Faculty Bibliography

Accumulation of toxic protein aggregates-amyloid-beta (Abeta) plaques and hyperphosphorylated tau tangles-is the pathological hallmark of Alzheimer disease (AD). Abeta accumulation has been hypothesized to result from an imbalance between Abeta production and clearance; indeed, Abeta clearance seems to be impaired in both early and late forms of AD. To develop efficient strategies to slow down or halt AD, it is critical to understand how Abeta is cleared from the brain. Extracellular Abeta deposits can be removed from the brain by various clearance systems, most importantly, transport across the blood-brain barrier. Findings from the past few years suggest that astroglial-mediated interstitial fluid (ISF) bulk flow, known as the glymphatic system, might contribute to a larger portion of extracellular Abeta (eAbeta) clearance than previously thought. The meningeal lymphatic vessels, discovered in 2015, might provide another clearance route. Because these clearance systems act together to drive eAbeta from the brain, any alteration to their function could contribute to AD. An understanding of Abeta clearance might provide strategies to reduce excess Abeta deposits and delay, or even prevent, disease onset. In this Review, we describe the clearance systems of the brain as they relate to proteins implicated in AD pathology, with the main focus on Abeta.

Background: Immunomodulation is a promising therapeutic approach for Alzheimer's disease (AD); however, major drawbacks are cerebral microhemorrhages associated with increased cerebral amyloid angiopathy (CAA) and excessive inflammation. Our initial findings indicate that stimulation of TLR9 signaling with CpG oligodeoxynucleotide (ODN) is effective against CAA without inducing toxicity in AD mouse models. To further assess potential human use of CpG ODN we advanced our studies using a well-established non-human primate model of sporadic CAA, squirrel monkey (Saimiri Boliviensis). Methods: Safety and efficacy assessment studies were first performed in young squirrel monkeys (SQM). Elderly female monkeys were subcutaneously injected either with the most effective and non-toxic dosages of the class B CpG ODN containing a primate specific immunostimulatory sequence or saline. Both age groups were subjected to behavioral testing. Plasma taken during the course of treatment was analyzed to identify immune responses and AD biomarkers. Fluidigm RT-PCR was used to evaluate mRNA levels of cytokines in SQM PBMCs. Results: CpG ODN elevated the levels of various Th1/Th2 cytokines in plasma from old monkeys. Upregulation of cytokines in CpG ODN group was further confirmed by RTPCR. Pre-treatment behavioral assessment in our aged monkeys demonstrated cognitive deficits on the Inhibitory Control of Behavior and Delayed Response tests. Age effect on cognitive abilities was observed as the young group performed with overall lower session error rates compared to old animals. Post-treatment behavioral testing in our aged monkeys is ongoing. Here we report the first pyroglutamate (pE3) immunohistochemistry of aged Saimiri Boliviensis. In addition to 6E10/4G8 As-positive plaques, pyroglutamate As-positive deposits in the form of CAA and parenchymal plaques were detected. Our preliminary biomarker analyses revealed a noticeable increase in As40, As42 and AspE3 plasma levels in CpG ODN-treated group. Further longitudinal assessment of potential AD biomarkers is currently in progress. Conclusions: The presented studies represent the first trial of specifically targeting CAA in non-human primates. We hope that our research will validate this novel approach of immunomodulation as a safer method to successfully ameliorate AD related pathologies and provide critical data for potential clinical use of CpG ODN in AD patients

Background: We have previously demonstrated that immuno-intervention in AD animal models can lead to prevention of some pathology through innate immune system stimulation via TLR9 induced by CpG ODN (Scholtzova et al 2014) or the modulation of the adaptive immune system through active vaccination with the beta-sheet oligomeric form of the polymerized Bri peptide (Goni et al 2014). A challenge to therapeutic immune stimulation of old AD Tg animals, with preexisting extensive pathology, is senescence of the immune system. We have now vaccinated old 3xTg AD animals with both Abeta and tau pathology, with the pBri as a conformational antigen and CpGODNas an immune stimulator. Methods: Two groups of at least 15 months old 3xTg AD animals were inoculated four times over a period of two months with either vehicle or oligomeric pBri in Alum as previously described. Another group was inoculated from 12 to 17 month old with five doses of pBri or CpG ODN in alternate weeks as reported. Behavioral and locomotor tests were performed after the 17 month of age. The animals were then euthanized, followed by histological and biochemical analyses. Results: We show that old animals still could mount a conformational immune response that results in diminished pathology, as well as rescue of cognitive function. Both groups vaccinated with pBri and pBri-CpG ODN showed behavioral rescue when compared to age matched controls. Biochemistry and immuno-histology showed improvements of some pathological features; importantly including diminished oligomeric Abeta and tau. Conclusions: The active immunomodulation using polymerized beta-sheet oligomeric pBri can elicit a conformational antibody response even in old animals. These antibodies directed to beta-sheet conformation can retard the progression and reverse some preexisting pathology. The use of CpG ODN can help to boost the innate immune system, in senescent animals, to help establish the subsequent adaptive conformational response

Background: It has been increasingly recognized that the pathogenesis of many neurodegenerative diseases is related to the accumulation of diverse proteins in aggregated/oligomeric forms. The pathological conformers can spread to different areas of the brain via a "prion-like" conversion mechanism mediated by the mobile b-sheet oligomeric structure of each particular peptide or protein. Previously we have characterized conformational monoclonal antibodies that react to both oligomers of Abeta and tau in AD, as well as to prion disease proteins. We have nowdetermined their binding specificity and capacity to be extended to synthetic oligomers of alpha-synuclein and to pathological intracellular structures present in Lewy body containing neurons of Parkinson's disease (PD) subjects. Methods: Recombinant alpha-synuclein was produced and characterized in monomeric, oligomeric and fibrillar forms by electron microscopy and circular dichroism. Histological specimens of formalin fixed brains from human AD and PD confirmed cases were used for reaction with three anti-conformational mAbs IgM previously described. The mAbs that reacted to oligomeric Abeta and tau and showed high affinity, specific binding by surface plasmon resonance, and/or were shown to reverse AD pathology after infusion in old 3xTg AD animal models were used for immunohistochemical detection on human PD brain specimens and detection of different alpha-synuclein conformers. Results: By SDS-PAGE the mAbs IgM showed specificity for oligomeric forms of polymerized alpha-synuclein but not to the monomeric forms. The mAbs showed specific intraneuronal reactivity around the Lewy bodies in human brains from confirmed cases of PD. Conclusions: Conformational monoclonal antibodies that are well characterized to react against pathological conformers in AD human brains and that can produce amelioration of existing AD pathology in AD animal models can also recognize oligomeric forms of alpha-synuclein and intraneuronal structures associated with Lewy bodies. Monoclonal antibodies that are specific for pathology associated conformations are good candidates to be used as immunotherapeutical agents alone or in combination with other approaches in many neurodegenerative diseases including Parkinson's disease

In the United States, estimates indicate there are between 250,000 and 400,000 individuals with Down syndrome (DS), and nearly all will develop Alzheimer's disease (AD) pathology starting in their 30s. With the current lifespan being 55 to 60 years, approximately 70% will develop dementia, and if their life expectancy continues to increase, the number of individuals developing AD will concomitantly increase. Pathogenic and mechanistic links between DS and Alzheimer's prompted the Alzheimer's Association to partner with the Linda Crnic Institute for Down Syndrome and the Global Down Syndrome Foundation at a workshop of AD and DS experts to discuss similarities and differences, challenges, and future directions for this field. The workshop articulated a set of research priorities: (1) target identification and drug development, (2) clinical and pathological staging, (3) cognitive assessment and clinical trials, and (4) partnerships and collaborations with the ultimate goal to deliver effective disease-modifying treatments.

Alzheimer's disease (AD) is the most prevalent form of dementia worldwide and is an emerging global epidemic. It is characterized by an imbalance between production and clearance of amyloid beta (Abeta) and tau proteins. Oligomeric forms of Abeta and tau are believed to be the most toxic. Dramatic results from AD animal models showed great promise for active and passive immune therapies targeting Abeta. However, there is very limited evidence in human studies of the clinical benefits from these approaches. Immunotherapies targeting only tau pathology have had some success but are limited so far to mouse models. The majority of current methods is based on immunological targeting of a self-protein; hence, benefits need to be balanced against risks of stimulating excessive autoimmune toxic inflammation. For greater efficacy the next generation of vaccines needs to focus more on concurrently targeting all the intermediate toxic conformers of oligomeric Abeta and tau species.