Gamma-secretase modulators and inhibitors in Alzheimer's disease: influence of genetic background on efficacy and mechanism of action

According to the amyloid hypothesis, Alzheimer’s disease (AD) is caused by aberrant production or clearance of the amyloid-β (Aβ) peptides, and in particular of the longer more aggregation-prone Aβ42. The Aβ peptides are generated through successive proteolytic cleavage of the amyloid precursor protein (APP) by the β-site APP cleaving enzyme (BACE) and γ-secretase. γ-secretase produces Aβ peptides with variable C-termini ranging from Aβ34 to Aβ48, presumably by sequential trimming of longer into shorter peptides. γ-secretase is a multiprotein complex consisting of at least four different proteins and the presenilin proteins (PS1 or PS2) contain the catalytic center of the complex. In 2001 several non-steroidal anti-inflammatory drugs were identified as the founding members of a new class of γ-secretase modulators (GSMs) that can selectively reduce production of Aβ42. Concomitantly, these GSMs increase Aβ38 production indicating closely coordinated generation of Aβ42 and Aβ38 and a potential precursor-product relationship between these peptides. GSMs seem to exert their activity by direct modulation of γ-secretase. Support for this hypothesis is drawn from the finding that some PS mutations associated with early-onset familial AD (FAD) can modulate the cellular response to GSMs and to γ-secretase inhibitors (GSIs), which inhibit production of all Aβ peptides and are known to directly interact with PS. A particularly interesting FAD PS mutation is PS1-ΔExon9, a complex deletion mutant that blocks endoproteolysis of PS1 and renders cells completely non-responsive to GSMs. Studies presented in this thesis show that the diminished response of PS1-ΔExon9 to GSMs is mainly caused by its lack of endoproteolytic cleavage. Furthermore, we were able to demonstrate that a reduced response to GSMs and GSIs is not limited to PS1-ΔExon9 but is a common effect of aggressive FAD-associated PS1 mutations. Surprisingly, we also found that while the Aβ42 response to GSMs is almost completely abolished by these PS1 mutations, the accompanying Aβ38 increase was indistinguishable to wild-type PS1. Finally, the reduced response to GSIs was confirmed in a mouse model with transgenic expression of an aggressive FAD-associated PS1 mutation as a highly potent GSI failed to reduce Aβ42 levels in brain of these mice. Taken together, our findings provide clear evidence for independent generation of Aβ42 and Aβ38 peptides, and argue that the sequential cleavage model might be an oversimplification of the molecular mechanism of γ-secretase. Most importantly, our results highlight the significance of genetic background in drug discovery efforts aimed at γ-secretase, and indicate that the use of cellular models with transgenic expression of FAD-associated PS mutations might confound studies of the potency and efficacy of GSMs and GSIs. Therefore, such models should be strictly avoided in the ongoing preclinical development of these promising and potentially disease-modifying therapeutics for AD.

The role of oxidative stress in C. elegans aging

The free radical theory of aging postulates that aging is caused by damage induced by oxidative stress. Such stress is present when the production of reactive oxygen species (ROS) exceeds the cellular antioxidant capacity. Hydrogen peroxide (H2O2) is one of the most abundant ROS. It is produced as a by-product by several enzymes and acts as second messenger controlling the activity of numerous cellular pathways. To maintain H2O2 levels that are sufficiently high to allow signaling to occur, but low enough to prevent damage of cellular macromolecules, the production and removal of H2O2 must be tightly regulated.rnWhen we investigated the effects of peroxide stress in the nematode C. elegans, we found that exogenous as well as endogenous peroxide stress causes age-related symptoms. We identified 40 target proteins of hydrogen peroxide that contain cysteines that get oxidized upon peroxide stress. Oxidation of redox-sensitive cysteines has been shown to regulate numerous cellular functions and likely contributes to the peroxide-mediated decrease in motility, fertility, growth rate and ATP levels. By monitoring the oxidation status of proteins over the lifespan of C. elegans, we discovered that many of the identified peroxide-sensitive proteins are heavily oxidized at distinct stages in life. As the free radical theory of aging predicts, we found oxidation to be significantly elevated in senescent worms. However, we were also able to identify numerous proteins that were significantly oxidized during the development of C. elegans. To investigate whether a correlation exists between developmental oxidative stress and lifespan, we monitored protein oxidation in long- and short-lived strains. We found that protein oxidation in short-lived C. elegans larvae was significantly increased. Additionally short-lived worms were incapable of recovering from the oxidative stress experienced during development which resulted in the inability to establish reducing conditions for the following reproductive phase. Long-lived C. elegans, on the other hand, did only experience a mild increase in protein oxidation in the developmental phase and were able to recover faster from oxidative stress than wild type worms. rnBecause many proteins that are sensitive to oxidation by H2O2 became oxidized in aging C. elegans, we monitored endogenous hydrogen peroxide concentrations over C. elegans lifespan and discovered that peroxide levels are significantly elevated in development. This suggests that the observed developmental protein oxidation is peroxide-mediated. The early onset of oxidative stress might be a result of increased metabolic activity in C. elegans development but could also represent the requirement of ROS dependent signaling events. Our results indicate that longevity is dependent on the worm’s ability to cope with this early boost of oxidants.rn