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Chicago: APP Roles in Caspase Gene Regulation, Muscle Function?
18 August 2008. One way to get the lowdown on someone is to check out the person’s closest friends and colleagues. Similarly, some Alzheimer disease researchers are teasing out the biological function of amyloid precursor protein (APP) by studying “whom” it associates with, and puzzling out what these partners might be doing in neurons. In a plenary talk at the International Conference on Alzheimer’s Disease (ICAD) held last month in Chicago, Joseph Buxbaum of Mount Sinai School of Medicine in New York presented new data suggesting that an APP interactor, Fe65, associates with teashirt (a zinc-finger transcription factor) and SET (a histone acetyltransferase inhibitor) to form a gene-silencing complex that binds caspase-4. In the study, AD appears linked with higher RNA levels of caspase-4 and decreased expression of Fe65 and teashirt, raising the intriguing possibility that APP processing could impinge on transcriptional regulation of an inflammatory caspase. Well-known for their role in apoptosis, some caspases, including caspase-4, also play a role in the maturation of cytokines that mediate inflammation (for reviews, see Nadiri et al., 2006 and Martinon and Tschopp, 2007), a process linked to AD in beneficial and harmful ways (for a recent example, see ARF related news story). Another study at ICAD—presented on a poster from the lab of Ulrike Müller at the University of Heidelberg in Germany—addressed APP’s physiological function using a different approach. Müller’s group studied the role of individual APP proteolytic fragments in mice lacking full-length APP and related family members.

Infamous as the cell-surface protein that gets snipped to form the Aβ peptides gumming up the brains of AD patients, APP has physiological functions about which comparatively little is known. Clues surfaced when an earlier study (Cao and Südhof, 2001) suggested that the APP cleavage product containing its cytoplasmic tail (aka AICD, or APP intracellular domain) may play a role in transcriptional activation by stably associating with the adaptor protein Fe65, and Tip60, a histone acetyltransferase (see ARF related news story). A number of candidate gene targets for this complex have subsequently been identified, but no such gene has since received broad-based replication and consensus, leaving the issue shrouded in mystery. Buxbaum and colleagues stepped up to the challenge by trying to identify other Fe65 interactors. Fe65 has two phosphotyrosine binding modules, the second of which (PTB2) binds APP (Fiore et al., 1995). To get at what might bind the first (PTB1), Yuji Kajiwara, an M.D./Ph.D. student in Buxbaum’s lab, did a yeast two-hybrid screen and pulled out teashirt (Tsh), a Drosophila homeotic protein. Mammals have three Tsh proteins, all of which were found to bind Fe65 in confocal microscopy experiments and immunoprecipitations from primary neuronal cultures, Buxbaum reported at ICAD. Based on the yeast two-hybrid data, he said Tsh3 was the most interesting to follow up, and this protein was used in most of the transcription studies presented subsequently.

In cells transfected with APP-Gal4 and various combinations of tagged Fe65 and Tsh3, the researchers showed that Tsh3 acts as a repressor. Fe65 profoundly activated gene expression by AICD, and Tsh3 knocked it down, Buxbaum reported in Chicago. Tsh3 did not seem to be a general inhibitor of transcription, as it only behaved as a repressor when bound to Fe65. Further experiments suggested that Tsh3’s repressive effects were mediated by recruitment of histone deacetylases (HDAC 1/2)—enzymes that promote gene silencing by removing acetyl groups from core histones, thereby making the associated DNA more compact and less accessible to transcription factors. Fe65 also binds the nucleosome assembly factor SET, and this interaction appears necessary for the transcriptional activation mediated by Fe65 (Telese et al., 2005). SET is a subunit of the inhibitors of acetyltransferases (INHAT) complex, which binds histones and blocks their access to acetyltransferases. Histone acetyltransferases (HATs), which oppose the function of HDACs, promote gene transcription by transferring acetyl groups onto histones, thereby loosening chromatin structure and increasing exposure of the associated DNA to transcription factors. (For a freely accessible review on HATs and HDACs in neurodegeneration, see Saha and Pahan, 2005.) Buxbaum boiled down his take on the proposed Fe65/Tsh/HDAC/SET complex (see figure below) in a phone conversation with this reporter. “You're taking off acetyl groups that are there (HDAC), and you're blocking further addition of acetyl groups (SET),” he said. “It's kind of a double mechanism to make sure the genome is shut down.”

The APP interactor, Fe65 (unlabeled green protein with two phosphotyrosine binding (PTB1 and PTB2) and WW domains), associates with SET and Tsh in proposed gene-silencing complex targeting caspase-4. Image credit: Joseph Buxbaum

Shifting attention to what this gene-silencing complex might target, Buxbaum and colleagues found a promising candidate—caspase-4—using a macroarray containing several hundred genes enriched for AD-related factors. The macroarray was probed using RNA from human neuroglioma cells stably transfected with Fe65 and Tsh3. In these same cells, the researchers showed that high expression of Fe65 and Tsh3 inhibited caspase expression. Conversely, knocking down expression of Fe65, Tsh3, or both using antisense RNAs led to increased caspase-4 expression, Buxbaum reported. Chromatin immunoprecipitations using nuclear extracts from these cells demonstrated direct physical interaction between Tsh and Fe65 proteins and the caspase-4 promoter.

Do these interactions have anything to do with AD? In Chicago, Buxbaum presented several lines of evidence to support a “yes” claim. First, data from postmortem human brain samples seem to indicate that Tsh/Fe65 and caspase-4 expression are anti-correlated—that is, Tsh3 expression drops while caspase-4 expression rises in early AD. These hundred or so samples came from the Mount Sinai Brain Bank and included controls and varying degrees of disease severity by several measures, including CDR scores and plaque pathology. “Caspase-4 goes from low to maximally expressed as you go from no to some neuritic plaques,” and remains high as disease progresses, Buxbaum said.

The other piece of evidence presented at ICAD to suggest that the Fe65/teashirt interaction is relevant to Alzheimer’s came from a search for Tsh gene variants in AD. Genome-wide scans turned up two AD-associated single-nucleotide polymorphisms (SNPs) in Tsh3 (p-values 0.00525 and 0.0095), and one in Tsh1 (p-value = 0.000205). For both Tsh3-associated SNPs, the risk alleles were associated with reduced Tsh expression, Buxbaum said, adding that separate cohorts will be analyzed to see if these effects—as yet unpublished—can be replicated.

The obvious next step for evaluating caspase-4 regulation by Fe65/Tsh is to analyze this activity in AD mouse models, but there’s a caveat: mice don’t have caspase-4. This could be interesting in and of itself, Buxbaum noted, as it might explain in part why most current AD mice show little neurodegeneration compared with what happens in human disease. Buxbaum’s group is collaborating with Greg Elder, also at Mount Sinai School of Medicine, to make a transgenic mouse containing the entire human caspase-4 gene. Thus far this has proven non-trivial, as the caspase genes are clustered in the human genome, making it hard to cleanly isolate caspase-4 with all its genetic elements. If the researchers succeed in making the humanized caspase-4 mouse, they will cross it to one of the APP-overexpressing transgenic lines. If they see increased neurodegeneration and/or more tau pathology in the caspase-4-expressing APP mice, these animals might serve as better disease models, Buxbaum said, noting recent studies (Colton et al., 2006 and Wilcock et al., 2008) in which knockout of an immune modulator—nitric oxide synthase 2—seemed to make mouse models better at recapitulating human disease (cerebral amyloid angiopathy and AD). Other studies (for example, Pompl et al., 2003) have looked more generally at caspases in AD, showing their expression goes up at the early stages of disease, but these findings are merely correlative. Caspase-4/APP transgenic mice would enable researchers to more clearly address the role of inflammatory caspases in disease progression—for instance, by seeing if the mice are improved by methods that regulate caspase-mediated inflammation.

Teasing Out APP Function in Mice: Knock-ins, Knockouts Galore
Uncovering biological roles for APP has proved challenging in part due to the presence of its close relatives APLP1 and APLP2. Ulrike Müller’s group had shown previously that these proteins in mice have overlapping and non-redundant functions (see ARF related news story). For instance, mice lacking APP survive, but APP/APLP2 double knockouts die after birth, as do mice with both APLP1 and APLP2 genes knocked out. On the other hand, APP/APLP1 double knockouts survive and appear phenotypically normal.

For a more detailed look at APP’s biological function, Müller and colleagues used a knock-in approach whereby they inserted genes encoding proteolytic fragments of APP into the mouse genome precisely where endogenous APP had been knocked out. They generated two lines of knock-in mice—one expressing the secreted APP ectodomain (APPsα) and another expressing a C-terminal truncation lacking the YENPTY motif essential for APP interactions with phosphotyrosine-binding domains of other proteins including Fe65. Based on brain and body weight assessments and various learning and motor tests with these mice, the researchers concluded that the APP C-terminus is dispensable and that APPsα is sufficient to mediate the physiological functions of APP (Ring et al., 2007). They wondered whether APLP2 and APLP1 might compensate for the loss of APP function in the APPsα-expressing knock-in (APPsα-KI) mice. To this end, analysis of APPsα-KI/APLP2-KO mice was described in the ICAD poster by first author Sascha Weyer and colleagues.

As it turns out, expression of APPsα rescued the postnatal lethality of the APP/APLP2 double knockouts. Sixty percent of the new mice, which lack APLP2 and express no full-length APP but only its secreted ectodomain, survived into adulthood. This finding was reported last year (see ARF SfN meeting report) and with expanded analysis at ICAD. The surviving mice had motor impairments by several tests including grip strength analysis, open field, rotarod, and beam walking. The researchers also found some neuromuscular junction abnormalities—fragmented post-synaptic acetylcholine receptor clusters that were associated with increased frequency and amplitude of spontaneous miniature endplate potentials—in APPsα/APPsα APLP2-/- mice, compared with APPsα-/+ APLP2-/- animals. The authors conclude that APPsα is important for muscle function through interaction with cell-surface APP interactors. Though these interactions may play a role in ensuring survival, the remaining deficits would seem to indicate that the APP C-terminus—which binds Fe65 and other cytoplasmic proteins—could still mediate key APP functions.—Esther Landhuis.

 
Comments on Related Papers
Related Paper: The secreted beta-amyloid precursor protein ectodomain APPs alpha is sufficient to rescue the anatomical, behavioral, and electrophysiological abnormalities of APP-deficient mice.

Comment by:  Andre Delacourte
Submitted 30 July 2007 Posted 30 July 2007
  I recommend this paper

Related Paper: The secreted beta-amyloid precursor protein ectodomain APPs alpha is sufficient to rescue the anatomical, behavioral, and electrophysiological abnormalities of APP-deficient mice.

Comment by:  Yadong Huang, ARF Advisor
Submitted 30 July 2007 Posted 30 July 2007
  I recommend this paper

Related Paper: The secreted beta-amyloid precursor protein ectodomain APPs alpha is sufficient to rescue the anatomical, behavioral, and electrophysiological abnormalities of APP-deficient mice.

Comment by:  Paul Coleman, ARF Advisor
Submitted 29 July 2007 Posted 30 July 2007
  I recommend this paper

Related Paper: The secreted beta-amyloid precursor protein ectodomain APPs alpha is sufficient to rescue the anatomical, behavioral, and electrophysiological abnormalities of APP-deficient mice.

Comment by:  Sanjay W. Pimplikar
Submitted 3 August 2007 Posted 3 August 2007

A Case of “Heads Win, Tails Don’t Lose”
The progress in uncovering the function of amyloid precursor protein (APP) has remained frustratingly slow due to the presence of APP-related proteins APLP1 and APLP2 and also because APP is continuously processed into three major fragments (paradoxically, intense focus on pathology of Aβ may also have contributed to this situation). However, the tide now seems to be shifting as more and more in vivo studies are shedding light on APP function in animal models ranging from C. elegans to mice (1). Employing an elegant approach, the Muller group used reverse genetics to express APP fragments in mice in which endogenous APP had been deleted (APP-KO). The “knock-in” strategy they used is superior to regular transgene-expression techniques since the endogenous regulatory elements still remain in place. The authors knocked-in either APPsα or APP lacking the last 15 residues of the cytoplasmic domain and subjected the resultant transgenic animals to a battery of behavioral tests. The authors report (2) that expression...  Read more

View all comments by Sanjay W. Pimplikar

Related Paper: The secreted beta-amyloid precursor protein ectodomain APPs alpha is sufficient to rescue the anatomical, behavioral, and electrophysiological abnormalities of APP-deficient mice.

Comment by:  Suzanne Guenette
Submitted 14 August 2007 Posted 14 August 2007

This is a carefully crafted and cautiously interpreted study showing that the α-secretase derived extracellular domain of APP (APPsα) is sufficient for rescue of the APP knockout (KO) mouse phenotypes that have been described so far. The beauty of this work is that a knock-in strategy was used, thus Ring et al. ensured that their conclusions would not be confounded by ectopic and/or excessive expression of APPsα and all isoforms of APP can be generated. Importantly, APPsα can rescue learning deficits of aged mice in the Morris water maze test and impaired long-term potentiation (LTP) in the CA3/CA1 pathway of hippocampal slices obtained from aged APP knockout mice to the same extent as an APP allele lacking the C-terminal 15 amino acid residues. Furthermore, the absence of the APP C-terminus did not affect behavior in the probe test, suggesting that retention of the learned behavior does not require the APP C-terminus.

Although these data do not preclude a role for the intracellular domain of APP and its related family members, APLP1 and APLP2, in normal...  Read more

View all comments by Suzanne Guenette


Related Paper: The secreted beta-amyloid precursor protein ectodomain APPs alpha is sufficient to rescue the anatomical, behavioral, and electrophysiological abnormalities of APP-deficient mice.

Comment by:  Frédéric Checler
Submitted 20 August 2007 Posted 21 August 2007
  I recommend this paper

Related Paper: The secreted beta-amyloid precursor protein ectodomain APPs alpha is sufficient to rescue the anatomical, behavioral, and electrophysiological abnormalities of APP-deficient mice.

Comment by:  Fred Van Leuven, ARF Advisor (Disclosure)
Submitted 20 August 2007 Posted 21 August 2007
  I recommend this paper

I stand in awe of this painstaking, comprehensive study from Ulrike Müller and coworkers. This is probably as close as we can get to the function of APP and the amyloid peptides in vivo—and to the problem of their physiological function and pathological role. The latter is evident and indisputable from what we have learned over the years since Glenner and Wong identified the amyloid peptides in 1984, but the normal function of APP and Aβ remains controversial. The data collected and documented in our own mouse models corroborated those of others (e.g., Kamenetz et al, 2003), and it led us to compare the amyloid peptides to totally unrelated but equally real and mysterious objects with unknown functions, i.e., the pentagonal dodecaeder from Gallo-Roman times (see comment by Dewachter and Van Leuven, 2005).

I fully agree that this study leaves little to the imagination about the amyloid peptides exerting major...  Read more

View all comments by Fred Van Leuven


Related Paper: The secreted beta-amyloid precursor protein ectodomain APPs alpha is sufficient to rescue the anatomical, behavioral, and electrophysiological abnormalities of APP-deficient mice.

Comment by:  Thomas Bayer
Submitted 28 August 2007 Posted 28 August 2007
  I recommend this paper

Related Paper: APP trafficking, processing and function.

Comment by:  Jurgen Gotz
Submitted 3 August 2008 Posted 4 August 2008
  I recommend this paper

Excellent review with an extensive coverage of APP, APLP1 and APLP2 knockout mice and the putative roles of APP under physiological conditions.

View all comments by Jurgen Gotz
Comments on Related News
Related News: Chicago: Out of the Blue—A Tau-based Treatment for AD?

Comment by:  joanna connolly
Submitted 12 August 2008 Posted 14 August 2008

Is anyone thinking of doing studies with this drug on PSP patients who only have tau tangles and do not have amyloid plaques at all?

View all comments by joanna connolly

Related News: Chicago: Out of the Blue—A Tau-based Treatment for AD?

Comment by:  Lane Simonian
Submitted 8 August 2008 Posted 14 August 2008

Methylene blue most likely decreases the hyperphosphorylation of tau proteins by inhibiting the formation of peroxynitrites (peroxynitrites form through the combination of superoxides and inducible nitric oxides). Methylene blue accepts electrons from various oxidases, thus limiting the formation of superoxides (and thus peroxynitrites).

Peroxynitrites play a critical role in the progression of Alzheimer disease. Peroxynitrites result in high GSK3 activity, which in turn causes the hyperphosphorylation of tau proteins. By largely inactivating protein kinase B (AKT) through tyrosine nitration and largely inactivating most forms of protein kinase C through cysteine oxidation of G proteins, peroxynitrites inhibit the two pathways by which GSK3 is inactivated. Peroxynitrites also decrease the protein kinase C mediated uptake of choline through muscarinic receptors and choline acetyltransferase activity. Thus, peroxynitrites cause large deficits in the memory storing compound acetylcholine.

Researchers should study the efficacy of other peroxynitrite inhibitors in combination...  Read more

View all comments by Lane Simonian


Related News: Why Good Microglia Turn Bad—A Matter of Timing?

Comment by:  Wolfgang Streit
Submitted 14 August 2008 Posted 14 August 2008

I’d like to make two major points about this paper from Hickman and colleagues.

First, I don’t view changing gene expression in microglia as a dysfunction. Microglia change their protein synthesis all the time, including surface receptors and proinflammatory cytokines, especially when activated under conditions of acute injury. The changes reported here for PS1-APP mice seem to be a result of the genetic manipulations in these mice since they do not occur in wild-type cells.

Second, the role of microglia in amyloid clearance remains controversial. Certainly, the histopathology of human brain does not support a role for microglia in amyloid clearance, especially when it comes to early diffuse amyloid, which does not seem to elicit any kind of response from microglia, i.e., the cells remain in their resting state.

That said, I do feel that understanding the role of microglia in AD is key to devising new treatments. I also think that microglial dysfunction plays a role, but in the sense that microglia themselves are subject to degeneration, resulting in a dysfunction...  Read more

View all comments by Wolfgang Streit


Related News: Chicago: Out of the Blue—A Tau-based Treatment for AD?

Comment by:  P.F. Jennings
Submitted 7 August 2008 Posted 15 August 2008

There is just a small handful of information about methylene blue and Alzheimer's (see Atamna et al., 2008; Necula et al., 2007; Taniguchi et al., 2005; Wischik et al., 1996).

As an interesting and somewhat related concept, the use of phenothiazines for prion diseases has been investigated at UC San Francisco. Apparently phenothiazines were derived from methylene blue—not everyone knew that, perhaps.

A press release from UCSF said:

"In [Korth's] current study, he set out by identifying classes of drugs that were known to cross the blood-brain barrier to the brain, and then tested their ability to inhibit prion formation in the cultured mouse neuroblastoma cells.

"He identified only one class that met both criteria: phenothiazines, a group of tricyclic drugs used to treat psychosis. He then determined that a phenothiazine containing a particular side chain structure was the most effective. This was chlorpromazine.

"When he discovered that phenothiazines were derived from methylene blue, a dye used in England in the 1850s, he examined other derivatives...  Read more

View all comments by P.F. Jennings


Related News: Chicago: Out of the Blue—A Tau-based Treatment for AD?

Comment by:  Jane Karlsson
Submitted 22 August 2008 Posted 22 August 2008

How Does RemberTM Work?
How exactly does Rember work? We have been puzzling over this in recent days, and are finding it difficult to believe that a drug so remarkably successful (yes, we know the caveats) could act on only one of the many problems in AD brain.

Rember is methylene blue, we are told. Methylene blue is a redox dye, which means it transports electrons. This is what mitochondria do. Methylene blue has been found to restore cognition to animals with dysfunctional cytochrome oxidase (Callaway et al., 2002), which is of great interest because cytochrome oxidase transports electrons in mitochondria and is low in AD brain (Mutisya et al., 1994).

Haem synthesis is another potential target of methylene blue. Very recently Atamna et al. (2008) found that methylene blue delays cellular senescence and improves haem synthesis. Haem is made in mitochondria and involves reduction of iron (III) to iron (II) by the electron transport chain, and specifically by cytochrome oxidase (Williams et al., 1976). In fact, cytochrome oxidase is itself a haem...  Read more

View all comments by Jane Karlsson


Related News: Chicago: Out of the Blue—A Tau-based Treatment for AD?

Comment by:  Francisco Gonzalez-Lima
Submitted 22 August 2008 Posted 22 August 2008

PubMed lists six peer-reviewed publications showing preclinical research in which methylene blue facilitates memory and one in which it prevents neurodegeneration by its combined action as a brain metabolic enhancer and antioxidant. Below is a list of these publications:

Wrubel KM, Riha PD, Maldonado MA, McCollum D, Gonzalez-Lima F. The brain metabolic enhancer methylene blue improves discrimination learning in rats. Pharmacol Biochem Behav. 2007 Apr;86(4):712-7. Epub 2007 Mar 6. Abstract

Wrubel KM, Barrett D, Shumake J, Johnson SE, Gonzalez-Lima F. Methylene blue facilitates the extinction of fear in an animal model of susceptibility to learned helplessness. Neurobiol Learn Mem. 2007 Feb;87(2):209-17. Epub 2006 Oct 2. Abstract

Zhang X, Rojas JC, Gonzalez-Lima F. Methylene blue prevents neurodegeneration caused by rotenone in the retina. Neurotox Res. 2006 Jan;9(1):47-57. Abstract

Riha PD, Bruchey AK, Echevarria DJ,...  Read more

View all comments by Francisco Gonzalez-Lima


Related News: Why Good Microglia Turn Bad—A Matter of Timing?

Comment by:  Terrence Town
Submitted 25 August 2008 Posted 26 August 2008

The timely report by Hickman, Allison, and El Khoury presents an interesting interpretation of the interplay between microglia and cerebral amyloidosis. It has long been established that Tg2576 mice manifest microglial activation concomitant with Abeta deposition, and that before plaques develop these animals have very little microgliosis (see for example Benzing et al., 1999). These authors have performed a related study in the APPPS1 mice developed by Joanna Jankowsky and David Borchelt (Jankowsky et al., 2001) and find a similar phenomenon.

They open their abstract by stating that “Early microglial accumulation in Alzheimer’s disease (AD) delays disease progression by promoting clearance of beta-amyloid (Abeta) before formation of senile plaques”. However, I'd like to note that this is a controversial statement, for which the authors do not present experimental evidence. Early ultrastructural studies from Henryk Wisniewski and Jerzy Wegiel actually suggested the opposite, that early microglial activation is a key factor in promoting progression of cerebral...  Read more

View all comments by Terrence Town


Related News: Chicago: Out of the Blue—A Tau-based Treatment for AD?

Comment by:  Boris Schmidt (Disclosure)
Submitted 24 August 2008 Posted 26 August 2008

Is methylene blue, a rather old drug, finally on the way to becoming a cure? Speculation and criticism come by the dozen.

The blue urine may enhance placebo effects. Therefore it would be worthwhile to investigate human brain penetration before we start to speculate, and well before we inject or swallow it in larger numbers. Iodine-labeled methylene blue did not reach the brain within 14h, but the additional iodine may have interfered with brain penetration (Link et al.,1996). Therefore an 11C-labeled methylene blue would be far more appropriate. Strange enough: 11C-labeled methylene blue has been available at the University of Aberdeen since 2003 (Schweiger et al, 2003)!

So where are the data? Was the brain penetration of methylene blue disclosed at the ICAD?

References:
Link EM, Costa DC, Lui D, Ell PJ, Blower PJ, Spittle MF. Targeting disseminated melanoma with radiolabelled methylene blue: Comparative bio-distribution studies in man and animals. Acta Oncol. 1996;35(3):331-41. Abstract

Schweiger L, Craib S, Welch A, Sharp P. Radiosynthesis of [N-methyl-11C]methylene blue. Journal of Labelled Compounds and Radiopharmaceuticals, 2003 Nov;46,(13):1221-1228. Abstract

View all comments by Boris Schmidt


Related News: Chicago: Does Saying “I Do” Lower Late-life Dementia Risk?

Comment by:  Kiumars Lalezarzadeh
Submitted 16 September 2008 Posted 19 September 2008

The demographic study of Krister Håkansson of Växjö University, Växjö, and Karolinska Institutet, Stockholm, Sweden, is very interesting. The effects of pair bonding and attachment have substantial effect on hormonal induction and neuroprotection.

Oxytocin is a hormone that has been studied to a great extent in the recent years, from both a psychological stance—learning about attachment—and the steroidal effects oxytocin has on the brain (Carter et al., 2005, and Carter, 2007).

Calza et al. (1997) showed that to a great extent corticotrophin-releasing hormone neurons of the paraventricular nucleus remain high in numbers in the elderly. However, the number of oxytocin neurons and vasopressin neurons decrease in the elderly. Thus, the induction of the hormone oxytocin with a rekindling of bonding and attachment is evident in the increase and maintenance of the number of oxytocin and vasopressin neurons, i.e., affecting both vascular circulation and neuroprotection from corticotrophin stress effects, which are excitotoxicity and cell death.

The involvement...  Read more

View all comments by Kiumars Lalezarzadeh


Related News: Chicago: Bapineuzumab’s Phase 2—Was the Data Better Than the Spin?

Comment by:  Jeffrey Muller
Submitted 22 March 2009 Posted 24 March 2009

This treatment should be combined with the cognishunt apparatus to clear the spinal fluid of the released plaque.

View all comments by Jeffrey Muller

Related News: Chicago: Out of the Blue—A Tau-based Treatment for AD?

Comment by:  Claude Wischik
Submitted 30 July 2009 Posted 30 July 2009

This report states that we had pooled randomization arms post-hoc in our efficacy analyses, which was not true. All of our analyses respected the original randomization, and the study remained double blind through to the end, i.e., two years. The primary analysis was conducted as pre-specified, and achieved statistical significance at the 24-week and 50-week time points. The effect was about an 84 percent reduction in the observed rate of progression over one year, regardless of how the analysis was conducted and which of several imputation methods was used in the ITT analysis.

View all comments by Claude Wischik
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