Souvenaid in the Management of Mild Cognitive Impairment: An Expert Consensus Opinion

Background Mild cognitive impairment (MCI) among an aging global population is a growing challenge for healthcare providers and payers. In many cases, MCI is an ominous portent for dementia. Early and accurate diagnosis of MCI provides a window of opportunity to improve the outcomes using a personalized care plan including lifestyle modifications to reduce the impact of modifiable risk factors (for example, blood pressure control and increased physical activity), cognitive training, dietary advice, and nutritional support. Souvenaid is a once-daily drink containing a mixture of precursors and cofactors (long-chain omega-3 fatty acids, uridine, choline, B vitamins, vitamin C, vitamin E, and selenium), which was developed to support the formation and function of neuronal membranes and synapses. Healthcare providers, patients, and carers require expert advice about the use of Souvenaid. Methods An international panel of experts was convened to review the evidence and to make recommendations about the diagnosis and management of MCI, identification of candidates for Souvenaid, and use of Souvenaid in real-world practice. This article provides a summary of the expert opinions and makes recommendations for clinical practice and future research. Summary of opinion Early diagnosis of MCI requires the use of suitable neuropsychological tests combined with a careful clinical history. A multimodal approach is recommended; dietary and nutritional interventions should be considered alongside individualized lifestyle modifications. Although single-agent nutritional supplements have failed to produce cognitive benefits for patients with MCI, a broader nutritional approach warrants consideration. Evidence from randomized controlled trials suggests that Souvenaid should be considered as an option for some patients with early Alzheimer’s disease (AD), including those with MCI due to AD (prodromal AD). Conclusion Early and accurate diagnosis of MCI provides a window of opportunity to improve the outcomes using a multimodal management approach including lifestyle risk factor modification and consideration of the multinutrient Souvenaid

Promoting tau secretion and propagation by hyperactive p300/CBP via autophagy-lysosomal pathway in tauopathy.

BackgroundThe trans-neuronal propagation of tau has been implicated in the progression of tau-mediated neurodegeneration. There is critical knowledge gap in understanding how tau is released and transmitted, and how that is dysregulated in diseases. Previously, we reported that lysine acetyltransferase p300/CBP acetylates tau and regulates its degradation and toxicity. However, whether p300/CBP is involved in regulation of tau secretion and propagation is unknown.MethodWe investigated the relationship between p300/CBP activity, the autophagy-lysosomal pathway (ALP) and tau secretion in mouse models of tauopathy and in cultured rodent and human neurons. Through a high-through-put compound screen, we identified a new p300 inhibitor that promotes autophagic flux and reduces tau secretion. Using fibril-induced tau spreading models in vitro and in vivo, we examined how p300/CBP regulates tau propagation.ResultsIncreased p300/CBP activity was associated with aberrant accumulation of ALP markers in a tau transgenic mouse model. p300/CBP hyperactivation blocked autophagic flux and increased tau secretion in neurons. Conversely, inhibiting p300/CBP promoted autophagic flux, reduced tau secretion, and reduced tau propagation in fibril-induced tau spreading models in vitro and in vivo.ConclusionsWe report that p300/CBP, a lysine acetyltransferase aberrantly activated in tauopathies, causes impairment in ALP, leading to excess tau secretion. This effect, together with increased intracellular tau accumulation, contributes to enhanced spreading of tau. Our findings suggest that inhibition of p300/CBP as a novel approach to correct ALP dysfunction and block disease progression in tauopathy

Population-based neuropathological studies of dementia: design, methods and areas of investigation – a systematic review

Background Prospective population-based neuropathological studies have a special place in dementia research which is under emphasised. Methods A systematic review of the methods of population-based neuropathological studies of dementia was carried out. These studies were assessed in relation to their representativeness of underlying populations and the clinical, neuropsychological and neuropathological approaches adopted. Results Six studies were found to be true population-based neuropathological studies of dementia in the older people: the Hisayama study (Japan); Vantaa 85+ study (Finland); CC75C study (Cambridge, UK); CFAS (multicentre, UK); Cache County study (Utah, USA); HAAS (Hawaï, USA). These differ in the core characteristics of their populations. The studies used standardised neuropathological methods which facilitate analyses on: clinicopathological associations and confirmation of diagnosis, assessing the validity of hierarchical models of neuropathological lesion burden; investigating the associations between neuropathological burden and risk factors including genetic factors. Examples of findings are given although there is too little overlap in the areas investigated amongst these studies to form the basis of a systematic review of the results. Conclusion Clinicopathological studies based on true population samples can provide unique insights in dementia. Individually they are limited in power and scope; together they represent a powerful source to translate findings from laboratory to populations

A precision medicine initiative for Alzheimer's disease: the road ahead to biomarker-guided integrative disease modeling

After intense scientific exploration and more than a decade of failed trials, Alzheimer’s disease (AD) remains a fatal global epidemic. A traditional research and drug development paradigm continues to target heterogeneous late-stage clinically phenotyped patients with single 'magic bullet' drugs. Here, we propose that it is time for a paradigm shift towards the implementation of precision medicine (PM) for enhanced risk screening, detection, treatment, and prevention of AD. The overarching structure of how PM for AD can be achieved will be provided through the convergence of breakthrough technological advances, including big data science, systems biology, genomic sequencing, blood-based biomarkers, integrated disease modeling and P4 medicine. It is hypothesized that deconstructing AD into multiple genetic and biological subsets existing within this heterogeneous target population will provide an effective PM strategy for treating individual patients with the specific agent(s) that are likely to work best based on the specific individual biological make-up. The Alzheimer’s Precision Medicine Initiative (APMI) is an international collaboration of leading interdisciplinary clinicians and scientists devoted towards the implementation of PM in Neurology, Psychiatry and Neuroscience. It is hypothesized that successful realization of PM in AD and other neurodegenerative diseases will result in breakthrough therapies, such as in oncology, with optimized safety profiles, better responder rates and treatment responses, particularly through biomarker-guided early preclinical disease-stage clinical trials

Quantitative Susceptibility Mapping in Cognitive Decline: A Review of Technical Aspects and Applications

In the human brain, essential iron molecules for proper neurological functioning exist in transferrin (tf) and ferritin (Fe3) forms. However, its unusual increment manifests iron overload, which reacts with hydrogen peroxide. This reaction will generate hydroxyl radicals, and irons higher oxidation states. Further, this reaction causes tissue damage or cognitive decline in the brain and also leads to neurodegenerative diseases. The susceptibility difference due to iron overload within the volume of interest (VOI) responsible for field perturbation of MRI and can benefit in estimating the neural disorder. The quantitative susceptibility mapping (QSM) technique can estimate susceptibility alteration and assist in quantifying the local tissue susceptibility differences. It has attracted many researchers and clinicians to diagnose and detect neural disorders such as Parkinsons, Alzheimers, Multiple Sclerosis, and aging. The paper presents a systematic review illustrating QSM fundamentals and its processing steps, including phase unwrapping, background field removal, and susceptibility inversion. Using QSM, the present work delivers novel predictive biomarkers for various neural disorders. It can strengthen new researchers fundamental knowledge and provides insight into its applicability for cognitive decline disclosure. The paper discusses the future scope of QSM processing stages and their applications in identifying new biomarkers for neural disorders

The Structural and Functional Connectome and Prediction of Risk for Cognitive Impairment in Older Adults

The human connectome refers to a comprehensive description of the brain's structural and functional connections in terms of brain networks. As the field of brain connectomics has developed, data acquisition, subsequent processing and modeling, and ultimately the representation of the connectome have become better defined and integrated with network science approaches. In this way, the human connectome has provided a way to elucidate key features of not only the healthy brain but also diseased brains. The field has quickly evolved, offering insights into network disruptions that are characteristic for specific neurodegenerative disorders. In this paper, we provide a brief review of the field of brain connectomics, as well as a more in-depth survey of recent studies that have provided new insights into brain network pathologies, including those found in Alzheimer's disease (AD), patients with mild cognitive impairment (MCI), and finally in people classified as being "at risk". Until the emergence of brain connectomics, most previous studies had assessed neurodegenerative diseases mainly by focusing on specific and dispersed locales in the brain. Connectomics-based approaches allow us to model the brain as a network, which allows for inferences about how dynamic changes in brain function would be affected in relation to structural changes. In fact, looking at diseases using network theory gives rise to new hypotheses on mechanisms of pathophysiology and clinical symptoms. Finally, we discuss the future of this field and how understanding both the functional and structural connectome can aid in gaining sharper insight into changes in biological brain networks associated with cognitive impairment and dementia

Blood-based biomarkers for Alzheimer disease: mapping the road to the clinic.

Biomarker discovery and development for clinical research, diagnostics and therapy monitoring in clinical trials have advanced rapidly in key areas of medicine - most notably, oncology and cardiovascular diseases - allowing rapid early detection and supporting the evolution of biomarker-guided, precision-medicine-based targeted therapies. In Alzheimer disease (AD), breakthroughs in biomarker identification and validation include cerebrospinal fluid and PET markers of amyloid-β and tau proteins, which are highly accurate in detecting the presence of AD-associated pathophysiological and neuropathological changes. However, the high cost, insufficient accessibility and/or invasiveness of these assays limit their use as viable first-line tools for detecting patterns of pathophysiology. Therefore, a multistage, tiered approach is needed, prioritizing development of an initial screen to exclude from these tests the high numbers of people with cognitive deficits who do not demonstrate evidence of underlying AD pathophysiology. This Review summarizes the efforts of an international working group that aimed to survey the current landscape of blood-based AD biomarkers and outlines operational steps for an effective academic-industry co-development pathway from identification and assay development to validation for clinical use.I recieved an honorarium from Roche Diagnostics for my participation in the advisory panel meeting leading to this pape

“Translation of HDAC6 PET imaging using [18F]EKZ-001 – cGMP production and measurement of HDAC6 target occupancy in NHPs” – A Review

The inhibition of histone deacetylase 6 (HDAC6) has been reported to alleviate the effects of neurodegenerative diseases such as Alzheimer’s disease. The brain-penetrant PET radioligand [18F]EKZ-001 has high affinity and selectivity towards HDAC6 and therefore suggests great promise in therapeutic treatment studies and development for neurodegenerative diseases. “Translation of HDAC6 PET imaging using [18F]EKZ-001 – cGMP production and measurement of HDAC6 target occupancy in NHPs” has achieved an effective, fully automated method of producing [18F]EKZ-001 in compliance with current good manufacturing practices (cGMP) to support the translation of [18F]EKZ-001 PET for first-in-human studies. This cGMP compliantly produced radioligand was utilized in PET studies in non-human primates (NHPs), where it was determined that the HDAC6 inhibitor EKZ-317 achieves greater target occupancy than the HDAC6 inhibitor ACY-775. The developments made by this research have had significant impact on the progression of therapeutic treatment studies for neurodegenerative diseases. The success of a cGMP compliant method of [18F]EKZ-001 production has enabled the first-in-human [18F]EKZ-001 PET study, further paving the way to a potential treatment for neurodegenerative diseases. This editorial aims to overview “Translation of HDAC6 PET imaging using [18F]EKZ-001 – cGMP production and measurement of HDAC6 target occupancy in NHPs”, to analyze and highlight the impact and relevance of this research, and propose future considerations for research in this area

Cellular Uptake of Amyloid Forming Proteins Related to Neurodegenerative Disease

Aggregation and deposition of disease-associated protein is a pathological hallmark of several human disorders, including Alzheimer’s disease (AD) and Parkinson’s disease (PD). These diseases are characterized by the formation of amyloid-β (Aβ) and α-synuclein (α-syn) amyloid fibrils, in extracellular and intracellular locations, respectively. Prior to extracellular deposition of Aβ into plaques, Aβ also accumulates within neurons, but the molecular and cellular mechanisms contributing to uptake are not fully understood. Moreover, exact links between disease onset and progression are missing, hindering the development of new disease-modifying therapies.This Thesis describes my research to elucidate how chemical and physical characteristics of Aβ and α-syn, and their ensuing aggregates, influence their cellular uptake. This is important as the endolysosomal system has been implicated as a potential site for onset and progression of disease pathology. Focusing on Aβ uptake I demonstrate that the most aggregation-prone and neurotoxic variant Aβ(1-42) is endocytosed twice as efficiently as Aβ(1-40). I show that the uptake of both variants occurs via clathrin- and dynamin-independent endocytosis, but my work also points to a mechanistic difference; Aβ(1-42) is for example more sensitive to inhibitors of action polymerisation. Further, in studies of Aβ(1-42), I demonstrate that uptake is regulated by small Rho GTPases and highly sensitive to changes in membrane tension, but apparently not via GRAF1-regulated CLIC/GEECs, suggesting the involvement of yet unidentified molecular players. I also show how uptake of pre-formed α-syn fibrils is inversely related to fibril length, and correlates to reductions in metabolic activity, pointing to an important role of cellular uptake and endolysosomal accumulation in toxicity. Lastly, I demonstrate that both monomeric Aβ and fibrillar α-syn are dependent on cell surface proteoglycans for uptake. Importantly, I show that for Aβ this dependency builds up over time, suggesting that local peptide aggregation at the cell surface could precede uptake.Altogether, this Thesis contribute new molecular and mechanistic insights into how cellular uptake contributes to intraneuronal accumulation of amyloidogenic proteins relevant in neurodegenerative disease