Part of the inflammatory response in Alzheimer's disease (AD) is the upregulation of the inducible nitric oxide synthase (NOS2) resulting in increased NO production. NO contributes to cell signaling by inducing posttranslational protein modifications. Under pathological conditions there is a shift from the signal transducing actions to the formation of protein tyrosine nitration by secondary products like peroxynitrite and nitrogen dioxide. We identified amyloid β (Aβ) as an NO target, which is nitrated at tyrosine 10 (3NTyr(10)-Aβ). Nitration of Aβ accelerated its aggregation and was detected in the core of Aβ plaques of APP/PS1 mice and AD brains. NOS2 deficiency or oral treatment with the NOS2 inhibitor L-NIL strongly decreased 3NTyr(10)-Aβ, overall Aβ deposition and cognitive dysfunction in APP/PS1 mice. Further, injection of 3NTyr(10)-Aβ into the brain of young APP/PS1 mice induced β-amyloidosis. This suggests a disease modifying role for NOS2 in AD and therefore represents a potential therapeutic target.

The Alzheimer's disease (AD) epidemic is a looming crisis, with an urgent need for new therapies to delay or prevent symptom onset and progression. There is growing awareness that clinical trials must target stage-appropriate pathophysiological mechanisms to effectively develop disease-modifying treatments. Advances in AD biomarker research have demonstrated changes in amyloid-beta (Aβ), brain metabolism and other pathophysiologies prior to the onset of memory loss, with some markers possibly changing one or two decades earlier. These findings suggest that amyloid-based therapies would optimally be targeted at the earliest clinically detectable stage (such as mild cognitive impairment (MCI)) or before. Postmortem data indicate that tau lesions in the locus coeruleus (LC), the primary source of subcortical norepinephrine (NE), may be the first identifiable pathology of AD, and recent data from basic research in animal models of AD indicate that loss of NE incites a neurotoxic proinflammatory condition, reduces Aβ clearance and negatively impacts cognition - recapitulating key aspects of AD. In addition, evidence linking NE deficiency to neuroinflammation in AD also exists. By promoting proinflammatory responses, suppressing anti-inflammatory responses and impairing Aβ degradation and clearance, LC degeneration and NE loss can be considered a triple threat to AD pathogenesis. Remarkably, restoration of NE reverses these effects and slows neurodegeneration in animal models, raising the possibility that treatments which increase NE transmission may have the potential to delay or reverse AD-related pathology. This review describes the evidence supporting a key role for noradrenergic-based therapies to slow or prevent progressive neurodegeneration in AD. Specifically, since MCI coincides with the onset of clinical symptoms and brain atrophy, and LC pathology is already present at this early stage of AD pathogenesis, MCI may offer a critical window of time to initiate novel noradrenergic-based therapies aimed at the secondary wave of events that lead to progressive neurodegeneration. Because of the widespread clinical use of drugs with a NE-based mechanism of action, there are immediate opportunities to repurpose existing medications. For example, NE transport inhibitors and NE-precursor therapies that are used for treatment of neurologic and psychiatric disorders have shown promise in animal models of AD, and are now prime candidates for early-phase clinical trials in humans.

Background Degeneration of the locus ceruleus (LC), the major noradrenergic nucleus in the brain, occurs early and is ubiquitous in Alzheimer’s disease. Experimental lesions to the LC exacerbate AD-like neuropathology and cognitive deficits in several transgenic mouse models of AD. Because the LC contains multiple neuromodulators known to affect Aβ toxicity and cognitive function, the specific role of noradrenaline (NA) in AD is not well understood. Methods To determine the consequences of selective NA deficiency in an AD mouse model, we crossed dopamine β-hydroxylase (DBH) knock-out mice with APP/PS1 mice, overexpressing mutant amyloid precursor protein and presenilin-1. DBH (−/−) mice are unable to synthesize NA but otherwise have normal LC neurons and co-transmitters. Spatial memory, hippocampal long-term potentiation (LTP), and synaptic protein levels were assessed. Results The modest impairments in spatial memory and hippocampal LTP displayed by young APP/PS1 or DBH(−/−) single mutant mice were augmented in DBH(−/−)/APP/PS1 double mutant mice. Deficits were associated with reduced levels of total Ca2+/calmodulin-dependent protein kinases II (CaMKII) and N-Methyl-D-aspartate receptor 2A (NR2A), increased N-Methyl-D-aspartate receptor 2B (NR2B) levels and were independent of Aβ accumulation. Spatial memory performance was partly improved by treatment with the NA precursor drug L-threo-DOPS. Conclusions These results indicate that early LC degeneration and subsequent NA deficiency in AD may contribute to cognitive deficits via altered levels of CaMKII and N-Methyl-D-aspartate receptors, and suggest that NA supplementation could be beneficial in early AD.

To assess the consequences of locus ceruleus (LC) degeneration and subsequent noradrenaline (NA) deficiency in early Alzheimer's disease (AD), mice overexpressing mutant amyloid precursor protein and presenilin-1 (APP/PS1) were crossed with Ear2(Ϫ/Ϫ) mice that have a severe loss of LC neurons projecting to the hippocampus and neocortex. Testing spatial memory and hippocampal long-term potentiation revealed an impairment in APP/PS1 Ear2(Ϫ/Ϫ) mice, whereas APP/PS1 or Ear2(Ϫ/Ϫ) mice showed only minor changes. These deficits were associated with distinct synaptic changes including reduced expression of the NMDA 2A subunit and increased levels of NMDA receptor 2B in APP/PS1 Ear2(Ϫ/Ϫ) mice. Acute pharmacological replacement of NA by L-threo-DOPS partially restored phosphorylation of ␤-CaMKII and spatial memory performance in APP/PS1 Ear2(Ϫ/Ϫ) mice. These changes were not accompanied by altered APP processing or amyloid ␤ peptide (A␤) deposition. Thus, early LC degeneration and subsequent NA reduction may contribute to cognitive deficits via CaMKII and NMDA receptor dysfunction independent of A␤ and suggests that NA supplementation could be beneficial in treating AD.

Abbreviations used: AD, Alzheimer's disease; APP, amyloid precursor protein; Ab, amyloid b; GFAP, glial fibrillar acidic protein; HPA, hypothalamic-pituitary-adrenal; IDE, insulin-degrading enzyme; MDA, malonyldialdehyde; NeuN, neuronal nuclei; NOS-2, nitric oxide synthase; TNF-a, tumor necrosis factor a. AbstractBoth hypercortisolemia and hippocampal damage are features found in patients diagnosed of Alzheimer's disease (AD) and epidemiological evidence supports a role for stress as a risk factor for AD. It is known that immobilization stress is followed by accumulation of oxidative/nitrosative mediators in brain after the release of proinflammatory cytokines, nuclear factor kappa B activation, nitric oxide synthase-2 and cyclooxygenase-2 expression. Long-term exposure to elevated corticosteroid levels is known to affect the hippocampus which plays a central role in the regulation of the hypothalamic-pituitary-adrenal axis. We therefore studied the effect of chronic immobilization stress on amyloid precursor protein/PS1 mice. Stress exposure increased AD-induced neuroinflammation characterized by astrogliosis, increased inflammatory gene transcription and lipid peroxidation. Importantly, immobilization stress did not increase the soluble or insoluble amyloid b levels suggesting that increased cortisol levels lower the threshold for a neuroinflammatory response, independently from amyloid b. Since inflammation may act as a factor that contributes disease progression, the stress-inflammation relation described here may be relevant to understand the initial mechanisms in underlying the risk enhancing action of stress on AD.

Introduction: The EU legislation on Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH) aims to improve the level of human health and environmental protection which has also implications for occupational health and safety. The authors describe their own subjective definition of 'the ideal REACH world' from an occupational point of view as a desirable but unobtainable goal. The practicability of proposed REACH instruments is discussed in relation to specific constraints imposed by the legal framework itself and by contravention against and misinterpretation of the law. This is based on their experiences from within a competent authority.

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