Current and future treatments for Alzheimer's disease
Open accessAbstract
Alzheimer's dementia (AD) is increasingly being recognized as one of the most important medical and social problems in older people in industrialized and non-industrialized nations. To date, only symptomatic treatments exist for this disease, all trying to counterbalance the neurotransmitter disturbance. Three cholinesterase inhibitors (CIs) are currently available and have been approved for the treatment of mild to moderate AD. A further therapeutic option available for moderate to severe AD is memantine, an N-methyl-D-aspartate receptor noncompetitive antagonist. Treatments capable of stopping or at least effectively modifying the course of AD, referred to as 'disease-modifying' drugs, are still under extensive research. To block the progression of the disease they have to interfere with the pathogenic steps responsible for the clinical symptoms, including the deposition of extracellular amyloid β plaques and intracellular neurofibrillary tangle formation, inflammation, oxidative damage, iron deregulation and cholesterol metabolism. In this review we discuss current symptomatic treatments and new potential disease-modifying therapies for AD that are currently being studied in phase I-III trials.
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Aβ peptides with A38, A40, and A42 are generated after sequential breakdown of amyloid precursor protein (APP) by β- and γ-secretase.
“After the sequential breakdown of the big precursor protein amyloid precursor protein (APP) by the β- and γ-e -secretase, Aβ peptides with A38, A40, and A42 being the most prevalent forms are generated (Yiannopoulou et al., 2013).”
From An update on the novel and approved drugs for Alzheimer disease (2022) · cites this paper as Yiannopoulou et al., 2013
Memantine is a non-competitive NMDA receptor antagonist that counteracts the negative effects of high glutamate concentrations in the brain.
“Memantine is known to be a non-competitive NMDA receptor antagonist that counteracts the negative effects of high glutamate concentrations in the brain (Yiannopoulou et al., 2013).”
From An update on the novel and approved drugs for Alzheimer disease (2022) · cites this paper as Yiannopoulou et al., 2013
Passive antibody immunotherapy using monoclonal antibodies is the most efficient and prospective class; its chief disadvantages are cerebral microhemorrhages and vasogenic edema.
“The most efficient and prospective class is passive Ab immunotherapy using mAbs. The chief disadvantages of this class of medicines are cerebral microhemorrhages and vasogenic edema (Yiannopoulou et al., 2013).”
From An update on the novel and approved drugs for Alzheimer disease (2022) · cites this paper as Yiannopoulou et al., 2013
Memantine is a noncompetitive low-affinity NMDA-receptor open-channel blocker and affects glutamatergic transmission.
“Memantine is a noncompetitive low-affinity NMDA-receptor open-channel blocker and affects glutamatergic transmission.5”
From Current and Future Treatments in Alzheimer Disease: An Update (2020) · cites this paper as [5]
Acetylcholinesterase inhibitors reduce the breakdown of acetylcholine in the brain by inhibiting acetylcholinesterase in the synaptic cleft.
“AChEIs attempt at reducing the breakdown of acetylcholine levels in the brain of the patients with AD by inhibiting the responsible enzyme acetylcholinesterase in the synaptic cleft.5”
From Current and Future Treatments in Alzheimer Disease: An Update (2020) · cites this paper as [5]
According to the amyloid hypothesis, Aβ production in the brain initiates a cascade of events leading to the clinical syndrome of Alzheimer disease.
“According to the “amyloid hypothesis” Aβ production in the brain initiates a cascade of events leading to the clinical syndrome of AD.”
From Current and Future Treatments in Alzheimer Disease: An Update (2020) · cites this paper as [5]
The primary histopathologic lesions of Alzheimer disease are extracellular amyloid plaques and intracellular Tau neurofibrillary tangles (NFTs).
“The basic pathophysiology and neuropathology of AD that drives the current research suggests that the primary histopathologic lesions of AD are the extracellular amyloid plaques and the intracellular Tau neurofibrillary tangles (NFTs).5”
From Current and Future Treatments in Alzheimer Disease: An Update (2020) · cites this paper as [5]
The elements of the amyloid cascade include local inflammation, oxidation, excitotoxicity (excessive glutamate), and tau hyperphosphorylation.
“The elements of the cascade include local inflammation, oxidation, excitoxicity (excessive glutamate), and tau hyperphosphorylation.5”
From Current and Future Treatments in Alzheimer Disease: An Update (2020) · cites this paper as [5]
The acetylcholinesterase inhibitors approved for Alzheimer disease are donepezil, galantamine, and rivastigmine.
“The acetylocholinesterase inhibitors (AChEIs) which are approved for the treatment of AD are donepezil, galantamine, and rivastigmine.4,5”
From Current and Future Treatments in Alzheimer Disease: An Update (2020) · cites this paper as [5]
Neurotoxicity is mainly attributed to the forming of amyloid oligomers, which initiates the amyloid cascade.
“It is the forming of amyloid oligomers to which neurotoxicity is mainly attributed and initiates the amyloid cascade.”
From Current and Future Treatments in Alzheimer Disease: An Update (2020) · cites this paper as [5]
Progressive neuronal destruction leads to shortage and imbalance between various neurotransmitters and to the cognitive deficiencies seen in Alzheimer disease.
“Progressive neuronal destruction leads to shortage and imbalance between various neurotransmitters (eg, acetylcholine, dopamine, serotonin) and to the cognitive deficiencies seen in AD.5”
From Current and Future Treatments in Alzheimer Disease: An Update (2020) · cites this paper as [5]
Memantine is approved for moderate to severe Alzheimer disease.
“A further therapeutic agent approved for moderate to severe AD is the low-to-moderate affinity, noncompetitive N-methyl-d-aspartate (NMDA) receptor antagonist memantine.4,5”
From Current and Future Treatments in Alzheimer Disease: An Update (2020) · cites this paper as [5]
APP cleavage by α-secretase leads to the nonamyloidogenic pathway, whereas APP cleavage by β-secretase (BACE1) leads to the amyloidogenic pathway.
“The APP cleavage by α-secretase leads to nonamyloidogenic pathway, whereas APP cleavage by β-secretase (BACE1) leads to amyloidogenic pathway.”
From Current and Future Treatments in Alzheimer Disease: An Update (2020) · cites this paper as [5]
Aβ derives from APP through sequential proteolysis by β-secretase (BACE1) in the extracellular domain and γ-secretase in the transmembrane region.
“The Aβ derives from a protein overexpressed in AD, APP through sequential proteolysis by β-secretase (BACE1) in the extracellular domain and γ-secretase in the transmembrane region.”
From Current and Future Treatments in Alzheimer Disease: An Update (2020) · cites this paper as [5]
Sequential cleavage of APP by BACE1 in the extracellular and γ-secretase in the transmembrane area results in Aβ production.
“Sequential cleavage of APP by BACE1 in the extracellular and γ-secretase in the transmembrane area results in the Aβ production.”
From Current and Future Treatments in Alzheimer Disease: An Update (2020) · cites this paper as [5]
The crucial step in Alzheimer disease pathogenesis is the production of amyloid Aβ, which forms senile plaques (insoluble and proteolysis-resistant fibrils).
“The crucial step in AD pathogenesis is the production of amyloid (Aβ), which forms SPs (insoluble and proteolysis-resistant fibrils).”
From Current and Future Treatments in Alzheimer Disease: An Update (2020) · cites this paper as [5]
Aβ40 is somewhat aggregation-prone and is mostly found in the cerebral vasculature as a main component of cerebral amyloid angiopathy.
“Aβ40 is somewhat aggregation-prone and it is mostly found in the cerebral vasculature as a main component of “cerebral amyloid angiopathy.””
From Current and Future Treatments in Alzheimer Disease: An Update (2020) · cites this paper as [5]
Oligomers can form Aβ-fibrils that eventually form amyloid plaques.
“Oligomers can form Aβ-fibrils that will eventually form amyloid plaques.”
From Current and Future Treatments in Alzheimer Disease: An Update (2020) · cites this paper as [5]
Major sites of γ-secretase cleavage usually occur at positions 40 and 42 of Aβ, so Aβ40 and Aβ42 oligomers are the main products of sequential APP cleavage, as the amyloidogenic pathway is favored in neurons because of greater plentifulness of BACE1.
“Major sites of γ-secretase cleavage usually occur in positions 40 and 42 of Aβ, thus Aβ40 and Aβ42 oligomers are the main products of the sequential APP cleavage, as the amyloidogenic pathway is favored in neurons because of the greater plentifulness of BACE1.”
From Current and Future Treatments in Alzheimer Disease: An Update (2020) · cites this paper as [5]
Aβ40 usually constitutes more than 50% of total detected Aβ.
“Aβ40 usually constitutes more than 50% of total detected Aβ.”
From Current and Future Treatments in Alzheimer Disease: An Update (2020) · cites this paper as [5]
γ-secretase acts on many other substances and cleaves different transmembrane proteins, including Notch receptor 1, which is essential for control of normal cell differentiation and communication.
“Unluckily, concerning γ-secretase, in addition to APP, this particular enzyme acts on many other substances and cleaves different transmembrane proteins. Notch receptor 1, which is essential for control of normal cell differentiation and communication, is among them.5”
From Current and Future Treatments in Alzheimer Disease: An Update (2020) · cites this paper as [5]
Aβ42 is the most aggregation-prone form and has the tendency to cluster into oligomers.
“Aβ42 is the most aggregation-prone form and has the tendency to cluster into oligomers.”
From Current and Future Treatments in Alzheimer Disease: An Update (2020) · cites this paper as [5]
Aβ38 is soluble and present in the vasculature of patients with sporadic and familial Alzheimer disease.
“Aβ38 is soluble, present in the vasculature of patients with sporadic and familial AD.”
From Current and Future Treatments in Alzheimer Disease: An Update (2020) · cites this paper as [5]
The nonamyloidogenic processing is more favored in other cells without BACE1 predominance.
“On the contrary, the nonamyloidogenic processing is more favored in other cells without BACE1 predominance.5”
From Current and Future Treatments in Alzheimer Disease: An Update (2020) · cites this paper as [5]
Cerebral microhemorrhages and vasogenic edema are the main drawbacks in passive Aβ immunotherapy via monoclonal antibodies.
“Cerebral microhemorrhages and vasogenic edema are the main drawbacks in this group of agents.5”
From Current and Future Treatments in Alzheimer Disease: An Update (2020) · cites this paper as [5]
Abnormal accumulation or dyshomeostasis of metal ions such as iron, copper, and zinc has been associated with the pathophysiology of Alzheimer disease.
“Abnormal accumulation or dyshomeostasis of metal ions such as iron, copper, and zinc has been associated with the pathophysiology of AD.5”
From Current and Future Treatments in Alzheimer Disease: An Update (2020) · cites this paper as [5]
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- Authors
- Yiannopoulou, K. G., & Papageorgiou, S. G.
- Affiliations
- Laiko General Hospital of Athens (GR)
- National and Kapodistrian University of Athens (GR)
- Venue
- Therapeutic Advances in Neurological Disorders
- Publisher
- SAGE Publications
- Published
- 2012-10-15
- Volume
- 6
- Issue
- 1
- Pages
- 19-33
- ISSN
- 1756-2856 (ISSN-L)
- 1756-2864
- PMC
- PMC3526946
- OpenAlex
- W1987204546
- Cited by
- 677
- References
- 83
- Citations by year
- 2026: 35 · 2025: 55 · 2024: 66 · 2023: 70 · 2022: 84 · 2021: 81 · 2020: 83 · 2019: 61 · 2018: 45 · 2017: 37 · 2016: 27 · 2015: 9 · 2014: 9 · 2013: 14
- FWCI
- 6.86
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Therapeutic Advances in Neurological Disorders (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Pharmacology › Cholinesterase and Neurodegenerative Diseases
- Keywords
- Alzheimer's disease, cholinesterase inhibitors, memantine, disease-modifying therapy, symptomatic treatment, amyloid plaques, neurofibrillary tangles, oxidative stress, neuroinflammation, cholesterol metabolism, NMDA receptor antagonists, clinical trials
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