7 July 2001. Using different approaches, two recent animal studies have reported some success toward achieving a goal common to several experimental AD therapies: both methods significantly lowered the Aβ burden in the brain.
In last month's Neuron, Ashley Bush at Massachusetts General Hospital,
with Colin Masters and colleagues in Australia and elsewhere, described
how the copper-zinc chelator clioquinol cut Aβ deposition in the brain by half without any apparent ill effects in AβPP2576 transgenic mice. Carrying a human familial AβPP mutation, these mice produce copious plaques, though they do not develop neuronal loss.
Also, in the July 2 early edition of PNAS, David Holtzman at Washington
University School of Medicine in St. Louis, et al., introduced a new
variation of AD immunotherapy. They found that intravenous injection of
an Aβ antibody was able to interfere with the bidirectional
transport of Aβ between the CNS and the periphery in such a way that
the equilibrium was shifted toward Aβ's efflux from the CNS, thus
reducing the amount of brain Aβ available for deposition.
First, consider the Neuron paper. Bush has worked out this approach
systematically since the early 1990s, moving from analyzing the biochemical
interaction of Aβ with copper and zinc to animal studies, and now, a
clinical trial conducted in Australia, said Gunnar Gouras of Cornell
University in New York, who cowrote a preview on Bush's paper in the
same issue of Neuron. The approach is built around the concept that chelating
copper and zinc ought to be able to break up plaques, since these metals are
shown to potentiate Aβ aggregation and toxicity.
Metal chelation has for years faced some skepticism in the field, but the
study addresses these concerns well, says Gouras. "This is rigorous,
well-controlled work. It should be tested in the clinic and, in
further animal studies," he adds.
In this study, Bush et al. use clioquinol, an antibiotic that crosses the
blood-brain barrier. They show that the drug dissolves Aβ deposits
induced by copper or zinc ions in vitro, and that it liberates Aβ from
postmortem brain samples of AD patients. They then found a 65 percent decrease in
Aβ sediment in a pilot study of five 12-month-old mice-the age when
plaques start to form in this model-and a 41 percent decrease in a larger cohort
of 21-month-old mice. The authors conclude that clioquinol treatment inhibits
and possibly reverses accumulation of Aβ deposits in the brains of these
mice. Hydrophobic chelators "merit further investigation for their
therapeutic utility, and the prevention and treatment of AD," they write.
A potential safety concern arises from evidence over the past few years
suggesting that plaques may not be as toxic to neurons as is soluble Ab,
possibly intracellular Aβ, or early aggregation stages such as Aβ
protofibrils. This raises the question whether therapies releasing soluble
Aβ from plaques may prove to be toxic. Bush addresses this concern by
reporting that he found no change in synaptophysin levels (this indicator
of synaptic loss correlates better with cognitive decline than do plaques),
in GFAP levels (an indicator of astrocytosis), or in AβPP levels (declining
AβPP levels would indicate neuronal dysfunction). His group also used a simple
measurement of general well-being and survival to suggest that the treatment
improved the health of the transgenic mice.
The pool of soluble Aβ did increase by 52 percent in treated mice, but the
authors note that soluble Aβ constitutes only a tiny fraction of total
Aβ, and that the soluble Aβ appearing after metal chelation may not
be a toxic form.
The paper also recounts clioquinol's history as an antiamebic drug that was
used for 20 years before being withdrawn worldwide in 1971 due to its likely
association with cases of subacute myelo-optic neuropathy arising mostly in
Japan. "Our current findings suggest that a reexamination of this drug and
its side effects may be warranted," the authors write.
The second paper reduces Aβ by a completely different mechanism, and
this approach is not yet advanced enough to include a detailed safety
evaluation. In this study, Holtzman and Steven Paul at Eli Lilly and Co.
in Indianapolis present a new twist to AD immunotherapies.
Searching for ways to improve Aβ clearance as a means to inhibit its
deposition in the brain, they found that the monoclonal antibody m266, which
binds Aβ with picomolar affinity, was able not only to sequester all
Aβ present in plasma, but also to "draw" more Aβ out of the brain
by removing it from the peripheral side of the central-peripheral transport
The study builds on previous work showing that receptor-mediated transport
mechanisms at the blood-brain barrier efficiently transport Aβ from the
CNS to plasma and back, and that such transport may regulate Aβ levels
in brain (Shibata et al., and Zlokovic, et al.). This could, in theory, give
them a handle for affecting brain Aβ from the outside, without the
antibody having to enter the CNS.
After establishing m266's ability to act as an Aβ "sink" in an in-vitro dialysis system, the scientists tested the antibody in PDAβPP transgenic
mice, in which a mutant human AβPP transgene results in production of
human Aβ exclusively in the CNS. With an ELISA specific to human
measured plasma and CSF Aβ before and after injecting the antibody
intravenously. Several days after injection, treated mice contained 1,000
times more plasma Aβ than did controls that had not received m266. All
of the Aβ was complexed with m266, suggesting that none was free to
move back into the brain.
The scientists infused Aβ into the CSF of wildtype mice treated
with intravenous m266, and monitored its appearance in the periphery.
They detected it within minutes, and after three hours, plasma Aβ had
accumulated 365-fold compared to controls. To determine whether increasing
the efflux and decreasing the influx of brain Aβ could affect its
deposition, the scientists treated PDAβPP mice with m266 from four months
until nine months of age. One of the 14 treated mice had severe Aβ
deposition compared to five of 13 and six of 14 in the two control groups.
The authors suggest that increasing Aβ clearance with a humanized
parenteral antibody-or any other binding protein that could serve as a
peripheral "sink"-could be useful in preventing and treating amyloid
deposition in the brain.-Gabrielle Strobel.
Reference:Cherny RA, Atwood CS, Xilinas ME, Gray DN, Jones WD, McLean CA, Barnham KJ, Volitakis I, Fraser FW, Kim Y, Huang X, Goldstein LE, Moir RD, Lim JT, Beyreuther K, Zheng H, Tanzi RE, Masters CL, Bush AI. Treatment with a copper-zinc chelator markedly and rapidly inhibits beta-amyloid accumulation in Alzheimer's disease transgenic mice.
Neuron. 2001 Jun;30(3):665-76. Abstract
DeMattos RB, Bales KR, Cummins DJ, Dodart JC, Paul SM, Holtzma n DM. Peripheral anti-A beta antibody alters CNS and plasma A beta clearance and decreases brain A beta burden in a mouse model of Alzheimer's disease. Proc Natl Acad Sci U S A 2001 Jul 17;98(15):8850-5. Abstract