Get Newsletter
Alzheimer Research Forum - Networking for a Cure Alzheimer Research Forum - Networking for a CureAlzheimer Research Forum - Networking for a Cure
   
What's New HomeContact UsHow to CiteGet NewsletterBecome a MemberLogin          
Papers of the Week
Current Papers
ARF Recommends
Milestone Papers
Search All Papers
Search Comments
News
Research News
Drug News
Conference News
Research
AD Hypotheses
  AlzSWAN
  Current Hypotheses
  Hypothesis Factory
Forums
  Live Discussions
  Virtual Conferences
  Interviews
Enabling Technologies
  Workshops
  Research Tools
Compendia
  AlzGene
  AlzRisk
  Antibodies
  Biomarkers
  Mutations
  Pathways
  Protocols
  Research Models
  Video Gallery
Resources
  Bulletin Boards
  Conference Calendar
  Grants
  Jobs
Early-Onset Familial AD
Overview
Diagnosis/Genetics
Research
News
Profiles
Clinics
Drug Development
Companies
Tutorial
Drugs in Clinical Trials
Disease Management
About Alzheimer's
  FAQs
Diagnosis
  Clinical Guidelines
  Tests
  Brain Banks
Treatment
  Drugs and Therapies
Caregiving
  Patient Care
  Support Directory
  AD Experiences
Community
Member Directory
Researcher Profiles
Institutes and Labs
About the Site
Mission
ARF Team
ARF Awards
Advisory Board
Sponsors
Partnerships
Fan Mail
Support Us
Return to Top
Home: News
News
News Search  
Adrenaline Jolt—Potential Therapeutic Strategy for AD?
25 November 2009. Boosting neurotransmitter signaling to compensate for sagging synapses and neuron loss in Alzheimer disease has met with skepticism, based partly on the notion that you can’t fix what’s gone. However, new work by researchers at Stanford University Medical School, Palo Alto, California, offers a measure of hope to therapeutic approaches that prop up the norepinephrine system, which has thus far languished beneath the travails of the cholinergic pathway, the target of most approved drugs for AD. Using drugs to revive norepinephrine transmission in the brain, the scientists were able to restore contextual memory in a mouse model for Down syndrome at a stage when the mice already had neurodegeneration and behavioral defects. Tampering with failing neurotransmitter circuits in people is tricky, but given the links between Down syndrome and dementia, experts say the new data suggest norepinephrine-based strategies could hold promise in AD. The study appeared online in the November 18 Science Translational Medicine. This interdisciplinary journal was launched last month by the American Association for the Advancement of Science (AAAS), which publishes the journal Science.

Ties between Down syndrome (DS) and AD exist on several levels. Epidemiological studies find a higher incidence of dementia among seniors with DS (56 percent) compared with age-matched adults in the general population (6 percent) (see, e.g., Janicki et al., 2000). Neuropathologically, the brains of middle-aged DS patients look strikingly similar to those of AD patients, filled with amyloid plaques and neurofibrillary tangles and showing neuronal atrophy patterns characteristic of AD (see review, Mann, 1988). And several years ago, first author Ahmad Salehi, who is now at the Veterans Affairs Palo Alto Health Care System, and colleagues showed that basal forebrain cholinergic neurons fizzle in the Ts65Dn Down syndrome model. These mice are trisomic for a chromosome 16 fragment that includes a quarter of some 400 genes triplicated in DS. Amyloid precursor protein (APP) is among the trisomic genes in Ts65Dn animals, and in the earlier study, Salehi’s team blamed the observed cholinergic deficits on disrupted transport of nerve growth factor caused by excess APP (Salehi et al., 2006 and ARF related news story).

In the new work, Salehi and colleagues analyzed the same mice for defects in neurotransmission mediated by a different transmitter, norepinephrine. The hippocampus gets its supply of this neurotransmitter almost exclusively from neurons in a brain stem region called the locus coeruleus (LC). Selectively killing LC neurons intensifies pathogenesis in APP-overexpressing AD mice (Heneka et al., 2006; Kalinin et al., 2006). Furthermore, researchers have reported LC degeneration in people with early AD and even mild cognitive impairment (MCI) (Grudzien et al., 2007), suggesting that norepinephrine deficiency develops early in the course of disease (see also Weinshenker, 2008 review).

Given norepinephrine’s role in helping the hippocampus integrate different types of information, Salehi and colleagues put the mice through two behavioral tests. One used nesting behavior as a readout for hippocampal-based cognition, which is compromised in DS patients. The other used tones and shocks to produce fear-based responses that were measured as episodes of freezing. The fear-conditioning test distinguishes contextual learning, which relies on the hippocampus, from cue-based recall, which depends on the amygdala and stays somewhat intact in DS.

At six months of age, the Ts65Dn mice did fine with cue-based tasks but showed significant disabilities in contextual learning and nesting behavior. “This fit with the function of the locus coeruleus,” said Salehi, noting that contextual learning requires the LC (Murchison et al., 2004). He and coworkers then wondered if they could reverse the learning deficits in the Ts65Dn mice—a prospect they thought unlikely given that the animals already had reduced amounts of norepinephrine and LC degeneration at the time of testing. However, the researchers found that hippocampal neurons, the downstream targets of LC cells, could still respond to norepinephrine, as revealed by their ability to fire when treated with a β1- and β2-adrenergic receptor agonist (isoproterenol). “The machinery was still there,” Salehi said.

This suggested that a norepinephrine boost might actually help the Ts65Dn mice. The researchers injected six-month-old animals subcutaneously with brain-penetrant norepinephrine precursors (L-threo-3,4-dihydroxyphenylserine, aka L-DOPS), along with carbidopa, which inhibits the conversion of L-DOPS to norepinephrine. Because carbidopa does not cross the blood-brain barrier, only the L-DOPS that reaches the brain gets converted to norepinephrine. This combination strategy thereby avoids norepinephrine’s peripheral side effects.

Since norepinephrine concentrations in the brain seemed to max out five hours post-treatment, the researchers did the behavioral tests at this timepoint, and found that L-DOPS/carbidopa restored Ts65Dn deficits in contextual memory and nesting behavior.

Doug Feinstein of the University of Illinois, Chicago, questioned whether the treatment regimen used in the current study would be relevant for AD. “They give one injection and look at behavior five hours later. It’s a single, short-term, acute treatment,” he told ARF. “It does not address the cause of pathology or means to halt or prevent further disease progression.” Salehi agreed that the treatment was acute and its effects short-lived. Indeed, nesting benefits disappeared two weeks after treatment was stopped.

Nonetheless, strategies that boost norepinephrine signaling appear promising in other disease scenarios. Feinstein said he has a paper in press in the Journal of Neuroimmune Pharmacology showing that treatment with L-DOPS and noradrenaline reuptake inhibitors (NARIs) improves symptoms in a mouse model of multiple sclerosis. His lab is also treating APP mice with L-DOPS on a chronic basis, and has seen encouraging results in Morris water maze testing. “Overall I think it has a lot of value,” he said. “It should be tested in AD patients.” In August, Feinstein submitted a proposal to the Alzheimer’s Disease Cooperative Study to test L-DOPS/carbidopa, along with a NARI, in MCI patients.

If the drug shows efficacy, it could enjoy a fast track to approval because prior studies have already shown it is safe. L-DOPS is currently marketed in Japan and southeast Asia under the brand name Droxidopa for neurogenic orthostatic hypotension (a condition marked by norepinephrine deficiency), and is in Phase 3 testing in the U.S.

But increasing norepinephrine as a therapeutic strategy for AD could prove complicated, suggested David Weinshenker of Emory University in Atlanta, Georgia, in an interview with ARF. Though LC neurons die in AD, the survivors try to compensate by shooting out new dendrites and axons (Szot et al., 2006). Thus, even though AD patients have fewer LC neurons, they actually have increased norepinephrine release (Raskind et al., 1984; Raskind et al., 1999). As such, treating AD patients with drugs that enhance norepinephrine transmission has been linked with increased agitation (Peskind et al., 1995), and blocking norepinephrine receptors can reduce these symptoms (Wang et al., 2009). “Increasing norepinephrine could alleviate cognitive problems but at the same time exacerbate some of the behavioral symptoms,” Weinshenker said, noting that the key may be early intervention. “If you could identify people with MCI before they progress to full-blown AD and start developing some of these behavioral abnormalities...maybe you'd get the benefit but not the side effects,” he said.

Salehi agreed that achieving the risk-benefit balance will be tough. “To treat or restore cognition in AD or DS, you need to have a multisystem approach,” he told ARF. This idea came out in the team’s final set of experiments, which explored the genetic basis of the LC degeneration and cognitive dysfunction seen in the DS mice. By analyzing Ts65Dn mice with either two or three copies of APP, they discovered that animals lacking the third copy of APP had intact LC neurons but still did not build nests properly. “This finding suggests that although increased APP gene dose alone can account for the degenerative changes in LC cell body size and number, this is not the case for the defects in contextual learning,” the authors write. “The most plausible conclusion is that other genes combine with APP to affect the degeneration of LC neurons.”—Esther Landhuis.

References:
Salehi A, Faizi M, Colas D, Valletta J, Laguna J, Takimoto-Kimura R, Kleschevnikov A, Wagner SL, Aisen P, Shamloo M, Mobley WC. Restoration of Norepinephrine-Modulated Contextual Memory in a Mouse Model of Down Syndrome. Sci Transl Med. 2009 Nov 18;1(7):7ra17. Abstract

Wiseman FK. Cognitive Enhancement Therapy for a Model of Down Syndrome. Sci Transl Med. 2009 Nov 18;1(7):7ps9. Abstract

 
Comments on News and Primary Papers
  Comment by:  J. Lucy Boyd
Submitted 26 November 2009 Posted 2 December 2009

I recommend this article.

View all comments by J. Lucy Boyd
Comments on Related Papers
  Related Paper: Locus ceruleus degeneration promotes Alzheimer pathogenesis in amyloid precursor protein 23 transgenic mice.

Comment by:  Paul Coleman, ARF Advisor
Submitted 4 February 2006 Posted 4 February 2006
  I recommend this paper

  Related Paper: Increased App expression in a mouse model of Down's syndrome disrupts NGF transport and causes cholinergic neuron degeneration.

Comment by:  Andre Delacourte
Submitted 7 July 2006 Posted 7 July 2006
  I recommend this paper

  Related Paper: Increased App expression in a mouse model of Down's syndrome disrupts NGF transport and causes cholinergic neuron degeneration.

Comment by:  Mary Reid
Submitted 24 July 2006 Posted 24 July 2006

The study by Salehi, Delcroix, Mobley, and colleagues reporting that increased APP expression results in basal forebrain cholinergic neuron loss due to the inhibition of retrograde transport of NGF is most interesting. This cholinergic loss is reported in several neurodegenerative disorders including amyotrophic lateral sclerosis (ALS) (1).

It's of interest that Hendy and Bonyhady (2) find that retrogradely transported NGF increases ornithine decarboxylase activity in rat superior cervical ganglia. I'd like to propose that there may be a feedback loop whereby ornithine decarboxylase decreases retrograde transport of NGF.

There are several studies that support this hypothesis, including those of Yatin and colleagues (3), finding that Aβ peptides increase ODC activity; Nilsson and colleagues’ (4) finding that APP induces expression of ODC; and Virgili and colleagues’ (5) finding ODC activity increased in the SOD1 G39A transgenic mice, an animal model for ALS.

The fact that increased activity of this enzyme is reported in H. pylori infection and is induced by...  Read more

Comments on Related News
  Related News: Trisomy Trouble: Neurotrophin Signaling Defective in Down Syndrome

Comment by:  Lino Tessarollo
Submitted 11 July 2006 Posted 11 July 2006

I think this study by Salehi and colleagues complements our work. If anything, the two studies combined stress once again the relevance of neurotrophin supply/signaling in supporting neuronal survival and function. What I find intriguing is that the two papers describe different mechanisms by which alterations in neurotrophin signaling can cause neuronal cell death, depending on the specific brain cell type affected. For example, Salehi et al. report that disrupted retrograde transport of NGF to the basal forebrain cholinergic neurons (BFCNs) causes degeneration of these neurons (I would like to note that BDNF is not a major signaling molecule in this neuronal cell population, which is why Salehi et al. find that the retrograde transport of BDNF and NT3 is below the limits of detection with the methodology used in their study). We find that an impairment of TrkB signaling causes cell death in cortical and hippocampal neurons, two cell populations that are responsive to BDNF and in which TrkB receptor isoforms alterations have been already described in Alzheimer disease (AD). As...  Read more

  Related News: Trisomy Trouble: Neurotrophin Signaling Defective in Down Syndrome

Comment by:  Bai Lu
Submitted 11 July 2006 Posted 11 July 2006

NGF has a potent effect on cholinergic neurons in the basal forebrain, which are prone to degeneration in AD. The idea that NGF dysfunction is involved in AD has been around for some time, but it has never been taken seriously because of the prominence of the “Aβ” hypothesis. Now Mobley and colleagues show that APP acts to reduce the retrograde transport of NGF in these cholinergic neurons, a process that might be important for their survival. The significance of the work by Mobley et al. is that they provide a mechanistic link between APP and NGF signaling in the basal forebrain neurons, therefore putting NGF back into the center stage of the AD field. The immediate task now is to test whether this works in an AD model.

The functional role of TrkB.T1, which is highly expressed in the brain, has been puzzling for some time now. One idea is that T1 has no function by itself, but prevents locally secreted BDNF from diffusion to distant places, and therefore ensures its local action. Another idea is that T1 can actually signal in glial cells in an unconventional way, but...  Read more


  Related News: Trisomy Trouble: Neurotrophin Signaling Defective in Down Syndrome

Comment by:  Volkmar Lessmann
Submitted 14 July 2006 Posted 14 July 2006

Yano and colleagues managed to proceed one step further in elucidating synaptic actions of neurotrophins. Although it was well established for quite some time that BDNF exerts presynaptic effects on the availability of presynaptic glutamate vesicles for synaptic transmission, the molecular determinants of this action were far from being understood. This paper now highlights new downstream signaling partners in the presynaptic actions of BDNF.

The observation, in the early 1990s, that BDNF can enhance presynaptic functions of excitatory synapses (Lohof et al., 1993; Lessmann et al., 1994) was followed shortly thereafter by the discovery of an essential role of BDNF in Schaffer collateral LTP (Korte et al., 1995; Patterson et al., 1996). Also, in 1996, Figurov and colleagues (1996) found that one of the important presynaptic actions of BDNF is to avoid transmitter vesicle depletion upon repetitive activity of juvenile synapses, although this presynaptic BDNF effect cannot account for the impaired LTP in adult animals. It took another four years to learn, from the data by...  Read more

  Submit a Comment on this News Article
Cast your vote and/or make a comment on this news article. 

If you already are a member, please login.
Not sure if you are a member? Search our member database.

*First Name  
*Last Name  
Country or Territory:
*Login Email Address  
*Password  
*Confirm Password  
Remember my Login and Password?  

I recommend the Primary Papers

Comment:

(If coauthors exist for this comment, please enter their names and email addresses at the end of the comment.)

References:


*Enter the verification code you see in the picture below:


This helps Alzforum prevent automated registrations.

Terms and Conditions of Use:Printable Version

By clicking on the 'I accept' below, you are agreeing to the Terms and Conditions of Use above.
Print this page
Email this page
Alzforum News
Follow on Twitter
Text size
Share & Bookmark
ADNI Related Links
ADNI Data at LONI
ADNI Information
DIAN
Foundation for the NIH
AddNeuroMed
neuGRID
Desperately

Antibodies
Cell Lines
Collaborators
Papers
Research Participants
Copyright © 1996-2010 Alzheimer Research Forum Terms of Use How to Cite Privacy Policy Disclaimer Disclosure Copyright
wma logoadadad