BS42023 L5 Flashcards

1
Q

what are newer diagnostic techniques for AD?

A

PET and functional neuroimaging (FTD)

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2
Q

describe the levels of CSF biomarkers in AD

A

tau increases by 300%

Ab decreases to about 50% (as there is increased deposition in plaques)

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3
Q

AD is pathologically defined by what?

A

presence of plaques and tangles

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4
Q

what are beta-amyloid plaques and neurofibrillary tangles?

A

plaques- insoluble aggregates of b-amyloid proteins that form outside of neurons
tangles- insoluble aggregates of hyperphosphorylated tau proteins that form inside neurons

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5
Q

how do Ab1-42 peptides come about?

A

b-secretase and y-secretase cleave at their sites on APP leaving a harmful AB1-42 peptide.

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6
Q

what happens to;
APP-null mice
APLP2-null mice
APP/APLP2-null mice

A
  • relatively normal
  • relatively normal
  • 80% die after 1 week
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7
Q

aggregation of b-amyloid peptide is facilitated by which metals?

A

zinc and copper

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8
Q

what properties does the Ab1-42 variant have?

A
  • more hydrophobic than Ab1-40
  • more prone to fibril formation
  • is the predominant isoform found in cerebral plaques
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9
Q

What is the toxic form of Ab-peptide: soluble or insoluble aggregates?

A

soluble monomeric Ab peptides are toxic to cells in culture and in brains of rhesus monkeys

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10
Q

The evidence for Ab as a cause of AD is (6)

A
  • There is an increased number of plaques in brains of patients with AD
  • Genetic mutations in familial (early-onset) AD cause increased production/deposition of Ab peptides (e.g. APP, PS1, PS2).
  • Ab plaques appear in Down Syndrome patients (trisomy 21) that carry an extra copy of the APP gene
  • APOE4 allele increases the risk of sporadic (late-onset) AD
  • Transgenic mice expressing mutant human APP genes develop plaques and neurodegeneration (but not extensive and no tangles)
  • Aggregated or fibrillar (but not soluble/monomeric) Ab peptide is toxic to cells in culture and the brains of aged rhesus monkeys.
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11
Q

what do Ab peptides induce?

A

production of reactive oxygen species, leading to cell damage and apoptosis

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12
Q

Cell culture, clinical and epidemiological studies suggest that what is protective of effects of Ab?

A

anti-oxidants, Vitamin E and oestrogen

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13
Q

how might Ab peptides act?

A

as non-selective ion channel or allow release of ROS. Ab may promote the aggregation of tau to form neurofibrillary tangles.

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14
Q

what are the two major hypotheses for AD?

A
  1. BAPtists- the accumulation of a fragment of the amyloid precursor protein or APP (the amyloid beta 42 residue fragment or Ab-42) leads to the formation of plaques that some kill neurons.
  2. TAUists- abnormal phosphorylation of tau proteins makes them “sticky” leading to the break up of microtubules. The resulting loss of axonal transport causes cell death.
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15
Q

where are neurofibrillary tangles expressed and found?

A

predominantly expressed by neurons in the CNS and predominantly found in axons.

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16
Q

why do NTs interact with tubulin/MTs?

A

They co-purify with tubulin/MTs, stabilise MTs integrity and promote MT assembly.

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17
Q

where is tau normally/in AD found?

A

in axons but in AD aggregates and is redistributed to cell bodies and dendrites.

18
Q

transgenic mice expressing FTDP-17 (disease caused by tau mutations) exhibit what?

A

Neurofibrillary tangles and neurodegeneration

19
Q

tau knockout mice exhibit what?

A

they are normal and show no obvious developmental, cognitive or neuronal polarity defects

20
Q

together, what do transgenic mice expressing FTDP-17 and tau knockout mice demonstrate?

A

the presence of abnormal tau/NFTs rather than the loss-of-function contributes to development of AD.

21
Q

when is tau hyperphosphorylated and by which enzymes?

A

early in AD- by kinases including GSK3, Cdk5, MAPK, DYRK

22
Q

what might hyperphosphorylated tau result in?

A

impair its ability to bind MTs and promotes its aggregation, forming NFTs creating imbalance between kinases and phosphatases and generate excessive NFTs

23
Q

how might imbalance of kinases/phosphatase activity result in tau hyperphosphorylation and NFTs? (5)

A
  • Association of p25 with Cdk5 leads to activation of Cdk5.
  • Activated Cdk5 can inhibit GSK3 by indirect regulation of the inhibitory serine phosphorylation of GSK3.
  • Consistently, results and data from studies indicate that Cdk5 acts via protein phosphatases such as PP1 and PP2A, possibly by affecting regulatory subunits.
  • GSK3 phosphorylates tau.
  • Thus, disruption of inhibitory GSK3 regulation, for example, by altered Cdk5 function, or pharmacological GSK3 inhibitor, like lithium may lead to tau hyperphosphorylation.
24
Q

what is the importance of tau pathology in AD?

A

NFTs are common to many forms of dementia and are often the only pathological lesion in these diseases- no conditions where there are plaques only.

NFTs show higher correlation with AD progression than plaques

25
describe the tau hypothesis (5)
- Ordinarily, the tau protein is a microtubule-associated protein that acts as a three-dimensional “railroad tie” for the microtubule. - The microtubule is responsible for axonal transport. - Accumulation of phosphate on the tau proteins cause “paired helical filaments” or PHFs (like two ropes twisted around each other) that accumulate and lead to the neurofibrillary tangles (NFT). - PHFs are the main component in NFTs. - Impaired axonal transport is the probable cause of cell death but the focus is on MAPT genes (microtubule-associated protein tau).
26
describe the amyloid hypothesis (4)
- The amyloid precursor protein (APP) is broken down by a series of secretases. - During this process, a non-soluble fragment of the APP protein (called Ab-42) accumulates and is deposited outside of the cell. - The non-soluble or “sticky” nature of Ab-42 helps other protein fragments (including apoE) to gather into plaques. - Somehow the plaques (or possibly the migration of Ab-42 outside the cell) cause neuronal death.
27
what is apolipoprotein E? (ApoE)
- a glycoprotein produced in high levels in the liver and brain. - synthesised by glia in the brain (predominantly astrocytes) - binds to soluble and aggregated amyloid-B
28
what role does ApoE have?
ApoE is the body’s primary cholesterol transport protein. It is secreted mainly from astrocytes and microglia.
29
what mediates influx of Ab peptide across the BBB?
RAGE
30
what mediates influx of Ab peptide across the BBB?
RAGE
31
what are two major proteases involved in Ab (monomer) degradation?
IDE and NEP
32
where are IDE and NEP located?
IDE is mostly cytoplasmic, NEP is a transmembrane protein whose catalytic site is located in its extracellular domain.
33
One of the earliest changes in AD progression is loss of what?
acetylcholine transferase activity in the cortex and hippocampus (catalyses choline + Acetyl-CoA --> ACh).
34
Cholinesterase inhibitors are designed to combat impairment of cholinergic neurons by slowing degradation of acetylcholine after its release at synapses. Three major AChE inhibitors currently in clinical use are...
donepezil, rivastigmine, and galantamine
35
what effects do AchE inhibitors have?
delay neurodegeneration by 6 months, this is most effective early on.
36
what is memantine?
an NMDA receptor antagonist which has similar effects as AChE inhibitors
37
What does a good model of AD need to show? (4)
- Face validity; have plaques and tangles, cognitive deficits and neurodegeneration - Reliability/reproducibility; needs to be able to be observed consistently in the same animals - Construct validity; observed in different environments, in different tests measuring the same thing AND across species. - Predictive validity; it needs to show temporal relevance to the disease and it needs to show that treatment aimed at the insult will make it better.
38
what are the three main therapeutic opportunities for treatment of AD?
1. Reducing Ab production 2. Prevention of Ab aggregation 3. Influencing Ab clearance/degradation
39
how would you reduce Ab production therapeutically?
y-secretase- cleaves other important substrates (e.g. notch) hence specificity is important. E.g. substrate docking sites are different so target APP binding site. E.g. likewise, ATP-binding site modulates APP processing specifically. Certain nonsteroidal anti-inflammatory drugs (NSAIDs) allosterically modulate y-secretase to favour production of Ab40 over Ab42. Inhibitor LY450139 lowered Ab in plasma but not CSF. b-secretase- lacks other substrates (KO is viable with very minor anomalies) and therefore is a safer target. a-secretase- stimulating its activity could decrease Ab since it cleaves within the peptide e.g. bryostatin, a protein kinase C inhibitor enhances activity.
40
how would you prevent aggregation of Ab therapeutically?
using alzhemed or clioquinol (although these treatments have been tried and failed)
41
how would you influence the clearance/degradation of Ab?
- by enhancing molecules that help transport Ab out of the brain and inhibit those that help transport Ab into the brain. - immunotherapy - antibody aducanumab - use ultrasound to break up the plaques (doesn't work)