Cited by 953Alzheimer's disease research and treatmentsIntracerebral and Subarachnoid Hemorrhage ResearchCerebrospinal fluid and hydrocephalus

Cerebral amyloid angiopathy and Alzheimer disease — one peptide, two pathways

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Greenberg, Steven M., Bacskai, Brian J., Hernandez-Guillamon, Mar, Pruzin, Jeremy, Sperling, Reisa, van Veluw, Susanne J.·2020·Nature Reviews Neurology

Abstract

The shared role of amyloid-β (Aβ) deposition in cerebral amyloid angiopathy (CAA) and Alzheimer disease (AD) is arguably the clearest instance of crosstalk between neurodegenerative and cerebrovascular processes. The pathogenic pathways of CAA and AD intersect at the levels of Aβ generation, its circulation within the interstitial fluid and perivascular drainage pathways and its brain clearance, but diverge in their mechanisms of brain injury and disease presentation. Here, we review the evidence for and the pathogenic implications of interactions between CAA and AD. Both pathologies seem to be driven by impaired Aβ clearance, creating conditions for a self-reinforcing cycle of increased vascular Aβ, reduced perivascular clearance and further CAA and AD progression. Despite the close relationship between vascular and plaque Aβ deposition, several factors favour one or the other, such as the carboxy-terminal site of the peptide and specific co-deposited proteins. Amyloid-related imaging abnormalities that have been seen in trials of anti-Aβ immunotherapy are another probable intersection between CAA and AD, representing overload of perivascular clearance pathways and the effects of removing Aβ from CAA-positive vessels. The intersections between CAA and AD point to a crucial role for improving vascular function in the treatment of both diseases and indicate the next steps necessary for identifying therapies.

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  • Brains from COVID patients also show ischemic and hemorrhagic lesions, as well as microglial activation, which can be seen in many AD patients with cerebral amyloid angiopathy.

    “Additionally, brains from COVID patients also show ischemic and hemorrhagic lesions, as well as microglial activation [79], which can be seen in many AD patients with cerebral amyloid angiopathy [80].”

    From What would it take to prove that a chronic infection is a causal agent in Alzheimer’s disease? (2025) · cites this paper as [80]

    The “Brain injury in CAA and AD” section describes hemorrhagic and presumed ischemic CAA-related lesions and says CAA and AD frequently co-occur. It does not establish microglial activation as a common feature in these patients; instead, it says inflammation does not seem to be a major component of CAA-related microhemorrhage or microinfarction, apart from an autoimmune subtype. The COVID-patient findings are cited separately to [79], not to this source. (LLM, conf=0.87)

    Experimental — accuracy not yet measured
  • Vascular deposits of Aβ peptides (amyloid angiopathy) are increasingly recognized as a common pathology in Alzheimer's disease cases.

    “Recently, vascular deposits of Aβ peptides (amyloid angiopathy) are increasingly recognized as a common pathology in AD cases, supporting that Aβ peptides circulate within the interstitial fluid, including CSF, and blood vessels through perivascular (e.g. lymphatic) drainage pathways during the crosstalk between the brain and the vascular system [77].”
  • Aβ peptides circulate within the interstitial fluid, including CSF, and blood vessels through perivascular drainage pathways during brain-vascular crosstalk.

    “Recently, vascular deposits of Aβ peptides (amyloid angiopathy) are increasingly recognized as a common pathology in AD cases, supporting that Aβ peptides circulate within the interstitial fluid, including CSF, and blood vessels through perivascular (e.g. lymphatic) drainage pathways during the crosstalk between the brain and the vascular system [77].”
  • Inflammation does not seem to be a major component in CAA-related microhemorrhage or microinfarction, with the exception of a rare clinical subtype: CAA-related inflammation.

    “Inflammation does, however, not seem to be a major component in CAA-related microhemorrhage or microinfarction [38], with the exception of a rare clinical subtype: CAA-related inflammation [6].”
  • AQP4 plays a vital role in glymphatic Aβ clearance in AD brain parenchyma.

    “AQP4 levels are reduced in CAA; since AQP4 plays a vital role in glymphatic Aβ clearance in AD brain parenchyma, this consequently impairs Aβ clearance [606, 608].”

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Research works printed but not linked: 1

  1. [191]Cummings JL ABBY: A phase 2 randomized trial of crenezumab in mild to moderate Alzheimer disease. Neurology 90, e1889– e1897 (2018). 29695589 PMC5962917

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Authors
Greenberg, S. M., Bacskai, B. J., Hernandez-Guillamon, M., Pruzin, J., Sperling, R., & van Veluw, S. J.
Affiliations
  • Harvard University (US)
  • Brigham and Women's Hospital (US)
Corresponding author
Greenberg, Steven M.
Venue
Nature Reviews Neurology
Published
2019-12-11
Volume
16
Issue
1
Pages
30-42
ISSN
  • 1759-4758 (ISSN-L)
  • 1759-4766
OpenAlex
W2995183059
Cited by
947
References
232
Citations by year
2026: 146 · 2025: 198 · 2024: 179 · 2023: 154 · 2022: 113 · 2021: 104 · 2020: 52
FWCI
7.92
Type
journal article
Language
en
Open access
Locations
  • Nature Reviews Neurology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute on Aging (R01AG026484)
  • National Institute of Neurological Disorders and Stroke (RF1NS110054, R01NS096730, U24NS100591)
Topics
  • Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
  • Health Sciences › Medicine › Neurology › Intracerebral and Subarachnoid Hemorrhage Research
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Cerebrospinal fluid and hydrocephalus
Keywords
cerebral amyloid angiopathy, Alzheimer's disease, amyloid-beta, amyloid-beta clearance, amyloid-related imaging abnormalities, anti-amyloid immunotherapy, vascular function
MeSH terms
Alzheimer Disease, Brain, Humans, Signal Transduction, Amyloid beta-Peptides, Cerebral Amyloid Angiopathy, Plaque, Amyloid

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