Contrôle de la neuroinflammation par la kinase PKR dans les processus pathologiques de la maladie d'Alzheimer

Alzheimer's disease (AD) is the most common neurodegenerative disease leading to dementia. More than 3% of those over 65 years are affected. Pathological features of AD are β amyloid (Aβ) deposition and neurofibrillary tangles resulting in neuronal death, specifically in cortex and hippocampus. Brain inflammation is associated and involved in the neurodegeneration process. Murine models of endotoxemia show inflammation in the central nervous system as observed in humans. Using a model of endotoxemia by peripheral LPS injections in mice, we observed an activation of microglia, an increase of Aβ production and BACE1 expression and a decreased metabolism in the hippampus of LPS treated animals. These reactions are controlled by the stress kinase PKR (double stranded RNA-dependent protein kinase) whose invalidation exerts a neuroprotective effect in vivo. Aβ production in this model would be regulated by the PKR-dependent activation of the transcription factor STAT3, responsible for transcriptional control of BACE1. Activation of PKR is involved at several levels of the degenerative process associated with AD and has been identified as a potential diagnostic and prognostic biomarker of AD. These results confirm the role of PKR in the pathogenesis of AD and the interest of PKR down-regulation for therapeutic research.La maladie d’Alzheimer (MA) est la pathologie neurodégénérative entraînant une démence la plus fréquente. Elle touche plus de 3% des plus de 65 ans. Les lésions cérébrales qui la constituent sont les dépôts de substance β amyloïde (Aβ) et les dégénérescences neurofibrillaires responsables de la mort neuronale, en particulier dans le cortex et l’hippocampe. Ces lésions s’accompagnent d’une réaction inflammatoire centrale qui participe au processus de neurodégénérescence. Les modèles murins d’endotoxémie reproduisent une réaction inflammatoire du système nerveux central comme observé chez l’homme. Nous avons utilisé un modèle murin d’endotoxémie par injections périphériques de LPS et mis en évidence une activation microgliale, une augmentation de la production d’Aβ et de l’expression de BACE1 ainsi qu’une altération du métabolisme dans l’hippocampe des animaux en réponse au LPS. Ces réactions sont contrôlées par la kinase de stress PKR (double-stranded RNA-dependant protein kinase) dont l’invalidation exerce in vivo un effet neuroprotecteur. La production d’Aβ serait régulée dans ce modèle par l’activation PKR-dépendante du facteur de transcription STAT3, responsable du contrôle transcriptionnel de BACE1. L’activation de PKR a été retrouvée à plusieurs niveaux du processus dégénératif associé à la MA et a été identifiée comme un potentiel biomarqueur diagnostique et pronostique de la maladie. Nos résultats confirment le rôle de PKR dans la pathogénèse de la MA et l’intérêt de l’inhibition de PKR pour la recherche thérapeutique

DYRK1A and Activity-Dependent Neuroprotective Protein Comparative Diagnosis Interest in Cerebrospinal Fluid and Plasma in the Context of Alzheimer-Related Cognitive Impairment in Down Syndrome Patients

Down syndrome (DS) is a complex genetic condition due to an additional copy of human chromosome 21, which results in the deregulation of many genes. In addition to the intellectual disability associated with DS, adults with DS also have an ultrahigh risk of developing early onset Alzheimer's disease dementia. DYRK1A, a proline-directed serine/threonine kinase, whose gene is located on chromosome 21, has recently emerged as a promising plasma biomarker in patients with sporadic Alzheimer's disease (AD). The protein DYRK1A is truncated in symptomatic AD, the increased truncated form being associated with a decrease in the level of full-length form. Activity-dependent neuroprotective protein (ADNP), a key protein for the brain development, has been demonstrated to be a useful marker for symptomatic AD and disease progression. In this study, we evaluated DYRK1A and ADNP in CSF and plasma of adults with DS and explored the relationship between these proteins. We used mice models to evaluate the effect of DYRK1A overexpression on ADNP levels and then performed a dual-center cross-sectional human study in adults with DS in Barcelona (Spain) and Paris (France). Both cohorts included adults with DS at different stages of the continuum of AD: asymptomatic AD (aDS), prodromal AD (pDS), and AD dementia (dDS). Non-trisomic controls and patients with sporadic AD dementia were included for comparison. Full-form levels of DYRK1A were decreased in plasma and CSF in adults with DS and symptomatic AD (pDS and dDS) compared to aDS, and in patients with sporadic AD compared to controls. On the contrary, the truncated form of DYRK1A was found to increase both in CSF and plasma in adults with DS and symptomatic AD and in patients with sporadic AD with respect to aDS and controls. ADNP levels showed a more complex structure. ADNP levels increased in aDS groups vs. controls, in agreement with the increase in levels found in the brains of mice overexpressing DYRK1A. However, symptomatic individuals had lower levels than aDS individuals. Our results show that the comparison between full-length and truncated-form levels of DYRK1A coupled with ADNP levels could be used in trials targeting pathophysiological mechanisms of dementia in individuals with DS

Markers of early changes in cognition across cohorts of adults with Down syndrome at risk of Alzheimer's disease.

IntroductionDown syndrome (DS), a genetic variant of early onset Alzheimer's disease (AD), lacks a suitable outcome measure for prevention trials targeting pre-dementia stages.MethodsWe used cognitive test data collected in several longitudinal aging studies internationally from 312 participants with DS without dementia to identify composites that were sensitive to change over time. We then conducted additional analyses to provide support for the utility of the composites. The composites were presented to an expert panel to determine the most optimal cognitive battery based on predetermined criteria.ResultsThere were common cognitive domains across site composites, which were sensitive to early decline. The final composite consisted of memory, language/executive functioning, selective attention, orientation, and praxis tests.DiscussionWe have identified a composite that is sensitive to early decline and thus may have utility as an outcome measure in trials to prevent or delay symptoms of AD in DS

Markers of early changes in cognition across cohorts of adults with Down syndrome at risk of Alzheimer's disease.

Introduction: Down syndrome (DS), a genetic variant of early onset Alzheimer's disease (AD), lacks a suitable outcome measure for prevention trials targeting pre-dementia stages. Methods: We used cognitive test data collected in several longitudinal aging studies internationally from 312 participants with DS without dementia to identify composites that were sensitive to change over time. We then conducted additional analyses to provide support for the utility of the composites. The composites were presented to an expert panel to determine the most optimal cognitive battery based on predetermined criteria. Results: There were common cognitive domains across site composites, which were sensitive to early decline. The final composite consisted of memory, language/executive functioning, selective attention, orientation, and praxis tests. Discussion: We have identified a composite that is sensitive to early decline and thus may have utility as an outcome measure in trials to prevent or delay symptoms of AD in DS

Prevalence of sleep disorders in adults with down syndrome: a comparative study of subjective, actigraphic and polygraphic findings

STUDY OBJECTIVES:Sleep problems are often undetected in adults with Down syndrome (DS). Our objective was to determine the prevalence of sleep disorders in adults with DS through self-reported and objective sleep measures. METHODS:We performed a community-based cross-sectional study of 54 adults with DS not referred for sleep disorders. Two polysomnography (PSG) sleep studies were performed. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI); daytime sleepiness was evaluated using the Epworth Sleepiness Scale (ESS) and the risk for the sleep apnea syndrome (OSA) was identified using the Berlin Questionnaire (BQ). Participants' sleep/wake pattern was assessed from sleep diaries and by wrist actigraphy. PSQI, ESS, and PSG measures were compared with 35 sex-, age-, and body mass index-matched patients in the control groups. RESULTS:In PSG measures, adults with DS showed lower sleep efficiency (69 ± 17.7 versus 81.6 ± 11; P < .001), less rapid eye movement sleep (9.4 ± 5.8 versus 19.4 ± 5.1; P < .001), a higher prevalence of OSA (78% versus 14%; P < .001), and a higher apnea-hypopnea index (23.5 ± 24.5 versus 3.8 ± 10.5; P < .001) than patients in the control group. In the DS group, the questionnaires (mean PSQI 3.7 ± 2.9; mean ESS 6.3 ± 4.5 and mean BQ 1 ± 0) did not reflect the sleep disturbances detected on the PSG. Actigraphy data recorded daytime sleep that was not self-reported (118.2 ± 104.2 minutes). CONCLUSIONS:Adults with DS show severe sleep disruption and a high prevalence of OSA, undetected by self-reported sleep measures. Actigraphy, PSG, and validated simplified devices for screening OSA should be routinely recommended for this population because treatment of sleep disorders can contribute to healthy aging

COVID-19 Vaccination of Individuals with Down Syndrome—Data from the Trisomy 21 Research Society Survey on Safety, Efficacy, and Factors Associated with the Decision to Be Vaccinated

Individuals with Down syndrome (DS) are among the groups with the highest risk for severe COVID-19. Better understanding of the efficacy and risks of COVID-19 vaccines for individuals with DS may help improve uptake of vaccination. The T21RS COVID-19 Initiative launched an international survey to obtain information on safety and efficacy of COVID-19 vaccines for individuals with DS. De-identified survey data collected between March and December 2021 were analyzed. Of 2172 individuals with DS, 1973 (91%) had received at least one vaccine dose (57% BNT162b2), 107 (5%) were unvaccinated by choice, and 92 (4%) were unvaccinated for other reasons. Most participants had either no side effects (54%) or mild ones such as pain at the injection site (29%), fatigue (12%), and fever (7%). Severe side effects occurred in <0.5% of participants. About 1% of the vaccinated individuals with DS contracted COVID-19 after vaccination, and all recovered. Individuals with DS who were unvaccinated by choice were more likely to be younger, previously recovered from COVID-19, and also unvaccinated against other recommended vaccines. COVID-19 vaccines have been shown to be safe for individuals with DS and effective in terms of resulting in minimal breakthrough infections and milder disease outcomes among fully vaccinated individuals with DS

The Behavioral and Psychological Symptoms of Dementia in Down Syndrome (BPSD-DS) Scale:Comprehensive Assessment of Psychopathology in Down Syndrome

People with Down syndrome (DS) are prone to develop Alzheimer's disease (AD). Behavioral and psychological symptoms of dementia (BPSD) are core features, but have not been comprehensively evaluated in DS. In a European multidisciplinary study, the novel Behavioral and Psychological Symptoms of Dementia in Down Syndrome (BPSD-DS) scale was developed to identify frequency and severity of behavioral changes taking account of life-long characteristic behavior. 83 behavioral items in 12 clinically defined sections were evaluated. The central aim was to identify items that change in relation to the dementia status, and thus may differentiate between diagnostic groups. Structured interviews were conducted with informants of persons with DS without dementia (DS, n = 149), with questionable dementia (DS+Q, n = 65), and with diagnosed dementia (DS+AD, n = 67). First exploratory data suggest promising interrater, test-retest, and internal consistency reliability measures. Concerning item relevance, group comparisons revealed pronounced increases in frequency and severity in items of anxiety, sleep disturbances, agitation & stereotypical behavior, aggression, apathy, depressive symptoms, and eating/drinking behavior. The proportion of individuals presenting an increase was highest in DS+AD, intermediate in DS+Q, and lowest in DS. Interestingly, among DS+Q individuals, a substantial proportion already presented increased anxiety, sleep disturbances, apathy, and depressive symptoms, suggesting that these changes occur early in the course of AD. Future efforts should optimize the scale based on current results and clinical experiences, and further study applicability, reliability, and validity. Future application of the scale in daily care may aid caregivers to understand changes, and contribute to timely interventions and adaptation of caregiving

COVID-19 Vaccination of Individuals with Down Syndrome—Data from the Trisomy 21 Research Society Survey on Safety, Efficacy, and Factors Associated with the Decision to Be Vaccinated

Individuals with Down syndrome (DS) are among the groups with the highest risk for severe COVID-19. Better understanding of the efficacy and risks of COVID-19 vaccines for individuals with DS may help improve uptake of vaccination. The T21RS COVID-19 Initiative launched an international survey to obtain information on safety and efficacy of COVID-19 vaccines for individuals with DS. De-identified survey data collected between March and December 2021 were analyzed. Of 2172 individuals with DS, 1973 (91%) had received at least one vaccine dose (57% BNT162b2), 107 (5%) were unvaccinated by choice, and 92 (4%) were unvaccinated for other reasons. Most participants had either no side effects (54%) or mild ones such as pain at the injection site (29%), fatigue (12%), and fever (7%). Severe side effects occurred in <0.5% of participants. About 1% of the vaccinated individuals with DS contracted COVID-19 after vaccination, and all recovered. Individuals with DS who were unvaccinated by choice were more likely to be younger, previously recovered from COVID-19, and also unvaccinated against other recommended vaccines. COVID-19 vaccines have been shown to be safe for individuals with DS and effective in terms of resulting in minimal breakthrough infections and milder disease outcomes among fully vaccinated individuals with DS

Erratum:The behavioral and psychological symptoms of dementia in down syndrome scale (BPSD-DS II): Optimization and further validation

BACKGROUND: People with Down syndrome (DS) are at high risk to develop Alzheimer's disease dementia (AD). Behavioral and psychological symptoms of dementia (BPSD) are common and may also serve as early signals for dementia. However, comprehensive evaluation scales for BPSD, adapted to DS, are lacking. Therefore, we previously developed the BPSD-DS scale to identify behavioral changes between the last six months and pre-existing life-long characteristic behavior. OBJECTIVE: To optimize and further study the scale (discriminative ability and reliability) in a large representative DS study population. METHODS: Optimization was based on item irrelevance and clinical experiences obtained in the initial study. Using the shortened and refined BPSD-DS II, informant interviews were conducted to evaluate 524 DS individuals, grouped according to dementia status: no dementia (DS, N = 292), questionable dementia (DS + Q, N = 119), and clinically diagnosed dementia (DS + AD, N = 113). RESULTS: Comparing item change scores between groups revealed prominent changes in frequency and severity for anxious, sleep-related, irritable, restless/stereotypic, apathetic, depressive, and eating/drinking behavior. For most items, the proportion of individuals displaying an increased frequency was highest in DS + AD, intermediate in DS + Q, and lowest in DS. For various items within sections about anxious, sleep-related, irritable, apathetic, and depressive behaviors, the proportion of individuals showing an increased frequency was already substantial in DS + Q, suggesting that these changes may serve as early signals of AD in DS. Reliability data were promising. CONCLUSION: The optimized scale yields largely similar results as obtained with the initial version. Systematically evaluating BPSD in DS may increase understanding of changes among caregivers and (timely) adaptation of care/treatment

Involvement of PKR-mediated inflammation in Alzheimer's disease pathology

La maladie d’Alzheimer (MA) est la pathologie neurodégénérative entraînant une démence la plus fréquente. Elle touche plus de 3% des plus de 65 ans. Les lésions cérébrales qui la constituent sont les dépôts de substance β amyloïde (Aβ) et les dégénérescences neurofibrillaires responsables de la mort neuronale, en particulier dans le cortex et l’hippocampe. Ces lésions s’accompagnent d’une réaction inflammatoire centrale qui participe au processus de neurodégénérescence. Les modèles murins d’endotoxémie reproduisent une réaction inflammatoire du système nerveux central comme observé chez l’homme. Nous avons utilisé un modèle murin d’endotoxémie par injections périphériques de LPS et mis en évidence une activation microgliale, une augmentation de la production d’Aβ et de l’expression de BACE1 ainsi qu’une altération du métabolisme dans l’hippocampe des animaux en réponse au LPS. Ces réactions sont contrôlées par la kinase de stress PKR (double-stranded RNA-dependant protein kinase) dont l’invalidation exerce in vivo un effet neuroprotecteur. La production d’Aβ serait régulée dans ce modèle par l’activation PKR-dépendante du facteur de transcription STAT3, responsable du contrôle transcriptionnel de BACE1. L’activation de PKR a été retrouvée à plusieurs niveaux du processus dégénératif associé à la MA et a été identifiée comme un potentiel biomarqueur diagnostique et pronostique de la maladie. Nos résultats confirment le rôle de PKR dans la pathogénèse de la MA et l’intérêt de l’inhibition de PKR pour la recherche thérapeutique.Alzheimer's disease (AD) is the most common neurodegenerative disease leading to dementia. More than 3% of those over 65 years are affected. Pathological features of AD are β amyloid (Aβ) deposition and neurofibrillary tangles resulting in neuronal death, specifically in cortex and hippocampus. Brain inflammation is associated and involved in the neurodegeneration process. Murine models of endotoxemia show inflammation in the central nervous system as observed in humans. Using a model of endotoxemia by peripheral LPS injections in mice, we observed an activation of microglia, an increase of Aβ production and BACE1 expression and a decreased metabolism in the hippampus of LPS treated animals. These reactions are controlled by the stress kinase PKR (double stranded RNA-dependent protein kinase) whose invalidation exerts a neuroprotective effect in vivo. Aβ production in this model would be regulated by the PKR-dependent activation of the transcription factor STAT3, responsible for transcriptional control of BACE1. Activation of PKR is involved at several levels of the degenerative process associated with AD and has been identified as a potential diagnostic and prognostic biomarker of AD. These results confirm the role of PKR in the pathogenesis of AD and the interest of PKR down-regulation for therapeutic research