Reinvestigation of the chemical structure of (-amyloid nonpathological by-product of cellular metabolism, whereas A3-(1-42) may have the more important role in the formation of neuritic plaques.With this in mind, we reexamined amyloid from the cerebrovasculature of AD brains and found that A,B-(1-42) is also the major form in these deposits. Interestingly, the amount of racemization and isomerization at aspartyl residues is much less than in neuritic plaque Af-(1-42). The localization of these undegradable aggregates suggests that their deposition might be linked to a compromised blood-brain barrier. MATERIALS AND METHODSHuman brains obtained at autopsy met the diagnostic criteria for AD established by the National Institutes of Health Neuropathology Panel (10) and by the Consortium to Establish a Registry for AD (CERAD) (11). Morphometric analyses identified brains that contained large amounts of AP in compact cores and in the blood vessels. Left hemispheres were analyzed histopathologically, while right hemispheres were stored at -70°C for subsequent A,3 isolation.Purification of A,B from Leptomeningeal Blood Vessels. The leptomeninges were gently pulled from the surface of 1-cmthick coronal sections with the aid of a dissecting microscope and immersed in 0.1 M Tris HCl (pH 8.0; TB) at 4°C. Blood vessels larger than 1 mm in diameter were discarded, and the remaining tissue was cut with scissors into 1-to 2-mm pieces. The tissue was washed eight times with 1 liter of TB at 4°C with continuous stirring for 10 min and was collected by filtration (45-,um mesh). After resuspension of this material in 20 vol of 2 mM CaCl2 in TB, 0.3 mg of collagenase (Worthington) and 10 p.g of DNase I (Worthington) were added per ml, and the suspension was shaken for 18 hr at 37°C. Large debris was removed by filtration (350-,gm mesh), and the smaller insoluble material was recovered by centrifugation at 6000 x g for 15 min. The resulting pellet was resuspended in 100 vol of 2% SDS in TB and incubated for 2 hr at room temperature, after which the insoluble material was again recovered by centrifugation (see above) and washed twice with distilled water. The pellet was then dissolved with 8 vol of 98% (vol/vol) glass-distilled formic acid (15 min at room temperature) and centrifuged at 430,000x g for 15 min in Polyallomer tubes in a TLA 100.2 rotor (Beckman). Pure A8 was isolated from the clear supernatant by size-exclusion chromatography with a Superose 12 column (10 x 300 mm) on a Pharmacia-LKB fast protein liquid chromatography (FPLC) system with a running buffer of 75%

Ultracentrifugation and graded molecular sieving, as well as a sensitive sandwich enzyme-linked immunosorbent assay were used to isolate and quantitate the amounts of water-soluble oligomers of beta amyloid (Abeta) peptides N-40 and N-42 in cerebral cortex of normal and Alzheimer disease (AD) brains. AD brains contained 6-fold more water-soluble Abeta (wsAbeta) than control brains. The majority of water-soluble peptides in most AD cases was A beta N-42, representing 12 times the amount found in control brains. The wsAbeta was present in the form of monomers and oligomers ranging from less than 10 kDa to greater than 100 kDa. The amount of wsAbeta N-42 in AD brains is about 50 times greater than the level of soluble Abeta N-42 found in the CSF of AD patients. This disparity may be due to the rapid association of wsAbeta N-42 into fibrillar deposits and/or to the integrity of the anatomical barriers which separate the two extracellular spaces. In this paper, we consider soluble any form of Abeta which has not yet polymerized into its insoluble, filamentous form. This includes both the newly synthesized forms of Abeta and those peptides which may be loosely attached to insoluble filaments but which can, nevertheless, still be considered soluble. It has been previously shown that, once it has aggregated into its filamentous form, the Abeta peptides are resistant to disaggregation and degradation by a number of denaturing agents and aqueous buffers containing proteolytic enzymes. Therefore, it is likely that the water-soluble Abeta peptides we quantified are precursors to its insoluble, filamentous form. Consequently, reducing the levels of soluble Abeta in AD brains could have profound effects on AD pathophysiology.

Alterations in transcription, RNA editing, translation, protein processing, and clearance are a consistent feature of Alzheimer's disease (AD) brain. To extend our initial study (Alzheimer Reports [2000] 3:161‐167), RNA samples isolated from control and AD hippocampal cornu ammonis 1 (CA1) were analyzed for 12633 gene and expressed sequence tag (EST) expression levels using DNA microarrays (HG‐U95Av2 Genechips; Affymetrix, Santa Clara, CA). Hippocampal CA1 tissues were carefully selected from several hundred potential specimens obtained from domestic and international brain banks. To minimize the effects of individual differences in gene expression, RNA of high spectral quality (A260/280 ≥ 1.9) was pooled from CA1 of six control or six AD subjects. Results were compared as a group; individual gene expression patterns for the most‐changed RNA message levels were also profiled. There were no significant differences in age, postmortem interval (mean ≤ 2.1 hr) nor tissue pH (range 6.6–6.9) between the two brain groups. AD tissues were derived from subjects clinically classified as CDR 2‐3 (CERAD/NIA). Expression data were analyzed using GeneSpring (Silicon Genetics, Redwood City, CA) and Microarray Data Mining Tool (Affymetrix) software. Compared to controls and 354 background/alignment markers, AD brain showed a generalized depression in brain gene transcription, including decreases in RNA encoding transcription factors (TFs), neurotrophic factors, signaling elements involved in synaptic plasticity such as synaptophysin, metallothionein III, and metal regulatory factor‐1. Three‐ or morefold increases in RNAs encoding DAXX, cPLA2, CDP5, NF‐κBp52/p100, FAS, βAPP, DPP1, NFIL6, IL precursor, B94, HB15, COX‐2, and CEX‐1 signals were strikingly apparent. These data support the hypothesis of widespread transcriptional alterations, misregulation of RNAs involved in metal ion homeostasis, TF signaling deficits, decreases in neurotrophic support and activated apoptotic and neuroinflammatory signaling in moderately affected AD hippocampal CA1. © 2002 Wiley‐Liss, Inc.

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We compare clinicopathologic data from 10 subjects identified in the very mild stage of senile dementia of the Alzheimer type with findings from similar studies in four cognitively normal subjects. We based the diagnosis of very mild dementia in the 10 subjects on informant reports and the judgment of experienced clinicians. Deficits of some psychometric measures of memory, language, and speeded psychomotor performance were observed for these subjects. The histologic markers of Alzheimer's disease, including neurofibrillary tangles and both the "diffuse" and classic subtypes of senile plaques, were present in the neocortex in all 10 subjects but essentially were absent in the four controls. These findings indicate that even "questionable" dementia can be diagnostic for Alzheimer's disease. Furthermore, because truly normal aging may be unaccompanied by neocortical senile plaques and neurofibrillary tangles, the presence of these lesions should suggest the possibility of clinically undetected Alzheimer's disease.

Hippocampal and parahippocampal atrophy occurs at a similar rate regardless of diagnostic group. Those who develop dementia may have smaller hippocampi to begin with, but become symptomatic because of accelerated loss of temporal lobe volume. Temporal lobe volume loss may mark the beginning of the disease process within six years prior to dementia onset.

The number of pyramidal neurones in the hippocampal cortex was determined in serially sectioned mesial temporal lobe from brains of 18 mentally normal people, as well as those of 8 demented patients with pathologically confirmed Alzheimer's disease. Normal ageing was accompanied by a gradual loss of neurones, whereas dements' brains showed a much more severe decrease, exceeding that of controls at any age. A high degree of negative exponential correlation was found between the density of neurones/mm3 of cortex and both the number of neurones with neurofibrillary degeneration and the number with granulovacular degeneration. The functional significance of the latter changes is thus probably greater than previously assumed, given the diminished population of surviving neurones in which these alterations appear. Both tangles and granulovacuoles demonstrated a stronger propensity for occurring in the posterior half of the hippocampus in demented patients' brains. This would not have been predicted from the relative distribution of neuronal loss in the two halves. The posterior portion of the hippocampus may be considerably more susceptible to the degenerative nerve cell changes prominent in dementia of the Alzheimer type.

MRI volumes measured over time are valid biomarkers of pathologic progression of AD across a range of antemortem clinical states. The rate of ventricular volume enlargement can be used to monitor disease progression or response to treatment in future clinical trials that are targeted at NFT and SP pathology.