Epidemiological studies suggest that statins (hydroxymethylglutaryl-CoA reductase inhibitors) could reduce the risk of Alzheimer disease. Although one possible explanation is through an effect on -amyloid (A) metabolism, its effect remains to be elucidated. Here, we explored the molecular mechanisms of how statins influence A metabolism. Fluvastatin at clinical doses significantly reduced A and amyloid precursor protein C-terminal fragment (APP-CTF) levels among APP metabolites in the brain of C57BL/6 mice. Chronic intracerebroventricular infusion of lysosomal inhibitors blocked these effects, indicating that up-regulation of the lysosomal degradation of endogenous APP-CTFs is involved in reduced A production. Biochemical analysis suggested that this was mediated by enhanced trafficking of APP-CTFs from endosomes to lysosomes, associated with marked changes of Rab proteins, which regulate endosomal function. In primary neurons, fluvastatin enhanced the degradation of APP-CTFs through an isoprenoid-dependent mechanism. Because our previous study suggests additive effects of fluvastatin on A metabolism, we examined A clearance rates by using the brain efflux index method and found its increased rates at high A levels from brain. As LRP1 in brain microvessels was increased, up-regulation of LRP1-mediated A clearance at the blood-brain barrier might be involved. In cultured brain microvessel endothelial cells, fluvastatin increased LRP1 and the uptake of A, which was blocked by LRP1 antagonists, through an isoprenoid-dependent mechanism. Overall, the present study demonstrated that fluvastatin reduced A level by an isoprenoid-dependent mechanism. These results have important implications for the development of disease-modifying therapy for Alzheimer disease as well as understanding of A metabolism.
Alzheimer disease (AD)2 is a progressive neurodegenerative disease, being the most prevalent disorder among dementia. The discoveries that the genes of familial AD-linked mutation up-regulate A production and the increased rate of A42 production is associated with the age of onset provide conclusive evidence for the amyloid hypothesis in the pathogenesis of AD (1). Several therapies based on the amyloid hypothesis are being examined, including ␥-secretase inhibitors and A vaccine therapy, as disease-modifying therapy. However, there are still many unresolved issues with their clinical application (2, 3). Furthermore, recent failures of clinical trials of these therapies raise questions on delayed timing of intervention and the efficacy of targeting only one pathway of A metabolism (4, 5). More efficient treatment with higher safety is needed to treat AD.On the other hand, from basic and clinical reports, statins (hydroxymethylglutaryl-CoA reductase inhibitors), which are widely used for the treatment of hypercholesterolemic patients, might be beneficial in AD. Clinically, many case control studies support the protective effect of statins (6 -8), whereas the results of prospective studies and randomized cli...