The effort to decipher the mechanism of Alzheimer's disease (AD) 1 has attracted the interest of investigators from diverse biological disciplines, including biochemistry, cell biology, molecular genetics, neuroscience, and structural biology. The eclectic nature of research approaches to AD and the intensity of scientific interest in the problem have made it increasingly likely that AD will become a premier example of the successful application of biological chemistry to the identification of rational therapeutic targets in a major human disease. Much of the recent progress in elucidating the pathogenesis of AD has centered on the apparent role of the 40 -42-residue amyloid -protein (A) (1) as a unifying pathological feature of the genetically diverse forms of this complex disorder.
Biochemistry of Cerebral -Amyloidosis, a Route toGenetic Insights It has been known since the time of Alzheimer (2) that insidiously progressive loss of memory, cognition, and behavioral stability in older humans can be associated with the development of innumerable intraneuronal and extracellular filamentous lesions in the limbic and cerebral cortices. Inside neurons, bundles of abnormal ϳ20-nm cytoplasmic fibers (paired helical filaments) occur both in neuronal cell bodies (comprising neurofibrillary tangles) and in axons and dendrites (referred to collectively as dystrophic neurites). In addition to this filamentous degeneration of selected neurons and their processes, AD is characterized by abundant extracellular masses of ϳ8-nm filaments composed of A. These spherical deposits of A fibrils (amyloid plaques) are often intimately associated with dystrophic axons and dendrites (some of which contain paired helical filaments) as well as with activated microglia and reactive astrocytes. The presence of such "neuritic plaques," together with numerous neurofibrillary tangles, in the hippocampus, amygdala, cerebral cortex, and certain other brain regions serves as the basis for a definitive pathological diagnosis of AD. It should be noted that the amyloid -protein of AD is only one of several different proteins that can accumulate excessively in the extracellular spaces of various tissues and produce distinct human diseases (collectively called amyloidoses).Although arguments were once raised that studying the biochemistry of the plaques and tangles would be unlikely to lead to insights into critical events in AD pathogenesis, this has not turned out to be the case. Immunocytochemical and biochemical analyses of the intraneuronal neurofibrillary tangles conducted during the last decade have led to the conclusion that the microtubule-associated phosphoprotein, tau, is the major or, more likely, the sole subunit of the paired helical filaments found in both the tangles and in many of the dystrophic neurites observed in AD cortex (3,4). Intensive studies by numerous laboratories have shown that tau protein, which normally enhances the polymerization of tubulin into microtubules and stabilizes these organelles in neurons, becomes e...