Gladstone Institute of Neurological Disease, 1650 Owens Street, San Francisco, CA, 94158, USA.
Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, 94158, USA.
Mol Neurodegener. 2020 Sep 14;15(1):53. doi: 10.1186/s13024-020-00393-5.
Alzheimer's disease (AD) is the most frequent and costly neurodegenerative disorder. Although diverse lines of evidence suggest that the amyloid precursor protein (APP) is involved in its causation, the precise mechanisms remain unknown and no treatments are available to prevent or halt the disease. A favorite hypothesis has been that APP contributes to AD pathogenesis through the cerebral accumulation of the amyloid-β peptide (Aβ), which is derived from APP through sequential proteolytic cleavage by BACE1 and γ-secretase. However, inhibitors of these enzymes have failed in clinical trials despite clear evidence for target engagement.
To further elucidate the roles of APP and its metabolites in AD pathogenesis, we analyzed transgenic mice overexpressing wildtype human APP (hAPP) or hAPP carrying mutations that cause autosomal dominant familial AD (FAD), as well as App knock-in mice that do not overexpress hAPP but have two mouse App alleles with FAD mutations and a humanized Aβ sequence.
Although these lines of mice had marked differences in cortical and hippocampal levels of APP, APP C-terminal fragments, soluble Aβ, Aβ oligomers and age-dependent amyloid deposition, they all developed cognitive deficits as well as non-convulsive epileptiform activity, a type of network dysfunction that also occurs in a substantive proportion of humans with AD. Pharmacological inhibition of BACE1 effectively reduced levels of amyloidogenic APP C-terminal fragments (C99), soluble Aβ, Aβ oligomers, and amyloid deposits in transgenic mice expressing FAD-mutant hAPP, but did not improve their network dysfunction and behavioral abnormalities, even when initiated at early stages before amyloid deposits were detectable.
hAPP transgenic and App knock-in mice develop similar pathophysiological alterations. APP and its metabolites contribute to AD-related functional alterations through complex combinatorial mechanisms that may be difficult to block with BACE inhibitors and, possibly, also with other anti-Aβ treatments.
阿尔茨海默病(AD)是最常见和最昂贵的神经退行性疾病。尽管有多种证据表明淀粉样前体蛋白(APP)参与了其发病机制,但确切的机制仍不清楚,也没有可用的治疗方法来预防或阻止这种疾病。一个流行的假设是,APP 通过大脑中淀粉样β肽(Aβ)的积累对 AD 发病机制做出贡献,Aβ是通过 BACE1 和 γ-分泌酶对 APP 的连续蛋白水解切割产生的。然而,尽管有明确的靶点结合证据,但这些酶的抑制剂在临床试验中都失败了。
为了进一步阐明 APP 及其代谢物在 AD 发病机制中的作用,我们分析了过表达野生型人 APP(hAPP)或携带导致常染色体显性家族性 AD(FAD)突变的 hAPP 的转基因小鼠,以及不过度表达 hAPP 但具有两个携带 FAD 突变和人源化 Aβ序列的小鼠 App 等位基因的 App 敲入小鼠。
尽管这些小鼠在皮质和海马区的 APP、APP C 端片段、可溶性 Aβ、Aβ 寡聚物和年龄依赖性淀粉样蛋白沉积方面存在显著差异,但它们都出现了认知缺陷和非惊厥性癫痫样活动,这也是一种网络功能障碍,也发生在相当一部分 AD 患者中。BACE1 的药物抑制可有效降低表达 FAD 突变 hAPP 的转基因小鼠中淀粉样蛋白生成的 APP C 端片段(C99)、可溶性 Aβ、Aβ 寡聚物和淀粉样蛋白沉积的水平,但即使在淀粉样蛋白沉积可检测之前的早期阶段开始治疗,也不能改善它们的网络功能障碍和行为异常。
hAPP 转基因和 App 敲入小鼠表现出相似的病理生理改变。APP 及其代谢物通过复杂的组合机制导致 AD 相关的功能改变,这些机制可能难以用 BACE 抑制剂阻断,也可能难以用其他抗 Aβ 治疗方法阻断。