William F. Goure

Targeting the proper amyloid-beta neuronal toxins: a path forward for Alzheimer’s disease immunotherapeutics

Levels of amyloid-beta monomer and deposited amyloid-beta in the Alzheimer’s disease brain are orders of magnitude greater than soluble amyloid-beta oligomer levels. Monomeric amyloid-beta has no known direct toxicity. Insoluble fibrillar amyloid-beta has been proposed to be an in vivo mechanism for removal of soluble amyloid-beta and exhibits relatively low toxicity. In contrast, soluble amyloid-beta oligomers are widely reported to be the most toxic amyloid-beta form, both causing acute synaptotoxicity and inducing neurodegenerative processes. None of the amyloid-beta immunotherapies currently in clinical development selectively target soluble amyloid-beta oligomers, and their lack of efficacy is not unexpected considering their selectivity for monomeric or fibrillar amyloid-beta (or both) rather than soluble amyloid-beta oligomers. Because they exhibit acute, memory-compromising synaptic toxicity and induce chronic neurodegenerative toxicity and because they exist at very low in vivo levels in the Alzheimer’s disease brain, soluble amyloid-beta oligomers constitute an optimal immunotherapeutic target that should be pursued more aggressively.

The case for soluble Aβ oligomers as a drug target in Alzheimer's disease

Soluble Aβ oligomers are now widely recognized as key pathogenic structures in Alzheimers disease. They inhibit synaptic function, leading to early memory deficits and synaptic degeneration, and they trigger the downstream neuronal signaling responsible for phospho-tau Alzheimers pathology. The marginal effects observed in recent clinical studies of solanezumab, targeting monomeric Aβ, and bapineuzumab, targeting amyloid plaques, prompted expert comments that drug discovery efforts in Alzheimers disease should focus on soluble forms of Aβ rather than fibrillar Aβ deposits found in amyloid plaques. Accumulating scientific data suggest that soluble Aβ oligomers represent the optimal intervention target within the amyloid manifold. Active drug discovery approaches include antibodies that selectively capture soluble Aβ oligomers, selective modifiers of oligomer assembly, and receptor antagonists. The onset of symptomatic clinical benefit is expected to be rapid for such agents, because neuronal memory signaling should normalize on blockage of soluble Aβ oligomers. This key feature is not shared by amyloid-lowering therapeutics, and it should translate into streamlined clinical development for oligomer-targeting drugs. Oligomer-targeting drugs should also confer long-term disease modification and slowing of disease progression, because they prevent the downstream signaling responsible for phospho-tau mediated cytoskeletal degeneration.

ACU-193: A candidate therapeutic antibody that selectively targets soluble beta-amyloid oligomers

However, the relationship between these two proteins and neuronal loss lacks amechanistic explanation. Furthermore, evidence from animal models suggests that amyloid beta toxicity is mediated by tau [1-6]. We hypothesize that tau oligomers formation plays curial role in driving AD pathogenesis. Thus, tau oligomers represent an ideal therapeutic target for the treatment of AD. In order to study the removal of toxic tau assemblies in an animal model of AD (Tg2576), we generated a tau oligomer specific antibody (TOMA). This antibody does not recognize the functional monomeric tau or oligomers from other amyloidogenic proteins. Methods: Here we used the Tg2576 mouse model which overexpress the human APP with the Swedish double mutations (K670N, M671L) under the control of a hamster prion protein promoter .14-month old Tg2576 mice, received a single iv injection of 30 mg of the TOMA antibody. Control group received 30 mg of non-specific IgG. Cognitive function was assessed by novel object recognition test, 15 days after injection. In addition, western blot, ELISA and Immunostaining were performed to evaluate the response to treatment. Results: Our results indicate that single iv-injection of the TOMA antibody, reduce endogenous tau oligomers and improve cognition in the Tg2576 mouse. Interestingly, removal of tau oligomers by immunotherapy decreases beta-amyloid-56* and increases deposition of plaques in immunized mice. Conclusions: Our results support the findings that tau oligomers mediate beta-amyloid toxicity in vivo. Moreover, removal of tau oligomers by immunotherapy may induce beta-amyloid aggregates to assembly into inert and perhaps protective plaques. Thus, targeting tau oligomers by immunotherapymay represent a novel strategy for the treatment of AD and other neurodegenerative tauopathies.