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Alzheimer’s Disease
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Outline
What’s Alzheimer’s Disease(AD)? ,[object Object],[object Object],[object Object]
Pathology ,[object Object],[object Object],[object Object],[object Object],Amyloid plaque NFTs
Sign and Symptom ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Stage of progression ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Stage of progression (Con.) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
Risk factors   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],http://www.memorylossonline.com/glossary/hippocampus.html
β -amyloid (A β ) ,[object Object],[object Object],[object Object],[object Object],[object Object]
β -amyloid production APP  : amyloid precursor protein (type-1 transmembrane glycoprotein) BACE-1  : beta-site amyloid precursor protein-cleaving enzyme 1  β -Secretase sAPP  : large  amyloid precursor protein C83, C99  : 83, 99-residue carboxyl-terminal fragment AICD  : amyloid intracellular domain
Aggregation & accumulation of  A β   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pathological features of Alzheimer’s disease
Clinical trials of therapeutic management ,[object Object],[object Object],[object Object],[object Object],[object Object]
Vaccination Dale Schenk, Michael Hagen, Peter Seubert.   Current progress in beta-amyloid immunotherapy.  Current Opinion in Immunology ,  Volume 16, Issue 5 ,  October 2004 ,  Pages 599-606
[object Object],[object Object],[object Object]
[  Tau  & Neurofibrillary tangles ]
Axonal transport http://www.mpih-frankfurt.mpg.de/global/Nc/view.htm http://www.colorado.edu/intphys/Class/IPHY3430-200/002cellular.htm
Structural organization of microtubule http://manual.blueprint.org/Home/glossary-of-terms/mechano-glossary--m/mechano-glossary-microtubules
Tau protein ,[object Object],[object Object],[object Object],[object Object],http://www.gate2biotech.com/early-testing-for-alzheimers-disease /
Querfurth HW, LaFerla FM. Alzheimer's disease. N Engl J Med.  Jan 28;362(4):329-44.
What accelerate Tau accumulation ? ,[object Object],[object Object],[object Object]
http://missinglink.ucsf.edu/lm/ids_104_neurodegenerative/Case1/Case1Micro2.htm Neurofibrillary tangles
Approaches for therapeutic agents ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The Synapse in  Alzheimer’s Disease
[object Object],[object Object],[object Object],[object Object],Synaptic failure
 
Depletion of Neurotrophin  Neurotrophins   are a family of proteins that induce the survival, development and function of neurons. learning  memory  behavior
Neurotrophin  Types  of  Neurotrophin ,[object Object],2.  Brain-derived neurotrophic factor (BDNF) 3.  Novel Neurotrophin-1 (NNT-1) 4.  Neurotrophin-3 (NT-3) 5.  Neurotrophin-4 (NT-4)
 
Depletion  of  neurotrophin
Depletion of neurotransmitter ,[object Object],[object Object],Building up of     - Amyloid and tua Deficiency of cholinergic projection Alzheimer’s disease
Depletion of neurotransmitter ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Depletion of neurotransmitter ,[object Object],[object Object],[object Object]
Synaptic Dysfunction in Alzheimer’s Disease
Mitochondrial Dysfunction   in Alzheimer’s Disease
Mitochondrial Dysfunction ,[object Object],[object Object],[object Object],[object Object],Cyt. C oxidase http :// pharmrev . aspetjournals . org / content / 54/1/101 / F1 . large . jpg
Mitochondrial Dysfunction ,[object Object],[object Object],[object Object],[object Object],[object Object],Promote tau phosphorylation TCA cycle Accumulation of mtDNA mutation Stress-activated p38 and JNK Toxic aldehyde disturbs glu transportation New England Journal of Medicine. 362(4):329-344, January 28, 2010.
Mitochondrial Dysfunction   Oxidative Stress ,[object Object],[object Object],[object Object],[object Object]
Mitochondrial Dysfunction   Oxidative Stress Amany Mohamed  , et. al., Int J Alzheimers Dis .  2011 ,  127984.   A   can be translocated to the cell via interacting with RAGE
Mitochondrial Dysfunction   Oxidative Stress A   can be translocated to mt via TOM Inhibit cyt. c oxidase    lead to ROS and oxidative stress Renato X. Santos , et. al.,  Int J Clin Exp Pathol 2010;3(5):570-581
Mitochondrial Dysfunction   Oxidative Stress ,[object Object],[object Object],[object Object]
Mitochondrial Dysfunction   Oxidative Stress http :// clinicaltrials . gov /
Mitochondrial Dysfunction Insulin Signaling Pathway ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mitochondrial Dysfunction Insulin Signaling Pathway ,[object Object],Douglas C.Wallace , et. al.,  Annu. Rev. Pathol. Mech. Dis. 2010.5:297-348.
ALZYMER’S DISEASE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
VASCULAR EFFECTS IN  ALZHEIMER’S DISEASE
VASCULAR EFFECT OF  ALZHEIMER’ S DISEASE ,[object Object],[object Object],[object Object],[object Object],[object Object],None of these changes alone explain the symmetric reductions  of cerebral blood flow in patients with Alzheimer's disease
Cerebral hypoperfusion and clinical onset of dementia: the Rotterdam Study.  Ruitenberg A, Ann Neurol. 2005 ,[object Object],[object Object],[object Object],[object Object]
Atherosclerosis of Cerebral Arteries in Alzheimer Disease Alex E. Roher, MD PhD;  Stroke.  2004 ,[object Object],[object Object],[object Object],[object Object]
Inflammation and Mechanism of A β  Clearance
VASCULAR CHANGED  IN ALZHEIMER’S THERAPY ,[object Object],Angiotensin-converting- enzyme inhibitor Folic acid Advance glycation end  product inhibitor The reduction of cognitive  decline Reduced homocyteine level  and may lower the risk of AD  but not improve cognitive Phase 2 study in mild-to- Moderate AD Might be concern increased vascular amyloid,  microhemorrhages, vasogenic edema
Chronic microglia  activation and macrophage infiltration in Alzheimer’s disease http://www.nature.com/nrn/journal/v6/n9/fig_tab/nrn1725_F2.html
Inflammatory-activated glia co-cultured neurons http://www.neuroscience.cam.ac.uk/directory/profile.php?gcb3
Some components of the inflammatory  to CNS degeneration http://www.gladstone.ucsf.edu/wp/2009/10/inflammationalzheimers/
Inflammatory responses and neurodegeneration http://www.gladstone.ucsf.edu/wp/2009/10/inflammationalzheimers/
Neurotoxic and neurotrophic action  of microglia and astrocytes McNally L, Bhagwager Z, Hannestad J, CNS Spectr, Vol 13 NO.6. 2008.
Using the inflammatory response against AD http://www.gladstone.ucsf.edu/wp/2009/10/inflammationalzheimers/
INFLAMMATION  IN ALZHEIMER’S THERAPY ,[object Object],[object Object],Nonsteroidal anti- Inflammatory agent Lower the risk’s of AD and slow  progression of disease the mechanisms of action is selective reduction of A β   42,  Inhibition of  COX 2 or prostaglandin receptor, stimulation of phagocytosis by  microglia  (Only in prospective Observation study) Not show evidence of reducing The risk of AD or slowing cognitive  decline Nonsteroidal anti- Inflammatory agent and  derivative( Tarenflubil ) Being investigated
Calcium Presenilin   mutation Disrupt calcium  homeostasis Calcium in  endoplasmic reticulum Release calcium  into cytoplasm Alzheimer’s disease   A β   level
Calcium   ,[object Object],[object Object],Glutaminergic receptor activation  + Cytosolic calcium Calcium – release channel in ER
Axonal – transport deficit   ,[object Object],[object Object]
Axonal – transport deficit   Impairment of transport   Amyloid precursor protein, vesicle and kinesin Exonal swelling, A β  deposition and neurodegeneration
Aberrant Cell-Cycle Reentry http://www.nature.com/nrn/journal/v8/n6/box/nrn2097_BX2.html  Oxidative stress     DNA-damaging agents
Cholesterol Metabolism http://en.wikibooks.org/wiki/File:Lipid_Raft*.png
Cholesterol Metabolism http://www.rndsystems.com/cb_detail_objectname_WI00_BaceAlzheimers.aspx promoted and clearance from the brain is reduced
Cholesterol Metabolism http://www.gladstone.ucsf.edu/wp/2009/10/alzheimersandapoe/
Cholesterol Metabolism High serum cholesterol levels Alzheimer’s disease ,[object Object],[object Object],[object Object],[object Object]
Definition ,[object Object]
[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object]
[object Object],[object Object]
[object Object],[object Object]
[object Object],[object Object]

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Alzheimer's disease

Editor's Notes

  1. Although amyloid plaques or senile plaques may be classified further according to their composition, all contain forms of β-amyloid protein (Aβ). Aβ is a 39- to 42-amino acid peptide that is formed by the proteolytic cleavage of β-amyloid precursor protein (APP) and is found in extracellular deposits throughout the central nervous system (CNS). 9   Aβ is believed to interfere with neuronal activity because of its stimulatory effect on production of free radicals, resulting in oxidative stress and neuronal cell death. In AD, the amyloid deposits are largely spherical, reaching up to 200 μm in diameter, and are prevalent throughout the cortex and hippocampus of brains from affected individuals. Neurofibrillary tangles are paired helical filaments composed of tau protein, which in normal cells is essential for axonal growth and development. However, when hyperphosphorylated, the tau protein forms tangles that are deposited within neurons located in the hippocampus and medial temporal lobe, the parietotemporal region, and the frontal association cortices, leading to cell death.
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  4. The biggest risk factor for Alzheimer's disease is increased age. The likelihood of developing Alzheimer's disease After age 65, and rises sharply after age 75 Genetics==== Family history of AD Sex=====Women are more likely to develop AD than men Having Down syndrome
  5. Proteolytic processing of amyloid precursor protein (APP) by the secretases. APP is a type-I transmembrane glycoprotein. The majority of APP is processed in the nonamyloidogenic pathway (thick arrow); APP is first cleaved by a-secretase within the amyloid-b peptide (Ab) domain (darker shaded region), leading to APPsa secretion and precluding Ab generation. Membrane-anchored a-carboxy terminal fragment (CTF) is then cleaved by g-secretase within the membrane, releasing the p3 peptide and APP intracellular domain (AICD). Alternatively, amyloidogenesis (thin arrow) takes place when APP is first cleaved by b-secretase, producing APPsb. Ab and AICD are generated upon cleavage by g-secretase of the b-CTF fragment retained in the membrane. Scissors indicate the cleavage sites of a-, b- and g–secretase.
  6. The neocortex is part of the cerebral cortex . It is involved in higher functions such as sensory perception , generation of motor commands , spatial reasoning, conscious thought and language .
  7. Beta-amyloid (Ab) immunotherapy strategies. Immunotherapy can be achieved through either active immunization with full length Ab or an Ab immunoconjugate, or passive administration of monoclonal anti-Ab antibodies. After active immunization with Ab1–42, the peptide is processed by antigen-presenting cells and Ab fragments are presented to T cells. Subsequently, various B-cells that can recognize epitopes on Ab1–42 are engaged, proliferate and produce polyclonal anti-Ab antibodies. The second type of active immunization approach involves the administration of small fragments of Ab conjugated to an unrelated carrier protein. The immunological response after immunization of an Ab peptide-carrier protein conjugate is similar to the first strategy, with the exception that the T cells are stimulated by the carrier protein rather than the Ab fragment (which lacks T-cell epitopes). The third strategy involves direct administration of monoclonal antibodies directed against Ab and, as such, does not require any type of immunological response from the host.
  8. Aging: synapse loss
  9. Figure 4 . Oxidative Stress and Mitochondrial Failure.A [beta]-amyloid peptide (A[beta])-centric scheme depicts production of reactive oxygen species (ROS) and reactive nitrogen species (RNS). Their peroxidative attack on cell and organelle membrane lipids yields the mitochondrial toxins hydroxynonenal (HNE) and malondialdehyde. Oxidative damage to membrane-bound, ion-specific ATPases and stimulation of calcium (Ca2+) entry mechanisms - for example, glutamate (N-methyl-d-aspartate [NMDA]) receptors (NMDAr), membrane-attack complex (MAC) of complement, and ion-selective amyloid pore formation - cause cytosolic and mitochondrial Ca2+ overload. Cellular A[beta] directly attacks electron transport complex IV (cytochrome c oxidase) and key Krebs-cycle enzymes ([alpha]-ketoglutarate and pyruvate dehydrogenase) and damages mitochondrial DNA (mtDNA), leading to fragmentation. Lipid peroxidation products also promote tau phosphorylation and aggregation, which in turn inhibit complex I. Exaggerated amounts of ROS and RNS are generated at complexes I and III. As the mitochondrial membrane potential (MPP) collapses and permeability-transition pores ([psi]m) open, caspases are activated. A[beta] also induces the stress-activated protein kinases p38 and c-jun N-terminal kinase (JNK), as well as p53, which are further linked with apoptosis. Substrate deficiencies, notably NADH and glucose, combine with electron transport uncoupling to further diminish ATP production. Alcohol dehydrogenase was recently identified as the mitochondrial-binding target for A[beta]. Endoplasmic reticulum contributions are shown. GLUT1, 4 denotes glucose transporter 1, 4.
  10. Long-term potentiation involved in memory
  11. However, there’s no single linear chain of events and matters are complicating