Faculty Bibliography

Alzheimer inverted question marks disease (AD) is the most common cause of dementia, and currently, there is no effective treatment. The major neuropathological lesions in AD are accumulation of amyloid beta (Abeta) as amyloid plaques and congophilic amyloid angiopathy, as well as aggregated tau in the form of neurofibrillary tangles (NFTs). In addition, inflammation and microglia/macrophage function play an important role in AD pathogenesis. We have hypothesized that stimulation of the innate immune system via Toll-like receptor 9 (TLR9) agonists, such as type B CpG oligodeoxynucleotides (ODNs), might be an effective way to ameliorate AD related pathology. We have previously shown in the Tg2576 AD model that CpG ODN can reduce amyloid deposition and prevent cognitive deficits. In the present study, we used the 3xTg-AD mice with both Ass and tau related pathology. The mice were divided into 2 groups treated from 7 to 20 months of age, prior to onset of pathology and from 11 to 18 months of age, when pathology is already present. We demonstrated that immunomodulatory treatment with CpG ODN reduces both Ass and tau pathologies, as well as levels of toxic oligomers, in the absence of any apparent inflammatory toxicity, in both animal groups. This pathology reduction is associated with a cognitive rescue in the 3xTg-AD mice. Our data indicates that modulation of microglial function via TLR9 stimulation is effective at ameliorating all the cardinal AD related pathologies in an AD mouse model mice suggesting such an approach would have a greater chance of achieving clinical efficacy.

The accumulation of aggregated, hyperphosphorylated tau as neurofibrillary tangles and neuropil threads are cardinal features of Alzheimer's disease (AD). The other lesions found in AD include amyloid plaques and congophilic amyloid angiopathy, both associated with the extracellular accumulation of the amyloid-beta (Abeta) peptide. AD is the most common cause of dementia globally. Currently, there are no effective means to treat AD or even to slow it down. The dominant theory for the causation of AD is the amyloid cascade hypothesis, which suggests that the aggregation of Abeta as oligomers and amyloid plaques is central to the pathogenesis of AD. Numerous therapies have been developed directed to Abeta-related pathology, in particular various immunotherapeutic approaches. So far all of these have failed in clinical trials. Recently, there has been more focus on therapy directed to tau-related pathology, which correlates better with the cognitive status of patients, compared to the amyloid burden. Immunotherapeutic targeting of tau pathology has shown great potential in treating tau pathologies in mouse models of AD. A number of studies have shown the efficacy of both passive and active immunization. This review summarizes recent advances in therapy targeting pathological tau protein, in particular focusing on immunotherapeutic approaches which are showing great promise. (c) 2014 S. Karger AG, Basel.

Several morphometric studies have revealed smaller than normal neurons in the neocortex of autistic subjects. To test the hypothesis that abnormal neuronal growth is a marker of an autism-associated global encephalopathy, neuronal volumes were estimated in 16 brain regions, including various subcortical structures, Ammon's horn, archicortex, cerebellum, and brainstem in 14 brains from individuals with autism 4 to 60 years of age and 14 age-matched control brains. This stereological study showed a significantly smaller volume of neuronal soma in 14 of 16 regions in the 4- to 8-year-old autistic brains than in the controls. Arbitrary classification revealed a very severe neuronal volume deficit in 14.3% of significantly altered structures, severe in 50%, moderate in 21.4%, and mild in 14.3% structures. This pattern suggests desynchronized neuronal growth in the interacting neuronal networks involved in the autistic phenotype. The comparative study of the autistic and control subject brains revealed that the number of structures with a significant volume deficit decreased from 14 in the 4- to 8-year-old autistic subjects to 4 in the 36- to 60-year-old. Neuronal volumes in 75% of the structures examined in the older adults with autism are comparable to neuronal volume in age-matched controls. This pattern suggests defects of neuronal growth in early childhood and delayed up-regulation of neuronal growth during adolescence and adulthood reducing neuron soma volume deficit in majority of examined regions. However, significant correction of neuron size but limited clinical improvements suggests that delayed correction does not restore functional deficits.

Basal forebrain cholinergic neurons play a key role in cognition. This neuronal system is highly dependent on NGF for its synaptic integrity and the phenotypic maintenance of its cell bodies. Basal forebrain cholinergic neurons progressively degenerate in Alzheimer's disease and Down's syndrome, and their atrophy contributes to the manifestation of dementia. Paradoxically, in Alzheimer's disease brains, the synthesis of NGF is not affected and there is abundance of the NGF precursor, proNGF. We have shown that this phenomenon is the result of a deficit in NGF's extracellular metabolism that compromises proNGF maturation and exacerbates its subsequent degradation. We hypothesized that a similar imbalance should be present in Down's syndrome. Using a combination of quantitative reverse transcription-polymerase chain reaction, enzyme-linked immunosorbent assay, western blotting and zymography, we investigated signs of NGF metabolic dysfunction in post-mortem brains from the temporal (n = 14), frontal (n = 34) and parietal (n = 20) cortex obtained from subjects with Down's syndrome and age-matched controls (age range 31-68 years). We further examined primary cultures of human foetal Down's syndrome cortex (17-21 gestational age weeks) and brains from Ts65Dn mice (12-22 months), a widely used animal model of Down's syndrome. We report a significant increase in proNGF levels in human and mouse Down's syndrome brains, with a concomitant reduction in the levels of plasminogen and tissue plasminogen activator messenger RNA as well as an increment in neuroserpin expression; enzymes that partake in proNGF maturation. Human Down's syndrome brains also exhibited elevated zymogenic activity of MMP9, the major NGF-degrading protease. Our results indicate a failure in NGF precursor maturation in Down's syndrome brains and a likely enhanced proteolytic degradation of NGF, changes which can compromise the trophic support of basal forebrain cholinergic neurons. The alterations in proNGF and MMP9 were also present in cultures of Down's syndrome foetal cortex; suggesting that this trophic compromise may be amenable to rescue, before frank dementia onset. Our study thus provides a novel paradigm for cholinergic neuroprotection in Alzheimer's disease and Down's syndrome.

Alzheimer's disease (AD) is the most common cause of dementia worldwide. In AD the normal soluble amyloid beta (sAbeta) peptide is converted into oligomeric/fibrillar Abeta. The oligomeric forms of Abeta are thought to be the most toxic, while fibrillar Abeta becomes deposited as amyloid plaques and congophilic angiopathy, which serve as neuropathological markers of the disease. In addition the accumulation of abnormally phosphorylated tau as soluble toxic oligomers and as neurofibrillary tangles is a critical part of the pathology. Numerous therapeutic interventions are under investigation to prevent and treat AD. Among the more exciting and advanced of these approaches is vaccination. Active and passive Immunotherapy targeting only Abeta has been successful in many AD model animal trials; however, the more limited human data has shown much less benefit so far, with encephalitis occurring in a minority of patients treated with active immunization and vasogenic edema or amyloid-related imaging abnormalities (ARIA) being a complication in some passive immunization trials. Therapeutic intervention targeting only tau has been tested only in mouse models; and no approaches targeting both pathologies concurrently has been attempted, until very recently. The immune approaches tried so far were targeting a self-protein, albeit in an abnormal conformation; however, effective enhanced clearance of the disease associated conformer has to be balanced with the potential risk of stimulating excessive toxic inflammation. The design of future more effective immunomodulatory approaches will need to target all aspects of AD pathology, as well as specifically targeting pathological oligomeric conformers, without the use of any self-antigen.

Inheritance of the apolipoprotein E4 (apoE4) genotype has been identified as the major genetic risk factor for late-onset Alzheimer's disease (AD). Studies have shown that the binding between apoE and amyloid-beta (Abeta) peptides occurs at residues 244-272 of apoE and residues 12-28 of Abeta. ApoE4 has been implicated in promoting Abeta deposition and impairing clearance of Abeta. We hypothesized that blocking the apoE/Abeta interaction would serve as an effective new approach to AD therapy. We have previously shown that treatment with Abeta12-28P can reduce amyloid plaques in APP/PS1 transgenic (Tg) mice and vascular amyloid in TgSwDI mice with congophilic amyloid angiopathy (CAA). In the present study, we investigated whether the Abeta12-28P elicits a therapeutic effect on tau-related pathology in addition to amyloid pathology using old triple transgenic Alzheimer's disease mice (3xTg, with PS1M146V , APPS we and tauP30 IL transgenes) with established pathology from the ages of 21 to 26 months. We show that treatment with Abeta12-28P substantially reduces tau pathology both immunohistochemically and biochemically, as well as reducing the amyloid burden and suppressing the activation of astrocytes and microglia. These affects correlate with a behavioral amelioration in the treated Tg mice

Background: We have shown that active immunization with a novel nonself amyloidogenic peptide (pABri) induced a humoral immune response, largely IgM, to both PHF and toxic Abeta species inAD model, APP/PS1 transgenic (Tg) mice. Histology revealed a lower amyloid burden in both the cortex and hippocampus, along with improved cognitive testing scores compared to controls. pABri immunization resulted in lower levels of soluble and insoluble Abeta42 and Abeta40 in Tg mice. Plasma from these mice was used to immunostain human AD temporal cortex brain tissue. Staining of cytoplasm and dendrites of neurons, paired helical filaments, and Abeta plaques was documented. Methods: The novel peptide, pABri, is a carboxyl fragment of an amyloidogenic protein which is deposited in the brain of patients with a rare autosomal dominant disease due to a missense mutation in a stop codon, resulting in the translation of an intronic sequence, with no known sequence homology to any mammalian protein. Hence, this immunomodulatory therapeutic is unlikely to produce autoimmune toxicity since it utilizes a non-self peptide. This current study utilizes the pABri peptide as an immunogen for active immunization in two other mouse AD Tg models: 3xTg, with tau and amyloid pathology, and TgSwDI, with extensive congophilic angiopathy. Toxicity, neuropathology, humoral immune responses, and cognitive behavior were assessed. Results: The antibodies produced are against both the primary sequence of the immunogen as well as to the pathology associated b-sheet structure that is shared by both NFTs and amyloid plaques. These conformationally specific antibodies, reacting to Abeta peptide and tau oligomers, are against a b-sheet conformation since the immunogen, pAbri, is predominantly in such a conformation. Treatment led to cognitive rescue with pABri matching cognition of WT mice. Brain homogenates revealed lower Abeta40 and Abeta42 levels in pABri treated 3xTg mice compared to controls. pABri treatment groups show lower amyloid bu!

Background: Immunomodulation has shown great promise as an Alzheimer's disease (AD) therapy but major limitations must be overcome, such as the need for effectively reducing cerebral amyloid angiopathy (CAA), without associated hemorrhages. CAA is a common feature in AD and cognitively normal elderly individuals. Our initial findings indicate that stimulation of innate immunity with CpG ODN appears to be an effective means of reducing vascular amyloid without inducing toxicity in AD mouse models. We are currently testing our approach in a well characterized nonhuman primate model of sporadic CAA, squirrel monkey (Saimiri Boliviensis), which share numerous biological similarities with humans. Methods: Varying doses of the class B CpG ODN preparation containing the primate specific immunostimulatory sequence were administered in young monkeys by a subcutaneous route (s.c.). The most effective and non-toxic dosage described in young animals was selected for our long term studies in the older animals (with expected CAA deposits). During the treatment, primates were closely monitored for signs of toxicity. The peripheral cytokine responses were determined in PBMC supernatants and plasma from control and treated monkeys at selected time points. In addition, the performances on cognitive tests are being compared between our aged and young squirrel monkeys. Results: We have shown that a TLR9 agonist prevented shortterm memory deficits in Tg-SwDI mice, a model with extensive CAA. CpG ODN treatment led to a reduction of CAA in the absence of microhemorrhages and increased inflammation. Transgenic models are ideal for initial screening of a potential therapy but prior to clinical trials it is imperative to perform studies in non-human primates, which are a more biologically proximate model to humans. Short duration safety and efficacy assessment studies were first performed in young monkeys. Characterization of immune responses and evaluation of cognitive function and working memory in our monkeys is curr!

Background: Currently there is no effective therapy for Alzheimer's Disease (AD). Active and passive immunomodulation still holds promise but current attempts only address one side of the pathology: either amyloid beta (Abeta) or the hyperphosphorylated tau (ptau) protein. Furthermore current approaches are not specific for the pathological conformers of either protein. From our novel immunization method targeting pathological beta-sheet conformation (PLoS ONE 5(10): e13391, 2010) we have developed monoclonal antibodies, some of them with promising binding capacities; and we propose to characterize a monoclonal specific for pathological conformers of Abeta and tau (TAB1) to be used for immunotherapy in AD mouse models. Methods: Monoclonal antibodies were obtained from our conformational inoculation of BALBc mice. Positive hybridomas were selected by their shared reactivity against Abeta, PHF and PrP Res. The best conformational candidate (TAB1) was selected after characterization by blots, ELISA and histology against pathological conformers in AD tissue. TAB1 is being used of treatment by intraperitoneal injection in 3xTg mice with both tau and Abeta related pathology. Results: TAB1 on tissue sections specifically immunolabels AD tissue with no labeling in young, health normal control brains. On Western blots TAB1 detects purified paired helical filament preparations, aggregated/ oligomeric Abeta and PrP Res, extracted from CJD brain tissue. Use of TAB1 therapeutically in 3xTg mice is on-going. Conclusions: We have developed a novel immunization procedure which we have used to produce monoclonal antibodies (mAbs) that recognize multiple pathological proteins, including PrP Res, oligomer A beta and ptau. We have characterized one of these mAbs, TAB1, which gives specific immunolabeling in AD tissue and onWestern blots to pathological conformers.We believe that immunotherapy that specifically targets the most toxic, oligomeric forms of Abeta and ptau, has the greatest chance of success with littl!