Cited by 457Alzheimer's disease research and treatmentsDementia and Cognitive Impairment ResearchNeuroinflammation and Neurodegeneration Mechanisms

Deciphering the mechanism underlying late-onset Alzheimer disease

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Krstic, Dimitrije, Knuesel, Irene·2013·Nature Reviews Neurology

Abstract

Drug development efforts for late-onset Alzheimer disease (AD) have met with disappointing results. Krstic and Knuesel argue for a re-evaluation of pathological mechanisms underlying the disease, with a shift of focus away from amyloid-β as the key therapeutic target. Through integration of their own research with the wider literature, they present a model that places inflammation and impairments in axonal functions and integrity at the heart of AD pathology. Despite tremendous investments in understanding the complex molecular mechanisms underlying Alzheimer disease (AD), recent clinical trials have failed to show efficacy. A potential problem underlying these failures is the assumption that the molecular mechanism mediating the genetically determined form of the disease is identical to the one resulting in late-onset AD. Here, we integrate experimental evidence outside the 'spotlight' of the genetic drivers of amyloid-β (Aβ) generation published during the past two decades, and present a mechanistic explanation for the pathophysiological changes that characterize late-onset AD. We propose that chronic inflammatory conditions cause dysregulation of mechanisms to clear misfolded or damaged neuronal proteins that accumulate with age, and concomitantly lead to tau-associated impairments of axonal integrity and transport. Such changes have several neuropathological consequences: focal accumulation of mitochondria, resulting in metabolic impairments; induction of axonal swelling and leakage, followed by destabilization of synaptic contacts; deposition of amyloid precursor protein in swollen neurites, and generation of aggregation-prone peptides; further tau hyperphosphorylation, ultimately resulting in neurofibrillary tangle formation and neuronal death. The proposed sequence of events provides a link between Aβ and tau-related neuropathology, and underscores the concept that degenerating neurites represent a cause rather than a consequence of Aβ accumulation in late-onset AD.

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Crossref · 10.1038/nrneurol.2012.236

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  1. Malamud, N. & Hirano, A. Atlas of Neuropathology 2 nd edn 314-327 (University of California Press, Berkley, Los Angeles, London, 1974).

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Authors
Krstic, D., & Knuesel, I.
Affiliations
University of Zurich (CH)
Venue
Nature Reviews Neurology
Published
2012-11-27
Volume
9
Issue
1
Pages
25-34
ISSN
  • 1759-4758 (ISSN-L)
  • 1759-4766
OpenAlex
W1964117773
Cited by
457
References
143
Citations by year
2026: 8 · 2025: 11 · 2024: 23 · 2023: 23 · 2022: 31 · 2021: 35 · 2020: 27 · 2019: 35 · 2018: 41 · 2017: 47 · 2016: 54 · 2015: 49 · 2014: 52 · 2013: 20 · 2012: 1
FWCI
4.25
Type
journal article
Language
en
Open access
Locations
  • Nature Reviews Neurology (publishedVersion, other-oa)
  • PubMed (publishedVersion)
  • Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
  • Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
  • Zurich Open Repository and Archive (University of Zurich)
Funders
  • National Science Foundation (310030)
  • Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (132629, 310030)
  • Olga Mayenfisch Stiftung
Topics
  • Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Life Sciences › Neuroscience › Neurology › Neuroinflammation and Neurodegeneration Mechanisms
Keywords
late-onset Alzheimer's disease, amyloid-beta, tau hyperphosphorylation, neuroinflammation, axonal integrity, axonal transport, mitochondrial accumulation, neurofibrillary tangles, neurite degeneration, amyloid precursor protein, drug development failure
MeSH terms
Aged, Alzheimer Disease, Animals, Brain, Disease Models, Animal, Humans, Amyloid beta-Peptides, Neurites, Neurofibrillary Tangles, tau Proteins, Cell Death, Disease Progression, Inflammation Mediators, Mice, Proteostasis Deficiencies

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