Pharmacotherapeutic targets in Alzheimer's disease

Clinical Therapeutics, 2004

Background: Alzheimer' s disease (AD), a progressive degenerative disorder of the brain, is the most common cause of cognitive impairment in the elderly. The pharmacotherapy of AD is evolving rapidly. Cholinergic stabilization with cholinesterase-inhibitor (ChEI) therapy implies neuroprotection and a resultant slowing of disability and disease progression. The moderate-affinity N-methyl-D-aspartate (NMDA)-receptor antagonist memantine may block neural excitotoxicity. Objective: The purpose of this review was to examine the evidence for the responsiveness to pharmacotherapy of established AD; specifically, the extent to which the benefits of therapy have been proved, the extent to which currently available ChEIs support cholinergic neurotransmission, and the extent to which currently available ChEIs and memantine provide neuroprotection. Methods: Relevant studies were identified through a comprehensive search of MEDLINE for articles published between January 1999 and February 2004 using the terms Alzheimer's pharmacotherapy, cholinesterase inhibitor therapy, Alzheimer's disease, donepezil, rivastigmine, galantamine, glutamatergic system modifiers, and memantine; a search of the reference lists of identified articles; and a manual search of pertinent journals. Articles were selected that contained higher-level evidence, based on explicit validated criteria. Results: ChEI therapy was associated with quality-of-life improvements that included enhanced performance of activities of daily living, reduced behavioral disturbances, stabilized cognitive impairment, decreased caregiver stress, and delay in the first dementia-related nursing home placement. In large clinical trials in moderate to severe AD (a stage that is associated with distress for patients and caregiver burden, and for which other treatments are not available), memantine showed an ability to delay cognitive and functional deterioration. The combination of memantine and ChEI therapy was significantly more efficacious than ChEI therapy alone (P < 0.001) and was well tolerated. Conclusions: The idea that AD is pharmacologically unresponsive appears to be changing. With the use of ChEI and NMDA-receptor antagonist therapy, the symptoms and outcomes of this devastating neurodegenerative disease can be improved and its course altered.

Drugs & aging, 2017

Alzheimer&#39;s disease is the most common major neurocognitive disorder with substantial social and economic impacts. This article is an update on current pharmacotherapy, advancements in biomarker use, and drugs in the pipeline for this disease. To date, no new drug has qualified to be added to the current therapeutic arsenal comprising cholinesterase inhibitors and the NMDA receptor antagonist memantine. Drugs in the pipeline include symptomatic therapies that are neurotransmitter-based, but mostly disease-modifying therapies. The latter have yielded disappointing results by focusing mainly on the two pathophysiological hallmarks of Alzheimer&#39;s disease: Aβ amyloid deposits and tau protein aggregates forming neurofibrillary tangles. These unsuccessful trials may have resulted from studying these drugs &#39;too late&#39; relative to Alzheimer&#39;s disease onset, in addition to focusing only on the amyloid cascade. In fact, Alzheimer&#39;s disease is a complex multifactorial di...

Drug Development Research, 2002

Alzheimer's disease (AD), the most common form of dementia among the elderly, is a progressive, degenerative disorder of the brain with a loss of memory and cognition. A defining characteristic of AD is the deposition of amyloid fibrils and neurofibrillary tangles in the brain of afflicted individuals. Biochemically, they are mainly composed of β-amyloid protein (Aβ) and phosphorylated tau proteins, respectively. There is also a loss of the presynaptic markers of the cholinergic system, such as acetylcholine, in the brain areas related to memory and learning. The biochemical pathways leading to AD are presently unknown and are a subject of intensive study with current theories favoring a hypothesis where Aβ aggregates to toxic forms that induce tau phosphorylation and aggregation. It is believed that this ultimately leads to dysfunction and death of cholinergic neurons, and compensation for this loss had been the primary focus of first generation therapeutic agents. The amyloid and tau hypotheses have lead to a focus on amyloid and tau as therapeutic targets. The current therapeutic goals are to reduce amyloid levels, prevention of amyloid aggregation/toxicity and tau phosphorylation/aggregation. AD has a heterogeneous etiology with a large percentage termed sporadic AD arising from unknown causes and a smaller fraction of early onset familial AD (FAD) caused by mutations in several genes, such as the β-amyloid precursor protein (APP) and presenilins (PS1, PS2). Other genes, such as apolipoprotein E (APOE), are considered to be risk factors for AD. Several proteins, such as APP, APOE, BACE (β-amyloid cleaving enzyme), PS1/2, secretases, and tau play important roles in the pathology of AD. Therefore, attempts are being made to develop new inhibitors for BACE, PS-1 and γ-secretase for treatment of AD. There is also a significant advancement in understanding the function of cholinesterase (ChE) in the brain and the use of ChE inhibitors in AD. The mechanism of a new generation of acetyl- and butyrylChE inhibitors is being studied and tested in human clinical trials for AD. Other strategies, such as vaccination, anti-inflammatory agents, cholesterol-lowering agents, anti-oxidants and hormone therapy, are also being studied for treating or slowing the progression of AD. Developments of early diagnostic tools based on quantitative biochemical markers will be useful to better follow the course of the disease and to evaluate different therapeutic strategies. In the present review, we attempt to critically examine recent trends in AD research from neurochemical to clinical areas. We analyze various neurobiological mechanisms that provide the basis of new targets for AD drug development. These current research efforts should lead to a deeper understanding of the pathobiochemical processes that occur in the AD brain to effectively diagnose and prevent their occurrence. Drug Dev. Res. 56:267–281, 2002. © 2002 Wiley-Liss, Inc.

European journal of pharmacology, 2017

Alzheimer&#39;s disease (AD) is a generalized term used for the loss in memory and other intellectual abilities on levels serious enough to interfere with daily life. It accounts for 60-80% of dementia cases. The characteristic features include aggregation of Amyloid-Beta (Aβ) plaques and Tau Protein Tangles in the nervous tissue of brain. Another important aspect associated with development of AD is the decrease in levels of Acetylcholine (ACh) in brain. The conventional pharmacotherapy of AD employs the use of compounds that inhibit the enzyme acetylcholinesterase (e.g. donepezil, rivastigmine) thereby elevating the levels of Acetylcholine in nervous tissue of brain. Lately, another drug has come into picture for treatment of AD i.e.memantine. It is a Glutamatergic antagonist that protects the nervous tissue against glutamate mediated excitotoxicity. However, both these classes of drugs provide only the symptomatic relief. There has been a desperate need arising since the past few...

Frontiers in Bioscience, 2014

Alzheimer's disease is characterized pathologically by the presence of neuritic plaques containing β-amyloid and neurofibrillary tangles containing tau. These have become two targets of investigational drugs aimed at preventing or slowing the disease. Early findings of extensive cholinergic degeneration inspired the development of drugs targeting cholinergic function. Cholinesterase inhibitors were the first drugs to be approved for treatment, followed by the NMDA receptor antagonist memantine. This chapter will focus on the development, mechanism of action, and results of clinical trials for drugs currently used or in development for treatment of Alzheimer's disease. Examples of these include drugs targeting cholinergic neurons, such as cholinesterase inhibitors, muscarinic receptor agonists and nicotinic receptor agonists, as well as memantine. Several drugs aimed at reducing levels of β-amyloid or tau are in development and will be addressed. Finally, drugs directed at other targets that may be useful in treatment of Alzheimer's disease will be discussed.

Trends in pharmacological sciences, 2002

Current Drug Targets, 2003

Alzheimer's disease (AD), a progressive, degenerative disorder of the brain, is believed to be the most common cause of dementia amongst the elderly. AD is characterized by the presence of amyloid deposits and neurofibrillary tangles in the brain of afflicted individuals. AD is associated with a loss of the presynaptic markers of the cholinergic system in the brain areas related to memory and learning. AD appears to have a heterogeneous etiology with a large percentage termed sporadic AD arising from unknown causes and a smaller fraction of early onset familial AD (FAD) caused by mutations in one of several genes, such as the β-amyloid precursor protein (APP) and presenilins (PS1, PS2). These proteins along with tau, secretases, such as β-amyloid cleaving enzyme (BACE), and apolipoprotein E play important roles in the pathology of AD. On therapeutic fronts, there is significant research underway in the development of new inhibitors for BACE, PS-1 and γ-secretase as targets for treatment of AD. There is also a remarkable advancement in understanding the function of cholinesterase (ChE) in the brain and the use of ChE-inhibitors in AD. A new generation of acetyl-and butyryl cholinesterase inhibitors is being studied and tested in human clinical trials for AD. The development of vaccination strategies, anti-inflammatory agents, cholesterol-lowering agents, anti-oxidants and hormone therapy are examples of new approaches for treating or slowing the progression of AD. In addition, nutritional, genetic and environmental factors highlight more effective preventive strategies for AD. Developments of early diagnostic tools and of quantitative markers are critical to better follow the course of the disease and to evaluate different therapeutic strategies. In this review, we attempt to critically examine recent trends in AD research from molecular, genetic to clinical areas. We discuss various neurobiological mechanisms that provide the basis of new targets for AD drug development. All these current research efforts should lead to a deeper understanding of the pathobiochemical processes that occur in the AD brain in order to effectively diagnose and prevent their occurrence.

Therapeutic advances in neurological disorders, 2013

Alzheimer's dementia (AD) is increasingly being recognized as one of the most important medical and social problems in older people in industrialized and nonindustrialized nations. To date, only symptomatic treatments exist for this disease, all trying to counterbalance the neurotransmitter disturbance. Three cholinesterase inhibitors (CIs) are currently available and have been approved for the treatment of mild to moderate AD. A further therapeutic option available for moderate to severe AD is memantine, an N-methyl-D-aspartate receptor noncompetitive antagonist. Treatments capable of stopping or at least effectively modifying the course of AD, referred to as 'disease-modifying' drugs, are still under extensive research. To block the progression of the disease they have to interfere with the pathogenic steps responsible for the clinical symptoms, including the deposition of extracellular amyloid β plaques and intracellular neurofibrillary tangle formation, inflammation, oxidative damage, iron deregulation and cholesterol metabolism. In this review we discuss current symptomatic treatments and new potential disease-modifying therapies for AD that are currently being studied in phase I-III trials.

Environment Conservation Journal

Dementia is a disorder which is associated with disruption of cerebral neurons, resulting in its characteristic symptomatology. Acetylcholine neurotransmitter is found to be significant for processing memory and learning. However it is diminished in both concentration and function in patients with Alzheimer disease. Nootropics are the drugs which is used to improve memory and learning by acting as AChEI (Acetyl cholineesterase inhibitors). Cognitive enhancers include drugs interacting with receptors (e.g. NMDA receptor antagonist: memantine), Enzymes (e.g. AChE inhibitors: tacrine, donepezil, galantamine), Antioxidants (e.g. resveratrol, curcumin, and acetyl-L-carnitine), Metal chelators (e.g. calcium and zinc chelator: DP-b99), Vaccines, Monoclonal antibodies (e.g. A beta-Amyloid: solanezumab under Phase III clinical trial). Apart from the pharmacological approaches, supplementation of a healthy diet and healthy physical & mental lifestyle impact cognitive research in the future. T...