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Nature may have the answers for Alzheimer’s disease Sungkwon Chung Dept. of Physiology Sungkyunkwan University School of Medicine Facts on Alzheimer’s disease (AD) It attacks and slowly steals the minds of its victims. Symptoms of the disease include: memory loss confusion impaired judgment personality changes disorientation loss of language skills. Always fatal, Alzheimer's disease is the most common form of irreversible dementia. 65-74 years : 10%, 75-84: 20%, 85 and older: 50% It is estimated that by 2020, 30 million people will be affected by this devastating disorder worldwide and by 2050, the number could increase to 45 million. Facts on Alzheimer’s disease (AD) The average cost for nursing home care is $42,000 per year, and the average lifetime cost of care for an individual with AD is $174,000. Medicare costs for beneficiaries with AD are over $100 billion. AD is a progressive, irreversible brain disorder with no known cause or cure. National Institute on Aging Alzheimer's Disease, Causes and Risk Factors “Scientists do not yet fully understand what causes Alzheimer's disease. There probably is not one single cause, but several factors that affect each person differently.” Alzheimer’s disease sporadic (late on-set): > 95% of patients - Epidemiological Factors Hypercholesterolaemia Hypertension Hyperrhomocysteinaemia Diabete mellitus Metabolic syndrome Smoking Systemic inflammation Increased fat intake and obesity genetic (early on-set): < 5% of patients (FAD) - ApoE ε4 polymorphism - mutations in APP - mutations in presenilin 1, 2 (PS1, PS2) Amyloid plaques and Neurofibrillary tangles Selkoe, 2004 Food and Drug Administration approved treatments for AD Drug Approved for Cholinesterase inhibitors Donepezil Galantamine Rivastigmine Tacrine Mild Mild Mild Mild to to to to moderate moderate moderate moderate AD AD AD AD NMDA receptor antagonist Memantine Moderate to severe AD Ab produced from Amyloid Precursor Protein (APP) AICD Presenilin (PS) Notch1 → NICD p75NTR → p75-ICD FAD Mutant Presenilins g-dependent Increases in Ab42 Q1: Even though potent inhibitors for γ-secretase had been developed, it could not be used for the patients. Why? Presenilin mutations linked to Familial Alzheimer's Disease cause an imbalance in PI(4,5)P2 metabolism (Landman et al., 2006) PI4K Down-regulation of ITRPM7 in FAD PS mutants A B -120 -100 ITRPM7 (pA/pF) ITRPM7 (pA/pF) 0 -30 -60 wt PS M146L L286V ∆E9 -90 * -80 * -60 -40 -120 0 150 300 450 Time (s) C D C Whole-cell patch clamp ITRPM7 (pA/pF) ITRPM7 (pA/pF) 0.0 -0.3 -0.6 wt PS M146L L286V ∆E9 -0.9 0 150 300 Time (s) 450 Down-regulation of PI(4,5)P2 in PS1, PS2 mutant cells Correlation of PI(4,5)P2 level and Aβ42 generation C D Ab42 (% of E9 control) E 100 PS1 WT PS1 E9 80 60 40 20 0 0 5 10 PIP2 (mM) Landman et al., 2006 15 20 Down-regulation of TRPM7 channel expression increases Ab42 production C) D) FAD Mutant Presenilins g-independent g-dependent Altered PIP2 Metabolism Increases in Ab42 ? TRPM7 channel / Ca2+ Defects Correlation of PIP2 levels and Aβ42 generation Up-regulation of PIP2 levels will be a possible therapeutic target for AD. I. Ginsenoside: increasing PIP2 Panax ginseng Ab42-lowering effect of Rg3 Increase of PI(4)P and PI(4,5)P2 by Rg3 PI(4)P PI(4,5)P2 PI(4,5)P2 PI(4,5)P2 Increase of PI(4)P by Rg3 via activation of PI4KII PI4KII decreases Ab42 production Ab42-lowering effect of Rg3 in vivo II. S62: increasing -cleavage Ab42 (% of control) 120 100 80 60 40 20 0 Cont 1 5 S62 10 (mg/ml) C1, C2 increase sAPP production Cont C1 C2 C3 C4 C5 sAPP 0.25 mM C1 decreases Ab42, Ab40 production 100 Ab40 (% of control) Ab42 (% of control) 100 80 60 40 20 0 0 0.005 0.01 0.05 0.1 C1 (mg/ml) 0.5 5.0 80 60 40 20 0 0 0.005 0.01 0.05 0.1 C1 (mg/ml) 0.5 5.0 C2 decreases Ab42, Ab40 production with less potency 100 Ab40 (% of control) Ab42 (% of control) 100 80 60 40 20 0 0 0.1 0.5 C2 (mg/ml) 5.0 80 60 40 20 0 0 0.1 0.5 C2 (mg/ml) 5.0 Dose-dependent effect of C1, and C2 on the production of sAPP (-secretase product) C1 (mg/ml) Cont 0.5 0.05 sAPP C2 (mg/ml) Cont sAPP 5 0.5 C1 decreases b-secretase product (sAPPb), while increases -secretase product (sAPP) 1000 100 sAPP (% of control) sAPPb-sw (% of control) 120 80 60 40 600 400 200 20 0 800 Cont 0 0.01 0.05 0.1 0.5 C1 (mM) 1 5 Cont 0.01 0.05 0.1 0.5 C1 (mM) 1 5 Q2: Why an activator for -secretase is considered as good therapeutic drug? III. E3: decreasing APP level E144, E3 decrease both mature, and immature forms of APP 100 Ab40 (% of control) Ab42 (% of control) 100 80 60 40 20 0 Cont 0.1 0.5 80 60 40 20 0 5 1 Cont E2 E144 maAPP imAPP β-tubulin 0.1 0.5 E144 (mM) E144 (mM) CTL 0.1 0.5 1 5 0.25 E3 0.25 μM 1 5 Morris Water maze test : APPsw/PSEN1dE9, Male - Acquisition Phase (with Platform) : 4~6 days, 3 trials/day. Probe Phase (without Platform) : Last day, Single trial. Recording: Acquisition Day 6 Background Transgenic Tg + Low Dose CJ Tg + High Dose CJ Probe Phase (without Platform) : Last day, Single trial Background Transgenic Low Dose High Dose 40X Background Transgenic Low Dose High Dose 100X Effects of CJ on Ab42 levels * Ab42 (% of control) 120 (Cerebral Cortex) 100 80 60 40 20 0 Cont CJ50 CJ150 120 120 100 80 60 40 20 0 (Cerebellum) Ab42 (% of control) Ab42 (% of control) (Hippocampus) Cont CJ50 CJ150 100 80 60 40 20 0 Cont CJ50 CJ150 Q3: Why decreasing APP is considered as good therapeutic target? Dept. of Physiology Samsung Biomedical Research Institute Sungkyunkwan Univ. School of Medicine Sungkwon Chung Yoon Sun Chun Sung Hee Yun Hyun Geun Oh KIST Gangneung Institute Hyun Ok Yang Dept. of Pathology Columbia Univ. College of Physicians & Surgeons Tae-Wan Kim Gilbert Di Paolo Min Suk Kang