissue plasminogen activator (tPA) deficiency contributes to the neurovascular and cognitive dysfunction caused by Aβ. In mice with florid amyloid pathology intranasal administration of tPA rescues the neurovascular and cognitive dysfunction and reduces brain atrophy and cerebral amyloid angiopathy. tPA deficiency plays a crucial role in neurovascular and cognitive dysfunction induced by Aβ and tPA reconstitution may be of therapeutic value.

Using Neuroimaging to Study Cerebral Amyloid Angiopathy and Its Relationship to Alzheimer's Disease.

Cerebral amyloid angiopathy (CAA) is characterized by amyloid-β aggregation in the media and adventitia of the leptomeningeal and cortical blood vessels. CAA is one of the strongest vascular contributors to Alzheimer's disease (AD). It frequently co-occurs in AD patients, but the relationship between CAA and AD is incompletely understood. CAA may drive AD risk through damage to the neurovascular unit and accelerate parenchymal amyloid and tau deposition. Conversely, early AD may also drive CAA through cerebrovascular remodeling that impairs blood vessels from clearing amyloid-β. Sole reliance on autopsy examination to study CAA limits researchers' ability to investigate CAA's natural disease course and the effect of CAA on cognitive decline. Neuroimaging allows for in vivo assessment of brain function and structure and can be leveraged to investigate CAA staging and explore its associations with AD. In this review, we will discuss neuroimaging modalities that can be used to investigate markers associated with CAA that may impact AD vulnerability including hemorrhages and microbleeds, blood-brain barrier permeability disruption, reduced cerebral blood flow, amyloid and tau accumulation, white matter tract disruption, reduced cerebrovascular reactivity, and lowered brain glucose metabolism. We present possible areas for research inquiry to advance biomarker discovery and improve diagnostics.

Chapter 17 - Familial cerebral amyloid disorders with prominent white matter involvement

Familial cerebral amyloid disorders are characterized by the accumulation of fibrillar protein aggregates, which deposit in the parenchyma as plaques and in the vasculature as cerebral amyloid angiopathy (CAA). Amyloid β (Aβ) is the most common of these amyloid proteins, accumulating in familial and sporadic forms of Alzheimer's disease and CAA. However, there are also a number of rare, hereditary, non-Aβ cerebral amyloidosis. The clinical manifestations of these familial cerebral amyloid disorders are diverse, including cognitive or neuropsychiatric presentations, intracerebral hemorrhage, seizures, myoclonus, headache, ataxia, and spasticity. Some mutations are associated with extensive white matter hyperintensities on imaging, which may or may not be accompanied by hemorrhagic imaging markers of CAA; others are associated with occipital calcification. We describe the clinical, imaging, and pathologic features of these disorders and discuss putative disease mechanisms. Familial disorders of cerebral amyloid accumulation offer unique insights into the contributions of vascular and parenchymal amyloid to pathogenesis and the pathways underlying white matter involvement in neurodegeneration. With Aβ immunotherapies now entering the clinical realm, gaining a deeper understanding of these processes and the relationships between genotype and phenotype has never been more relevant.

Accelerated cerebral amyloid angiopathy and vascular alterations in a mixed mouse model of Alzheimer’s disease and cerebral small vessel disease

AbstractBackgroundWhile aging is the primary risk factor for Alzheimer’s disease (AD), emerging evidence suggests that vascular dysfunction, present in cerebral small vessel diseases (CSVD) such as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), is also a major contributor for disease progression. Indeed, several studies have provided clinical evidence for a close synergistic relationship between AD and CSVD in cases where both diseases coexist. CSVD can elicit amyloid pathology, while Alzheimer’s‐associated cerebral amyloid angiopathy (CAA) and Ab plaque deposition may lead to concomitant vascular damage. Mutations in genes such as APP, PSEN1, and PSEN2 are not limited to AD, as APP mutations can also cause CAA, while PSEN1 and PSEN2 are involved in Notch3 signaling, a process known to be dysregulated in CADASIL. Here, we aimed to investigate the additive or synergistic effects of amyloid pathology and CADASIL‐related vascular damage on disease progression.MethodTo explore alterations in amyloid and vascular pathology when AD and CADASIL‐related CSVD coexist, we used PET/CT and histology to analyze over time the amyloid deposition in the form of plaques and CAA in a relevant mouse model of AD (5xFAD) carrying the Notch3 C456R mutation that causes CADASIL. Methoxy‐X04, Thioflavin‐S, or 6E10 were used to visualize amyloid accumulation in fixed brain tissues. The progression of microvascular dysfunction and neuroinflammation were assessed by immunofluorescence staining, Western blotting, RNA sequencing, and real‐time PCR.ResultAdult 5xFAD‐Notch3C456R mice showed accelerated parenchymal and vascular amyloid deposition compared to 5xFAD mice. Progressive gliosis and microvascular damage were concomitant to parenchymal and vascular amyloid accumulation. These changes were associated with blood‐brain barrier disruption and reduction in pericyte coverage of cerebral capillaries.ConclusionWe found accelerated amyloid plaque deposition, CAA, gliosis, and vascular damage in a mixed murine model of AD and CADASIL, suggesting that CSVD‐associated vascular changes directly contribute to AD pathology. This model offers novel opportunities to investigate the intricate interplay between CSVD and AD. This research was funded by NIH/NINDS grant RF1NS117486.

O-GalNAc glycosylation determines intracellular trafficking of APP and Aβ production

A primary pathology of Alzheimer's disease (AD) is amyloid β (Aβ) deposition in brain parenchyma and blood vessels, the latter being called cerebral amyloid angiopathy (CAA). Parenchymal amyloid plaques presumably originate from neuronal Aβ precursor protein (APP). Although vascular amyloid deposits' origins remain unclear, endothelial APP expression in APP knock-in mice was recently shown to expand CAA pathology, highlighting endothelial APP's importance. Furthermore, two types of endothelial APP-highly O-glycosylated APP and hypo-O-glycosylated APP-have been biochemically identified, but only the former is cleaved for Aβ production, indicating the critical relationship between APP O-glycosylation and processing. Here, we analyzed APP glycosylation and its intracellular trafficking in neurons and endothelial cells. Although protein glycosylation is generally believed to precede cell surface trafficking, which was true for neuronal APP, we unexpectedly observed that hypo-O-glycosylated APP is externalized to the endothelial cell surface and transported back to the Golgi apparatus, where it then acquires additional O-glycans. Knockdown of genes encoding enzymes initiating APP O-glycosylation significantly reduced Aβ production, suggesting this non-classical glycosylation pathway contributes to CAA pathology and is a novel therapeutic target.

Aquaporin 4 is associated with cerebral amyloid‐beta and tau deposits in mouse models

AbstractBackgroundEmerging evidence indicates that the glymphatic system plays an important role in Alzheimer’s disease. Aquaporin 4 (AQP4) constitutes a critical part of the glymphatic system in the clearance of accumulated amyloid‐beta and tau from the brain. Here, we aimed to establish the association between AQP4 and tau as well as amyloid‐beta (Aβ).MethodPerfusion and susceptibility weighted imaging (SWI) magnetic resonance imaging (MRI, at 7 or 9.4 T) were performed in arcAβ mouse model of amyloidosis (aged 16‐18 months), P301L mouse model of 4‐repeat tau (pR5 line) and respective nontransgenic littermates (aged 10‐12 months). Immunofluorescence staining was performed using antibodies against AQP4, CD31, astrogliosis (GFAP, s100β), microgliosis (Iba1, CD68), Aβ (6E10), and tau (AT‐8 and AT‐100) in brain tissue slices from transgenic arcAβ mice and wild‐type littermates.ResultCerebral microbleeds were detected in the cortex and subcortical regions in arcAβ mice. Cerebral blood flow was reduced in the cortex and hippocampus of arcAβ compared to nontransgenic mice but preserved in P301L mice. Increased AQP4 levels were observed surrounding tau deposits in the forebrain of P301L mice and parenchymal amyloid plaques/cerebral amyloid angiopathy in the cortex and hippocampus of arcAβ mice. Depolarization of AQP4 was detected in both arcAβ and P301L mice compared to their respective nontransgenic littermates. Increased s100b‐GFAP and CD68‐Iba1 fluorescence intensities indicative of atrogliosis and microgliosis were detected around tau deposits in P301L mice and amyloid plaques in arcAβ mice.ConclusionWe observed impaired perfusion in arcAβ mice but not in P301L mice, and a spatial association of AQP4 with both tau and Aβ in the brain.

Using amyloid PET as a biomarker to detect progression of early Alzheimer disease

AbstractBackgroundAlzheimer’s disease (AD), the most common form of dementia, is a complex polygenic disease with genetic, cellular, pathologic, and clinical heterogeneity. Recently, significant attempts have been made for identifying AD biomarkers for reliably tracking disease progression in its early asymptomatic stages. To this end, amyloid PET imaging has provided useful information tracking accumulation of parenchymal amyloid beta (Aβ) deposits in the brain. Previous investigations have conducted genetic association studies of CSF Aβ42, both continuously as well as using a threshold for amyloid positivity, and identified novel genes and loci potentially contributing to the preclinical stage in AD. In a recent case‐control based study using amyloid PET as a quantitative trait, Raghavan et al., identified a novel locus for amyloidosis within RBFOX1 gene in 4,314 participants, however, further investigations are needed to replicate and expand on these findings.MethodIn order to investigate the underlying genetic basis for brain amyloidosis in AD, we systematically analyzed the largest collection of amyloid imaging data (N = 6,320), across multiple ethnicities from multicenter cohorts (ADRC, A4, DIAN, ADNI, ADNIDOD, UPitt, and HABS) as a quantitative trait to identify the functional variants and genes driving the association of AD. Furthermore, we have conducted diagnosis‐, gender‐, and APOE‐stratified analyses to investigate the effect of these variables on the brain amyloidosis.ResultPreliminary results found a strong APOE signal in chr19 (min P = 1e‐185) and a genome‐wide significant hit (P = 2e‐08) in the chromosome 7 (potentially, associated to TMEM106B gene) warranting further investigation (Fig. 1). Moreover, some suggestive signals were detected in chr10 (P = 1e‐07) and chr12 (P = 5e‐07). Consistent with previous finding, we found RBFOX1 to be associated with increased amyloid burden (β = 0.07), however, the signal was only nominally significant (P = 0.03). Additional analyses including multi‐ancestry meta‐analysis using FHS, AIBL, and EISAI cohorts and post‐GWAS analyses are ongoing.ConclusionThe identification of pre‐clinical AD‐specific molecular signatures and pathways will enable the characterization of appropriate therapeutic targets for the prevention and/or treatment of AD. Results generated from our investigation will further serve to generate prediction models for amyloid positivity and Mendelian Randomization (MR) analyses.

Spontaneous intracerebral haemorrhage associated with early-onset cerebral amyloid angiopathy and Alzheimer’s disease neuropathological changes five decades after cadaveric dura mater graft

Cerebral amyloid angiopathy (CAA) is a small vessel disease, causing spontaneous intracerebral hemorrhage (ICH) in the elderly. It is strongly associated with Alzheimer disease (AD), as most CAA patients show deposition of Aβ—i.e. the basic component of parenchymal Alzheimer amyloid deposits—in the cerebral vessels. Iatrogenic early-onset CAA has been recently identified in patients with a history of traumatic brain injury or other cerebral as well as extra-cerebral lesions that led to neurosurgery or other medical procedures as intravascular embolization by cadaveric dura mater extracts many years before the first ICH event. In those patients, a transmission of Aβ seeds from neurosurgical instruments or from cadaveric dura mater exposure was suggested. We report a 51-year-old woman with unremarkable family history who presented abruptly with aphasia and right hemiparesis. A cerebral left lobar haemorrhagic stroke was documented by neuroimaging. Accurate anamnesis revealed a neurosurgical procedure with cadaveric dura mater graft at the age of 2 years for an arachnoid cyst. The neuropathological examination of the cerebral parietal biopsy showed severe amyloid angiopathy in many leptomeningeal and cortical vessels, as well as abundant parenchymal Aβ deposits, neurofibrillary tangles and neuropil threads. The mechanism involved in the human-to-human transmission of the Aβ proteinopathy remains to be clarified. In our patient the cadaver derived dura used for grafting is a very strong candidate as the source of the transmission. A systematic monitoring of individuals who have had neurosurgical procedures in early life, especially those involving cadaveric dural grafts, is required to determine the ratio of those affected by CAA many years later and unaffected. Moreover, our report confirms that in addition to vascular and parenchymal Aβ pathology, neurofibrillary changes indistinguishable from AD may develop in specific conditions with long latency period from the neurosurgical or embolization procedure.

Genetically diverse mouse models of Alzheimer’s Disease reveal an association between amyloid deposition and glycan metabolism in the brain

AbstractBackgroundVarying degrees of cerebral amyloid angiopathy (CAA) co‐occur with parenchymal amyloid deposition in majority of Alzheimer’s Disease (AD) cases. However, common mouse models of familial AD generated on a single inbred strain do not recapitulate the spectrum of parenchymal and vascular amyloid pathogenesis in the brain. To better represent phenotypic diversity in AD, we generated a panel of genetically diverse Collaborative Cross (CC) mouse strains harboring APOE4 allele and amyloidogenic mutations.MethodFive CC strains (CC002, CC006, CC013, CC037 and CC041) were selected for maximal genetic and transcriptional variation in AD‐relevant genes. Selected CC strains were crossed to C57BL/6J (B6J) mice homozygous for humanized APOE4 allele and carrying mutant APP and PS1 alleles (APPswe , PS1de9 ). Cohorts of male and female B6JCCnF1.APOE4.APP/PS1 mice and controls were aged to 8 months, and brain hemispheres were processed for RNA‐Seq transcriptomics and neuropathological assessment. Weighted Gene Co‐Expression Networks Analysis (WGCNA) and gene set enrichment analysis were performed to identify gene modules and biological pathways associated with plaque deposition and CAA in CC strains.ResultNeuropathological assessment revealed significant strain and sex‐dependent differences in both parenchymal and vascular amyloid pathology. Highest levels of plaque deposition in cortex and hippocampus was observed in female CC002 mice. Female mice had higher plaque load compared to male mice in all strains, whereas CAA score was higher in males and in CC037 strain. CC006 represented lowest levels of plaque deposition and CAA at comparable levels with B6J mice. RNA‐Seq data revealed a common microglia/neuroinflammation related transcriptional response observed in all strains and both sexes. On the other hand, gene expression signatures associated with varying levels of plaque deposition and CAA revealed alterations in metabolic pathways, in particular glucose, lipid and glycan metabolisms.ConclusionOur results suggest that major genetic diversity modulates distinctive parenchymal and vascular amyloid phenotypes, and differentially impacts transcriptomic signatures in the mouse brain. Overall, CC lines mouse models better represent the spectrum of neuropathological and molecular phenotypes associated with AD.

Chronic Treatment Study Using Class C CpG ODN in Aged Non‐Human Primate Model of Sporadic CAA (Saimiri boliviensis boliviensis).

AbstractBackgroundTherapeutics that target innate immunity present promising avenues for the treatment of Alzheimer’s disease (AD) neuropathology. Our recently published study using squirrel monkeys (SQMs), a non‐human primate model of sporadic AD with extensive cerebral amyloid angiopathy (CAA), demonstrated that treatment with TLR9 agonist, Class B CpG ODN, safely reduces cognitive deficits and pathological features including parenchymal amyloid deposits, tau pathology, and CAA. Subsequently, we initiated the first chronic treatment study using Class C CpG ODN, and demonstrated its safety and efficacy in eliciting an immune response in a geriatric SQM population. Here, we assess the efficacy of Class C CpG ODN by evaluating plasma biomarkers of neurodegeneration and cognitive status using an innovative computerized testing system.MethodGeriatric SQMs received monthly injections of Class C CpG ODN or saline. Plasma biomarkers of neurodegeneration (NfL, GFAP), neuroinflammation (YKL‐40/CHI3L1), and Aβ40/42 autoantibodies were detected longitudinally using Luminex, SIMOA, or ELISA assays. Furthermore, we have implemented an innovative, touchscreen‐based Automated Cognitive Testing System (ACTS) among socially living SQMs to monitor behavioral changes. Actical® activity monitors recorded general activity parameters (step count, activity count, energy expenditure, and intensity level).ResultPlasma levels of NfL, GFAP, and YKL‐40 were significantly increased in saline‐administered monkeys compared to CpG ODN‐treated cohort. No changes were observed in both treatment groups in general activity parameters. Longitudinal plasma hematological/biochemical parameters and Aβ40/42 IgG and IgM titers revealed no differences between treatment groups, further validating the safety of our immunomodulatory approach. Geriatric SQMs completed the ACTS SHAPE training tasks to a 95% criterion of success within 10 days and are progressing through advanced cognitive tests [Match‐to‐Sample (MTS) and Two‐Choice Discrimination]. Preliminary MTS testing revealed that CpG ODN‐treated group performed with a greater response accuracy than saline controls over the last 1000 trials. Additional biofluid biomarkers and cognitive assessments are being finalized. Longitudinal gene expression profiles (RNA‐seq and NanoString analyses) involved in CpG ODN pathways using PBMCs are underway.ConclusionOur findings enhance the translational value of the SQM model for preclinical research on AD and CAA pathogenesis, as we continue to demonstrate Class C CpG ODN’s safety and therapeutic efficacy in geriatric SQMs.

Lack of ApoE inhibits ADan amyloidosis in a mouse model of familial Danish dementia

The Apolipoprotein E-ε4 allele (APOE-ε4) is the strongest genetic risk factor for late onset Alzheimer disease (AD). ApoE plays a critical role in amyloid-β (Aβ) accumulation in AD, and genetic deletion of the murine ApoE gene in mouse models results in a decrease or inhibition of Aβ deposition. The association between the presence of ApoE and amyloid in amyloidoses suggests a more general role for ApoE in the fibrillogenesis process. However, whether decreasing levels of ApoE would attenuate amyloid pathology in different amyloidoses has not been directly addressed. Familial Danish dementia (FDD) is an autosomal dominant neurodegenerative disease characterized by the presence of widespread parenchymal and vascular Danish amyloid (ADan) deposition and neurofibrillary tangles. A transgenic mouse model for FDD (Tg-FDD) is characterized by parenchymal and vascular ADan deposition. To determine the effect of decreasing ApoE levels on ADan accumulation invivo, we generated a mouse model by crossing Tg-FDD mice with ApoE KO mice (Tg-FDD+/-/ApoE-/-). Lack of ApoE results in inhibition of ADan deposition up to 18months of age. Additionally, our results from a genetic screen of Tg-FDD+/-/ApoE-/- mice emphasize the significant role for ApoE in neurodegeneration in FDD via glial-mediated mechanisms. Taken together, our findings suggest that the interaction between ApoE and ADan plays a key role in FDD pathogenesis, in addition to the known role for ApoE in amyloid plaque formation in AD.

OPHTHALMOLOGIC INVOLVEMENT IN PATIENTS WITH HEREDITARY TRANSTHYRETIN AMYLOIDOSIS.

The aim of this study was to determine the ophthalmologic involvement in patients with hereditary transthyretin amyloidosis and its correlation with the mutations described in the literature. Cross-sectional, noninterventional study. Fifty-two eyes of 26 consecutive patients diagnosed with hereditary transthyretin amyloidosis who visited the Puerta de Hierro-Majadahonda University Hospital from September 2019 to March 2022. All patients underwent complete ophthalmologic examination and multimodal imaging. Cardiologic, neurologic, digestive, and renal examinations were also recorded. Eighteen eyes of the total (34.61%) showed amyloid-related ocular involvement, vitreous amyloid deposits being the most common ocular manifestation (18/52). Statistically significant differences were found for the presence of vitreous amyloid deposits ( P < 0.01), crystalline amyloid deposits ( P < 0.05), parenchymal amyloid deposits ( P < 0.01), and vascular alterations ( P < 0.01) when comparing affected and unaffected eyes. Moreover, affected eyes showed worse best-corrected visual acuity ( P < 0.01). Ocular manifestations are present in a substantial number of patients with ATTR that could potentially lead to devastating consequences to patients' best-corrected visual acuity and quality of life. Therefore, it is important to emphasize the importance of multidisciplinary management and ophthalmologic assessment, follow-up and surgical treatment when necessary. To the best of our knowledge, this represents the largest series in Spain of amyloidosis' ophthalmologic involvement.

Clusterin Binding Modulates the Aggregation and Neurotoxicity of Amyloid-β(1-42).

Alzheimer's disease (AD) is the most common neurodegenerative disorder characterized by the accumulation of amyloid-β (Aβ) aggregates in the brain. Clusterin (CLU), also known as apolipoprotein J, is a potent risk factor associated with AD pathogenesis, in which Aβ aggregation is essentially involved. We observed close colocalization of CLU and Aβ(1-42) (Aβ42) in parenchymal amyloid plaques or vascular amyloid deposits in the brains of human amyloid precursor protein (hAPP)-transgenic Tg2576 mice. Therefore, to elucidate the binding interaction between CLU and Aβ42 and its impact on amyloid aggregation and toxicity, the two synthetic proteins were incubated together under physiological conditions, and their structural and morphological variations were investigated using biochemical, biophysical, and microscopic analyses. Synthetic CLU spontaneously bound to different possible variants of Aβ42 aggregates with very high affinity (Kd = 2.647nM) in vitro to form solid CLU-Aβ42 complexes. This CLU binding prevented further aggregation of Aβ42 into larger oligomers or fibrils, enriching the population of smaller Aβ42 oligomers and protofibrils and monomers. CLU either alleviated or augmented Aβ42-induced cytotoxicity and apoptosis in the neuroblastoma-derived SH-SY5Y and N2a cells, depending on the incubation period and the molar ratio of CLU:Aβ42 involved in the reaction before addition to the cells. Thus, the effects of CLU on Aβ42-induced cytotoxicity were likely determined by the extent to which it bound and sequestered toxic Aβ42 oligomers or protofibrils. These findings suggest that CLU could influence amyloid neurotoxicity and pathogenesis by modulating Aβ aggregation.

Novel App knock-in mouse model shows key features of amyloid pathology and reveals profound metabolic dysregulation of microglia

BackgroundGenetic mutations underlying familial Alzheimer’s disease (AD) were identified decades ago, but the field is still in search of transformative therapies for patients. While mouse models based on overexpression of mutated transgenes have yielded key insights in mechanisms of disease, those models are subject to artifacts, including random genetic integration of the transgene, ectopic expression and non-physiological protein levels. The genetic engineering of novel mouse models using knock-in approaches addresses some of those limitations. With mounting evidence of the role played by microglia in AD, high-dimensional approaches to phenotype microglia in those models are critical to refine our understanding of the immune response in the brain.MethodsWe engineered a novel App knock-in mouse model (AppSAA) using homologous recombination to introduce three disease-causing coding mutations (Swedish, Arctic and Austrian) to the mouse App gene. Amyloid-β pathology, neurodegeneration, glial responses, brain metabolism and behavioral phenotypes were characterized in heterozygous and homozygous AppSAA mice at different ages in brain and/ or biofluids. Wild type littermate mice were used as experimental controls. We used in situ imaging technologies to define the whole-brain distribution of amyloid plaques and compare it to other AD mouse models and human brain pathology. To further explore the microglial response to AD relevant pathology, we isolated microglia with fibrillar Aβ content from the brain and performed transcriptomics and metabolomics analyses and in vivo brain imaging to measure energy metabolism and microglial response. Finally, we also characterized the mice in various behavioral assays.ResultsLeveraging multi-omics approaches, we discovered profound alteration of diverse lipids and metabolites as well as an exacerbated disease-associated transcriptomic response in microglia with high intracellular Aβ content. The AppSAA knock-in mouse model recapitulates key pathological features of AD such as a progressive accumulation of parenchymal amyloid plaques and vascular amyloid deposits, altered astroglial and microglial responses and elevation of CSF markers of neurodegeneration. Those observations were associated with increased TSPO and FDG-PET brain signals and a hyperactivity phenotype as the animals aged.DiscussionOur findings demonstrate that fibrillar Aβ in microglia is associated with lipid dyshomeostasis consistent with lysosomal dysfunction and foam cell phenotypes as well as profound immuno-metabolic perturbations, opening new avenues to further investigate metabolic pathways at play in microglia responding to AD-relevant pathogenesis. The in-depth characterization of pathological hallmarks of AD in this novel and open-access mouse model should serve as a resource for the scientific community to investigate disease-relevant biology.

Absence of microglia promotes diverse pathologies and early lethality in Alzheimer's disease mice.

SUMMARYMicroglia are strongly implicated in the development and progression of Alzheimer’s disease (AD), yet their impact on pathology and lifespan remains unclear. Here we utilize a CSF1R hypomorphic mouse to generate a model of AD that genetically lacks microglia. The resulting microglial-deficient mice exhibit a profound shift from parenchymal amyloid plaques to cerebral amyloid angiopathy (CAA), which is accompanied by numerous transcriptional changes, greatly increased brain calcification and hemorrhages, and premature lethality. Remarkably, a single injection of wild-type microglia into adult mice repopulates the microglial niche and prevents each of these pathological changes. Taken together, these results indicate the protective functions of microglia in reducing CAA, blood-brain barrier dysfunction, and brain calcification. To further understand the clinical implications of these findings, human AD tissue and iPSC-microglia were examined, providing evidence that microglia phagocytose calcium crystals, and this process is impaired by loss of the AD risk gene, TREM2.

The Extracellular Chaperone Clusterin in Aβ and Non‐Aβ Cerebral Amyloidoses

Clusterin, a multifunctional glycoprotein also known as apolipoprotein J, has been implicated in several physiological processes and is an important contributor to many pathological conditions, including Alzheimer’s disease (AD) in which genetic variants and plasma levels of the apolipoprotein were identified as risk factors for the disorder. To investigate whether clusterin exerted a more general role in the pathophysiology of cerebral amyloidoses, we turned to two unrelated hereditary conditions, familial British and Danish dementias (FBD and FDD), which share striking neuropathological similarities with AD, including neurofibrillary degeneration in limbic areas as well as parenchymal and vascular amyloid deposition. Two different 4 kDa molecules – ABri in FBD and ADan in FDD – totally unrelated to the 4 kDa Alzheimer’s Aβ, are the main constituents of the amyloid deposits in these forms of cerebral amyloidoses. Mirroring findings in AD, a panel of immunohistochemical studies demonstrated clusterin co‐localization with cerebral parenchymal and vascular amyloid deposits in both disorders. Ligand affinity chromatography with downstream Western blot and amino acid sequence analyses unequivocally identified clusterin as the major ABri‐ and ADan‐binding plasma protein. Solid‐phase enzyme‐linked immunosorbent assays highlighted a specific saturable binding of clusterin to ABri and ADan. Non‐linear regression analysis of the data revealed Kd values within the same low nanomolar range as those demonstrated for the clusterin‐Aβ interaction. Consistent with its reported chaperone activity, clusterin showed a modulatory effect on ABri, ADan, and Aβ aggregation/fibrillization properties evaluated using thioflavin T, a dye that displays enhanced fluorescence upon binding fibrillar and protofibrillar amyloid conformations. Our findings, together with the known multifunctional activity of clusterin and its modulatory activity on the complex cellular pathways leading to oxidative stress, mitochondrial dysfunction, and the induction of cell death mechanisms – all known pathogenic features of protein folding disorders, including AD, FBD, and FDD – suggests the likelihood of a more complex role and a translational potential of clusterin in the amelioration/prevention of these pathogenic mechanisms.

P 25 CSF biomarkers in CAA compared to AD

Background: Both, cerebral amyloid angiopathy (CAA) and Alzheimer’s disease (AD) pathologies coexist on a spectrum, where one end represents parenchymal amyloid deposition causing AD-dementia, and the other end represents vascular amyloid deposition leading to intracerebral hemorrhage and vascular cognitive impairment. CAA is present, to varying degrees, in several AD patients, resulting in a large overlap between the two pathologies in the same brain. Cerebrospinal fluid (CSF) biomarkers could aid in the better discrimination between CAA and AD pathology. Objective: To assess core biomarkers of AD pathology and axonal degeneration in CAA compared to AD and healthy controls. Methods: In a hospital-based setting we recruited 234 patients. N=96 (41%) had probable CAA according to the modified Boston criteria, but did not meet the NIA-AA criteria for AD. N=99 (42%) had AD, and of those n=21 (9%) had AD with CAA, while n=78 (33%) had AD without CAA. N=39 (17%) were considered controls without CAA or AD. CSF measures included β-amyloid (Aβ) 1-40, Aβ 1-42, phosphorylated tau (ptau), total tau (ttau) and neurofilament light chain (NfL). NfL data were missing in n=139 (59%) subjects. Group comparisons were conducted applying ANOVA, adjusted for age and sex, respectively. Bonferroni-adjusted p-values ≤ 0.01 were considered significant. Results: Group differences became obvious for Aβ 1-42, ptau and ttau (Figure). Aβ 1-42 was lower in AD with and without CAA compared to CAA and controls. Ptau was higher in AD with and without CAA compared to CAA and controls. Compared to controls, ttau was higher in AD with and without CAA, and in CAA. There were no group differences for Aβ 1-40 and NfL, albeit there was a clear trend towards higher NfL levels in AD with CAA and CAA compared to AD without CAA and controls (Figure). None of the CSF markers differed between AD with CAA compared to AD without CAA. Conclusion: Lower CSF Aβ 1-42 and higher ptau seem to be specific markers for AD pathology independent of the concurrent occurrence of CAA. They could aid in the discrimination between pure CAA and CAA with AD pathology. Outlook: Upcoming analysis will focus on the correlation between CSF biomarkers and CSVD MRI features according to the STRIVE criteria.

Activated endothelial cells induce a distinct type of astrocytic reactivity

Reactive astrogliosis is a universal response of astrocytes to abnormal events and injuries. Studies have shown that proinflammatory microglia can polarize astrocytes (designated A1 astrocytes) toward a neurotoxic phenotype characterized by increased Complement Component 3 (C3) expression. It is still unclear if inflammatory stimuli from other cell types may also be capable of inducing a subset of C3+ neurotoxic astrocytes. Here, we show that a subtype of C3+ neurotoxic astrocytes is induced by activated endothelial cells that is distinct from astrocytes activated by microglia. Furthermore, we show that endothelial-induced astrocytes have upregulated expression of A1 astrocytic genes and exhibit a distinctive extracellular matrix remodeling profile. Finally, we demonstrate that endothelial-induced astrocytes are Decorin-positive and are associated with vascular amyloid deposits but not parenchymal amyloid plaques in mouse models and AD/CAA patients. These findings demonstrate the existence of potentially extensive and subtle functional diversity of C3+-reactive astrocytes.

STAT3 inhibitor mitigates cerebral amyloid angiopathy and parenchymal amyloid plaques while improving cognitive functions and brain networks

Previous reports indicate a potential role for signal transducer and activator of transcription 3 (STAT3) in amyloid-β (Aβ) processing and neuritic plaque pathogenesis. In the present study, the impact of STAT3 inhibition on cognition, cerebrovascular function, amyloid pathology, oxidative stress, and neuroinflammation was studied using in vitro and in vivo models of Alzheimer’s disease (AD)-related pathology. For in vitro experiments, human brain vascular smooth muscle cells (HBVSMC) and human brain microvascular endothelial cells (HBMEC) were used, and these cultured cells were exposed to Aβ peptides followed by measurement of activated forms of STAT3 expression and reactive oxygen species (ROS) generation. Further, 6 months old 5XFAD/APOE4 (5XE4) mice and age-matched negative littermates were used for in vivo experiments. These mice were treated with STAT3 specific inhibitor, LLL-12 for 2 months followed by neurobehavioral and histopathological assessment. In vitro experiments showed exposure of cerebrovascular cells to Aβ peptides upregulated activated forms of STAT3 and produced STAT3-mediated vascular oxidative stress. 5XE4 mice treated with the STAT3-specific inhibitor (LLL-12) improved cognitive functions and functional connectivity and augmented cerebral blood flow. These functional improvements were associated with a reduction in neuritic plaques, cerebral amyloid angiopathy (CAA), oxidative stress, and neuroinflammation. Reduction in amyloid precursor protein (APP) processing and attenuation of oxidative modification of lipoprotein receptor related protein-1 (LRP-1) were identified as potential underlying mechanisms. These results demonstrate the broad impact of STAT3 on cognitive functions, parenchymal and vascular amyloid pathology and highlight the therapeutic potential of STAT3 specific inhibition for treatment of AD and CAA.