Objective: Niemann-Pick disease type C (NPC) is an inherited disorder characterized by intracellular accumulation of lipids such as cholesterol and glycosphingolipids in endosomes and lysosomes. This accumulation induces progressive degeneration of the nervous system. NPC shows some intriguing similarities with Alzheimer disease (AD), including neurofibrillary tangles, but patients with NPC generally lack amyloid- (A) plaques. Lipids affect ␥-secretase-dependent amyloid precursor protein (APP) metabolism that generates A in vitro, but this has been difficult to prove in vivo. Our aim was to assess the effect of altered lipid constituents in neuronal membranes on amyloidogenic APP processing in humans.
Methods:We examined A in CSF from patients with NPC (n ϭ 38) and controls (n ϭ 14). CSF was analyzed for A 38 , A 40 , A 42 , ␣-cleaved soluble APP, -cleaved soluble APP, total-tau, and phospho-tau.Results: A release was markedly increased in NPC, with a shift toward the A 42 isoform. Levels of ␣-and -cleaved soluble APP were similar in patients and controls. Patients with NPC had increased total-tau. Patients on treatment with miglustat (n ϭ 18), a glucosylceramide synthase blocker, had lower A 42 and total-tau than untreated patients.
Conclusion:Increased CSF levels of A 38 , A 40 , and A 42 and unaltered levels of -cleaved soluble APP are consistent with increased ␥-secretase-dependent A release in the brains of patients with NPC. These results provide the first in vivo evidence that neuronal lipid accumulation facilitates ␥-secretase-dependent A production in humans and may be of relevance to AD pathogenesis. Neurology Abnormal amyloid- (A) metabolism is a core pathologic event in Alzheimer disease (AD).1 A is released from the transmembrane protein A precursor protein (APP) through cleavages by the enzymes -secretase and ␥-secretase. A metabolism has been linked to lipid homeostasis 2,3 and several studies suggest that ␥-secretase efficiency is affected by membrane lipid raft topography. [4][5][6][7] Evidence from humans of the effects of cellular cholesterol homeostasis on amyloid metabolism is lacking. To evaluate the effects of altered lipid constituents in neuronal membranes on APP processing in vivo, we examined A in CSF from patients with Niemann-Pick type C disease (NPC).NPC is a lysosomal storage disorder resulting from mutations in the genes encoding for the NPC1 and NPC2 proteins. 8 The clinical spectrum is broad, but progressive neurologic impaire-Pub ahead of print on December 29, 2010, at www.neurology.org. References e1-e18 are available on the Neurology Web site at www.neurology.org.