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Abstract Background Alzheimer's disease (AD) was described in 1907, and since then it changed from a relatively rare condition to one of the most prevalent diseases. Objective To describe the evolution of the notions of dementias and AD, and to investigate the reasons for the increase in scientific interest in AD. Methods A historical analysis was carried out on knowledge about dementia, the site of mental activity, the relationships between brain diseases and mental activity, and on the advances in research about AD, since its discovery until the publication of the amyloid cascade hypothesis in 1992. A search was carried out in the National Library of Medicine (PubMed) for scientific articles that included the terms dementia or AD over 50 years, from 1972 to 2021. Results The scientific research on AD increased from 615 papers with the term AD in the first decade (1972-1981), to 100,028 papers in the last decade (2012-2021): an increase of 162.6 times whereas publications with the term dementia increased 28.6 times in the same period. In the 1960s and 1970s, a consensus was reached that AD is responsible for the majority of cases of dementia previously known as senile dementia. In the 1980s, beta-amyloid peptide was identified in the core of the senile plaque, hyperphosphorylated tau protein was found in neurofibrillary tangles, and a mutation was discovered in a hereditary form of AD. Conclusion The expansion of the concept of AD to include senile dementia, and the discoveries that occurred in the 1980s greatly expanded research in AD.
Resumo Antecedentes A doença de Alzheimer (DA) foi descrita em 1907 e, desde então, deixou de ser relativamente rara para se tornar uma das doenças mais prevalentes. Objetivo Descrever a evolução das noções sobre demências e DA e investigar as razões do aumento do interesse científico pela DA. Métodos Foi realizada uma análise histórica dos conhecimentos sobre demência, o local da atividade mental, as relações entre doenças cerebrais e a atividade mental, e sobre os avanços na pesquisa sobre a DA, desde a sua descoberta até a publicação da hipótese da cascata amiloide em 1992. Foi realizada uma busca na Biblioteca Nacional de Medicina dos Estados Unidos da América (PubMed) por artigos científicos que incluíssem os termos demência ou DA nos 50 anos, de 1972 a 2021. Resultados A pesquisa científica sobre DA aumentou de 615 artigos com o termo doença de Alzheimer na primeira década (1972-1981), para 100.028 artigos na última década (2012-2021): um aumento de 162,6 vezes enquanto as publicações com o termo demência aumentaram 28,6 vezes no mesmo período. Nas décadas de 1960 e 1970, chegou-se a um consenso de que a DA é responsável pela maioria dos casos de demência, anteriormente conhecida como demência senil. Na década de 1980, o peptídeo beta-amiloide foi identificado no núcleo da placa senil, a proteína tau hiperfosforilada foi encontrada em emaranhados neurofibrilares e uma mutação foi descoberta em uma forma hereditária de DA. Conclusão A expansão do conceito de DA para incluir a demência senil e as descobertas ocorridas na década de 1980 ampliaram enormemente a pesquisa em DA.
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The multifactorial nature of Alzheimer's disease (AD) is now widely recognized, which has increased the interest in compounds that can address more than one AD-associated targets. Herein, we report the inhibitory activity on the human cholinesterases (acetylcholinesterase, hAChE and butyrylcholinesterase, hBChE) and on the AChE-induced ß-amyloid peptide (Aß) aggregation by a series of peptide derivatives designed by mutating aliphatic residues for aromatic ones. We identified peptide W3 (LGWVSKGKLL-NH2 ) as an interesting scaffold for the development of new anti-AD multitarget-directed drugs. It showed the lowest IC50 value against hAChE reported for a peptide (0.99±0.02â µM) and inhibited 94.2 %±1.2 of AChE-induced Aß aggregation at 10â µM. Furthermore, it inhibited hBChE (IC50 , 15.44±0.91â µM), showed no inâ vivo toxicity in brine shrimp and had shown moderated radical scavenging and Fe2+ chelating capabilities in previous studies. The results are in line with multiple reports showing the utility of the indole moiety for the development of cholinesterase inhibitors.
Assuntos
Doença de Alzheimer , Peptídeos beta-Amiloides , Humanos , Acetilcolinesterase/metabolismo , Butirilcolinesterase/metabolismo , Relação Estrutura-Atividade , Inibidores da Colinesterase/farmacologia , Inibidores da Colinesterase/química , Doença de Alzheimer/tratamento farmacológicoRESUMO
Abstract Alzheimer's disease is a neurodegenerative condition that causes changes in memory and cognition, in addition to behavioral disorders, and most commonly affects the elderly. Several studies in the literature have presented therapeutic measures in an attempt to interfere with the pathogenic mechanisms of the disease and to mitigate its clinical manifestations. Some factors, such as excitotoxicity, cholinergic dysfunctions, oxidative stress, tau protein hyperphosphorylation, changes in amyloid-beta peptide metabolism, herpes viruses, apolipoprotein E, glycogen synthase kinase 3, insulin resistance, and the endocannabinoid system seem to be related to pathophysiology of Alzheimer's disease. Given this, a literature review was carried out to address the molecular mechanisms associated with the pathophysiological hypotheses previously mentioned, aiming to better understanding their underlying causes and contributing to possible pharmacological strategies about treatment of the disease.
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Alzheimer's disease (AD) is a neurodegenerative disease, characterized histopathologically by intra-neuronal tau-related lesions and by the accumulation of amyloid ß-peptide (Aß) in the brain parenchyma and around cerebral blood vessels. According to the vascular hypothesis of AD, an alteration in the neurovascular unit (NVU) could lead to Aß vascular accumulation and promote neuronal dysfunction, accelerating neurodegeneration and dementia. To date, the effects of insoluble vascular Aß deposits on the NVU and the blood-brain barrier (BBB) are unknown. In this study, we analyze different Aß species and their association with the cells that make up the NVU. We evaluated post-mortem AD brain tissue. Multiple immunofluorescence assays were performed against different species of Aß and the main elements that constitute the NVU. Our results showed that there are insoluble vascular deposits of both full-length and truncated Aß species. Besides, insoluble aggregates are associated with a decrease in the phenotype of the cellular components that constitute the NVU and with BBB disruption. This approach could help identify new therapeutic targets against key molecules and receptors in the NVU that can prevent the accumulation of vascular fibrillar Aß in AD.
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Doença de Alzheimer/patologia , Peptídeos beta-Amiloides/metabolismo , Astrócitos/patologia , Vasos Sanguíneos/patologia , Encéfalo/patologia , Microglia/patologia , Actinas/metabolismo , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/metabolismo , Vasos Sanguíneos/metabolismo , Encéfalo/irrigação sanguínea , Encéfalo/metabolismo , Estudos de Casos e Controles , Caspases/metabolismo , Humanos , Junções Íntimas/patologiaRESUMO
RESUMO A doença neurodegenerativa mais comum no mundo é a doença de Alzheimer (DA), e 10% dos casos apresentam sintomas antes dos 65 anos, quase todos com associação genética, com hereditariedade autossômica dominante e penetrância entre 92 a 100% dos portadores. Na presente revisão, realizamos uma busca sobre as variantes genéticas associadas à doença de Alzheimer de início precoce (DAIP), enfatizando as características associadas mais importantes e as principais mutações já descritas. Os genes mais comumente relacionados com o surgimento da DAIP são APP, PSEN1, PSEN2 e MAPT, e mutações nestes afetam o metabolismo e a estrutura destas proteínas, resultando em acúmulos de peptídeo Aβ que causam inflamação e toxicidade no cérebro, levando à ativação da micróglia e promovendo a liberação de fatores neurotóxicos e pró-inflamatórios que aceleram a neurodegeneração. O gene PSEN1 é responsável por 70% das mutações conhecidas da DAIP, sendo a L166P associada à idade de ocorrência da doença abaixo dos 30 anos. Mutações em APP levam à agregação da proteína em placas neurodegenerativas. Todas as mutações descritas para MAPT estão associadas a um aumento dos emaranhados neurofibrilares. O polimorfismo E4 da Apolipoproteína E (APOE) influencia o aumento no risco de DAIP elevando as chances em três vezes para portadores heterozigotos e entre oito a dez vezes para os homozigotos. Apenas 5% das mutações associadas à DAIP são conhecidas, e novos estudos apresentam outros genes candidatos, bem como a importância de alterações epigenéticas na gênese desta doença.
SUMMARY The most common neurodegenerative disease in the world is Alzheimer's Disease (AD). Ten percent of Alzheimer patients experience symptoms before the age of 65, and almost all of them present genetic features of autosomal dominant inheritance nature, and penetrance of 92 to 100%. In the present review, we searched for genetic variants associated with early onset Alzheimer's disease (EOAD), emphasizing the most important characteristics and the main mutations. The genes most commonly related to the onset of EOAD are APP, PSEN1, PSEN2 and MAPT, whose mutations affect the metabolism and structure of these proteins. This process results in accumulations of Aβ peptide that leads to activation of the microglia and release of neurotoxic and pro-inflammatory factors that accelerate neurodegeneration. The PSEN1 gene is responsible for 70% of the known mutations in EOAD, while L166P is associated with below 30 years as the starting age of occurrence. APP mutations lead to protein aggregation in neurodegenerative plaques. All of the mutations described for MAPT are associated with an increase in neurofibrillary tangles. The E4 polymorphism of Apolipoprotein E (APOE) influences an increased risk of EOAD increasing up to three times the chances for heterozygous, and between eight and ten times for homozygotes carriers. Only 5% of the mutations associated with EOAD are known; new studies will show other candidate genes, as well as the importance of epigenetic factors changes in the etio-pathogenesis of this disease.
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PURPOSE: [18F]FDG-PET and [11C]PIB-PET are validated as neurodegeneration and amyloid biomarkers of Alzheimer's disease (AD). We used a PET staging system based on the 2018 NIA-AA research framework to compare the proportion of amyloid positivity (A+) and hypometabolism ((N)+) in cases of mild probable AD, amnestic mild cognitive impairment (aMCI), and healthy controls, incorporating an additional classification of abnormal [18F]FDG-PET patterns and investigating the co-occurrence of such with A+, exploring [18F]FDG-PET to generate hypotheses in cases presenting with clinical-biomarker "mismatches." METHODS: Elderly individuals (N = 108) clinically classified as controls (N = 27), aMCI (N = 43) or mild probable AD (N = 38) were included. Authors assessed their A(N) profiles and classified [18F]FDG-PET neurodegenerative patterns as typical or non-typical of AD, performing re-assessments of images whenever clinical classification was in disagreement with the PET staging (clinical-biomarker "mismatches"). We also investigated associations between "mismatches" and sociodemographic and educational characteristics. RESULTS: AD presented with higher rates of A+ and (N)+. There was also a higher proportion of A+ and (N)+ individuals in the aMCI group in comparison to controls, however without statistical significance regarding the A staging. There was a significant association between amyloid positivity and AD (N)+ hypometabolic patterns typical of AD. Non-AD (N)+ hypometabolism was seen in all A- (N)+ cases in the mild probable AD and control groups and [18F]FDG-PET patterns classified such individuals as "SNAP" and one as probable frontotemporal lobar degeneration. All A- (N)- cases in the probable AD group had less than 4 years of formal education and lower socioeconomic status (SES). CONCLUSION: The PET-based staging system unveiled significant A(N) differences between AD and the other groups, whereas aMCI and controls had different (N) staging, explaining the cognitive impairment in aMCI. [18F]FDG-PET could be used beyond simple (N) staging, since it provided alternative hypotheses to cases with clinical-biomarker "mismatches." An AD hypometabolic pattern correlated with amyloid positivity. Low education and SES were related to dementia in the absence of biomarker changes.
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Doença de Alzheimer , Disfunção Cognitiva , Idoso , Doença de Alzheimer/diagnóstico por imagem , Peptídeos beta-Amiloides/metabolismo , Biomarcadores , Encéfalo/diagnóstico por imagem , Encéfalo/metabolismo , Disfunção Cognitiva/diagnóstico por imagem , Fluordesoxiglucose F18 , Humanos , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios XRESUMO
Alzheimer's disease (AD) affects millions of people, however, there is still no effective treatment. The use of focused ultrasound with microbubbles (FUS-MB) for the opening of the blood-brain barrier has been recently studied and may become a promising therapeutic target. OBJECTIVE: To discuss the use of FUS-MB for the treatment of AD and to present some of the techniques used. METHODS: A systematic review was performed of MEDLINE/PubMed and Biblioteca Virtual em Saúde (BVS) services, using the keywords: focused ultrasound, Alzheimer, amyloid-b. Original articles were included in the study; studies that did not focus on Alzheimer's treatment were excluded. RESULTS: Fifteen original studies were selected. Preclinical trials were able to reduce amyloid-b plaques and tau phosphorylation, improving cognitive performance in AD animals. CONCLUSION: The results are very promising, but the therapy still requires maturation. Further studies are needed to systematize all the techniques used and their effects in order to enable use in humans.
A doença de Alzheimer (DA) afeta milhões de pessoas, porém, ainda não há um tratamento efetivo. O uso de ultrassonografia focalizada com microbolhas (FUS-MB) para a abertura da barreira hematoencefálica (BHE) tem sido objeto de estudos recentes, podendo tornar-se um alvo terapêutico bastante promissor. OBJETIVO: Discutir o uso da FUS-MB para o tratamento da DA e apresentar algumas das técnicas utilizadas. MÉTODOS: Revisão sistemática através dos serviços MEDLINE/PubMed e Biblioteca Virtual em Saúde (BVS), através das seguintes palavras-chaves: focused ultrasound, Alzheimer, amyloid-b. Foram incluídos no estudo artigos originais. Foram excluídos estudos que não tinham o tratamento do Alzheimer como foco. RESULTADOS: Foram selecionados 15 estudos originais. Os resultados pré-clínicos são positivos para redução de placas amiloides, fosforilação da proteína tau e sobre desempenho cognitivo de animais com DA. CONCLUSÃO: Os resultados são promissores, mas terapia ainda necessita de aperfeiçoamento, necessitando de mais estudos que sistematize todas as técnicas e seus efeitos, para ser possível o seu uso em humanos.
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ABSTRACT Alzheimer's disease (AD) affects millions of people, however, there is still no effective treatment. The use of focused ultrasound with microbubbles (FUS-MB) for the opening of the blood-brain barrier has been recently studied and may become a promising therapeutic target. Objective: To discuss the use of FUS-MB for the treatment of AD and to present some of the techniques used. Methods: A systematic review was performed of MEDLINE/PubMed and Biblioteca Virtual em Saúde (BVS) services, using the keywords: focused ultrasound, Alzheimer, amyloid-b. Original articles were included in the study; studies that did not focus on Alzheimer's treatment were excluded. Results: Fifteen original studies were selected. Preclinical trials were able to reduce amyloid-b plaques and tau phosphorylation, improving cognitive performance in AD animals. Conclusion: The results are very promising, but the therapy still requires maturation. Further studies are needed to systematize all the techniques used and their effects in order to enable use in humans.
RESUMO A doença de Alzheimer (DA) afeta milhões de pessoas, porém, ainda não há um tratamento efetivo. O uso de ultrassonografia focalizada com microbolhas (FUS-MB) para a abertura da barreira hematoencefálica (BHE) tem sido objeto de estudos recentes, podendo tornar-se um alvo terapêutico bastante promissor. Objetivo: Discutir o uso da FUS-MB para o tratamento da DA e apresentar algumas das técnicas utilizadas. Métodos: Revisão sistemática através dos serviços MEDLINE/PubMed e Biblioteca Virtual em Saúde (BVS), através das seguintes palavras-chaves: focused ultrasound, Alzheimer, amyloid-b. Foram incluídos no estudo artigos originais. Foram excluídos estudos que não tinham o tratamento do Alzheimer como foco. Resultados: Foram selecionados 15 estudos originais. Os resultados pré-clínicos são positivos para redução de placas amiloides, fosforilação da proteína tau e sobre desempenho cognitivo de animais com DA. Conclusão: Os resultados são promissores, mas terapia ainda necessita de aperfeiçoamento, necessitando de mais estudos que sistematize todas as técnicas e seus efeitos, para ser possível o seu uso em humanos.
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Terapia por Ultrassom , Doença de Alzheimer , Terapêutica/métodos , Barreira HematoencefálicaRESUMO
A doença de Alzheimer é a patologia neurodegenerativa mais frequente associada à idade, cujas manifestações cognitivas e neuropsiquiátricas resultam em deficiência progressiva e incapacitação. Existem vários tipos de terapias farmacológicas que visam melhorar a qualidade de vida do paciente afetado por esta patologia. Muitos medicamentos são usados há muito tempo para o tratamento da doença, sendo os inibidores da colinesterase as drogas de primeira escolha para o tratamento, mas nenhum deles regride a progressão da doença de Alzheimer. Novos estudos têm sido realizados, com o objetivo de procurar um novo medicamento que seja capaz de ajudar em sua regressão. Ainda, novos tratamentos, como a terapêutica antiamiloide, são opções que estão sendo observados para uma melhor terapêutica. Estes tratamentos são descritos nesta revisão, que teve como objeitvo analisar os benefícios do tratamento da doença de Alzheimer, por meio da terapêutica antiamiloide, em que se enquadra a imunoterapia.(AU)
Alzheimer's disease is the most common neurodegenerative disorder associated with age, whose cognitive and neuropsychiatric manifestations result in progressive disability and incapacitation. There are several types of pharmacological therapies aimed at improving the patient's quality of life affected by this disease. Many medications have long been used for the treatment of the disease, with cholinesterase inhibitors being the drugs of first choice for the treatment but none of them regress the progression of Alzheimer's disease. Further studies have been made to search a new drug able to assist in the regression of the disease. In addition, new therapies such as the anti-amyloid one are options that are being observed to improve treatment. These therapies are described in this review, which aims at analyzing the benefits of anti-amyloid therapy for Alzheimer's disease, in which immunotherapy is included.(AU)
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Humanos , Peptídeos beta-Amiloides/uso terapêutico , Demência/tratamento farmacológico , Doença de Alzheimer/tratamento farmacológico , ImunoterapiaRESUMO
Background: Recent evidence suggests that early neurodegenerative events associated with Alzheimer's disease (AD) probably begin in the synaptic terminal, where it has been reported a large accumulation of ß-amyloid protein (Aß), one of the main factors described in the development of AD. We analyzed the influence of energy metabolism on the toxic effects of Aß during aging on synaptosomes from neocortex and hippocampus of rats exposed to inhibitors of glycolytic and mitochondrial metabolism and we evaluated the protective effects of some antioxidant compounds. Methods: Synaptosomes were obtained by differential centrifugation in sucrose gradients and their redox activity was determined with the MTT assay. Results: The mitochondrial activity of synaptosomes from young rats was not altered by the presence of Aß; the ones obtained from old rats showed an increase in susceptibility to Aß; this activity was greater in the synaptic terminals of the hippocampus. Conclusions: These results provide experimental support for the hypothesis that certain risk factors, such as energy metabolism dysfunction or the aging process itself, may increase vulnerability to Aß. Hippocampal region is more susceptible to Aß and its effect increases with age in relation to the neocortex, which would agree with the damage gradient reported in the AD.
Introducción: evidencia reciente sugiere que eventos neurodegenerativos tempranos asociados con la enfermedad de Alzheimer (EA) probablemente se inicien en la terminal sináptica, en donde se observa una gran acumulación de la proteína ß-amiloide (Aß), uno de los factores involucrados en el desarrollo de la EA. Estudiamos la influencia del metabolismo energético en los efectos tóxicos de la Aß en el envejecimiento en sinaptosomas de neocorteza e hipocampo de ratas expuestas a inhibidores del metabolismo glucolítico y mitocondrial, y evaluamos los efectos protectores de algunos antioxidantes. Métodos: los sinaptosomas se obtuvieron por centrifugación diferencial en gradientes de sacarosa y su actividad óxido-reductura se determinó con la técnica de MTT. Resultados: la actividad mitocondrial de los sinaptosomas de ratas jóvenes no se alteró por la presencia de la Aß; los de ratas viejas mostraron un aumento en la susceptibilidad a la Aß, el efecto fue mayor en las terminales sinápticas del hipocampo. Conclusiones: los resultados sustentan la hipótesis de que ciertos factores de riesgo, como las disfunciones del metabolismo energético o el proceso de envejecimiento, pueden incrementar la vulnerabilidad a la Aß y su efecto se incrementa con la edad en relación con la neocorteza, lo cual concordaría con el gradiente de daño reportado en la EA.
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Envelhecimento/fisiologia , Peptídeos beta-Amiloides/toxicidade , Antioxidantes/metabolismo , Metabolismo Energético/fisiologia , Hipocampo/metabolismo , Neocórtex/metabolismo , Sinaptossomos/metabolismo , Doença de Alzheimer/metabolismo , Peptídeos beta-Amiloides/metabolismo , Animais , Biomarcadores/metabolismo , Oxirredução , Ratos , Ratos WistarRESUMO
Periodontitis is an oral chronic infection/inflammatory condition, identified as a source of mediators of inflammation into the blood circulation, which may contribute to exacerbate several diseases. There is increasing evidence that inflammation plays a key role in the pathophysiology of Alzheimer's disease (AD). Although inflammation is present in both diseases, the exact mechanisms and crosslinks between periodontitis and AD are poorly understood. Therefore, this article aims to review possible comorbidity between periodontitis and AD. Here, the authors discuss the inflammatory aspects of periodontitis, how this oral condition produces a systemic inflammation and, finally, the contribution of this systemic inflammation for worsening neuroinflammation in the progression of AD.
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Abstract Alzheimer disease (AD) is the most prevalent form of dementia of adult-onset, characterized by progressive impairment in cognition and memory. There is no cure for the disease and the current treatments are only symptomatic. Drug discovery is an expensive and time-consuming process; in the last decade no new drugs have been found for AD despite the efforts of the scientific community and pharmaceutical companies. The Aβ immunotherapy is one of the most promising approaches to modify the course of AD. This therapeutic strategy uses synthetic peptides or monoclonal antibodies (mAb) to decrease the Aβ load in the brain and slow the progression of the disease. Therefore, this article will discuss the main aspects of AD neuropathogenesis, the classical pharmacologic treatment, as well as the active and passive immunization describing drug prototypes evaluated in different clinical trials.
Resumen La enfermedad de Alzheimer (EA) es la forma más frecuente de demencia de inicio en el adulto, caracterizada por un deterioro progresivo en la cognición y la memoria. No hay cura para la enfermedad y los tratamientos actuales son sólo sintomáticos. El descubrimiento de fármacos es un proceso costoso y que consume mucho tiempo; en la última década no se han encontrado nuevos fármacos para la EA a pesar de los esfuerzos de la comunidad científica y las compañías farmacéuticas. La inmunoterapia contra Aβ es uno de los enfoques más prometedores para modificar el curso de la EA. Esta estrategia terapéutica utiliza péptidos sintéticos o anticuerpos monoclonales (mAb) para disminuir la carga de Aβ en el cerebro y retardar la progresión de la enfermedad. Por lo tanto, este artículo discutirá los principales aspectos de la neuropatogénesis de la EA, el tratamiento farmacológico clásico, así como la inmunización activa y pasiva describiendo los prototipos de fármacos evaluados en diferentes ensayos clínicos.
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Humanos , Peptídeos beta-Amiloides/imunologia , Doença de Alzheimer/terapia , Imunoterapia/métodos , Peptídeos/uso terapêutico , Peptídeos/farmacologia , Progressão da Doença , Doença de Alzheimer/fisiopatologia , Doença de Alzheimer/imunologia , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais/farmacologiaRESUMO
ABSTRACT CONTEXT AND OBJECTIVE: Dementia is a syndrome characterized by functional and cognitive decline. Alzheimer's disease (AD) is one of the most common causes of dementia and has high prevalence among the elderly. It is known that there is no drug capable of interfering with the course of the disease. Research on treatments for AD has been marked by the appearance of new drugs and their abandonment. This study aimed to describe drugs that have been studied with regard to treating AD and which are capable of influencing the course of the disease. DESIGN AND SETTING: Narrative review on original articles published worldwide. METHODS: A systematized search was conducted in the PubMed/MEDLINE, Cochrane Library/Cochrane and SciELO/Bireme databases. The descriptors "Molecular Mechanisms of Pharmacological Action" and "Drug Therapy" were each combined with the descriptor "Alzheimer disease". All of these can be found in MeSH and DeCS. These descriptors were used alone or in combination, and a filter specifying publication between January 2009 and October 2015 in English, Spanish or Portuguese was set. RESULTS: 6,888 articles were found, of which 37 were included in this review; 70.3% of the articles selected were of good quality with low or unclear risk of bias. 86 drugs were considered promising for AD treatment and these were classified into 20 pharmacological categories. CONCLUSION: There are no drugs capable of influencing the course of AD such that treatments are safe and effective. However, immunomodulators stood out as promising, given their effectiveness and quality in the articles analyzed.
RESUMO CONTEXTO E OBJETIVO: A demência é uma síndrome caracterizada por declínio funcional e cognitivo, sendo a doença de Alzheimer (DA) uma das causas mais comuns e de alta prevalência em idosos. Sabe-se que não há medicamento capaz de interferir no curso da doença e as pesquisas para o tratamento da DA têm sido marcadas pelo surgimento e abandono de novas drogas. O objetivo deste estudo foi descrever as drogas capazes de influenciar o curso da DA que têm sido estudadas para o tratamento da doença. TIPO DE ESTUDO E LOCAL: Revisão narrativa de artigos originais publicados mundialmente. MÉTODOS: Foi realizada uma busca sistematizada nas bases de dados PubMed/MEDLINE, Cochrane Library/Cochrane e SciELO/Bireme. Cada um dos seguintes descritores "Mecanismos Moleculares de Ação Farmacológica" e "Quimioterapia" foram combinados com o descritor "Doença de Alzheimer", todos encontrados no MeSH e DeCS. Os descritores foram usados sozinhos ou em combinação, fixando como filtros as publicações de 2009 a 2015, em língua inglesa, espanhola e portuguesa. RESULTADOS: Foram encontrados 6.888 artigos, dos quais 37 foram incluídos nesta revisão; 70,3% dos artigos selecionados tiveram boa qualidade com baixo ou indefinido risco de viés. Foram elencadas 86 drogas promissoras ao tratamento da AD. Elas foram classificadas em 20 categorias farmacológicas. CONCLUSÃO: Não há fármacos capazes de interferir no curso da DA com efetividade e segurança no tratamento. Contudo, os imunomoduladores foram considerados promissores devido ao fato de apresentarem efetividade e qualidade nos artigos analisados.
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Humanos , Doença de Alzheimer/tratamento farmacológico , Inibidores da Colinesterase/uso terapêutico , Peptídeos beta-Amiloides/efeitos dos fármacos , Anti-Inflamatórios/uso terapêutico , Antioxidantes/uso terapêuticoRESUMO
Electrophoretic mobilities of amyloid-beta (1-40) and (1-42) peptides and their aggregates are modeled to study the amyloidogenic pathway associated with Alzheimer´s Disease. The near molecule pH generated by the intraparticle charge regulation phenomenon during the oligomerization of amyloid-beta (1-40) and (1-42) peptides is evaluated and discussed as a relevant mechanism supporting the "amyloid cascade hypothesis" proposed in the literature. A theoretical framework associated with the oligomerization of amyloid-beta peptides including simple scaling laws and the consideration of electrokinetic and hydrodynamic global properties of oligomers is presented. The central finding is the explanation of the near molecule pH change toward the pI when the oligomerization number increases. These results allow one to rationalize consecutive physical stages that validate the amyloid cascade hypothesis. Concluding remarks involving mainly the effects of pair and intraparticle charge regulation phenomena on the amyloidogenic pathway with some suggestions for future research are provided.
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Peptídeos beta-Amiloides/química , Amiloide/química , Eletroforese Capilar/métodos , Amiloide/metabolismo , Peptídeos beta-Amiloides/metabolismo , Simulação por Computador , Fragmentos de Peptídeos/química , Fragmentos de Peptídeos/metabolismo , PolimerizaçãoRESUMO
Alzheimer disease (AD) is the most prevalent form of dementia of adult-onset, characterized by progressive impairment in cognition and memory. There is no cure for the disease and the current treatments are only symptomatic. Drug discovery is an expensive and time-consuming process; in the last decade no new drugs have been found for AD despite the efforts of the scientific community and pharmaceutical companies. The Aß immunotherapy is one of the most promising approaches to modify the course of AD. This therapeutic strategy uses synthetic peptides or monoclonal antibodies (mAb) to decrease the Aß load in the brain and slow the progression of the disease. Therefore, this article will discuss the main aspects of AD neuropathogenesis, the classical pharmacologic treatment, as well as the active and passive immunization describing drug prototypes evaluated in different clinical trials.
La enfermedad de Alzheimer (EA) es la forma más frecuente de demencia de inicio en el adulto, caracterizada por un deterioro progresivo en la cognición y la memoria. No hay cura para la enfermedad y los tratamientos actuales son sólo sintomáticos. El descubrimiento de fármacos es un proceso costoso y que consume mucho tiempo; en la última década no se han encontrado nuevos fármacos para la EA a pesar de los esfuerzos de la comunidad científica y las compañías farmacéuticas. La inmunoterapia contra Aß es uno de los enfoques más prometedores para modificar el curso de la EA. Esta estrategia terapéutica utiliza péptidos sintéticos o anticuerpos monoclonales (mAb) para disminuir la carga de Aß en el cerebro y retardar la progresión de la enfermedad. Por lo tanto, este artículo discutirá los principales aspectos de la neuropatogénesis de la EA, el tratamiento farmacológico clásico, así como la inmunización activa y pasiva describiendo los prototipos de fármacos evaluados en diferentes ensayos clínicos.
Assuntos
Doença de Alzheimer/terapia , Peptídeos beta-Amiloides/imunologia , Imunoterapia/métodos , Doença de Alzheimer/imunologia , Doença de Alzheimer/fisiopatologia , Anticorpos Monoclonais/farmacologia , Anticorpos Monoclonais/uso terapêutico , Progressão da Doença , Humanos , Peptídeos/farmacologia , Peptídeos/uso terapêuticoRESUMO
To evaluate the effects of PHA-543613 (7-nAChR agonist) and galantamine (acetylcholinesterase inhibitor (AChEI)) on recognition memory and neurovascular coupling (NVC) response in beta-amyloid (A) 25-35-treated mice. METHODS: PHA-543613 (1 mg/kg, i.p.), and galantamine (3 mg/kg, s.c.), effects were tested in A25-35 mice model of AD. 7-nAChR antagonist, methyllycaconitine (MLA) (1 mg/kg, i.p.), was used for evaluation of receptor blockade effects. Recognition memory in animals was assessed by the novel object recognition (NOR) task. NVC response was analyzed by laser-doppler flow meter in barrel cortex by whisker stimulation method. RESULTS: Both, PHA-543613 and galantamine improve recognition memory in A-treated animals. However, the advantageous effects of PHA-543613 were significantly higher than galantamine. Also, pretreatment with MLA reversed both galantamine and PHA-543613 effects on NOR. Impaired NVC response in AD animals was improved by PHA-543613 and galantamine. However, MLA pretreatment disrupts this function. CONCLUSION: Activation of 7-nAChR improved recognition memory possible through enhancement of neurovascular response in Alzheimer's disease in animals.(AU)
Assuntos
Animais , Camundongos , Receptores Nicotínicos , Memória/efeitos dos fármacos , Peptídeos beta-Amiloides , Doença de AlzheimerRESUMO
PURPOSE: To evaluate the effects of PHA-543613 (α7-nAChR agonist) and galantamine (acetylcholinesterase inhibitor (AChEI)) on recognition memory and neurovascular coupling (NVC) response in beta-amyloid (Aβ) 25-35-treated mice. METHODS: PHA-543613 (1 mg/kg, i.p.), and galantamine (3 mg/kg, s.c.), effects were tested in Aβ25-35 mice model of AD. α7-nAChR antagonist, methyllycaconitine (MLA) (1 mg/kg, i.p.), was used for evaluation of receptor blockade effects. Recognition memory in animals was assessed by the novel object recognition (NOR) task. NVC response was analyzed by laser-doppler flow meter in barrel cortex by whisker stimulation method. RESULTS: Both, PHA-543613 and galantamine improve recognition memory in Aβ-treated animals. However, the advantageous effects of PHA-543613 were significantly higher than galantamine. Also, pretreatment with MLA reversed both galantamine and PHA-543613 effects on NOR. Impaired NVC response in AD animals was improved by PHA-543613 and galantamine. However, MLA pretreatment disrupts this function. CONCLUSION: Activation of α7-nAChR improved recognition memory possible through enhancement of neurovascular response in Alzheimer's disease in animals.
Assuntos
Animais , Masculino , Peptídeos beta-Amiloides , Compostos Bicíclicos Heterocíclicos com Pontes/farmacologia , Inibidores da Colinesterase/farmacologia , Galantamina/farmacologia , Transtornos da Memória/tratamento farmacológico , Acoplamento Neurovascular/efeitos dos fármacos , Fragmentos de Peptídeos , Quinuclidinas/farmacologia , /metabolismo , Doença de Alzheimer/tratamento farmacológico , Doença de Alzheimer/fisiopatologia , Modelos Animais de Doenças , Fluxometria por Laser-Doppler , Camundongos Endogâmicos BALB C , Transtornos da Memória/fisiopatologia , Testes Neuropsicológicos , Acoplamento Neurovascular/fisiologia , Reprodutibilidade dos Testes , Reconhecimento Psicológico/efeitos dos fármacos , Fatores de Tempo , Resultado do TratamentoRESUMO
O desenvolvimento das doenças neurodegenerativas, como a doença de Alzheimer, está associado à presença de agregados proteicos contendo Tau hiperfosforilada (p-Tau). Esta disfunção da Tau leva a prejuízos na homeostase celular. Um mecanismo chave para diminuir e/ou prevenir os danos promovidos pelos agregados contendo Tau seria o estímulo de sua degradação. Neste sentido, a proposta do presente estudo foi analisar a degradação da proteína Tau após aumento da expressão exógena da cochaperona Bag-2, a qual influencia o sistema proteassomal de degradação; bem como avaliar a ativação dos sistemas de degradação, a fim de correlacionar estes sistemas em cultura de células primárias e organotípica do hipocampo de ratos. Os resultados mostraram que a rotenona foi capaz de aumentar os níveis de p-Tau e que a superexpressão de Bag-2, foi eficiente em prevenir e degradar a p-Tau. O mecanismo envolvido neste processo envolve a coordenação dos sistemas proteassomal e lisossomal, já que a Rab7 e a Rab24 (envolvidas na via lisossomal) mostraram-se diminuídas na fase que antecede a agregação proteica, enquanto houve aumento da Rab24 na presença dos agregados proteicos. Com relação ao peptídeo beta amiloide, foi demonstrado tendência de aumento de p-Tau acompanhado de diminuição da atividade proteassomal e lisossomal. O tratamento com PADK (ativador lisossomal) foi capaz de reverter este efeito nestas diferentes condições. A análise da interrelação entre os sistemas mostrou que uma inibição do proteassoma favorece a via lisossomal e que o inverso não se repete. Os resultados sugerem que a modulação das vias de degradação pode ser interessante para o estudo, prevenção e tratamento das doenças neurodegenerativas associadas à agregação de proteínas...
Neurodegenerative diseases, such as Alzheimer's, are associated to protein inclusions containing hyperphosphorylated Tau (p-Tau). It is well established that Tau dysfunction impairs cell homeostasis. A key mechanism to prevent and/or reduce the damage promoted by aggregates of Tau might be its degradation. In view of this, the aims of the present study are to evaluate p- Tau clearance following exogenous expression of Bag-2, which stimulates proteasome; as well as to analyze the activation of both lysosome and proteasome pathways in order to understand the crosstalk between these two systems in primary and organotypic cultures of rat hippocampus. Results showed that rotenone was able of increasing p-Tau that was prevented and degraded by Bag-2 overexpression. Mechanisms involved in this process involve the coordination of cell degradation systems, depending upon aggregation status, since Rab7 and Rab24 (involved in lysosomal pathway) were decreased before protein aggregation, while Rab24 increased in the presence of protein inclusions. Amyloid-beta peptide also increased p-Tau accompanied by decreased proteasome and lysosome activity. PADK (lysosomal activator) treatment reverted the inhibition promoted by amyloidbeta peptide. Inhibition of proteasome leads to activation of lysosome, but lysosome inhibition does not affect proteasome. Overall, results suggest that targeting degradation pathways might be useful to understand, prevent and treat neurodegenerative diseases associated with protein deposits...
Assuntos
Animais , Ratos , Doença de Alzheimer , Peptídeos beta-Amiloides , Lisossomos , Chaperonas Moleculares , Doenças Neurodegenerativas , Emaranhados Neurofibrilares , Proteínas rab de Ligação ao GTP , Rotenona/farmacologia , Proteínas tau , Tauopatias/fisiopatologia , Envelhecimento , Hipocampo , Modelos Animais , Ratos Endogâmicos Lew , Ratos Sprague-DawleyRESUMO
La enfermedad de Alzheimer es la causa de demencia senil más común en el mundo. Los marcadores histopatológicos asociados a la enfermedad son la acumulación extracelular de los péptidos β-amiloides y la intracelular de la proteína tau hiperfosforilada. La fosforilación de la proteína tau es regulada por múltiples quinasas y fosfatasas, y del equilibrio entre éstas depende su adecuada función o su agregación. La quinasa dependiente de ciclina 5 es una de las principales quinasas implicadas en la fosforilación de la proteína tau; tiene una acción directa sobre diversos residuos y participa en la regulación de diferentes sustratos para el funcionamiento correcto de la neurona; sin embargo, en condiciones alteradas puede desencadenar la enfermedad de Alzheimer. Así mismo, alteraciones que lleven a la agregación de proteínas o fallas en las vías de degradación de éstas en la célula, como el sistemaubicuitina-proteasoma y la autofagia, pueden facilitar el desarrollo de la enfermedad. La búsqueda de estrategias terapéuticas eficaces para los pacientes con la enfermedad de Alzheimer debe intentar unificar los mecanismos patogénicos de la enfermedad desde la complejidad que representa un proceso crónico y multifactorial.
Alzheimer disease is the most common cause of dementia in the world. The major histopathologicalmarkers associated with the disease are the accumulation of extracellular amyloid β-peptides and the accumulation of intracellular hyperphosphorylated tau protein. Multiple kinases and phosphatases can regulate tau phosphorylation, and the adequate function or aggregation depends on the balance between these enzymes. Cyclin-dependent kinase 5 is one of the major kinases involved in tau phosphorylation.This kinase has a direct action by phosphorylating various residues, and participates in the regulation of a variety of substrates for proper neuron function; however, dysregulation conditions can trigger Alzheimer disease. As well, changes in the cell that leading to protein aggregation or failure in their degradation pathways, such as the ubiquitin-proteasome system and autophagy, can facilitate the development of the disease. The search of effective treatment strategies for patients with Alzheimer disease should try to unify the pathogenic mechanisms from within complexity of this chronic and multifactorial condition.