Amyloid plaques and neurofibrillary tangles are the hallmarks of Alzheimer's disease and have been the focus of disease etiology and pathogenesis. However, in the larger picture of a complex disease, the precise etiology of the lesions per se, as well as the clinical disease, remain to be defined. In this regard, to date no single process has been identified as a useful target and treatment efforts have shown no meaningful progress. Therefore, alternative ideas that may lead to new and effective treatment options are much needed.
KeywordsAlzheimer's disease; amyloid; fibrillary deposits; oxidative stress; tau Amyloid plaques and neurofibrillary tangles (NFTs) are pathological hallmarks of the progression of Alzheimer's disease (AD). The questions of how, why and when they appear are, therefore, pertinent to understanding the disorder and, as a result, research efforts into the relationship between lesion and pathogenesis have been substantial. It is now known that specific molecular events are associated with the development of AD, although their exact relationship to lesion appearance is still controversial. Pathogenic mutations leading, for example, to amyloid-β (Aβ) deposition, are a primary piece of evidence [1][2][3], while a wide range of other metabolic abnormalities have been proposed [4][5][6][7][8]. During early AD stages, cell cycle deregulation has been related to the disease [9,10], which may also contribute to the protein aggregates. Other processes, such as oxidative damage to DNA and RNA, have † Author for correspondence: Tel.: +1 216 368 3670 Fax: +1 216 368 8964 mark.smith@case.edu.For reprint orders, please contact reprints@expert-reviews.com
Financial & competing interests disclosureThis work was funded by NIH grant AG026151. Mark A Smith is, or has in the past been, a paid consultant for, owns equity or stock options in and/or receives grant funding from Anavex, Canopus BioPharma, Medivation, Neurotez, Neuropharm, Panacea Pharmaceuticals and Voyager Pharmaceuticals. George Perry is, or has in the past been, a paid consultant for and/or owns equity or stock options in Neurotez Pharmaceuticals, Panacea Pharmaceuticals, Takeda Pharmaceuticals and Voyager Pharmaceuticals. Xiongwei Zhu is a paid Advisory Board member for Medivation. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript. Genetic events: causative, but how?
NIH Public AccessPathogenic mutations leading to familial autosomal-dominant AD involve the Aβ precursor protein (APP) gene [22,23], and presenilin 1 (PSEN1) and presenilin 2 (PSEN2) genes [24]. Apolipoprotein E (APOE) polymorphisms, sometimes referred to as familial late-onset AD, are not mutations per se, but are a significant predisposing factor [25,26]. In particular, the APOE gene has three isoforms (ε2,...