Journal of Alzheimer's Disease - Volume 46, issue 4

Authors: Kärkkäinen, Elisa | Lahtinen, Hanna-Maija | Närväinen, Johanna | Gröhn, Olli | Tanila, Heikki

Article Type: Research Article

Abstract: Magnetic resonance imaging (MRI) volumetry is widely used in Alzheimer’s disease (AD) research and diagnostics alongside clinical assessment. Yet few MRI volumetry studies have been conducted in AD model mice with mixed results. We performed in vivo and ex vivo MRI and extensive postmortem histological analysis in transgenic mice derived from crossing amyloid plaque producing AβPP/PS1 mice with brain-derived neurotrophic factor (BDNF) +/− mice. This allowed us to compare developmental volumetric changes due to BDNF deficiency with progressive changes due to amyloid accumulation. We found decreased whole brain volume at 3 months and decreased cortical volume at both …3 and 8 months in vivo in BDNF +/− Tg mice but increased whole brain and cortical volumes at 8 months in AβPP/PS1 mice. Consistent with this, the postmortem histological analysis showed decreased brain parenchymal area in BDNF +/− mice but an increase in AβPP/PS1 mice. BDNF gene deficiency did not affect brain amyloid load or astrogliosis, but led to decreased dentate gyrus length, whereas AβPP/PS1 mice had significantly increased amyloid load, astrogliosis, and decreased neurogenesis. Distinct and layer-specific effects were found in the hippocampus of AβPP/PS1 and BDNF +/− mice. In contrast to human AD patients, brain atrophy in amyloid producing mice appears to be masked by volume increase due to amyloid accumulation and especially accompanying astrogliosis. Our results indicate that cortical MRI volumetry can be used to some extent as a proxy to progressive brain amyloidosis in preclinical studies. Show more

Keywords: Alzheimer’s disease, amyloid plaques, amyloid-β protein precursor, BDNF, magnetic resonance imaging, presenilin -1, volumetry

DOI: 10.3233/JAD-150059

Citation: Journal of Alzheimer's Disease, vol. 46, no. 4, pp. 929-946, 2015

Authors: Voyle, Nicola | Baker, David | Burnham, Samantha C. | Covin, Antonia | Zhang, Zhanpan | Sangurdekar, Dipen P. | Tan Hehir, Cristina A. | Bazenet, Chantal | Lovestone, Simon | Kiddle, Steven | Dobson, Richard J.B. | and the AIBL research group

Article Type: Research Article

Abstract: Background: Four previously reported studies have tested for association of blood proteins with neocortical amyloid-β burden (NAB). If shown to be robust, these proteins could have utility as a blood test for enrichment in clinical trials of Alzheimer’s disease (AD) therapeutics. Objective: This study aimed to investigate whether previously identified blood proteins also show evidence for association with NAB in serum samples from the Australian Imaging, Biomarker and Lifestyle Flagship Study of Ageing (AIBL). The study considers candidate proteins seen in cohorts other than AIBL and candidates previously discovered in the AIBL cohort. Methods: Our …study used the SOMAscan platform for protein quantification in blood serum. Linear and logistic regressions were used to model continuous NAB and dichotomized NAB respectively using single proteins as a predictor. Multiple protein models were built using stepwise regression techniques and support vectors machines. Age and APOE ɛ 4 carriage were used as covariates for all analysis. Results: Of the 41 proteins previously reported, 15 AIBL candidates and 20 non-AIBL candidates were available for testing. Of these candidates, pancreatic polypeptide (PPY) and IgM showed a significant association with NAB. Notably, IgM was found to associate with continuous NAB across cognitively normal control subjects. Conclusions: We have further demonstrated the association of PPY and IgM with NAB, despite technical differences between studies. There are several reasons for a lack of significance for the other candidates including platform differences and the use of serum rather than plasma samples. To investigate the possibility of technical differences causing lack of replication, further studies are required. Show more

Keywords: Alzheimer’s disease, amyloid plaques, blood, positron emission tomography scan, proteomics

DOI: 10.3233/JAD-150020

Citation: Journal of Alzheimer's Disease, vol. 46, no. 4, pp. 947-961, 2015

Authors: Boccia, Maddalena | Acierno, Mauro | Piccardi, Laura

Article Type: Research Article

Abstract: Depression and cognitive impairment are both common disorders in elderly people and frequently occur together. Due to the presence of a common set of behavioral and cognitive symptoms, differential diagnosis may become arduous. Neuroimaging may offer a good tool during diagnosis. We performed a coordinate-based meta-analysis to compare gray matter changes in Alzheimer’s disease (AD) and late-life depression (LLD). AD and LLD led to brain atrophy in networks only partially overlapping. Both conditions are linked to a reduction of the bilateral hippocampal volume, but AD is correlated with great atrophy in the left anterior hippocampus and bilateral posterior cingulate cortex, …while LLD is correlated with great atrophy in the precuneus, superior frontal gyrus, and ventromedial frontal cortex. Present results shed some light on neural underpinnings of AD and LLD and provide new useful evidence for differential diagnosis. Show more

Keywords: Aging, Alzheimer’s disease, dementia, late-life depression, magnetic resonance imaging, neuroimaging, voxel-based morphometry

DOI: 10.3233/JAD-142955

Citation: Journal of Alzheimer's Disease, vol. 46, no. 4, pp. 963-970, 2015

Authors: Welt, Tobias | Kulic, Luka | Hoey, Sarah E. | McAfoose, Jordan | Späni, Claudia | Chadha, Antonella Santuccione | Fisher, Abraham | Nitsch, Roger M.

Article Type: Research Article

Abstract: Indirect modulation of cholinergic activity by cholinesterase inhibition is currently a widely established symptomatic treatment for Alzheimer’s disease (AD). Selective activation of certain muscarinic receptor subtypes has emerged as an alternative cholinergic-based amyloid-lowering strategy for AD, as selective muscarinic M1 receptor agonists can reduce amyloid-β (Aβ) production by shifting endoproteolytic amyloid-β protein precursor (AβPP) processing toward non-amyloidogenic pathways. In this study, we addressed the hypothesis that acute stimulation of muscarinic M1 receptors can inhibit Aβ production in awake and freely moving AβPP transgenic mice. By combining intracerebral microdialysis with retrodialysis, we determined hippocampal Aβ concentrations during simultaneous pharmacological modulation of …brain M1 receptor function. Infusion with a M1 receptor agonist AF102B resulted in a rapid reduction of interstitial fluid (ISF) Aβ levels while treatment with the M1 antagonist dicyclomine increased ISF Aβ levels reaching significance within 120 minutes of treatment. The reduction in Aβ levels was associated with PKCα and ERK activation resulting in increased levels of the α -secretase ADAM17 and a shift in AβPP processing toward the non-amyloidogenic processing pathway. In contrast, treatment with the M1 receptor antagonist dicyclomine caused a decrease in levels of phosphorylated ERK that was independent of PKCα , and led to an elevation of β-secretase levels associated with increased amyloidogenic AβPP processing. The results of this study demonstrate rapid effects of in vivo M1 receptor modulation on the ISF pool of Aβ and suggest that intracerebral microdialysis with retrodialysis is a useful technical approach for monitoring acute treatment effects of muscarinic receptor modulators on AβPP/Aβ metabolism. Show more

Keywords: AβPP processing, AβPP transgenic mice, Alzheimer’s disease, amyloid-β, microdialysis, muscarinic acetylcholine receptor

DOI: 10.3233/JAD-150152

Citation: Journal of Alzheimer's Disease, vol. 46, no. 4, pp. 971-982, 2015

Authors: Wurtman, Richard J.

Article Type: Research Article

Abstract: Drugs that block muscarinic cholinergic neurotransmission in the brain can, as a consequence, increase the formation of amyloid-β, and decrease brain levels of phosphatidylcholine (by slowing its synthesis and accelerating its turnover). Both of these effects might cause a decrease in brain synapses, as characterizes and probably underlies the memory disorder of early Alzheimer’s disease.

Keywords: Acetylcholine, amyloid, choline, neurotransmission, synapses, synaptic membrane

DOI: 10.3233/JAD-150290

Citation: Journal of Alzheimer's Disease, vol. 46, no. 4, pp. 983-987, 2015

Authors: Yeo, Hyeon-Gu | Lee, Youngjeon | Jeon, Chang-Yeop | Jeong, Kang-Jin | Jin, Yeung Bae | Kang, Philyong | Kim, Sun-Uk | Kim, Ji-Su | Huh, Jae-Won | Kim, Young-Hyun | Sim, Bo-Woong | Song, Bong-Seok | Park, Young-Ho | Hong, Yonggeun | Lee, Sang-Rae | Chang, Kyu-Tae

Article Type: Research Article

Abstract: In line with recent findings showing Alzheimer’s disease (AD) as an insulin-resistant brain state, a non-transgenic animal model with intracerebroventricular streptozotocin (icv-STZ) administration has been proposed as a representative experimental model of AD. Although icv-STZ rodent models of AD have been increasingly researched, studies in non-human primate models are very limited. In this study, we aimed to characterize the cerebral damage caused by icv-STZ in non-human primates; to achieve this, three cynomolgus monkeys (Macaca fascicularis ) were administered four dosages of STZ (2 mg/kg) dissolved in artificial cerebrospinal fluid and another three controls were injected with only artificial cerebrospinal fluid at …the cerebellomedullary cistern. In vivo neuroimaging was performed with clinical 3.0 T MRI, followed by quantitative analysis with FSL for evaluation of structural changes of the brain. Immunohistochemistry was performed to evaluate cerebral histopathology. We showed that icv-STZ caused severe ventricular enlargement and parenchymal atrophy, accompanying amyloid-β deposition, hippocampal cell loss, tauopathy, ependymal cell loss, astrogliosis, and microglial activation, which are observed in human aged or AD brain. The findings suggest that the icv-STZ monkey model would be a valuable resource to study the mechanisms and consequences of a variety of cerebral pathologies including major pathological hallmarks of AD. Furthermore, the study of icv-STZ monkeys could contribute to the development of treatments for age- or AD-associated cerebral changes. Show more

Keywords: Alzheimer’s disease, animal model, brain, monkey, streptozotocin

DOI: 10.3233/JAD-143222

Citation: Journal of Alzheimer's Disease, vol. 46, no. 4, pp. 989-1005, 2015

Authors: Zhang, William I. | Antonios, Gregory | Rabano, Alberto | Bayer, Thomas A. | Schneider, Anja | Rizzoli, Silvio O.

Article Type: Research Article

Abstract: Alzheimer’s disease (AD) is neuropathologically characterized by aggregates of amyloid-β peptides (Aβ) and tau proteins. The consensus in the AD field is that Aβ and tau should serve as diagnostic biomarkers for AD. However, their aggregates have been difficult to investigate by conventional fluorescence microscopy, since their size is below the diffraction limit (∼200 nm). To solve this, we turned to a super-resolution imaging technique, stimulated emission depletion (STED) microscopy, which has a high enough precision to allow the discrimination of low- and high-molecular weight aggregates prepared in vitro . We used STED to analyze the structural organization of Aβ and …tau in cerebrospinal fluid (CSF) from 36 AD patients, 11 patients with mild cognitive impairment (MCI), and 21 controls. We measured the numbers of aggregates in the CSF samples, and the aggregate sizes and intensities. These parameters enabled us to distinguish AD patients from controls with a specificity of ∼87% and a sensitivity of ∼79% . In addition, the aggregate parameters determined with STED microscopy correlated with the severity of cognitive impairment in AD patients. Finally, these parameters may be useful as predictive tools for MCI cases. The STED parameters of two MCI patients who developed AD during the course of the study, as well as of MCI patients whose Aβ ELISA values fall within the accepted range for AD, placed them close to the AD averages. We suggest that super-resolution imaging is a promising tool for AD diagnostics. Show more

Keywords: Alzheimer’s disease, amyloid-β, diagnostics, imaging, super-resolution, tau

DOI: 10.3233/JAD-150064

Citation: Journal of Alzheimer's Disease, vol. 46, no. 4, pp. 1007-1020, 2015

Authors: Mehta, Pankaj D. | Patrick, Bruce A. | Barshatzky, Marc | Mehta, Sangita P. | Frackowiak, Janusz | Mazur-Kolecka, Bozena | Miller, David L.

Article Type: Research Article

Abstract: Secreted soluble amyloid-β (Aβ)38 is the second most prominent Aβ form next to Aβ40 , and is found in cerebrospinal fluid (CSF) and blood. Recent studies have shown the importance of quantitation of CSF Aβ38 levels in combination with those of Aβ40 and Aβ42 to support the diagnosis of Alzheimer’s disease (AD), and other neurodegenerative diseases, and to facilitate drug discovery studies. However, the availability of reliable and specific Aβ38 monoclonal antibody is limited. Our first aim was to generate and partially characterize rabbit monoclonal antibody (RabmAb) to Aβ38 . The antibody was specific to …Aβ38 , since it did not react with Aβ37 , Aβ39 , Aβ40 , or Aβ42 in ELISA or immunoblotting. The antibody was sensitive enough to measure Aβ38 levels in plasma. Our second aim was to quantitate Aβ38 levels in plasma from older Down syndrome (DS) persons and age-matched controls. Persons with DS (35 years and older) have neuropathological changes characteristic of AD. Studies have shown that plasma Aβ40 and Aβ42 levels are higher in older persons with DS than in controls. However, none examined Aβ38 levels in DS. Our quantitation data showed that, like Aβ40 and Aβ42 plasma levels, Aβ38 plasma levels were higher in DS than in controls. Longitudinal studies will determine whether plasma Aβ38 levels in combination with levels of Aβ40 and Aβ42 are useful to predict early signs of AD in DS. Show more

Keywords: Alzheimer’s disease, amyloid-β (Aβ) peptide, Down syndrome, ELISA, immunoblotting, plasma, rabbit monoclonal antibodies to Aβ peptides

DOI: 10.3233/JAD-142592

Citation: Journal of Alzheimer's Disease, vol. 46, no. 4, pp. 1021-1032, 2015

Authors: Cagnin, Annachiara | Simioni, Mariachiara | Tagliapietra, Matteo | Citton, Valentina | Pompanin, Sara | Della Puppa, Alessandro | Ermani, Mario | Manara, Renzo

Article Type: Research Article

Abstract: Background: Idiopathic normal-pressure hydrocephalus (iNPH) can resemble or occur in combination with other brain disorders frequently present in the elderly such as Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB). Objective: To study the accuracy of a simplified callosal angle measure in differentiating iNPH from DLB and AD using conventional brain MRI. Methods: 76 patients (24 iNPH, 30 DLB, 22 AD) and 40 healthy controls served as discovering cohort. The callosal angle measure was obtained on standard coronal brain MRI images crossing the corpus callosum midpoint. 41 patients (21 iNPH and 20 DLB/AD) were …used as independent validation cohort. A set of other conventional MRI markers of iNPH was also evaluated. Results: iNPH showed a significantly decreased mean callosal angle value compared to both disease groups and controls (iNPH = 109±9; DLB = 136.9±8.2; AD = 135.4±11.3; Controls = 138.5±5.2; p  <  0.00001). Using a cut off angle of 123, derived by the mean -3SD of the control group, an accuracy of 96% (sensitivity 100% , specificity 95.4% ) was obtained. By ROC analysis, the area under the curve was 0.99 (95% CI: 0.97–1). The measure was consistent (intra-rater: r  = 0.94) and reproducible (inter-rater: r  = 0.89). In the validation cohort, this cut off angle value discriminated iNPH from DLB/AD with 97.5% accuracy. None of the conventional MRI signs reached the same accuracy. Conclusions: This simplified callosal angle measure represents an accurate, reproducible, and easy marker of iNPH. Show more

Keywords: Alzheimer’s disease, dementia with Lewy bodies, idiopathic normal-pressure hydrocephalus, MRI marker

DOI: 10.3233/JAD-150107

Citation: Journal of Alzheimer's Disease, vol. 46, no. 4, pp. 1033-1038, 2015

Authors: Dregan, Alex | Chowienczyk, Phil | Gulliford, Martin C.

Article Type: Research Article

Abstract: Background: There is limited primary-care based evidence for an association between chronic inflammation and related therapy with all-cause dementia. Objective: To estimate the association between several chronic inflammatory disorders and related drug therapy and all-cause dementia. Methods: The study population included a cohort of patients diagnosed with inflammatory conditions and matching controls (ratio 1:2) from the Clinical Practice Research Datalink, a database or primary care records in the UK. Inflammation patients and controls were matched on age, gender, and family practice. The study outcome measure was all-cause dementia. Chronic inflammation diagnosis and anti-inflammatory drugs represented …the exposure variables of interest. Competing risks analyses were used to estimate the risk of dementia associated with exposure variables. Results: There were 1,378 (1% ) and 2,805 (1% ) dementia events recorded for chronic inflammation patients and their matched controls, respectively. Systemic vasculitis was associated with increased hazard ratios of dementia (1.75, 95% confidence interval (CI) 1.35–2.27, p  <  0.001). The analyses revealed increased risk of dementia for systemic vasculitis (1.64, 95% CI 1.24–2.18), Crohn’s diseases (2.08, 95% CI 1.16–3.74), bullous skin diseases (1.55, 95% CI 1.11–2.18), and inflammatory arthritis (1.33, 95% CI1.06–1.63) among treated patients. Combined glucocorticoids and NSAID therapy suggested reduced risk of dementia across most conditions, particularly systemic autoimmune disorders (0.41, 95% CI 0.18–0.95). Conclusion: The association between chronic inflammation and dementia varied across inflammatory disorders, being stronger for systemic vasculitis. There was evidence that combined therapy was associated with lower risk of dementia across most disorders. These data highlight potential avenues for future mechanistic and intervention investigations. Show more

Keywords: Chronic inflammation, dementia, glucocorticoids, NSAIDs, primary care

DOI: 10.3233/JAD-150171

Citation: Journal of Alzheimer's Disease, vol. 46, no. 4, pp. 1039-1047, 2015

Authors: Wang, Hui | Tan, Lan | Wang, Hui-Fu | Liu, Ying | Yin, Rui-Hua | Wang, Wen-Ying | Chang, Xiao-Long | Jiang, Teng | Yu, Jin-Tai

Article Type: Research Article

Abstract: Background: The application of non-invasive proton magnetic resonance spectroscopy (1 H-MRS) could potentially identify changes in cerebral metabolites in the patients with Alzheimer’s disease (AD). However, whether these metabolites can serve as biomarkers for the diagnosis of AD remains unclear. Objective: Using meta-analysis, we aimed to investigate the patterns of cerebral metabolite changes in several cerebral regions that are strongly associated with cognitive decline in AD patients. Methods: Using Hedges’ g effect size, a systematic search was performed in PubMed, Cochrane Library, Ovid, Embase, and EBSCO, and 38 studies were integrated into the final meta-analysis. …Results: According to the observational studies, N-acetyl aspartate (NAA) in AD patients was significantly reduced in the posterior cingulate (PC) (effect size (ES) =−0.924, p  <  0.005) and bilateral hippocampus (left hippocampus: ES =−1.329, p  <  0.005; right hippocampus: ES =−1.287, p  <  0.005). NAA/Cr (creatine) ratio decreased markedly in the PC (ES =−1.052, p  <  0.005). Simultaneously, significant elevated myo-inositol (mI)/Cr ratio was found not only in the PC but also in the parietal gray matter. For lack of sufficient data, we failed to elucidate the efficacy of pharmacological interventions with the metabolites changes. Conclusion: The available data indicates that NAA, mI, and the NAA/Cr ratio might be potential biomarkers of brain dysfunction in AD subjects. Choline (Cho)/Cr and mI/NAA changes might also contribute toward the diagnostic process. Thus, large, well-designed studies correlated with cerebral metabolism are needed to better estimate the cerebral extent of alterations in brain metabolite levels in AD patients. Show more

Keywords: Alzheimer’s disease, choline, creatine, glutamate and glutamine, magnetic resonance spectroscopy, meta-analysis, myo-inositol, N-acetyl aspartate

DOI: 10.3233/JAD-143225

Citation: Journal of Alzheimer's Disease, vol. 46, no. 4, pp. 1049-1070, 2015

Authors: DiFrancesco, Jacopo C. | Touat, Mehdi | Caulo, Massimo | Gallucci, Massimo | Garcin, Béatrice | Levy, Richard | Uncini, Antonino | Piazza, Fabrizio

Article Type: Research Article

Abstract: Background: Cerebral amyloid angiopathy-related inflammation (CAA-ri) represents the most readily responsive form of CAA, if diagnosed and treated early. Although CAA-ri typically presents with a monophasic pattern, recurrences have been occasionally reported. Objectives: To describe the evolution of the clinical and neuroradiological features of CAA-ri recurrence. Methods: From the 60 CAA-ri cases recruited through the i CAβ International Network, we identified those patients who experienced a CAA-ri recurrence at more than 12 months after the first inflammatory event. Neuroradiological evidence of cerebral inflammation (vasogenic edema) and sulcal superficial siderosis or multiple areas of cortical/subcortical microhemorrhages …(MHs) were evaluated based upon fluid-attenuated inversion recovery and T2 * -weighted gradient echo or susceptibility weighted imaging, respectively. In one patient, the deposition of amyloid-β was evaluated using 11 C-Pittsburgh Compound B-positron emission tomography (PiB-PET). Results : Of the 60 cases, two were identified as having experienced a late CAA-ri recurrence, at two and seven years after the first presentation, respectively. At recurrence, the inflammatory lesions colocalized with the appearance of new MHs and were observed in brain areas different from those where the first onset occurred. PiB-PET four months after remission showed particularly low amyloid-β deposition in the left frontal lobe, while no change was observed in the area of the inflammatory relapse. Conclusions: Our observations highlight the importance of not underestimating any new neurological symptoms in patients who have already experienced an episode of CAA-ri. Although the frequency of CAA-ri recurrences is rare, in cases of suspected relapse, a prompt clinical and radiological follow-up should be considered in order to obtain a timely diagnosis and treatment, having a potential strong impact on patients’ clinical outcome. Show more

Keywords: Alzheimer’s disease, amyloid-PET, amyloid-related imaging abnormalities, cerebral amyloid angiopathy related inflammation, immunotherapy trials, iCAβ International Network, inflammatory relapse, microhemorrhages, steroid treatment, vasogenic edema

DOI: 10.3233/JAD-150070

Citation: Journal of Alzheimer's Disease, vol. 46, no. 4, pp. 1071-1077, 2015

Authors: Burnham, Samantha C. | Raghavan, Nandini | Wilson, William | Baker, David | Ropacki, Michael T. | Novak, Gerald | Ames, David | Ellis, Kathryn | Martins, Ralph N. | Maruff, Paul | Masters, Colin L. | Romano, Gary | Rowe, Christopher C. | Savage, Greg | Macaulay, S. Lance | Narayan, Vaibhav A. | for the Alzheimer’s Disease Neuroimaging Initiative | the AIBL Research Group

Article Type: Research Article

Abstract: Background: There is a growing consensus that disease-modifying therapies must be given at the prodromal or preclinical stages of Alzheimer’s disease (AD) to be effective. A major unmet need is to develop and validate sensitive measures to track disease progression in these populations. Objective: To generate novel statistically-derived composites from standard scores, which have increased sensitivity in the assessment of change from baseline in prodromal AD. Methods: An empirically based method was employed to generate domain specific, global, and cognitive-functional novel composites. The novel composites were compared and contrasted with each other, …as well as standard scores for their ability to track change from baseline. The longitudinal characteristics and power to detect decline of the measures were evaluated. Data from participants in the Australian Imaging, Biomarkers and Lifestyle (AIBL) Study characterized as mild cognitively impaired with high neocortical amyloid-β burden were utilized for the study. Results: The best performing standard scores were CDR Sum-of-Boxes and MMSE. The statistically-derived novel composites performed better than the standard scores from which they were derived. The domain-specific composites generally did not perform as well as the global composites or the cognitive-functional composites. Conclusion: A systematic method was employed to generate novel statistically-derived composite measures from standard scores. Composites comprised of measures including function and multiple cognitive domains appeared to best capture change from baseline. These composites may be useful to assess progression or lack thereof in prodromal AD. However, the results should be replicated and validated using an independent clinical sample before implementation in a clinical trial. Show more

Keywords: Alzheimer’s disease, clinical marker, clinical trial, mild cognitive impairment, prodromal stage

DOI: 10.3233/JAD-143015

Citation: Journal of Alzheimer's Disease, vol. 46, no. 4, pp. 1079-1089, 2015

Authors: Bogstedt, Anna | Groves, Maria | Tan, Keith | Narwal, Rajesh | McFarlane, Mary | Höglund, Kina

Article Type: Research Article

Abstract: Utilizing decision making biomarkers in drug development requires thorough assay validation. Special considerations need to be taken into account when monitoring biomarkers using immunoassays in the presence of therapeutic antibodies. We have developed robust and sensitive assays to assess target engagement and proof of mechanism to support the clinical progression of a human monoclonal antibody against the neurotoxic amyloid-β (Aβ)42 peptide. Here we present the introduction of novel pre-treatment steps to ensure drug-tolerant immunoassays and describe the validation of the complete experimental procedures to measure total Aβ42 concentration (bound and unbound) in cerebrospinal fluid (CSF) and plasma, free …Aβ42 concentration (unbound) in CSF, and Aβ40 concentration in CSF. The difference in composition of the matrices (CSF and plasma) and antigen levels therein, in combination with the hydrophobic properties of Aβ protein, adds to the complexity of validation. Monitoring pharmacodynamics of an Aβ42 specific monoclonal antibody in a non-human primate toxicology study using these assays, we demonstrated a 1500-fold and a 3000-fold increase in total Aβ42 in plasma, a 4-fold and 8-fold increase in total Aβ42 in CSF together with a 95% and 96% reduction of free Aβ42 in CSF following weekly intravenous injections of 10 mg/kg and 100 mg/kg, respectively. Levels of Aβ40 were unchanged. The accuracy of these data is supported by previous pre-clinical studies as well as predictive pharmacokinetic/pharmacodynamics modeling. In contrast, when analyzing the same non-human primate samples excluding the pre-treatment steps, we were not able to distinguish between free and total Aβ42 . Our data clearly demonstrate the importance of thorough evaluation of antibody interference and appropriate validation to monitor different types of biomarkers in the presence of a therapeutic antibody. Show more

Keywords: Alzheimer’s disease, amyloid-β, biomarkers, cerebrospinal fluid, immunotherapy, plasma, pre-clinical

DOI: 10.3233/JAD-142988

Citation: Journal of Alzheimer's Disease, vol. 46, no. 4, pp. 1091-1101, 2015

Authors: Jongbloed, Wesley | van Dijk, Karin D. | Mulder, Sandra D. | van de Berg, Wilma D.J. | Blankenstein, Marinus A. | van der Flier, Wiesje | Veerhuis, Robert

Article Type: Research Article

Abstract: Background: Increased clusterin levels have been reported in brain, cerebrospinal fluid (CSF), and plasma of Alzheimer’s disease (AD) patients. Because changes are also observed in mild cognitive impairment (MCI), a possible relationship between clusterin levels and early neurodegenerative changes in AD was suggested. Objectives: To determine whether clusterin concentrations could 1) serve as a diagnostic marker for AD, 2) predict disease progression in MCI, and 3) correlate with AD-biomarkers. Methods: Clusterin levels in CSF and plasma, as well as AD biomarker levels of Aβ 42 , Tau, and pTau in CSF and Mini-Mental State …Examination scores (MMSE) were determined in 67 controls, 50 MCI, and 107 AD patients. Repeated MMSE was obtained for 44 MCI and 72 AD patients after, on average, 2.7 years. Results: Elevated clusterin concentrations in plasma, but not in CSF, were a risk factor for AD (HR 18.6; 95% CI 2.8–122), and related to cognitive decline in MCI (r  =−0.38; p  <  0.01). An inverse relation between plasma clusterin levels and cognitive decline was observed in AD patients (r  = 0.23; p ≤0.05). In CSF, but not in plasma, clusterin levels correlated with Tau and pTau in all groups. Conclusion: Elevated plasma clusterin levels in MCI confer an increased risk for progression to AD, and more rapid cognitive decline. We speculate that clusterin levels in CSF may reflect its involvement in the earliest neurodegenerative processes associated with AD pathology. Whereas neither clusterin levels in CSF nor in plasma had diagnostic value, plasma clusterin levels may serve as a prognostic marker for AD. Show more

Keywords: Alzheimer’s disease, apolipoprotein J, biomarker, cerebrospinal fluid, clusterin, disease progression, mild cognitive impairment, plasma

DOI: 10.3233/JAD-150036

Citation: Journal of Alzheimer's Disease, vol. 46, no. 4, pp. 1103-1110, 2015

Authors: Gustafson, Deborah R. | Clare Morris, Martha | Scarmeas, Nikolaos | Shah, Raj C. | Sijben, John | Yaffe, Kristine | Zhu, Xiongwei

Article Type: Meeting Report

Abstract: Accumulating evidence shows nutritional factors influence the risk of developing Alzheimer’s disease (AD) and its rate of clinical progression. Dietary and lifestyle guidelines to help adults reduce their risk have been developed. However, the clinical dementia picture remains complex, and further evidence is required to demonstrate that modifying nutritional status can protect the brain and prevent, delay, or reduce pathophysiological consequences of AD. Moreover, there is a pressing need for further research because of the global epidemic of overweight and obesity combined with longer life expectancy of the general population and generally observed decreases in body weight with aging and …AD. A new research approach is needed, incorporating more sophisticated models to account for complex scenarios influencing the relationship between nutritional status and AD. Systematic research should identify and address evidence gaps. Integrating longitudinal epidemiological data with biomarkers of disease, including brain imaging technology, and randomized controlled interventions may provide greater insights into progressive and subtle neurological changes associated with dietary factors in individuals at risk for or living with AD. In addition, greater understanding of mechanisms involved in nutritional influences on AD risk and progression, such as oxidative stress and loss of neuronal membrane integrity, will better inform possible interventional strategies. There is consensus among the authors that nutritional deficits, and even states of excess, are associated with AD, but more work is needed to determine cause and effect. Appropriately designed diets or nutritional interventions may play a role, but additional research is needed on their clinical–cognitive effectiveness. Show more

Keywords: Alzheimer’s disease, cognition disorders, diet therapy, neuronal membrane, nutrition

DOI: 10.3233/JAD-150084

Citation: Journal of Alzheimer's Disease, vol. 46, no. 4, pp. 1111-1127, 2015

Article Type: Meeting Report

DOI: 10.3233/JAD-150337

Citation: Journal of Alzheimer's Disease, vol. 46, no. 4, pp. 1129-1133, 2015

Article Type: Other

Citation: Journal of Alzheimer's Disease, vol. 46, no. 4, pp. 1135-1146, 2015