Amyloid β-interacting partners in Alzheimer's disease: From accomplices to possible therapeutic targets

Amyloid β-interacting partners in Alzheimer's disease: From accomplices to possible therapeutic targets

Accepted Manuscript Title: Amyloid ␤-interacting partners in Alzheimer’s disease: From accomplices to possible therapeutic targets Author: Sun-Ho Han ...

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Accepted Manuscript Title: Amyloid ␤-interacting partners in Alzheimer’s disease: From accomplices to possible therapeutic targets Author: Sun-Ho Han Ph.D. Jong-Chan Park B.S. Inhee Mook-Jung Ph.D. PII: DOI: Reference:

S0301-0082(15)30036-8 http://dx.doi.org/doi:10.1016/j.pneurobio.2015.12.004 PRONEU 1410

To appear in:

Progress in Neurobiology

Received date: Revised date: Accepted date:

25-6-2015 2-12-2015 9-12-2015

Please cite this article as: Han, S.-H., Park, J.-C., Mook-Jung, I.,Amyloid rmbeta-interacting partners in Alzheimer’s disease: From accomplices to possible therapeutic targets, Progress in Neurobiology (2015), http://dx.doi.org/10.1016/j.pneurobio.2015.12.004 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Amyloid -interacting partners in Alzheimer’s disease:

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From accomplices to possible therapeutic targets

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Sun-Ho Han (Ph.D.), Jong-Chan Park (B.S.) and Inhee Mook-Jung (Ph.D.)*

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Department of Biochemistry and Biomedical Sciences, Seoul National University,

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College of Medicine, 28 Yungun-dong, Jongro-gu, Seoul 110-799, Korea

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*Corresponding Author:

Inhee Mook-Jung, Ph.D

Department of Biochemistry and Biomedical Sciences, Seoul National University, College of Medicine, 28 Yungun-dong, Jongro-gu, Seoul 110-799, Korea E-mail: [email protected]

Phone number: +82-2-740-8245 Fax number: +82-2-3672-7352 

Total word count: 12,134

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Contents 1. Introduction 2. A-interacting proteins in the blood and brain

2.2. Apolipoprotein E

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2.3. A-interacting proteins in the cerebrospinal fluid 2.4. A-interacting proteins in the blood

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3. Metal ions

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2.1. Albumin

3.1 Copper

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3.2 Zinc

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3.3 Iron 3.4 Aluminium

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3.5 Therapeutic strategy targeting metal ions

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4. A-binding membrane components (receptors) 4.1 Receptor for advanced glycation end products 4.2 Low-density lipoprotein-related protein 4.3 Prion protein

4.5 Ephrin type-B receptor2 4.6 Serpin-enzyme complex 4.7 Insulin receptor

4.8 Neurotransmitter receptors 4.9 Integrin 4.10 Leukocyte immunoglobulin-like receptor B2 4.11 Membrane lipids 4.12 Amyloid precursor protein

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5. Intracellular A-binding proteins 5.1 Endoplasmic reticulum-associated A-interacting proteins 5.2 Chaperone proteins

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5.3 X11-llike, ˞B-crystallin and lysozyme 6. Mitochondrial A-binding components

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6.1 Cytochrome c oxidase

6.3 Mitochondrial permeability transition pore

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6.2 A-binding alcohol dehydrogenase

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7. 6.4 Mitochondrial enzymesA-interacting mediators of immune activation 7.1 Toll-like receptors

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7.2 Receptor for advanced glycation end products

7.4 Microglial receptors

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7.3 CD36

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8. Other amyloidogenic proteins 8.1 alpha-Synuclein 8.2 A40 and 42

8.3 Trnasthyretin

9. Conclusion

Acknowledgements References

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Abstract Alzheimer’s disease (AD) is one of the most devastating neurodegenerative diseases in modern society because of insurmountable difficulties in early diagnosis and lack of therapeutic treatments. AD pathogenesis is tightly linked to the abnormal accumulation and

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aggregation of amyloid  (A), seemingly the main causative factor of AD; however,

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intensive research on A has not yet explained the complexity of AD pathogenesis. Consequently, the role of other supportive partners of A have been elucidated and evaluated

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in the etiology of AD, and their potential molecular mechanisms have emerged as possible therapeutic targets. In this review, we compile information regarding A-interacting partners

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in normal conditions and AD pathology, and analyze their etiological roles in diverse areas.

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Furthermore, we integrate this information into suggestions for probable clinical applications for AD diagnosis and therapeutics. We include A-interacting partners localized to the cell

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surface and intracellular and extracellular compartments of different cell types ranging from

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the central nervous system to peripheral regions. Additionally, we expand the range of Ainteracting partners by including not only proteins, but also inorganic substances like metals, expecting that one of these partners may yield a critical breakthrough in the field of AD diagnostics and therapeutic drug development.

Key Words: Alzheimer’s disease, Amyloid , Amyloid -interacting protein, Blood brain barrier, cerebrospinal fluid

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1. Introduction Alzheimer’s disease (AD) is one of the most concerning neurodegenerative diseases in present society due to the lack of early diagnostic methods and therapeutic remedies. Amyloid β (A) plaques are regarded as the main etiological hallmark of AD. Plaque

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formation begins with abnormal production or impaired clearance of A and consequent

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accumulation and aggregation, leading to formation of A plaques in the brain (Mawuenyega et al., 2010; Querfurth and LaFerla, 2010). Increased A levels are tightly associated with

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synaptic dysfunctions and neuronal network perturbations, which are regarded as the main

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cause of cognitive impairment in AD (Palop and Mucke, 2010). Contrary to AD, in other types of dementia aggregated forms of A are not present, suggesting that aggregation of Aβ

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peptides is a peculiar characteristic of AD, and plays a pivotal role in its pathogenesis. Therefore, inhibition of A aggregation or its effects may be a key solution to prevent the

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initiation of AD or slow down its etiological progression.

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Accumulating evidence suggests that A elicits its deleterious effects, including toxicity on cellular and synaptic functions, through binding to certain molecular partners. However, other molecules may interact with A and prevent the A-mediated toxic effects. Therefore, Ainteracting proteins and molecules are tightly associated with diverse aspects of AD pathophysiology. Firstly, numerous A-interacting proteins play a critical role in influencing the lifespan of A via regulating A generation, aggregation, disaggregation, and degradation (Bohrmann et al., 1999; Clinton et al., 2010; Hone et al., 2003). Certain A-interacting proteins are capable of modulating the amyloidogenic and catabolic process by interacting with A (Fagan et al., 2002; Ono et al., 2012). Other A-interacting proteins either enhance or inhibit A aggregation by maintaining A in a free or bound form, respectively (Clinton et al., 2010; Schwarzman and Goldgaber, 1996). This process is critical in AD pathogenesis, because abnormally accumulated A, usually the free form of A, aggregates to form

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neurotoxic A, whereas bound forms do not tend to aggregate (Bohrmann et al., 1999). Secondly, A-interacting partners, localized in both intra/extracellular compartments and on the cell surface, typically serve as mediators for A-triggered signaling (activation or inhibition) (Freir et al., 2011; Sturchler et al., 2008), which is closely linked to synaptic

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dysfunction and neuronal toxicity. Thirdly, A directly binds to certain enzymes that are

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critical in cell dynamics, and modulates their activities and functions (Chen and Yan, 2007; Hernandez-Zimbron et al., 2012; Lustbader et al., 2004), which leads to the breakdown of

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cellular homeostasis and further toxicity. A-interacting partners attract a great interest, as they might help in understanding the pathophysiology of AD, and therefore, comprehensive

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assessment of A-interacting proteins and their diverse roles is necessary for developing

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therapeutic agents for AD targeting these proteins. Careful investigation of A-interacting partners may provide valuable information to understand A-mediated cellular toxicity in AD

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these regulatory partners.

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and promising first-line interventions to delay or prevent disease progression by modulating

2. A-interacting proteins in the blood and brain 2.1 Albumin

Albumin, a 65-kDa protein, is the most abundant protein in the serum, and binds toxic materials in the circulation, including A (Carter and Ho, 1994) (Fig. 1). Serum albumins bind the majority of serum A, sequestrating 90–95% of A in the blood, and therefore, very little free A exists in the blood (Biere et al., 1996; Kuo et al., 2000). In addition, albumin inhibits A polymerization through A/albumin interactions at physiological concentrations; thus, representing 60% of all A polymerization inhibitory activities among various plasma proteins (Bohrmann et al., 1999). Therefore, differences in albumin concentration between the serum (~640 M) and cerebrospinal fluid (CSF, 3 M) might explain why A plaques are

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deposited in the brain instead of peripheral tissues (Stanyon and Viles, 2012; Stevens et al., 1979). Level of serum albumin is tightly associated with cognitive impairment, as the elderly with low serum albumin levels have increased odds for impaired cognitive function after adjusting for possible risk factors such as age, sex, and education (Llewellyn et al., 2010).

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Additionally, patients with AD exhibit significantly decreased serum albumin levels

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compared with control individuals (Maes et al., 1999), which supports a relationship between serum albumin levels and cognitive impairment. Notably, decreased levels of the albumin/A

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complex in the serum is associated with an increased prevalence of AD (Yamamoto et al., 2013). Furthermore, a positive correlation between Mini-Mental State Examination (MMSE)

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scores and decreased serum albumin levels in patients with AD suggests that serum albumin

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levels are directly correlated with cognitive impairment during AD pathogenesis (Kim et al., 2006). Albumin may act on cognitive function in AD via the inhibition of A fibril growth,

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which is achieved by both increasing the lag time for A fibrillization and decreasing the

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amount of free A, as the formation of amyloid fibers is directly proportional to the amount of the free A (Stanyon and Viles, 2012). Therefore, treatment with human albumin was attempted for patients with mild to moderate AD through plasma exchange to sequestrate free A and modulate the equilibrium between the albumin-bound and free form of A (Boada et al., 2009). Beneficial effects were observed in albumin-treated patients with regard to A40 mobilization and cognitive status scores, including MMSE and the Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-Cog); thus, albumin could be a therapeutic target for AD. Additional studies and clinical trials are ongoing to investigate the therapeutic use of albumin and immunoglobulins in the treatment of AD (Costa et al., 2012) (Table 1). 2.2 Apolipoprotein E Apolipoprotein E (ApoE) exists in both the brain and blood. Numerous studies have investigated the binding of ApoE to A and its subsequent involvement in A clearance and

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aggregation (Fig. 1). Different ApoE isoforms, either free or lipid-associated forms, produce sodium dodecyl sulfate-resistant complexes with A according to their isoform-specific binding patterns to A (Aleshkov et al., 1997; LaDu et al., 1994; Sanan et al., 1994; Strittmatter et al., 1993b; Yang et al., 1997). ApoE interacts with the residues 12–28 of A,

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and the isoform-specific efficacy for A binding is ApoE2 > ApoE3 > ApoE4 in lipidated

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conditions (Strittmatter et al., 1993a; Strittmatter et al., 1993b; Tokuda et al., 2000). This suggests that different binding capacities of various ApoE isoforms may result in different

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degree of A clearance, which is supported by the increased risk for AD development in

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ApoE epsilon 4 allele carriers. However, the consequences of ApoE/Aβ interactions are controversial, even though it is obvious that ApoE affects AD pathogenesis by modulating A

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aggregation and clearance. Some reports suggest that interaction of ApoE and A, regardless of the ApoE isotype, promotes A fibrillization; however, apoE4 exhibits a particularly high

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efficacy for inducing A fibrillization compared with ApoE2 and ApoE3 (Castano et al., 1995;

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Wisniewski et al., 1994). By contrast, other in vitro studies demonstrated that human ApoE isoforms decrease A fibrillization due to the inhibition of A nucleation formation (Webster and Rogers, 1996; Wood et al., 1996).

In vivo studies using mouse models of AD revealed that overexpression of different ApoE isoforms had various effects on AD neuropathogenesis by modulating A deposition and plaque formation (Fagan et al., 2002; Holtzman et al., 2000), and the ApoE4 isoform promotes the most prominent fibrillar A deposition. Besides their role in A deposition, both murine and human ApoE are crucial in regulating neuritic degeneration (Holtzman et al., 2000). Human ApoE isoforms are more beneficial for delaying A deposition than mouse ApoE molecules (Fagan et al., 2002), which is consistent with the finding that apoE levels are decreased in the serum of patients with AD, and this decrease correlates with disease severity as represented by the MMSE score (Han et al., 2014). The beneficial effects of human ApoE

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expression are also isoform-dependent, as human ApoE3 expression delayed synaptic deficits, while ApoE4 expression failed to protect against them (Buttini et al., 2002). Furthermore, amyloid plaque deposition was more prominent following ApoE4 expression compared with ApoE3 expression. In other study, ApoE knockout mice exhibit a significant decrease in A

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deposition, neuritic dystrophy, and amyloid plaques (Bales et al., 1997; Holtzman et al., 2000;

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Holtzman et al., 1999).

In addition, ApoE is involved in A metabolism, including A production and clearance.

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Although the isomer-specific involvement of ApoE in amyloid precursor protein (APP) processing remains controversial (Cedazo-Minguez et al., 2001; Ye et al., 2005), it is

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conceivable that ApoE influences A clearance and metabolism through several mechanisms.

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The connection between ApoE and A metabolism is supported by the ApoE-mediated decrease of soluble A levels, localization of A in membrane microdomains (Fagan et al.,

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2002), and AD-related alterations of ApoE levels in the CSF and serum (Gupta et al., 2011;

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Han et al., 2014; Hesse et al., 2000). Lipidated ApoE can sequestrate A, and modulate either its cellular degradation by reuptake through receptor-mediated endocytosis or its systemic removal after crossing the blood brain barrier (BBB) (Jiang et al., 2008; Kim et al., 2009; Trouw et al., 2008; Yamauchi et al., 2000). Therefore, diverse ApoE-targeting therapeutic approaches have been attempted recently, such as increasing ApoE levels, increasing ApoE receptor expression, and modulation of ApoE/A interactions. Blocking A/ApoE interaction by non-toxic homologous to the binding motif within ApoE prevents brain A accumulation, neuritic degeneration and ameliorate memory deficit in AD model mice (Pankiewicz et al., 2014). Other study shows that A/ApoE interaction contributes to intraneuronal A accumulation, demonstrating increased A content using neurons/astrocyte co-culture system (Kuszczyk et al., 2013). In this study, blocking A/ApoE interaction using in vitro homologous and in vivo knockout mice inhibit intracellular A accumulation and loss of

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synaptic protein, which indicate possible therapy of modulating A/ApoE interaction. Transcriptional activation of ApoE expression by retinoid X receptor (RXR) agonists, most notably bexarotene (Targretin), a highly selective and BBB permeable RXR agonist, increases A clearance and microglial phagocytosis through the activation of peroxisome

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proliferator-activated receptor gamma (PPAR) and liver X receptor (LXR) (Cramer et al.,

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2012). In a mouse model of AD, bexarotene reduces A levels in the cerebral interstitial fluid, cortex, and hippocampus; these levels correlate with the behavioral improvements and

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bexarotene-mediated increases in ApoE expression. This suggests that a treatment targeting ApoE may be beneficial for the treatment of AD. Notably, bexarotene is currently undergoing

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a phase 2 clinical trial (ClinicalTrials.gov identifier: NCT01782742, Table 1) for the

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treatment of amyloid plaques in AD (Aicardi, 2013; Dai et al., 2014). However, controversial genetic studies also suggest that decreasing ApoE levels are beneficial in AD, proving

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decrease A level, plaque formation and microglial activation by genetically manipulated

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reduction of ApoE level (Bien-Ly et al., 2012; Kim et al., 2011). Further studies are necessary to validate the function of ApoE in A metabolism in vivo and in vitro, because the effect of ApoE on A clearance is likely affected by diverse conditions including lipidation status, isomer type, inflammatory activation, and BBB integrity during AD pathogenesis. 2.3 A-interacting proteins in the cerebrospinal fluid Apolipoprotein J (apoJ, clusterin) is a sulfated glycoprotein present in most body fluids, and it binds to a diverse spectrum of molecules (Aronow et al., 1993; Calero et al., 2000; de Silva et al., 1990). Among its diverse ligands, ApoJ interacts with soluble A peptides in a 1:1 stoichiometry regardless of its lipidation status, and forms a stable complex under physiological conditions (Calero et al., 2000). This binding between A and apoJ is saturable, reversible, and of high affinity with a dissociation constant of 2ൈ10-9 M, which is not likely to be dissociated by other competitors such as ApoE, transthyretin, or 1-antichymotrypsin

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(Matsubara et al., 1995). Formation of the apoJ/A complex prevents the aggregation, polymerization, and fibrillization of A, which was proved by the co-incubation of A and apoJ. apoJ serves as the major A-binding protein in the CSF under normal conditions; however, the A binding propensity of apo proteins shifts during AD pathogenesis from apoJ

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towards ApoE (Golabek et al., 1995). Besides the protective role of apoJ against A

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aggregation, apoJ is neuroprotective during cellular stress, and is upregulated to defend neurons against local damage after diverse insults including the pathological progression of

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AD (Calero et al., 2000). Binding of apoJ and A accelerates the receptor-mediated cellular clearance of A from the brain by facilitating the binding of A to the low-density lipoprotein

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receptor-related protein (LRP) 2/megalin (Hammad et al., 1997). In addition, apoJ can trigger

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protective signaling cascades directly, which affect neurodegeneration and apoptosis, or activate the recovery systems regulating lipid transport or membrane recycling (Calero et al.,

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2000). Furthermore, apoJ is co-localized with A fibrillary deposits and present in amyloid

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plaques and cerebrovascular amyloid deposits in the cortex and hippocampus of patients; however, it is not present in neurofibrillary tangles (Calero et al., 2000; McGeer et al., 1992). Increased mRNA and protein expression of apoJ is demonstrated in the hippocampus and cortex of the patients with AD, which implies a compensatory protective response during AD pathogenesis (Duguid et al., 1989; May et al., 1990; Oda et al., 1994). In contrast to the increase in apoJ levels in the AD brain, apoJ levels are decreased in the CSF, which might serve as a useful diagnostic biomarker (Puchades et al., 2003). Other A-binding proteins that exist at low concentrations show a mild reduction in their levels in the CSF during AD pathogenesis, including -trace/prostaglandin D2 synthase, cystatin C, 1-antitrypsin, and transthyretin (Hansson et al., 2009). Among them, reduction of 1-antitrypsin and transthyretin levels is AD-specific, while reduction in levels of the others is also shown in frontotemporal dementia. Positive correlations between the levels of A1-42

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and transthyretin, cystatin C, and -trace/prostaglandin D2 synthase in the CSF from AD suggest that deficient A-binding by partner proteins may influences the amyloidogenic pathway during AD pathogenesis (Hansson et al., 2009). 2.4 A-interacting proteins in the blood

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In addition to albumin and ApoE, A interacts with diverse plasma proteins, including

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transthyretin, amyloid P component, 1-antichymotrypsin, and 2-macroglobulin (Du et al., 1997; Janciauskiene et al., 1998; Kalaria and Perry, 1993; Schwarzman et al., 1994) (Fig. 1).

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Transthyretin is a 64-kDa homotetrameric protein synthesized in the choroid plexus; it is present in the CSF and serum(Sousa et al., 2007). Transthyretin binds and sequestrates A,

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and subsequently inhibits Aβ aggregation and fibrillation in vitro (Schwarzman and

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Goldgaber, 1996). The A binding domains of transthyretin were recently identified; strong binding is associated with residues 106–117 (strand G on the inner -sheet of transthyretin)

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and a weak interaction at residues 59–83 (strand E through the E/F helix and loop) (Du et al.,

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2012). In another study, transthyretin was demonstrated to interact with, cleave, and degrade A aggregates (Costa et al., 2008). Furthermore, transthyretin levels in the CSF, serum, and plasma were altered significantly in the patients with AD, and the extent of decrease in plasma transthyretin levels correlates with the severity of AD pathology (Castano et al., 2006; Han et al., 2011a; Hansson et al., 2009; Velayudhan et al., 2012). Accordingly, increased transthyretin expression was suggested as one of the protective mechanisms against AD progression, because it might prevent plaque deposition and A-mediated neuronal toxicity in the brains of mice overexpressing APP with Swedish mutation (Stein and Johnson, 2002). These results indicate that transthyretin may have beneficial effects in both a diagnosis and therapeutic strategy in AD. Similar to transthyretin, 2-macroglobulin interacts with A, and prevents A fibril formation (Hughes et al., 1998). 2-Macroglobulin is the specific ligand for LRP, and promotes A

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clearance through LRP in cortical neurons (Chappell et al., 1992; Qiu et al., 1999). Interaction of A with 2-macroglobulin protease complexes increases A degradation, which may reduce the risk of AD development (Lauer et al., 2001). Notably, 2macroglobulin is one of the confirmed late onset genes leading to an increased risk for AD

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(Blacker et al., 1998; Kovacs, 2000). Furthermore, elevated 2-macroglobulin levels in the

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blood of patients with AD validate the correlation between this A-interacting protein and AD pathogenesis (Hye et al., 2006; Zabel et al., 2012).

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Similarly, 1-antichymotrypsin was reported to interact with A; however, its role in A aggregation is controversial. Certain studies suggest that 1-antichymotrypsin interacts with

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A to stimulate A fibrillization in vitro and plaque deposition in a mouse model of AD (Ma

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et al., 1994; Nilsson et al., 2001), while other studies reported that 1-antichymotrypsin inhibits A fibrillization and promotes disaggregation of A fibrils (Eriksson et al., 1995).

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The exact functions and mechanisms of these interactions with A require further

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investigations; however, it is conceivable that interactions between A and plasma proteins affect the fate of A by modulating the aggregation process and clearance efficacy, which play critical roles in AD pathogenesis. Furthermore, AD-related alterations in the plasma levels of these interacting proteins could indicate disease progression and enable possible therapeutic interventions (Han et al., 2011a; Han et al., 2014; Velayudhan et al., 2012). Numerous blood proteins bind directly to A, and prevent the formation of A fibrils or accelerate A fibrillization. High density lipoproteins (HDL), including ApoA-I, ApoA-II, ApoE, clusterin, and serum amyloid A, are the main serum proteins that bind directly to A (Wilson et al., 2006). In the case of serum amyloid P (SAP), the literature is controversial. One study suggests that the component of SAP accelerates the formation of amyloid fibrils at unsaturated physiological concentrations of A42, and stabilizes the amyloid fibril (Mold et al., 2012), while another study proposes that SAP binds A peptides, inhibits fibril formation,

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and increases the solubility of Aβ (Janciauskiene et al., 1995).

3. Metal ions The relevance of metal ions in AD pathogenesis has been investigated in both the brain and

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periphery in various studies. Metal ion homeostasis is perturbed drastically during AD

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pathogenesis, and diverse proteins crucial in AD pathology interact with transition metals. Notably, several metal ions affect A polymerization, nucleation, and plaque formation.

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Recently, metal ions have been suggested to play a dual role in AD, which makes the

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appreciation of metal ions complex and confusing in AD, with regard to both etiology and possible therapeutic strategies by utilizing metal chelators.

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3.1 Copper

Copper (Cu) is one of the ions implicated in AD, and serum copper levels are higher in

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patients with AD than in control subjects (Brewer et al., 2010) with a cutoff value of 16

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mol/L (Squitti et al., 2002). In the brain, Cu is concentrated in the extracellular compartment and in the amyloid plaques, which suggest the possibility of an interaction between Cu and A (Atwood et al., 1998; Lovell et al., 1998). However, it is controversial whether Cu/A interactions increase or inhibit A aggregation (Atwood et al., 1998; Faller, 2009; Raman et al., 2005). In addition to direct Cu/A interactions, even low levels of Cu modulate A production and clearance in the brain (Singh et al., 2013). In a mouse model of AD, Cu accumulates in the brain capillaries and parenchyma, and this accumulation is related to increased A production, neuroinflammation, and reduced A clearance through the downregulation of LRP1 (Singh et al., 2013). Furthermore, oxidative stress and neuronal toxicity, induced by hydrogen peroxide and toxic hydroxyl radicals, reduce Cu(II) to Cu(I) through Cu/A interactions (Hureau and Faller, 2009). Therefore, Cu affects A production, clearance, aggregation, and fibrillization through diverse mechanisms, either directly or

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indirectly. This is a strong evidence for the role of Cu in AD pathogenesis as an inorganic binding partner of A. Furthermore, several lines of evidence suggests that Cu binds not only to A, but also to tau, and thus exacerbates both amyloid and tau pathology in AD (Kitazawa et al., 2009; Ma et al., 2005; Martic et al., 2013).

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3.2 Zinc

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Zinc (Zn) is distributed ubiquitously in the normal brain, and its level significantly increases in the brain (including the hippocampus and cortex) of patients with AD (Deibel et al., 1996;

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Religa et al., 2006). Synaptic vesicular Zn levels are regulated by the transporter, ZnT3, which is essential for memory maintenance and normal cognitive function (Adlard et al.,

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2010). Disturbed synaptic Zn levels in the ZnT3 knockout mice induce a significant decrease

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in key synaptic proteins and synaptic density in the hippocampus, and cause age-dependent deficits in learning and memory, and thus might phenocopy AD. Ever since Zn levels were

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found to be significantly higher in the serum and hippocampus of patients with AD than in

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controls (Danscher et al., 1997; Rulon et al., 2000), Zn has attracted much attention, as it was also reported to bind to A directly via a special binding site at the hydrophilic region of the N-terminus (Kozin et al., 2001). Similar to Cu or other A-interacting proteins, Zn is enriched in amyloid plaques and concentrated in the blood cells of patients with AD, and Zn/A interaction facilitates A aggregation (Mantyh et al., 1993; Suh et al., 2000). Interestingly, Zn is also involved in tau pathology by increasing tau hyperphosphorylation and aggregation (Sun et al., 2012; Xiong et al., 2013). Zn inactivates protein phosphatase (PP) 2A and induces tau hyperphosphorylation through the Src-dependent phosphorylation of PP2A at Y307 (Xiong et al., 2013). Zn was reported to elicit biphasic effects by initiating deleterious A deposition, redirecting A deposition towards amorphous aggregation, and quenching oxidative stress (Cuajungco and Faget, 2003; Huang et al., 2000; Rezaei-Ghaleh et al., 2011). Similarly, Cu/A

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complexes mediate cellular toxicity through oxidative mechanisms while they play a protective role by preventing the formation of amorphous aggregates from forming toxic fibril (Cuajungco and Faget, 2003; Suzuki et al., 2001; Yoshiike et al., 2001). Possibly, dual effects of metal ions on A-induced toxicity may occur in an A aggregation status dependent

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manner, because A monomers sequestrate metal ion-induced oxygen radicals and protect

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neurons, whereas A aggregates induce the formation of oxygen radicals and neuronal death (Hou and Zagorski, 2006; Zou et al., 2002). Bifunctional compounds with binding motifs to

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both metal (Cu, Zn) and A is used to inhibit the metal-mediated A42 aggregation and disaggregates amyloid fibrils (Sharma et al., 2012). Unexpectedly, increased formation of

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neurotoxic soluble A42 due to inhibition of A aggregation and fibril disaggregation

be the simple answer in AD.

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3.3 Iron

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increases cellular toxicity, which apply therapeutic strategy to inhibit A aggregation may not

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In contrast to the extracellular localization of Cu and Zn, iron (Fe) is accumulated intracellularly during AD pathogenesis, leading to oxidative injury and neurodegeneration through redox-generated free radicals (Bush, 2013; Smith et al., 1997). Ferroxidase activity of the neuronal ferroxidase APP, which interacts with ferroportin to export Fe from the cells, is decreased in AD via the inhibition of Zn in the extracellular amyloid mass. Therefore, there is a pathological correlation between intracellular Fe accumulation and extracellular Zn deposition in the amyloid plaques (Bush, 2013; Duce et al., 2010; Smith et al., 1997). Fe binds to the first 16 amino acid residues of A at physiological pH (Bousejra-ElGarah et al., 2011), and redox-active Fe evokes A toxicity by causing cellular oxidative stress and lipid oxidation (Rottkamp et al., 2001). Furthermore, Fe binds to tau neurofibrillary tangles, and induces oxidative stress depending on the microenvironmental redox balance (Sayre et al., 2000). Tau maintains intracellular Fe levels by regulating APP trafficking and modulating the

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ferroxidase activity of APP; therefore, cognitive impairment and parkinsonism caused by brain atrophy and Fe accumulation in the tau KO mice are completely rescued by treatment with the Fe chelator clioquinol (Bush, 2013; Lei et al., 2012). 3.4 Aluminium

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Aluminium (Al) is also a suspected risk factor for AD and the enhancement of A

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aggregation via its direct influence on aggregation and deposition processes (Kawahara et al., 1994; Neri and Hewitt, 1991). The presence of Al induced the conformational transition of

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A40 from -helical to a -sheet and also AlATP enhanced the formation of thioflavin T reactive A fibrils with a -pleated sheet conformation (Exley and Korchazhkina, 2001;

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Exley et al., 1993; House et al., 2004). Unlike Cu or Zn, Al and Fe directly influence the

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precipitation of A -sheets, and the combination of these metals with the -sheets of A promotes oxidative neurotoxicity and neurodegeneration (Exley, 2006). Al-induced AD-

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related neurotoxicity might be initiated by the modulation of anabolism and catabolism for

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APP and A and by increasing the formation of A and ubiquitin in neurons (Banks et al., 1996; Campbell et al., 2000; Exley, 2005; Korchazhkina et al., 2002). Al inhibits several proteases including the serine protease plasmin, which cleaves A, and therefore, it might inhibit the A degradation activity of plasmin (Clauberg and Joshi, 1993; Korchazhkina et al., 2002; Zatta et al., 1993).

3.5 Therapeutic strategy targeting metal ions Therapeutic candidates for AD targeting metal ions in the brain have been actively tested. The strategy of this AD therapy is to modulate the interaction between A and metal ions and to redistribute metal ions in the brain. Because Al or Fe initiates and stabilizes the assembly of the -pleated amyloid form, chelation of these metal ions would be beneficial to prevent the formation of A fibrils (House et al., 2004). Similarly, treatment with chelators that bind bioavailable Cu or Zn, such as clioquinol and PBT2, decreased A deposits and increased

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soluble A levels in a mouse model of AD (Cherny et al., 2001), and significantly improved cognitive function in a randomized, double-blinded, placebo-controlled Phase IIa clinical trial (Faux et al., 2010; Lannfelt et al., 2008). Clioquinol and PBT2 have multi-mechanistic actions, including competition for metal ions against Aβ, and activation of cellular protective

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signaling pathways by increasing the intracellular levels of these metals, as these

cr

chelator/metal complexes are easily transported across membranes (Crouch and Barnham, 2012). However, complexity of metal ion dynamics during AD pathogenesis will be the main

us

challenge in clinical trials testing therapeutic candidates targeting Cu or Zn in AD (Bayer et

an

al., 2003; Kessler et al., 2008; Lannfelt et al., 2008) (Table 1). Furthermore, considering the effects of other metal ions relevant to AD pathogenesis, including Fe and Al, dynamics of

M

various metal ions can influence not only the aggregation and metabolism of A, but also tau

d

activity during AD pathogenesis in parallel, which requires further studies.

Ac ce pt e

4. A-binding membrane components (receptors) To elicit their physiological functions, diverse forms of A need to interact with membrane proteins to signal towards intracellular compartments or to be internalized during AD pathogenesis. Probing into these events is regarded as one of the most promising ways to prevent AD or delay its pathological progression. Therefore, it is critical to understand the cellular membrane proteins that bind A, and their expression levels and propensities to interact with A to initiate cellular downstream signaling (Fig. 2). 4.1 Receptor for advanced glycation end products Receptor for advanced glycation end products (RAGE) is a single transmembrane protein that binds to multiple ligands. Ever since RAGE was reported as the cellular membrane receptor of A, RAGE-mediated cellular signaling and its consequences have attracted much attention,

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as they are especially relevant to AD pathology (Han et al., 2011b; Yan et al., 1996; Yan et al., 2000). RAGE interacts with diverse forms of A including monomeric, oligomeric, and fibrillar forms (Sturchler et al., 2008; Verdier et al., 2004); however, the oligomeric form of A activates RAGE to a greater extent than the monomer form, and initiates inflammation

ip t

and tissue damaging processes (Herold et al., 2007). Kinetic studies demonstrated that

cr

RAGE/A interaction is fairly specific with Kd values ranging from 40 to 57 nM in different cell types (Yan et al., 1998). Additionally, RAGE/A interaction is dependent upon the

us

aggregation status of A and the binding sites in RAGE. The examination of RAGE binding sites using different forms of A and various inhibitors indicated that the Vd domain of

an

RAGE is responsible for A oligomer-induced apoptosis in SHSY-5Y cells and rat cortical

(Sturchler et al., 2008).

M

neurons, whereas the C1d domain of RAGE is involved in A aggregate-induced apoptosis

d

Depending on cell types or structures, such as cerebral vessels, microglia, and neurons,

Ac ce pt e

diverse ligands activate RAGE and thus various downstream signaling events including oxidative stress, activation of extracellular signal-related kinases (ERK), p38, and nuclear factor kappa B (NF-B) (Bianchi et al., 2007; de Arriba et al., 2003; Han et al., 2011b; Huttunen et al., 1999; Origlia et al., 2008; Poelmans et al., 2011; Riehl et al., 2009; Taguchi et al., 2000; Vazzana et al., 2009; Yan et al., 1996) (Fig. 2). The RAGE/A interaction induces cellular dysfunction and cytotoxicity through different signaling events, including oxidative stress and ERK activation, and is involved in mitochondrial dysfunction, neuronal toxicity, and synaptic dysfunction induced by increased A generation, intracellular transport, and RAGE expression (Arancio et al., 2004; Cho et al., 2009; Origlia et al., 2008; Takuma et al., 2009; Yan et al., 1996). Notably, elevated RAGE expression in neurons and microglia of animal models of AD and patients with AD implies that RAGE/A interaction may act as positive feedback mechanism during AD progression (Choi et al., 2014; Yan et al., 1998).

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Furthermore, RAGE overexpression increases the amount of A deposits and plaques clearly demonstrating the deleterious effect of this membrane receptor in the pathological progression of AD (Cho et al., 2009). Besides acting as a mediator of A-induced neuronal toxicity, RAGE serves as the primary

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route for A to cross the BBB and enter the brain, which plays a critical role in AD

cr

pathogenesis (Deane et al., 2003; Deane and Zlokovic, 2007; Mackic et al., 1998; Yan et al., 1996). Peripheral A levels greatly impact A level and clearance in the central nervous

us

system; therefore, expression level and function of RAGE in the BBB is a crucial factor for

an

regulating cerebral Aβ levels (Marques et al., 2009; Sutcliffe et al., 2011). RAGE/A interactions result in the translocation of peripheral A into the brain across the BBB to

2003). Therefore, blockade of RAGE

M

increase cerebral A levels (Deane et al., 2003; Kawarabayashi et al., 2001; Matsuoka et al., in the BBB using a specific RAGE inhibitor (FPS-

d

ZM1) inhibits circulating A 40 and 42 to enter the brain, and therefore rescues from

Ac ce pt e

cognitive impairment caused by increased A40 and 42 levels in a mouse model of AD (Deane et al., 2012). Specifically, a region-specific inhibitor of RAGE may selectively antagonize a specific form of A and block a particular signaling cascade that is harmful to neurons. Additionally, interaction of A and RAGE in the BBB induced the expression of proinflammatory cytokines and endothelin-1, which might influence AD pathophysiology (Deane et al., 2003). Furthermore, another study reported that interaction of A and RAGE in cerebral endothelial cells disrupts the tight junctions in the BBB through the Ca2+-calcineurin signaling pathway, alters the integrity of microvessels close to the A plaques, and increases endothelial RAGE expression and matrix metalloprotease (MMP) secretion in a mouse model of AD (Kook et al., 2012). In addition, clinical trials for RAGE inhibitors are under investigation, including the phase III trial of TTP488 and the completed phase II trial for the oral inhibitor PF-04494700 (Burstein et al., 2014; Galasko et al., 2014; Sabbagh et al.,

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2011)(ClinicalTrials.gov identifier: NCT02080364, NCT00566397, Table 1). Therefore, RAGE regulates the cerebral A levels through diverse mechanisms. 4.2 Low-density lipoprotein receptor-related protein Low-density lipoprotein receptor-related protein (LRP) is a endocytic transmembrane

ip t

receptor with multi-ligand binding, belonged to low-density lipoprotein receptor (LDLR)

cr

family (Zerbinatti and Bu, 2005). LRP is expressed in the endothelial cells of the brain, and mediates rapid ligand endocytosis and signal transduction (Herz and Marschang, 2003; Herz

us

and Strickland, 2001; Shibata et al., 2000). Even though RAGE is the primary transporter of A across the BBB into the brain, accumulating evidence supports that LRP interacts with A

an

and is involved in the clearance of cerebral A by the endocytosis/transcytosis of A across

M

the BBB out of the brain (Deane et al., 2004; Donahue et al., 2006; Shibata et al., 2000). This LRP/A interaction and following LRP-dependent A was demonstrated in cellular context

d

of BBB, not in other cell types including fibroblasts or neuroblastoma cells expressing LRP1

Ac ce pt e

(Yamada et al., 2008). Accordingly, there is an increased expression of RAGE within the microvasculature of the hippocampus in AD compared to that in normal controls. By contrast, minimal LRP staining is observed in brains with AD, and this reduced expression correlates with regional A accumulation in such brains (Donahue et al., 2006; Shibata et al., 2000). In astrocyte, low-density lipoprotein receptor (LDLR) expressed mediate A uptake and degradation by direct interaction between LDLR and A, regardless of the presence of A (Basak et al., 2012). LDLR regulates brain A levels and the overexpression of LDLR could enhance A transport to lysosomes and promotes A degradation. LRP is also expressed in the neurons of the cortex and hippocampus (Bu et al., 1994; Tooyama et al., 1995; Wolf et al., 1992). LRP also mediates the neuronal A uptake and clearance in both a direct and indirect manner (Bu et al., 1994; Fuentealba et al., 2010; Tooyama et al., 1995). Receptor-mediated endocytosis is suggested as one of the neuronal

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mechanisms for A clearance by LRP1 (Kanekiyo et al., 2013). Conditional knockout of LRP1 exacerbate brain A levels and plaque deposition in cortex of APP/PS1 mice. Neuronal deletion of LRP1 in mice forebrain causes the breakdown of brain lipid homeostasis leading to dendritic spine loss, synaptic degeneration, memory loss, and finally neurodegeneration

ip t

(Liu et al., 2010). However, there are conflicting results on in vivo LRP study using LRP-

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overexpressing transgenic mice. Overexpression of LRP1 in the brain of PDAPP mice results in the increased soluble brain A (monomers/dimers), but not A plaque, which is

us

significantly related to spatial learning and memory deficit (Zerbinatti et al., 2004). Also followed study demonstrates that LRP1 overexpression in PDAPP mice increases membrane-

an

associated A 42 and intraneuronal A42 in the region of hippocampus or frontal cortex

M

(Zerbinatti et al., 2006). In addition, LRP influences the prion protein mediated toxicity of A oligomers by modulating cell surface interactions, the internalization process, and spreading

Ac ce pt e

4.3 Prion protein

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of intracellular toxicity mediated by A oligomers (Rushworth et al., 2013).

Prion protein (PrP) has been recently identified as a critical high affinity receptor for toxic A assemblies that mediates diverse downstream toxic events including impairments in synaptic plasticity, memory, and neuronal survival (Alier et al., 2011; Bate and Williams, 2011; Gimbel et al., 2010; Kudo et al., 2012; Lauren et al., 2009). Inhibition of long term potentiation (LTP) by A occurs in a PrP-dependent manner (Freir et al., 2011), and is mediated by A protofibrils with a triple helical nanotube structure, rather than by the monomer or oligomer forms, while A fibrils inhibit LTP in a PrP-independent manner (Nicoll et al., 2013). Considering downstream signaling, soluble A assemblies interact with cellular PrP, and this event activates Fyn, which phosphorylates the NR2B subunit of Nmethyl-D-aspartate (NMDA) receptors, and relocalizes NMDA receptors, leading to neuronal impairments (Um et al., 2012) (Fig. 2). The process also results in dendritic spine loss and

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lactate dehydrogenase release after an initial increase of NMDA receptors, followed by the loss of these receptors. Therefore, anti-cellular PrP monoclonal antibodies are suggested as a new potential therapy for AD, because these antibodies improve behavioral effects of AD in a

prevent LTP inhibition and PrP/A interaction (Freir et al., 2011).

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4.4 Ephrin type-B receptor2

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mouse model (Chung et al., 2010), and specific antibodies against helix-1 of PrP effectively

The receptor tyrosine kinase Ephrin type-B receptor2 (EphB2) is closely related with synaptic

us

function, including LTP, by modulating the NMDA-dependent Ca2+ influx and downstream transcription factors (Benilova and De Strooper, 2013; Henderson et al., 2001; Takasu et al.,

an

2002) (Fig. 2). The reduction of hippocampal EphB2 level was detected in transgenic mice

M

expressing the human APP and in the postmortem tissue from AD patients compared with non-transgenic controls and non-demented controls, respectively, suggesting the clinical

d

relevance of EphB2 in AD pathogenesis (Cisse et al., 2011; Simon et al., 2009). A

Ac ce pt e

oligomers bind directly to EphB2, and increase the proteasomal degradation of EphB2, which is another key factor of the A-mediated inhibition of LTP and subsequent memory impairment (Cisse et al., 2011; Simon et al., 2009). Increased levels of EphB2 in the dentate gyrus of mice that model AD reversed not only the impairment of NMDA receptor mediated LTP, but also memory decline (Cisse et al., 2011). 4.5 75-kD neurotrophin receptor

The 75-kD neurotrophin receptor (p75NTR), which leads to neuronal death in AD, is another receptor for specific A interactions (Yaar et al., 1997). A activates p75NTR, but not Trk, and mediates the downstream activation of the intracellular death domain of p75NTR and JNK phosphorylation, which induces apoptosis in hippocampal neurons (Diarra et al., 2009; Dinamarca et al., 2012). Similarly, p75NTR enhances A generation via the -cleavage of APP, while tyrosine kinase receptor A (TrkA), another neurotrophin receptor, reduces APP

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cleavage. A generation is increased in the brain during normal aging, which results from the upregulation of p75NTR signaling by switching from the TrkA-mediated signaling to the p75NTR-mediated signaling (Yaar et al., 1997). 4.6 Serpin-enzyme complex

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The serpin-enzyme complex (SEC) receptor is a transmembrane protein expressed on diverse

cr

cell types, and is identified as a receptor for 1-antitrypsin/elastase complexes (Joslin et al., 1992). Soluble A interacts specifically with the SEC receptors in hepatoma and neuronal

us

cells, and SEC receptors mediate the internalization and metabolism of A (Boland et al., 1995). Amino acid residues 31-35 of the A peptide are identified as the critical region for the

an

association of SEC receptor and A. Inability of the SEC receptor to bind the aggregated

M

form of A, such as A fibrils, implies that this receptor exerts beneficial effects, including

al., 1996; Verdier et al., 2004).

Ac ce pt e

4.7 Insulin receptor

d

A clearance, rather than mediating the cytotoxic effects induced by fibrillar A (Boland et

It is not surprising that A binds directly to the insulin receptor, because insulin and A shares many common features including their consensus sequence, which serves as the substrate for insulin-degrading enzymes (Kurochkin, 1998; Xie et al., 2002). A competes with insulin for binding to the insulin receptor (A: 16-26 amino acid residues, insulin: 21-30 amino acid residues), and inhibits the action of insulin, which is tightly linked to insulin resistance caused by the excessive amount of A during AD pathogenesis. In addition, A blocks insulin receptor signaling directly by inhibiting the autophosphorylation of the insulin receptor (Ling et al., 2002). 4.8 Neurotransmitter receptors Numerous neurotransmitter receptors bind A, and these associations play a critical role in neuronal function and the neurodegenerative pathophysiology of AD. The 7 nicotinic

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acetylcholine receptor (7nAChR) is a neuronal pentameric cation-selective channel complex modulating the permeability of Ca2+ and Na+ (Breese et al., 1997; Verdier et al., 2004). It is an integral membrane protein, which is highly expressed in basal cholinergic neurons projecting to the hippocampus and cortex (Breese et al., 1997). A and 7nAChR can be co-

ip t

immunoprecipitated, and both are found in neuritic plaques in the brains of patients with AD

cr

(Wang et al., 2000a). The consequence of the 7nAChR/A interaction is still controversial; both agonist- and antagonist-like effects are suggested (Dougherty et al., 2003; Liu et al.,

us

2001). Agonist-like effects are observed in the presynaptic nAChRs inducing a sustained increase in Ca2+ levels at the presynaptic terminals (Dougherty et al., 2003; Mehta et al.,

an

2009), while other studies demonstrated that A inhibits neuronal 7nAChRs in rat

M

hippocampal slices and cultures (Liu et al., 2001; Pettit et al., 2001), and prevents the Ca2+ influx in synaptosomes (Lee and Wang, 2003; Wang et al., 2009a). It has been shown recently

d

that the agonistic effect of A on the 7nAChRs in presynaptic nerve terminals is mediated

Ac ce pt e

by receptor-associated lipid rafts (Khan et al., 2010). Similarly, tau phosphorylation is stimulated by the interaction of A and 7nAChRs (Wang et al., 2003). The binding affinity between A42 and 7nAChR is exceptionally high, within the picomolar concentration range, which suggests that this interaction might serve as a precipitating factor in amyloid plaque formation contributing to the degeneration of cholinergic neurons (Wang et al., 2000b). A binds and blocks 7nAChR reversibly through the extracellular N-terminal domain of the receptor, which is a non-competitive and voltage/use-independent process (Liu et al., 2001). Recent clinical study of the novel 7nAChR agonist, ABT-126, has suggested a promising result (Gault et al., 2015) and this kind of 7nAChR agonist may show their effectiveness through dual mechanism of receptor stimulation and blocking of A binding (Table 1). The NMDA receptor is another neurotransmitter receptor that interacts with A, and this binding influences synaptic function (Danysz and Parsons, 2012). Co-immunoprecipitation

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studies revealed that the interaction between NR1 or NR2A and soluble A oligomers in present in excitatory pyramidal neurons, but not in GABAergic neurons, and the interaction induces synaptic loss (Lacor et al., 2007; Venkitaramani et al., 2007). Binding of A to the NMDA receptor influences the internalization and pathogenic effect of A, which is blocked

ip t

by NMDA receptor antagonists (Bi et al., 2002). Selective NMDA receptor antagonists

cr

inhibit not only the internalization of A, but also the upregulation of cathepsin D and microglial activation. Similarly, oxidative stress induced by A application in vivo is

us

ameliorated by NMDA receptor antagonists (Parks et al., 2001). A activates NF-B through the NMDA receptor and via activation of the NMDA-Src-Ras-like protein, mitogen-activated

an

protein kinase (MAPK), and phosphatidylinositol 3-kinase (PI3-k) signaling pathway in

M

cultured cerebellar cells, which is regarded neuroprotective in response to A (Kawamoto et

related to the integrins.

Ac ce pt e

4.9 Integrin

d

al., 2008). Furthermore, in terms of A internalization, function of NMDA receptors is tightly

Integrins are heterodimers compiled of  and  glycoprotein transmembrane subunits, and they are related to the uptake of microorganisms such as bacteria and virus. Integrins bind directly to A, and cooperate with NMDA receptors to regulate A internalization (Bi et al., 2002; Isberg and Tran Van Nhieu, 1994). As mentioned above, NMDA receptor antagonists completely block A internalization, cathepsin D upregulation, and microglia activation, while antagonists of integrins enhance these phenomena; thus, suggesting that these two receptors work cooperatively during A internalization. In particular, fibronectin receptor 51 is highly expressed in the hippocampus, and mediates the internalization of non-fibrillar A by binding to the Arg-Gly-Asp (RGD)-like sequence of A, and thus enhances A clearance (Ghiso et al., 1992; Matter et al., 1998; Sabo et al., 1995). Therefore, 51 has a protective effect against A deposition/fibrillization, A-mediated toxicity, and apoptosis.

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4.10 Leukocyte immunoglobulin-like receptor B2 Besides PrP and EphB2, leukocyte immunoglobulin-like receptor B2 (LilrB2; paired immunoglobulin-like receptor B, PirB, in mice) has recently been found to bind A oligomers directly, and is involved in memory loss and the impairment of synaptic plasticity in a

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transgenic model of AD (Kim et al., 2013). PirB (LilrB2) is a typical receptor of the

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immunoglobulin-like receptor family, and was originally thought to be expressed in a wide range of immunogenic cell types including B cells, mast cells, dendritic cells, and

us

macrophages (Takai, 2005). In the immune system, PirB inhibits receptor-mediated activation signals by interacting with other activating receptors. In addition, it contributes to major

an

histocompatibility complex (MHC) recognition (Takai, 2005). Recently, PirB has been found

M

in neurons and synapses (Atwal et al., 2008; Syken et al., 2006). Similar to EphB2, PirB inhibits LTP, alters synaptic plasticity, and induces behavioral impairments in a mouse model

d

of AD through the direct binding of PirB and A oligomers; these alterations can be rescued

Ac ce pt e

by PirB deletion (Kim et al., 2013). The downstream mechanism for the PirB/A oligomer interaction involves cofilin recruitment and activation by phosphorylation in an Adependent manner, as demonstrated in vitro and in vivo. Furthermore, alterations in cofilin phosphorylation are detected in patients with AD, which implies an AD-related role for PirB/A oligomer interaction. 4.11 Membrane lipids

A interacts not only with membrane-bound receptors, but also with the cell membrane directly. A interacts with the plasma membrane and membrane of subcellular organelles including the Golgi complex, lysosomes, and endoplasmic reticulum (Terzi et al., 1997; Waschuk et al., 2001). These interactions influence the properties (fluidity and structure) and function of the membrane through releasing lipid molecules from the neuronal plasma membrane, A fibrillogenesis, and abnormal Ca2+ entry into the cell through amyloid

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channels (Talaga and Quere, 2002). A has limited solubility in aqueous solutions, its structure is transformed into  sheets at an acidic pH, and it binds electrostatically to the outer region of the polar head group of the membrane, but does not penetrate the polar groups (Terzi et al., 1997). Similarly, A binding studies using surface plasmon resonance revealed

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that a large proportion of A is bound to membrane lipids, and this interaction disrupts the

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lipid structure and fluidity of the membrane, which might influence the localization and function of various receptors and channels on the cell membrane (Small et al., 2007). Lipid

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compositions of different membranes influence A aggregation (Waschuk et al., 2001). A fibrillogenesis is accelerated in the presence of plasma lipid vesicles as fiber bundles along

an

the bilayer, driven by the interaction of A with the lipid surface. However, interaction of A

M

with the Golgi membrane does not enhance A fibril formation; it increases membrane fluidity through possible stabilization of A by the interaction between A and lipid head

d

groups in the Golgi and induction of interfacial packing defects. Furthermore, the lipid

Ac ce pt e

composition of the membrane, including the presence of gangliosides and cholesterol, plays a critical role in amyloid formation, because GM-1 ganglioside accelerates A fibril formation by binding Aβ possibly serving as seed (Kakio et al., 2002). In the other hand, soluble form of Aβ oligomers are sequestered and bound to GM1 ganglioside on brain membranes, more rapidly compared to monomer (Hong et al., 2014). This interaction between Aβ oligomer and GM-1 ganglioside has a critical role in Aβ–mediated synaptic dysfunction because the interference of this interaction prevented the impairment of long-term potentiation in mouse hippocampus slices. Similarly, diverse factors regulate the association between A and membrane lipid, including ions of Cu2+, Zn2+, pH, and cholesterol (Curtain et al., 2003). 4.12 Amyloid precursor protein Interestingly, A interacts with its own precursor protein, APP (Lorenzo et al., 2000). APP is a type I transmembrane protein with a large extracellular domain of N-terminus and a short

Page 28 of 68

C-terminal cytoplasmic tail. APP plays diverse developmental and functional roles including synaptic activity, response to stress, and injury repair (Panegyres, 2001). In addition, APP may function as a cell surface receptor and mediate cell adhesion and neurite outgrowth (Breen et al., 1991; Kang et al., 1987; Milward et al., 1992). In cortical neurons, its binding

ip t

affinity to the toxic fibrillar A is drastically increased compared with that to the soluble A,

cr

showing a binding affinity to fibrillary A at the nanomolar concentration range (Lorenzo et al., 2000). Furthermore, neuronal toxicity of A is mediated by the APP/A interaction,

us

because APP-null neurons exhibit reduced neurotoxicity to A. This study also showed that fibrillar A binds mainly to the cell membrane associated form of APP, but a much lower

an

interaction is detected with secreted soluble APP, which implies that a certain part of the C-

M

terminal residue or the transmembrane orientation are prerequisite for APP/A interaction.

d

5. Intracellular A-interacting proteins

Ac ce pt e

In addition to the extracellular accumulation, intracellular accumulation of A is an early event in AD pathogenesis, and the region of intraneuronal A detection is more prone to the brain region of AD pathology (hippocampus and the entorhinal cortex) in mild cognitive disorder (Gouras et al., 2000; LaFerla et al., 2007). Therefore, binding partners of intracellular A would be direct targets or mediators of intracellular A toxicity. 5.1 Endoplasmic reticulum-associated A peptide binding protein Endoplasmic reticulum-associated A peptide binding protein (ERAB) binds to A and mediates A neurotoxicity, because blocking ERAB prevents A-mediated toxicity, and its overexpression enhances toxicity (Yan et al., 1997). ERAB is an intracellular polypeptide without a signal peptide or transmembrane-spanning domain, and is considered as a hydroxysteroid dehydrogenase enzyme. Co-immunoprecipitation of ERAB and A, and overexpression of neuronal ERAB in A-treated cells suggest that intracellular binding of

Page 29 of 68

ERAB with A plays a critical role in neuronal dysfunction in AD. Additionally, extracellular A exposure upregulates ERAB, and redistributes intracellular ERAB to the plasma membrane. ERAB is an intracellular target of A, and consequently induces cellular stress and apoptosis during AD pathogenesis.

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5.2 Chaperone proteins

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Chaperone proteins have been suggested to bind to A and modulate the metabolism, function, and toxicity of intracellular A. Using transgenic Caenorhabditis elegans, six

us

chaperone proteins were identified to bind to intracellular A, including two in the heat shock protein (Hsp) 70 family and three Hsp16 proteins (B-crystallin-related small heat shock

an

proteins), suggesting their direct and early functional contribution to age-associated

M

neurodegenerative diseases (Fonte et al., 2002). Furthermore, numerous small heat shock proteins, including Hsp20, Hsp27, HspB2, show extracellular expression, and colocalize with

d

A in amyloid plaques (Wilhelmus et al., 2006).

Ac ce pt e

5.3 X11-like, B-crystallin and lysozyme

Indirectly, intracellular protein binds to APP, and modulate the amyloidogenic process and metabolism of APP, which has a critical effect on AD pathogenesis. X11-like (X11L) is a neuronal adapter protein with a phosphotyrosin-binding (PTB) domain and two C-terminal PDZ domains, and suppresses the amyloidogenic process of mature APP by accumulating immature APP in the early secretory pathway (Saito et al., 2011). B-crystallin, the small heat-shock protein family, shows increased expression in brains from AD patients and immunoreactivity to B-crystallin in astrocyte and microglia is detected mainly in the area with senile plaques and neurofibrillary tangles (Renkawek et al., 1994). The core domain of B-crystallin binds to A, and prevents the A aggregation process, even though its structure is not altered upon A binding (Das et al., 2014). Lysozyme also binds to A and inhibits the A aggregation, competing with B-crystallin for inter-peptide interaction

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with different A binding dynamics.

6. Mitochondrial A-binding components Mitochondrial dysfunction is an early event observed during AD pathogenesis, and A-

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mediated mitochondrial dysfunction has been well investigated (Canevari et al., 2004;

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Tillement et al., 2011). Diverse AD-related phenomena are observed in the mitochondria, including alterations in membrane permeability, dysfunction of respiratory enzymes, altered

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mitochondrial fission/fusion balance, subsequent mitochondrial fragmentation, and abnormal localization (Casley et al., 2002; Cha et al., 2012; Moreira et al., 2002; Santos et al., 2010;

an

Wang et al., 2009b). Therefore, mitochondria are regarded as one of the main targets of A-

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mediated toxicity, and much effort has been devoted to elucidate the relevant mitochondrial proteins and their mechanisms involved in A-induced mitochondrial toxicity (Fig. 3).

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6.1 Cytochrome c oxidase

Ac ce pt e

Cytochrome c oxidase is a component of a respiratory chain enzyme complex localized in the mitochondrial inner membrane. This system utilizes electrons from NADH to maintain the membrane potential that is necessary for ATP generation. After passing electrons through this redox system, they are finally transferred to oxygen by cytochrome c oxidase in complex IV (Mick et al., 2011). Cytochrome c oxidase has 13 subunits, and, importantly, the aminoterminal region of cytochrome c oxidase subunit 1 binds to A 1-42, and aggregates Aβ in the brains with AD (Hernandez-Zimbron et al., 2012). This interaction results in a stable helixhelix structure, and induces deleterious effects during AD pathogenesis, including the impaired activity of respiratory chain complex IV and neuronal metabolic dysfunction (Hernandez-Zimbron et al., 2012). The direct binding of cytochrome c oxidase and A might explain the AD-related reduction in cytochrome c oxidase activity and the decrease of both oxidative stress and plaque formation in a transgenic animal model of AD with cytochrome c

Page 31 of 68

oxidase deficiency (Fukui et al., 2007; Pickrell et al., 2009). 6.2 A-binding alcohol dehydrogenase A-binding alcohol dehydrogenase (ABAD) is an enzyme composed of 261 amino acid residues localized in the mitochondrial matrix of neurons, and it directly interacts with

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mitochondrial A in the mitochondria of a transgenic mouse model of AD and in patients

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with AD (Chen and Yan, 2007; Lustbader et al., 2004). Interaction of ABAD and A promotes neuronal oxidative stress, mitochondrial dysfunction, and cell death, leading to

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hippocampal dysfunction and memory impairment (Lustbader et al., 2004; Pinho et al., 2014; Takuma et al., 2005). Prevention of the ABAD/A interaction ameliorates A accumulation

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in the brain, and rescues from A-mediated apoptosis, free radical production, and

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mitochondrial dysfunction in a mouse model of AD (Lustbader et al., 2004; Yao et al., 2011). Behavioral stress significantly aggravates AD-related pathologies, including oxidative stress,

d

mitochondrial dysfunction, and plaque formation, which are mediated by increased

Ac ce pt e

mitochondrial ABAD expression in the brain (Seo et al., 2011). This demonstrates that the expression level of ABAD is a critical factor for modulating A-mediated mitochondrial toxicity during AD pathogenesis.

6.3 Mitochondrial permeability transition pore Mitochondrial permeability transition pore (mPTP) is composed of several core proteins, including voltage-dependent anion channel (VDAC), mitochondrial benzodiazepine receptor, adenine nucleotide translocase (ANT), and cyclophilin D, which are localized in the outer and inner mitochondrial membranes (Halestrap et al., 2002). It plays a critical role in apoptotic and necrotic cell death, and has attracted much attention in AD, because A interacts with more than one component of the mPTP, and modulates pore opening. Cyclophilin D is a key factor that triggers the opening of mPTP by its translocation from the mitochondrial matrix to the mitochondrial inner membrane under oxidative and cellular stress

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(Andreeva et al., 1999; Connern and Halestrap, 1994; Henry-Mowatt et al., 2004). In studies, which performed genetic inactivation or deletion of cyclophilin D, mitochondrial permeability transition was regulated by cyclophilin D via modulating the sensitivity of mPTP to calcium overload and oxidative stress. Therefore, cyclophilin D deficits protect from

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stress-induced cell death (Basso et al., 2005; Schinzel et al., 2005). During AD pathogenesis,

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cyclophilin D is a mitochondrial target of A mediated by their direct interaction resulting in subsequent mitochondrial dysfunction and leading to behavioral impairments, synaptic

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dysfunction, and neuronal death. Notably, these effects can be rescued by cyclophilin D deficiency (Du et al., 2008; Du et al., 2011).

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VDAC is another interacting partner of A in the mitochondria, localized in the

M

mitochondrial outer membrane, and it mediates the transport of metabolites in and out of the mitochondria (Colombini, 2012; Hodge and Colombini, 1997). Three VDAC isoforms have

d

been described (VDAC1, 2, and 3), and VDAC1 is the most widely expressed isoform in the

Ac ce pt e

brain (Yamamoto et al., 2006). VDAC1 expression is upregulated in the cortical tissue of patients with AD and in the cerebral cortex of APP overexpressing transgenic mice. Notably, VDAC1 interacts with A and this interaction is detected both in patients with AD and various transgenic mouse models of AD (Manczak and Reddy, 2012b). Interestingly, VDAC1 interacts not only with A, but also with phosphorylated tau, which is the second major pathological hallmark of AD. The interaction of VDAC with either A or phosphorylated tau results in abnormal operation of the mitochondrial pore, and leads to impairments in oxidative phosphorylation and mitochondrial function, possibly causing neuronal death (Manczak and Reddy, 2012b). Also, recent study has shown that A interacted with VDAC1, specifically in the N-terminal region, and induced mitochondrial dysfunction and mitochondria-mediated apoptosis, which was prevented by non-cell-penetrating VDAC1 Nterminal peptide or silencing VDAC1 expression (Smilansky et al., 2015).

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6.4 Mitochondrial enzymes Mitochondrial structural abnormalities are thought to be closely related to mitochondrial functional impairments during AD progression. Furthermore, the main cause of abnormal mitochondrial structure and morphology is the imbalance between fission and fusion (Wang

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et al., 2009b; Wang et al., 2008). Diverse mitochondrial enzymes can be influenced by the

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direct interactions with A, which alter enzyme activities, followed by changes in mitochondrial structure and function, and finally result in mitochondrial impairment.

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Dynamin-related protein Drp1 is one of the main GTPase proteins that maintain mitochondrial morphology and structure by regulating mitochondrial fission, together with

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fission 1(Fis1) protein (Suen et al., 2008). Interestingly, Drp1 interacts with A in the frontal

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cortex of patients with AD and in the cerebral cortex of transgenic mouse models of AD (Manczak et al., 2011). Drp1 expression is upregulated in AD, and this increase primarily

d

occurs in the early phase of AD. Furthermore, interaction between Drp1 and A increases

Ac ce pt e

with disease progression. This finding implies that abnormal mitochondrial dynamics are early events during AD pathogenesis (Manczak et al., 2011). In a subsequent study, it was shown that Drp1 also binds to hyperphosphorylated tau in neurons with AD, leading to increased GTPase activity, abnormal mitochondrial fragmentation, mitochondrial and synaptic dysfunction, neuronal damage, and ultimately cognitive impairment in AD (Manczak and Reddy, 2012a). Additionally, subunit  of the F1F0-ATP synthase was suggested as an A-interacting mitochondrial protein (Schmidt et al., 2008). F1F0-ATP synthase, also known as complex V, is responsible for ATP production, ATP hydrolysis, and maintenance of the mitochondrial proton gradient. F1F0-ATP synthase also interacts with A at the surface of neuronal cells (Schmidt et al., 2008; von Ballmoos et al., 2009). The binding sequence of A to ATP synthase is fairly similar to that of a naturally occurring inhibitor of the ATP synthase complex in the mitochondria—inhibitor of F1, and the activity of ATP

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synthase is decreased through its interaction with A (Schmidt et al., 2008). The detailed mechanism of decreased ATP synthase activity in AD has been discovered that the direct interaction between ATP synthase subunit  and A inhibited the glycosylation with O-linked -N-acetylglucosamine at Thr432 in ATP synthase, which resulted in impairments of both

ip t

ATPase activity and ATP production (Cha et al., 2015).

cr

The mitochondrial peptidasome, known as the presequence protease (PreP), is a metallopeptidase localized to the mitochondrial matrix (Alikhani et al., 2011; Falkevall et al.,

us

2006). The human PreP homologue degrades diverse forms of A, such as A1–40 and A1– 42, by direct interaction (Alikhani et al., 2011; Falkevall et al., 2006). Mitochondrial PreP

an

activity is lower in the temporal lobe of patients with AD than in controls; however, no

M

difference was observed in the cerebellum, which is spared from the accumulation and influence of A (Alikhani et al., 2011). A accumulation and increased mitochondrial

d

oxidative stress may correlate with a decreased PreP activity in AD.

Ac ce pt e

Mitochondria are one of the most vulnerable organelles affected by A. They act as repositories for diverse molecular targets for direct A interactions that might initiate and propagate AD. Therefore, it is a promising strategy for AD therapeutics to rescue mitochondrial function by modulating the expression or function of A-interacting mitochondrial proteins or by rescuing AD-related enzymatic imbalances and dysfunctions in the mitochondria.

7. A-interacting mediators of immune activation The innate immune response in AD pathogenesis is currently considered as one of the most critical issues in the field of AD research. Many studies have aimed to determine how immune cells are triggered by A itself or A-related signaling pathways, and how immune activation, including inflammatory responses, affects AD progression (Fig. 2).

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7.1 Toll-like receptors In terms of the A-induced microglial activation and inflammatory response, toll-like receptors (TLRs) may be one of the most essential mediators of A. TLRs are pattern recognition receptors expressed abundantly on innate immune cells with a prominent immune

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reaction against pathogens (Akira, 2001; Gordon, 2002; Medzhitov, 2001). TLRs function as

cr

dimers, and often cooperate with co-receptors, such as cluster of differentiation (CD)14, to recognize pathogens (Baumann et al., 2010). TLR signaling is involved in A uptake and

us

clearance in the brain (Richard et al., 2008; Tahara et al., 2006). Notably, TLR2 is the primary A-binding receptor that initiates neuroinflammation (Liu et al., 2012). TLR2

an

activation induces inflammatory responses through diverse signaling pathways including

M

mitogen-activated protein 3 kinases (MAP3K), ERK, c-Jun N-terminal kinases (JNK), and p38 (Canton et al., 2013; Kariko et al., 2004; Strober et al., 2006) (Fig. 2). Furthermore,

d

TLR2 interacts with the fibrillar form of A and stimulates activation of microglia, which are

Ac ce pt e

critical components of AD pathogenesis (Jana et al., 2008). TLR2/fibrillar A42 engagement activates microglia, and consequently induces NO synthase, proinflammatory cytokines, and integrin markers, which are blocked in knockout animals or by the functional inhibition of TLR2 (Jana et al., 2008). Evidence suggests that both TLR2 and TLR4 are involved in the inflammatory response initiated by aggregated A, and specific antagonism of TLR2 and TLR4 causes ~50% and ~35% decrease in the A-induced response, respectively (Udan et al., 2008). Furthermore, fibrillar A fails to induce phagocytic responses and ROS production, or activate microglia without TLR2 or TLR4 function, as shown by the use of blocking antibodies in microglial cell lines or primary cultures from knockout mice (Reed-Geaghan et al., 2009). Accordingly, increased TLR2 and TLR4 expression was detected in the brains of APP-overexpressing transgenic mice and patients with AD, especially in a pattern associated with A plaque deposition in the entorhinal cortex (Letiembre et al., 2009; Walter et al.,

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2007). Additionally, TLR expression is closely associated with A-induced cellular toxicity, as A42 infusion greatly increases TLR2 expression in the hippocampus of wild type CD1 mice (Letiembre et al., 2009; Richard et al., 2008). Moreover, TLR2- and CD14-positive microglia are associated with A plaques in the cortex of APP overexpressing transgenic mice

ip t

(Letiembre et al., 2009; Richard et al., 2008). Similar to the central nervous system, clinical

cr

data shows increased TLR2 and TLR4 expression in peripheral blood mononuclear cells from patients with AD compared with that from controls (Zhang et al., 2012). Importantly,

us

microglial activation by TLR2 or TLR4 ligands increases the clearance of A in vitro and in vivo (Herber et al., 2007; Tahara et al., 2006), and a lipopolysaccharide (LPS)-derived

an

detoxified TLR4 agonist improves pathology in a mouse model of AD (Michaud et al., 2013).

M

Several mechanisms might explain this phenomenon, including the increased phagocytic activity of microglia by TLR activation or the TLR2-mediated upregulation of mouse G-

d

protein coupled formyl peptide receptor (mFPR2)-mediated A uptake (Chen et al., 2006).

Ac ce pt e

Therefore, ligands of TLR2 or 4 have been considered as new therapeutic candidates; however, it remains controversial whether TLR/A interaction, followed by microglial activation and induction of reactive oxygen species, is beneficial to AD pathology, because microglial activation is a complicated process, and can produce biphasic effects and diverse phenotypes depending on the environment (Mizuno, 2012; Morgan et al., 2005; Tahara et al., 2006; Walker and Lue, 2005).

7.2 Receptor for advanced glycation end products As discussed earlier, RAGE plays critical roles in A-mediated toxicity in neurons. This receptor is associated with the A-mediated activation of the immune response, and is localized at the surface of innate immunogenic cells (Fang et al., 2010; Yan et al., 1996). In addition, microglial RAGE/A interactions amplify inflammatory responses through microglial proliferation and migration (Fang et al., 2010; Yan et al., 1996). Microglial RAGE

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mediates A-induced synaptic dysfunction, including transient depression of basal synaptic functions and impairment of long term depression, which can be rescued by inhibiting microglial RAGE, but not by the suppression of RAGE in neurons (Origlia et al., 2010). Increased RAGE immunoreactivity was detected in the microglia of patients with AD,

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primarily in the hippocampus (Lue et al., 2001). Additionally, RAGE/A engagement

cr

increases the expression and secretion of macrophage-colony stimulating factor (M-CSF) in both microglial cell cultures and brain-derived microglia from patients with AD, with a

us

significantly greater effect in microglia derived from the brains with AD than in those from the control brains (Lue et al., 2001). Furthermore, increased levels of M-CSF and A

an

upregulate RAGE expression, forming a positive feedback loop of microglial activation

M

induced by the RAGE/A interaction and increased M-CSF expression followed by RAGE expression, which might be a critical process during AD pathophysiology. Diverse

d

downstream signaling pathways are activated by microglial RAGE activation, which are

Ac ce pt e

shown in Figure 2 (Bianchi et al., 2007; Riehl et al., 2009). 7.3 CD36

CD36, a scavenger receptor, is expressed on monocytic lineage cells, such as microglia and macrophages. It binds to ligands with a diverse range of structures, and plays a critical role in the activation of innate immune responses. This scavenger receptor is an important mediator in the pathogenesis of AD, because lack of it abolishes A-mediated oxidative stress and cerebrovascular dysfunction in APP overexpressing mice (Park et al., 2011). Furthermore, CD36 is associated with cerebral amyloid angiopathy (CAA); it increases vascular amyloid deposition, resulting in subsequent cerebrovascular damage and dysfunction leading to cognitive impairment (Park et al., 2013). Evidence shows that A fibrils activate microglia and induce the secretion of proinflammatory cytokines by interacting with a receptor complex consisting of CD36, integrin-associated protein/CD47, and 61-integrin (Bamberger et al.,

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2003). This interaction is mediated by a tyrosine kinase-based downstream signaling cascade, and both antagonists and A peptide competitors of the CD36 receptor complex abolish the A-mediated stimulation of tyrosine kinase-based signaling and interleukin 1 production (Bamberger et al., 2003; Canton et al., 2013) (Fig. 2). The activation of tyrosine kinases Lyn

ip t

and Syk induce transient calcium release, which results in protein kinase C (PKC) and protein

cr

tyrosine kinase PYK2 (calcium sensitive tyrosine kinase) and then ERK1/ERK2 activation, leading to the generation of neurotoxic products including superoxide radicals (Combs et al.,

us

1999; McDonald et al., 1997). Furthermore, engagement of fibrillar A and this receptor complex induces a phagocytic response, which is mainly driven by 1 integrin, and is distinct

an

from the typical type I and type II phagocytic mechanisms (Koenigsknecht and Landreth,

7.4 Microglial receptors

M

2004).

d

Microglial class A scavenger receptor (SR) interacts with A fibrils via its collagen-like

Ac ce pt e

domain, and plays a critical role in microglial adhesion to fibrillary A (El Khoury et al., 1996). Furthermore, SR mediates the removal and clearance of A by its binding and uptake (Paresce et al., 1996). Additionally, A is a chemotactic agonist for immune response by binding to the FPR-Like-1 (FPRL1) receptor expressed on mononuclear phagocytes (microglial cells, monocytes, and monocytic cell lines) and inflammatory cells infiltrating the cerebral amyloid plaques in patients with AD (Le et al., 2001). FPRL1 is a seventransmembrane G protein-coupled receptor, and the association of FPRL1 and A induces proinflammatory responses through the migration and activation of monocytes in humans. While the SEC receptor mediates the internalization of A in neuronal cells, FPRL1 is involved in A internalization in macrophages, binding and internalizing A, and accumulating the fibrils form (Yazawa et al., 2001).

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8. Other amyloidogenic proteins Some amyloidogenic proteins are tightly involved in protein aggregation disorders, including transthyretin, -synuclein and A. Interestingly, they interact with each other and affect protein aggregation status, which has an impact on pathophysiology of disease progression.

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Cross-seeding or cross-inhibition of aggregation is one of those outcomes for mutual

cr

interactions between amyloidogenic proteins, which is crucial to understand the neuropathological comorbidity of several neurodegenerative disorders.

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8.1 Alpha-Synuclein

Sharing some clinical and pathophysiological features has raised the possibility of molecular

an

link between A and -synuclein, the main pathological hallmarks in AD and Parkinson’s

M

disease (PD) respectively. AD environment accelerate the formation of -synuclein fibril, proved by the effect of the CSF obtained from different neurological diseases including AD

d

(Ono et al., 2007). In doubly transgenic mice of human A peptides and -synuclein, A

Ac ce pt e

enhances -synuclein accumulation, fibril formation, and furthermore neuronal deficits (Masliah et al., 2001). In the other way, in vivo study using transgenic mice demonstrates that neurodegeneration induced by -synuclein alters ubiquitin/proteasome system, increases ApoE levels and A accumulation (Gallardo et al., 2008). A, tau and -synuclein appear to interact each other and enhance the accumulation and aggregation mutually which aggravate the cognitive dysfunction in 3XTg AD mice with mutant human -synuclein transgene (Clinton et al., 2010). Direct interaction between A and -synuclein was proved by in vitro multidimensional NMR spectroscopy study and in vivo study of brains from AD/PD patient and transgenic mice, which may be the possible pathophysiological mechanism of dementia with Lewy body disease (Mandal et al., 2006; Tsigelny et al., 2008). Cross-seeding effect has been confirmed after direct interaction between A and -synuclein (Ono et al., 2012) and this process is suspected as the molecular mechanisms contributing neuropathology. However,

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the seeming conflicting results propose that -synuclein plays a role not in cross-seeding of A plaques, but in inhibiting A plaque formation in vivo (Bachhuber et al., 2015). Significant increase of forebrain A plaque load is caused by loss of -synuclein in APP transgenic mice, which also support the idea that -synuclein is not associated with cross-

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seeding of A aggregation (Kallhoff et al., 2007). In spites of these discrepancies,

cr

understanding of molecular relationship between -synuclein and A would be critical to develop effective treatment for PD and AD.

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8.2 A40 and A42

Numerous isoforms of A peptides have properties to interact with each other. Specially,

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A40 and A42 are in the center of interest because their interacting patterns and aggregating

M

status are tightly related to pathogenesis of AD. A40 interacts with A42 and affects propensity of aggregation, inhibiting A42 oligomerization, aggregation and amyloid

d

deposition (Kim et al., 2007; Murray et al., 2009; Yan and Wang, 2007). A40 interacts to

Ac ce pt e

A42 in concentration and ratio-dependent manner, changes the solubility, stability and morphological characteristics of A42 aggregates and finally inhibits the further maturation into fibrillization according to the ratio of A40 to A42 (Jan et al., 2008). Equilibrium point of the amyloid peptides has been suggested to be dependent upon the A40/A42 ratio and implicated in pathogenesis of AD. Besides affecting A42 aggregation pattern, A40-bound A42 oligomers are less toxic than A42 alone oligomers, reducing the toxicity on synapse including synaptic vesicle recycling and synaptophysin level (Bate and Williams, 2010). The possible mechanism for this less toxicity is the alleviation of cytoplasmic phospholipase A2 activation induced by A42 in synapse (Bate and Williams, 2010). BRI2 protein is type2 transmembrane protein with 266 amino acids and the two mutations in the ITM2b gene encoding BRI2 is responsible for familial British and Danish dementias which are neurodegenerative dementia characterized by neuronal loss, amyloid deposits, neurofibrillary

Page 41 of 68

tangles and cerebral amyloid angiopathy (Ghiso et al., 2006). Similar to the beneficial effect of A40, wild-type human BRI2 expression is reported to decrease A deposit in AD mouse model and bri23 released BRI2 prevents A aggregation in vitro which may mediate the antiamyloidogenic effect in vivo (Kim et al., 2008).

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8.3 Transthyretin

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Transthyretin modulates A deposition by direct interaction and co-localizes in plaques with A (Buxbaum et al., 2008). Overexpression of human transthyretin was ameliorative while

us

the removals of transthyretin expression in diverse transgenic animal models aggravate the neuropathological phenotype caused by A, which suggest that transthyretin is protective by

an

binding to A aggregates in intracellular and extracellular compartment (Buxbaum et al.,

M

2008; Choi et al., 2007). However, in spite of beneficial effect of transthyretin to A pathology, transthyretin has no effect on reduction of A deposition, rather accelerate total

Ac ce pt e

d

and vascular A deposition in the mouse model of AD (Wati et al., 2009).

9. Conclusion

A-interacting molecules influence the etiology of AD, and may become useful indicative biomarkers or therapeutic targets following alterations in their expression levels in the brain or periphery. To date, multiple clinical trials targeting A resulted in disappointing failures. Therefore, researchers have realized that A is likely not the sole cause of AD, and have sought alternative therapeutic approaches. A-interacting molecules have attracted much attention based on their association with the predominant etiological factor A. Beneficial effects of the modulation of A-interacting partners during AD pathogenesis and disease progression have further expanded the fields of clinical application for possible AD therapeutics (Table 1). Specially, peripheral blood is a dynamic environment reflecting diverse changes in molecular and cellular functions in different regions of the body. Plasma

Page 42 of 68

levels of A-interacting proteins change during AD pathogenesis, and these alterations dependent on disease progression may provide critical information as diagnostic and surrogate biomarker. Also, multiple forms of A elicit diverse effects on intracellular organelles, neurons and synapses through binding to cellular, membrane and other effector

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proteins. Thus, perturbation of these events may be the primary step to prevent the initiation

cr

or progression of AD and further utilized in therapeutic strategy. Investigation of specific A binding sites in A-interacting proteins would be helpful to inhibit or enhance interactions,

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depending on the beneficial or deleterious effects resulted from these interactions. Further binding affinity studies for molecular structure modification may provide a better

an

understanding and discovery of effective binding competitors might open promising avenues

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for the future development of AD therapeutic drugs modified from specific A-interacting

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molecules.

This

Ac ce pt e

Acknowledgement work

was

supported

by

grants

from

NRF

(2015R1A2A1A05001794,

2014M3C7A1046047, 2015M3C7A1028790 and MRC (2012R1A5A2A44671346)) for I.MJ.

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Table 1. Clinical trials targeting A-interacting molecules Table 1. Clinical trials targeting A-interacting molecules

Instituto Grifols, S.A Albumin

Instituto Grifols, S.A

RAGE

ApoE

Characterisitics A Study to Evaluate Albumin and Immunoglobulin in Alzheimer's Disease (AMBAR) Efficacy and Safety of Plasma Exchange With 5% Albutein in Beta-Amyloid Peptide Clearance in Cerebrospinal Fluid

Status

NCT number

Pfizer & Alzheimer's Disease A Phase 2 Study Evaluating The Efficacy And Safety Of Cooperative Study (ADCS) PF 04494700 In Mild To Moderate Alzheimer's Disease

Phase ൖ (Completed)

NCT00742417

Phase ൖ (Completed)

NCT00566397

MN Sabbagh et al (Alzheimer Dis Assoc Disord. 2011), Galasko D et al (Neurology. 2014)

vTv Therapeutics

Evaluation of the Efficacy and Safety of TTP488 in Patients With Mild Alzheimer's Disease

Phase ൗ (Recruiting)

NCT02080364

AH Burstein et al (BMC Neurol. 2014)

The Cleveland Clinic

Bexarotene Amyloid Treatment for Alzheimer's Disease (BEAT-AD)

Phase ൖ (Completed)

NCT01782742

Dai W et al (Neurodegener Dis. 2014), Aicardi G et al (Rejuvenation Res. 2013), etc.

NCT00608946

TA Bayer et al (Proc Natl Acad Sci USA. 2003), H Kessler et al (J Neural Transm. 2008)

Copper, Zinc

us

University Hospital, Saarland & Treatment With Copper in Patients With Mild Alzheimer´s Phase ൖ (Completed) University of Goettingen Dementia

Adeona Pharmaceuticals

Trial of Novel Oral Zinc Cysteine Preparation in Alzheimer's Disease

Prana Biotechnology Limited

Study Evaluating the Safety, Tolerability and Efficacy of PBT2 in Patients With Early Alzheimer's Disease

Phase ൖ (Completed)

NCT00471211

L Lannfelt et al (Lancet Neurol. 2008)

AbbVie

Evaluate the Efficacy and Safety of ABT-126 in Subjects Phase ൖ (Completed) with Mild to Moderate Alzheimer's Disease

NCT00948909

LM Gault et al (Alzheimers Dement. 2015)

an

Unknown

NCT01099332

M

7- nAchR

Relevant Publications

Phase ൖ & ൗ trial (Recruiting) NCT01561053

ip t

Company/Sponsors

cr

Molecules



Ac ce pt e

d

Data obtained from www.clinicaltrials.gov

      

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Ac ce pt e

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Figure 1. Diverse A-interacti A ing moleculles in differeent regions of body com mpartmentss

Abbrevviations: SA AP, serum amyloid a P componentt; ApoE, Apolipoprote A ein E; HDL L, highdensity lipoproteinn; RAGE, receptor r forr advanced d glycation end-produccts; TLR2, toll-like n; PrP, prion n protein; Ep EphB2, Ephrrin typereceptorr 2; LRP, lipoprotein receptor-relaated protein B recepptor 2; AP PP, amyloid precursoor protein; NMDA, N-methyl-D N D-aspartate; ERAB, endoplaasmic reticuulum-associiated amylooid beta; Ap poJ, Apolip poprotein J;; LilrB2, leeukocyte immunooglobulin-liike recepto or subfamilly B; 7nA AChR, alph ha-7 nicotinnic recepto or; SEC receptorr, serpin-ennzyme comp plex receptoor; p75NTR R, p75 neurotrophin receeptor

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Ac ce pt e

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Figure 22. A-binding membraane receptorrs in neuron and microg glia.

Abbrevviations: SEC receptor, serpin-enzzyme compllex receptorr; PirB, pairred Ig-like receptor B; p75N NTR, p75 neurotrophi n in receptor;; PrP, prion n protein; NMDA, N N-m methyl-D-asspartate; EphB2,, Ephrin typpe-B recepto or 2; 7nAC ChR, alpha--7 nicotinic acetylcholiine receptorr; RAGE, receptorr for advannced glycattion end-prooducts; TL LR2, toll-lik ke receptor 2; JNK, c-Jun c Nterminaal kinase; p38-MAPK, p , p38-mitoggen-activateed protein kinase; k NF--B, nucleaar factor kappa B B; PI3K, phhosphoinosittide 3-kinasse; ERK, ex xtracellular signal-regul s lated kinasees; PKC, protein kinase C; PYK2, P calciium sensitivve tyrosine kinase k 2

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Ac ce pt e

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Figure 33. Mitochonndrial A-biinding compponents

Abbrevviations: TO OM, translo ocase of thhe outer membrane; m ABAD, A A binding alcohol dehydroogenase; AN NT, adenine nucleotidde translocaator; hPreP, human preesequence protease; p VDAC,, voltage-deependent an nion channnel; Fis1, fission f proteein 1; Drp 1, dynamin n-related protein 1

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Abbreviation list.

AD: Alzheimer’s Disease A: amyloid beta

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ADAS-Cog : Alzheimer’s Disease Assessment Scale-cognitive subscale MMSE: Mini-Mental State Examination

cr

ApoE: Apolipoprotein E

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APP: amyloid precursor protein BBB: blood brain barrier

an

RXR: retinoid X receptor

PPAR: peroxisome proliferator-activated receptor gamma

M

LXR: liver X receptor ApoJ: apolipoprotein J

Ac ce pt e

HDL: high density lipoproteins

d

LRP: low-density lipoprotein receptor-related protein

SAP: serum amyloid P component PP2A: protein phosphatase 2A

RAGE: receptor for advanced glycation end products ERK: extracellular signal-related kinases NF-B: nuclear factor kappa B MMP: matrix metalloprotease

NMDA: N-methyl-D-aspartate

p75NTR: the 75-kD neurotrophin receptor TrkA: tyrosine kinase receptor A SEC receptor: serpin-enzyme complex receptor 7nAChR: 7 nicotinic acetylcholine receptor

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MAPK: mitogen-activated protein kinase PI3-k: phosphatidylinositol 3-kinase EphB2: ephrin type-B receptor 2 PrP: prion protein

ERAB: endoplasmic reticulum-associated A peptide binding protein

cr

PTB domain: phosphotyrosin-binding domain

mPTP: mitochondrial permeability transition pore

an

ABAD: A-binding alcohol dehydrogenase VDAC: voltage-dependent anion channel

d

Ac ce pt e

Drp1: dynamin related protein 1

M

ANT: adenine nucleotide translocase

hPreP: presequence protease

us

Hsp: heat shock protein

TOM: translocase of the outer membrane

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LilrB2(PriB): leukocyte immunoglobulin-like receptor B2

Fis 1: fission protein 1

PreP: presequence protease TLR: toll-like receptor

MAP3K: mitogen-activated protein 3 kinases JNK: c-Jun N-terminal kinases

mFPR2: mouse G-protein coupled formyl peptide receptor M-CSF: macrophage-colony stimulating factor CAA: cerebral amyloid angiopathy PKC: protein kinase C PYK2: calcium sensitive tyrosine kinase SR: scavenger receptor

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Highlights

z A-interacting proteins in the blood and brain

z Intracellular A-binding proteins z Mitochondrial A-binding components

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z A-interacting mediators of immune activation

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z A-binding membrane components (receptors)

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z A-interacting metal ions

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z Other amyloidogenic proteins

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