Department of Developmental Biology, Harvard School of Dental Medicine, Boston, MA 02115, USA.
Division of Molecular Medicine, Children's Hospital, Boston, MA 02115, USA.
Int J Mol Sci. 2024 May 30;25(11):6036. doi: 10.3390/ijms25116036.
The centrality of amyloid-beta (Aβ) is an indisputable tenet of Alzheimer's disease (AD). It was initially indicated by the detection (1991) of a mutation within Aβ protein precursor (AβPP) segregating with the disease, which served as a basis for the long-standing Amyloid Cascade Hypothesis (ACH) theory of AD. In the intervening three decades, this notion was affirmed and substantiated by the discovery of numerous AD-causing and AD-protective mutations with all, without an exception, affecting the structure, production, and intraneuronal degradation of Aβ. The ACH postulated that the disease is caused and driven by extracellular Aβ. When it became clear that this is not the case, and the ACH was largely discredited, a new theory of AD, dubbed ACH2.0 to re-emphasize the centrality of Aβ, was formulated. In the ACH2.0, AD is caused by physiologically accumulated intraneuronal Aβ (Aβ) derived from AβPP. Upon reaching the critical threshold, it triggers activation of the autonomous AβPP-independent Aβ generation pathway; its output is retained intraneuronally and drives the AD pathology. The bridge between Aβ derived from AβPP and that generated independently of AβPP is the neuronal integrated stress response (ISR) elicited by the former. The ISR severely suppresses cellular protein synthesis; concurrently, it activates the production of a small subset of proteins, which apparently includes components necessary for operation of the AβPP-independent Aβ generation pathway that are absent under regular circumstances. The above sequence of events defines "conventional" AD, which is both caused and driven by differentially derived Aβ. Since the ISR can be elicited by a multitude of stressors, the logic of the ACH2.0 mandates that another class of AD, referred to as "unconventional", has to occur. Unconventional AD is defined as a disease where a stressor distinct from AβPP-derived Aβ elicits the neuronal ISR. Thus, the essence of both, conventional and unconventional, forms of AD is one and the same, namely autonomous, self-sustainable, AβPP-independent production of Aβ. What distinguishes them is the manner of activation of this pathway, i.e., the mode of causation of the disease. In unconventional AD, processes occurring at locations as distant from and seemingly as unrelated to the brain as, say, the knee can potentially trigger the disease. The present study asserts that these processes include traumatic brain injury (TBI), chronic traumatic encephalopathy, viral and bacterial infections, and a wide array of inflammatory conditions. It considers the pathways which are common to all these occurrences and culminate in the elicitation of the neuronal ISR, analyzes the dynamics of conventional versus unconventional AD, shows how the former can morph into the latter, explains how a single TBI can hasten the occurrence of AD and why it takes multiple TBIs to trigger the disease, and proposes the appropriate therapeutic strategies. It posits that yet another class of unconventional AD may occur where the autonomous AβPP-independent Aβ production pathway is initiated by an ISR-unrelated activator, and consolidates the above notions in a theory of AD, designated ACH2.0/E (for expanded ACH2.0), which incorporates the ACH2.0 as its special case and retains the centrality of Aβ produced independently of AβPP as the driving agent of the disease.
淀粉样蛋白-β(Aβ)的核心地位是阿尔茨海默病(AD)不可争议的原则。最初是通过检测 Aβ 蛋白前体(AβPP)中的突变与疾病分离出来的,这为 AD 的淀粉样蛋白级联假说(ACH)理论提供了基础。在这三个十年期间,通过发现许多导致 AD 和保护 AD 的突变,这一观点得到了证实和证实,所有这些突变无一例外地影响了 Aβ的结构、产生和细胞内降解。ACH 假设疾病是由细胞外 Aβ引起和驱动的。当很明显情况并非如此,ACH 基本上受到质疑时,一种新的 AD 理论,称为 ACH2.0,重新强调了 Aβ的核心地位,被制定出来。在 ACH2.0 中,AD 是由源自 AβPP 的生理上积累的细胞内 Aβ(Aβ)引起的。当达到临界阈值时,它会触发自主的 AβPP 独立的 Aβ产生途径的激活;其输出保留在细胞内,并驱动 AD 病理学。源自 AβPP 的 Aβ和独立于 AβPP 生成的 Aβ之间的桥梁是前者引发的神经元整合应激反应(ISR)。ISR 严重抑制细胞蛋白质合成;同时,它激活了一小部分蛋白质的产生,这些蛋白质显然包括在正常情况下不存在的、用于操作 AβPP 独立的 Aβ生成途径的必需成分。上述事件序列定义了“常规”AD,它既由差异衍生的 Aβ引起,也由其驱动。由于 ISR 可由多种应激源引发,ACH2.0 的逻辑要求必须发生另一种类型的 AD,称为“非常规”。非常规 AD 定义为一种由与 AβPP 衍生的 Aβ不同的应激源引发的神经元 ISR 的疾病。因此,常规和非常规形式的 AD 的本质是相同的,即自主、自我可持续的 AβPP 独立的 Aβ产生。使它们区别开来的是激活这条途径的方式,即疾病的发病模式。在非常规 AD 中,发生在远离大脑且看似与大脑无关的部位的过程,例如膝盖,可能会引发疾病。本研究断言,这些过程包括创伤性脑损伤(TBI)、慢性创伤性脑病、病毒和细菌感染以及广泛的炎症状态。它考虑了所有这些发生事件共有的途径,并最终引发神经元 ISR,分析了常规 AD 与非常规 AD 之间的动态,展示了前者如何演变成后者,解释了为什么单次 TBI 会加速 AD 的发生,以及为什么需要多次 TBI 才能引发疾病,并提出了适当的治疗策略。它假设,可能会出现另一种类型的非常规 AD,其中自主的 AβPP 独立的 Aβ产生途径由与 ISR 无关的激活剂启动,并在 AD 的理论 ACH2.0/E(扩展的 ACH2.0)中整合了上述概念,该理论将 ACH2.0 作为其特例,并保留了 AβPP 独立产生的 Aβ作为疾病驱动因素的核心地位。