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Amyloid β oligomers in Alzheimer’s disease pathogenesis, treatment, and diagnosis

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Abstract

Protein aggregation is common to dozens of diseases including prionoses, diabetes, Parkinson’s and Alzheimer’s. Over the past 15 years, there has been a paradigm shift in understanding the structural basis for these proteinopathies. Precedent for this shift has come from investigation of soluble Aβ oligomers (AβOs), toxins now widely regarded as instigating neuron damage leading to Alzheimer’s dementia. Toxic AβOs accumulate in AD brain and constitute long-lived alternatives to the disease-defining Aβ fibrils deposited in amyloid plaques. Key experiments using fibril-free AβO solutions demonstrated that while Aβ is essential for memory loss, the fibrillar Aβ in amyloid deposits is not the agent. The AD-like cellular pathologies induced by AβOs suggest their impact provides a unifying mechanism for AD pathogenesis, explaining why early stage disease is specific for memory and accounting for major facets of AD neuropathology. Alternative ideas for triggering mechanisms are being actively investigated. Some research favors insertion of AβOs into membrane, while other evidence supports ligand-like accumulation at particular synapses. Over a dozen candidate toxin receptors have been proposed. AβO binding triggers a redistribution of critical synaptic proteins and induces hyperactivity in metabotropic and ionotropic glutamate receptors. This leads to Ca2+ overload and instigates major facets of AD neuropathology, including tau hyperphosphorylation, insulin resistance, oxidative stress, and synapse loss. Because different species of AβOs have been identified, a remaining question is which oligomer is the major pathogenic culprit. The possibility has been raised that more than one species plays a role. Despite some key unknowns, the clinical relevance of AβOs has been established, and new studies are beginning to point to co-morbidities such as diabetes and hypercholesterolemia as etiological factors. Because pathogenic AβOs appear early in the disease, they offer appealing targets for therapeutics and diagnostics. Promising therapeutic strategies include use of CNS insulin signaling enhancers to protect against the presence of toxins and elimination of the toxins through use of highly specific AβO antibodies. An AD-dependent accumulation of AβOs in CSF suggests their potential use as biomarkers and new AβO probes are opening the door to brain imaging. Overall, current evidence indicates that Aβ oligomers provide a substantive molecular basis for the cause, treatment and diagnosis of Alzheimer’s disease.

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Abbreviations

Aβ:

Amyloid beta

AβO:

Amyloid beta oligomer

AD:

Alzheimer’s disease

AFM:

Atomic force microscopy

CNS:

Central nervous system

CSF:

Cerebrospinal fluid

FAD:

Familial Alzheimer’s disease

HMW:

High molecular weight

IDP:

Intrinsically disordered proteins

LMW:

Low molecular weight

LTP:

Long-term potentiation

MAb:

Monoclonal antibody

MCI:

Mild cognitive impairment

MRI:

Magnetic resonance imaging

MW:

Molecular weight

PET:

Positron emission tomography

PrP:

Prion protein

scFv:

Single chain variable fragment

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Acknowledgments

We would like to thank Erika Cline, Henry Weiss, and Kyle Wilcox for their editorial contributions. We would also like to thank our supporters: the National Institutes of Health (AG022547, AG029460 and AG045637), Baxter Healthcare, Inc., and the Northwestern University Clinical and Translational Sciences Institute.

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Viola, K.L., Klein, W.L. Amyloid β oligomers in Alzheimer’s disease pathogenesis, treatment, and diagnosis. Acta Neuropathol 129, 183–206 (2015). https://doi.org/10.1007/s00401-015-1386-3

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