Hermann Esselmann

Presenilin clinical mutations can affect gamma-secretase activity by different mechanisms.

Mutations in human presenilin (PS) genes cause aggressive forms of familial Alzheimers disease. Presenilins are polytopic proteins that harbour the catalytic site of the γ‐secretase complex and cleave many type I transmembrane proteins including β‐amyloid precursor protein (APP), Notch and syndecan 3. Contradictory results have been published concerning whether PS mutations cause ‘abnormal’ gain or (partial) loss of function of γ‐secretase. To avoid the possibility that wild‐type PS confounds the interpretation of the results, we used presenilin‐deficient cells to analyse the effects of different clinical mutations on APP, Notch, syndecan 3 and N‐cadherin substrate processing, and on γ‐secretase complex formation. A loss in APP and Notch substrate processing at ɛ and S3 cleavage sites was observed with all presenilin mutants, whereas APP processing at the γ site was affected in variable ways. PS1‐Δ9 and PS1‐L166P mutations caused a reduction in β‐amyloid peptide (Aβ)40 production whereas PS1‐G384A mutant significantly increased Aβ42. Interestingly PS2, a close homologue of PS1, appeared to be a less efficient producer of Aβ than PS1. Finally, subtle differences in γ‐secretase complex assembly were observed. Overall, our results indicate that the different mutations in PS affect γ‐secretase structure or function in multiple ways.

The mechanism of γ-Secretase dysfunction in familial Alzheimer disease.

The mechanisms by which mutations in the presenilins (PSEN) or the amyloid precursor protein (APP) genes cause familial Alzheimer disease (FAD) are controversial. FAD mutations increase the release of amyloid β (Aβ)42 relative to Aβ40 by an unknown, possibly gain‐of‐toxic‐function, mechanism. However, many PSEN mutations paradoxically impair γ‐secretase and ‘loss‐of‐function’ mechanisms have also been postulated. Here, we use kinetic studies to demonstrate that FAD mutations affect Aβ generation via three different mechanisms, resulting in qualitative changes in the Aβ profiles, which are not limited to Aβ42. Loss of ε‐cleavage function is not generally observed among FAD mutants. On the other hand, γ‐secretase inhibitors used in the clinic appear to block the initial ε‐cleavage step, but unexpectedly affect more selectively Notch than APP processing, while modulators act as activators of the carboxypeptidase‐like (γ) activity. Overall, we provide a coherent explanation for the effect of different FAD mutations, demonstrating the importance of qualitative rather than quantitative changes in the Aβ products, and suggest fundamental improvements for current drug development efforts.

Neurochemical diagnosis of Alzheimer’s dementia by CSF Aβ42, Aβ42/Aβ40 ratio and total tau

Cerebrospinal fluid (CSF) concentrations of amyloid β peptides ending at positions 42 and 40 (Aβ42 and Aβ40, respectively), and total tau (tTau) protein were measured by ELISA in order to compare their accuracy in discriminating patients with Alzheimer’s disease (AD, n=22), non-Alzheimer dementia (nAD, n=11) and control subjects (CON, n=35). As compared to the other groups, the concentrations of Aβ42 and tTau were decreased (P<0.001) and increased (P<0.001) in AD, respectively, while Aβ40 did not differ significantly among the groups. Receiver operating characteristic (ROC) analysis was performed to define cut-off values for maximized sensitivity and specificity. For all groups compared the Aβ peptide ratio 42/40 classified more patients correctly, as compared to the concentration of Aβ42 alone: AD versus controls, 94 and 86.7%; AD versus nAD, 90 and 85% and AD versus nAD plus controls, 90.8 and 87%, respectively. The percentage of correctly classified patients was further improved when the Aβ ratio was combined with the analysis of the tTau concentration. Presence of the apolipoprotein E e4 allele, age or degree of mental disability did not significantly influence the parameters studied.

γ-secretase heterogeneity in the Aph1 subunit: relevance for Alzheimer’s Disease

Tactical Target Intramembrane proteolysis by the γ-secretase complex is important during development and in the pathology of Alzheimers disease. γ-Secretase has usually been considered as a homogeneous activity. Serneels et al. (p. 639, published online 19 March; see the Perspective by Golde and Kukar) now show that the Aph1B component of the γ-secretase complex is responsible for the generation of long β-amyloid species involved in Alzheimers disease. In a mouse model of Alzheimers disease, full knockout of Aph1B improved disease phenotypes, without the sort of toxicity previously observed when targeting γ-secretase more generally. Targeted knockout of only part of the γ-secretase complex lessens toxicity and still improves disease phenotypes. The γ-secretase complex plays a role in Alzheimer’s disease and cancer progression. The development of clinically useful inhibitors, however, is complicated by the role of the γ-secretase complex in regulated intramembrane proteolysis of Notch and other essential proteins. Different γ-secretase complexes containing different Presenilin or Aph1 protein subunits are present in various tissues. Here we show that these complexes have heterogeneous biochemical and physiological properties. Specific inactivation of the Aph1B γ-secretase in a mouse Alzheimer’s disease model led to improvements of Alzheimer’s disease–relevant phenotypic features without any Notch-related side effects. The Aph1B complex contributes to total γ-secretase activity in the human brain, and thus specific targeting of Aph1B-containing γ-secretase complexes may help generate less toxic therapies for Alzheimer’s disease.

CSF amyloid-β-peptides in Alzheimer's disease, dementia with Lewy bodies and Parkinson's disease dementia

Abstract As the differential diagnosis of dementias based on established clinical criteria is often difficult, biomarkers for applicable diagnostic testing are currently under intensive investigation. Amyloid plaques deposited in the brain of patients suffering from Alzheimers disease, dementia with Lewy bodies (DLB) and Parkinsons disease dementia (PDD) mainly consist of carboxy-terminally elongated forms of amyloid-beta (Aβ) peptides, such as Aβ1–42. Absolute Aβ1–42 levels in CSF have shown diagnostic value for the diagnosis of Alzheimers disease, but the discrimination among Alzheimers disease, DLB and PDD was poor. A recently established quantitative urea-based Aβ-sodium-dodecylsulphate–polyacrylamide-gel-electrophoresis with Western immunoblot (Aβ-SDS–PAGE/immunoblot) revealed a highly conserved Aβ peptide pattern of the carboxy-terminally truncated Aβ peptides 1–37, 1–38, 1–39 in addition to 1–40 and 1–42 in human CSF. We used the Aβ-SDS–PAGE/immunoblot to investigate the CSF of 23 patients with Alzheimers disease, 21 with DLB, 21 with PDD and 23 non-demented disease controls (NDC) for disease-specific alterations of the Aβ peptide patterns in its absolute and relative quantities. The diagnostic groups were matched for age and severity of dementia. The present study is the first attempt to evaluate the meaning of Aβ peptide patterns in CSF for differential diagnosis of the three neurodegenerative diseases—Alzheimers disease, DLB and PDD. The Aβ peptide patterns displayed disease-specific variations and the ratio of the differentially altered Aβ1–42 to the Aβ1–37 levels subsequently discriminated all diagnostic groups from each other at a highly significant level, except DLB from PDD. Additionally, a novel peptide with Aβ-like immunoreactivity was observed constantly in the CSF of all 88 investigated patients. The pronounced percentage increase of this peptide in DLB allowed a highly significant discrimination from PDD. Using a cut-off point of 0.954%, this marker yielded a diagnostic sensitivity and specificity of 81 and 71%, respectively. From several lines of indication, we consider this peptide to represent an oxidized α-helical form of Aβ1–40 (Aβ1–40*). The increased abundance of Aβ1–40* probably reflects a disease-specific alteration of the Aβ1–40 metabolism in DLB. We conclude that Aβ peptide patterns reflect disease-specific pathophysiological pathways of different dementia syndromes as distinct neurochemical phenotypes. Although Aβ peptide patterns failed to fulfil the requirements for a sole biomarker, their combined evaluation with other biomarkers is promising in neurochemical dementia diagnosis. It is noteworthy that DLB and PDD exhibit distinct clinical temporal courses, despite their similar neuropathological appearance. Their distinct molecular phenotypes support the view of different pathophysiological pathways for each of these neurodegenerative diseases.

Amyloid β peptide ratio 42/40 but not Aβ42 correlates with phospho-Tau in patients with low- and high-CSF Aβ40 load

Neurochemical dementia diagnostics (NDD) can significantly improve the clinically based categorization of patients with early dementia disorders, and the cerebrospinal fluid (CSF) concentrations of amyloid β peptides ending at the amino acid position of 42 (Aβx‐42 and Aβ1‐42) are widely accepted biomarkers of Alzheimer’s disease (AD). However, in subjects with constitutively high‐ or low‐CSF concentrations of total Aβ peptides (tAβ), the NDD interpretation might lead to erroneous conclusions as these biomarkers seem to correlate better with the total Aβ load than with the pathological status of a given patient in such cases. In this multicenter study, we found significantly increased CSF concentrations of phosphorylated Tau (pTau181) and total Tau in the group of subjects with high CSF Aβx‐40 concentrations and decreased Aβx‐42/x‐40 concentration ratio compared with the group of subjects with low CSF Aβx‐40 and normal Aβ ratio (p < 0.001 in both cases). Furthermore, we observed significantly decreased Aβ ratio (p < 0.01) in the group of subjects with APOE ε4 allele compared with the group of subjects without this allele. Surprisingly, patients with low‐Aβx‐40 and the decreased Aβ ratio characterized with decreased pTau181 (p < 0.05), and unaltered total Tau compared with the subjects with high Aβx‐40 and the Aβ ratio in the normal range. We conclude that the amyloid β concentration ratio should replace the ‘raw’ concentrations of corresponding Aβ peptides to improve reliability of the neurochemical dementia diagnosis.

Soluble amyloid precursor proteins in the cerebrospinal fluid as novel potential biomarkers of Alzheimer's disease: a multicenter study

In this report, we present the results of a multicenter study to test analytic and diagnostic performance of soluble forms of amyloid precursor proteins α and β (sAPPα and sAPPβ) in the cerebrospinal fluid (CSF) of patients with different forms of dementing conditions. CSF samples were collected from 188 patients with early dementia (mini-mental state examination⩾20 in majority of cases) and mild cognitive impairment (MCI) in 12 gerontopsychiatric centers, and the clinical diagnoses were supported by neurochemical dementia diagnostic (NDD) tools: CSF amyloidβ peptides, Tau and phospho-Tau. sAPPα and sAPPβ were measured with multiplexing method based on electrochemiluminescence. sAPPα and sAPPβ CSF concentrations correlated with each other with very high correlation ratio (R=0.96, P<0.001). We observed highly significantly increased sAPPα and sAPPβ CSF concentrations in patients with NDD characteristic for Alzheimers disease (AD) compared to those with NDD negative results. sAPPα and sAPPβ highly significantly separated patients with AD, whose diagnosis was supported by NDD findings (sAPPα: cutoff, 117.4 ng ml−1, sensitivity, 68%, specificity, 85%, P<0.001; sAPPβ: cutoff, 181.8 ng ml−1, sensitivity, 75%, specificity, 85%, P<0.001), from the patients clinically assessed as having other dementias and supported by NDD untypical for AD. We conclude sAPPα and sAPPβ might be regarded as novel promising biomarkers supporting the clinical diagnosis of AD.

Consensus Paper of the WFSBP Task Force on Biological Markers of Dementia: The role of CSF and blood analysis in the early and differential diagnosis of dementia

Aging of population, and increasing life expectancy result in an increasing number of patients with dementia. This symptom can be a part of a completely curable disease of the central nervous system (e.g, neuroinflammation), or a disease currently considered irreversible (e.g, Alzheimers disease, AD). In the latter case, several potentially successful treatment approaches are being tested now, demanding reasonable standards of pre-mortem diagnosis. Cerebrospinal fluid and serum analysis (CSF/serum analysis), whereas routinely performed in neuroinflammatory diseases, still requires standardization to be used as an aid to the clinically based diagnosis of AD. Several AD-related CSF parameters (total tau, phosphorylated forms of tau, Aβ peptides, ApoE genotype, p97, etc.) tested separately or in a combination provide sensitivity and specificity in the range of 85%, the figure commonly expected from a good diagnostic tool. In this review, recently published reports regarding progress in neurochemical pre-mortem diagnosis of dementias are discussed with a focus on an early and differential diagnosis of AD. Novel perspectives offered by recently introduced technologies, e.g, fluorescence correlation spectroscopy (FCS) and surface enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS) are briefly discussed.

Elevation of beta-amyloid peptide 2-42 in sporadic and familial Alzheimer's disease and its generation in PS1 knockout cells.

Urea-based β-amyloid (Aβ) SDS-polyacrylamide gel electrophoresis and immunoblots were used to analyze the generation of Aβ peptides in conditioned medium from primary mouse neurons and a neuroglioma cell line, as well as in human cerebrospinal fluid. A comparable and highly conserved pattern of Aβ peptides, namely, 1–40/42 and carboxyl-terminal-truncated 1–37, 1–38, and 1–39, was found. Besides Aβ1–42, we also observed a consistent elevation of amino-terminal-truncated Aβ2–42 in a detergent-soluble pool in brains of subjects with Alzheimers disease. Aβ2–42 was also specifically elevated in cerebrospinal fluid samples of Alzheimers disease patients. To decipher the contribution of potential different γ-secretases (presenilins (PSs)) in generating the amino-terminal- and carboxyl-terminal-truncated Aβ peptides, we overexpressed β-amyloid precursor protein (APP)-trafficking mutants in PS1+/+ and PS1−/− neurons. As compared with APP-WT (primary neurons from control or PS1-deficient mice infected with Semliki Forest virus), PS1−/− neurons and PS1+/+ neurons overexpressing APP-Δct (a slow-internalizing mutant) show a decrease of all secreted Aβ peptide species, as expected, because this mutant is processed mainly by α-secretase. This drop is even more pronounced for the APP-KK construct (APP mutant carrying an endoplasmic reticulum retention motif). Surprisingly, Aβ2–42 is significantly less affected in PS1−/− neurons and in neurons transfected with the endocytosis-deficient APP-Δct construct. Our data confirm that PS1 is closely involved in the production of Aβ1–40/42 and the carboxyl-terminal-truncated Aβ1–37, Aβ1–38, and Aβ1–39, but the amino-terminal-truncated and carboxyl-terminal-elongated Aβ2–42 seems to be less affected by PS1 deficiency. Moreover, our results indicate that the latter Aβ peptide species could be generated by a βAsp/Ala-secretase activity.

International quality control survey of neurochemical dementia diagnostics.

UNLABELLED Currently, neurochemical dementia diagnostics (NDD) are increasingly entering routine clinical neurochemistry, offering improved early and differential diagnosis of dementias. However, there is an obvious lack of standardization in pre-analytical sample handling and systematic quality surveys. Therefore, in this study, 14 laboratories in Germany, Austria, and Switzerland were given aliquots of a human cerebrospinal fluid (CSF) sample, and were asked to measure Alzheimers disease (AD) biomarkers (amyloid beta (Abeta) peptides, total Tau protein, and phosphorylated Tau protein (P-tau(181P))) according to their routine protocols. RESULTS The inter-laboratory coefficients of variation of the results obtained by the laboratories participating in this study were in the range of 20-30%. Although the results of this quality control survey are promising, the quality of measurements has to be further optimized.