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Rheumatic brain disease: a disease in its own right.

In many cases of patients who had rheumatic fever--at times undiagnosed--there is a chronic involvement of the brain as a result of disseminated recurrent obliterating arteritis or emboli in the small blood vessels, especially in the brain membranes or the cortex. As a result, disseminated, unstable, and transient neurological and psychiatric symptoms appear. The nature of these symptoms depends upon the age of the patient and the time of onset of the disease. It is suggested that the term "rheumatic brain disease" or "rheumatic encephalopathy" be used, and introduced into the nomenclature of the American Rheumatic Association.

Adult↗

Lack of topographical relationship between sites of aluminum deposition and senile plaques in the Alzheimer's disease brain.

Aluminum has been presumed to be involved in the pathogenesis or etiology of Alzheimer's disease. Histochemical demonstration of aluminum in autopsy brains from Alzheimer's disease victims by means of the solochrome azurine method in combination with the methenamine silver technique revealed aluminum-related staining in some neocortical and hippocampal senile plaques and tangles, as well as in the cytoplasm and/or the nuclei of some neurons, and in the cytoplasm of endothelial cells of blood capillaries and pericytes around larger blood vessels. In double-stained samples (first with methenamine silver and then with solochrome azurine) only some plaques displayed the presence of aluminum, while others did not show any sign of the presence of the trace metal. The specificity and sensitivity of solochrome azurine staining was checked in paper spot-test and test-tube experiments combined with flameless atomic absorption spectrophotometry. The results suggest that aluminum is present in brain samples from Alzheimer's disease victims, but the structural localization indicates that it is not primarily involved in the etiology of the disease.

Aged↗

Glycosylation of microtubule-associated protein tau in Alzheimer's disease brain.

In the neurofibrillary pathology of Alzheimer's disease (AD), neurofibrillary tangles (NFTs) contain paired helical filaments (PHFs) as their major fibrous component. Abnormally hyperphosphorylated, microtubule-associated protein tau is the major protein subunit of PHFs. A recent in vitro study showed that PHF tangles from AD brains are highly glycosylated, whereas no glycan is detected in normal tau. Deglycosylation of PHF tangles converts them into bundles of straight filaments and restores their accessibility to microtubules. We showed that PHF tangles from AD brain tissue were associated with specific glycan molecules by double immunostaining with peroxidase and alkaline phosphatase labeling. Intracellular tangles and dystrophic neurites in a neuritic plaque with abnormally hyperphosphorylated tau, detected with the monoclonal antibodies AT-8 and anti-tau-2, were also positive with lectin Galanthus nivalis agglutinin (GNA) which recognizes both the N- and O-glycosidically linked saccharides. Colocalization was not seen in the extracellular tangles and amyloid deposition, suggesting that the glycosylation of tau might be associated with the early phase of insoluble NFT formation. Thus, although abnormal phosphorylation might promote aggregation of tau and inhibition of the assembly of microtubules, glycosylation mediated by a GNA-positive glycan appears to be responsible for the formation of the PHF structures in vivo.

Alzheimer Disease↗

Neuronal expression and intracellular localization of presenilins in normal and Alzheimer disease brains.

The expression patterns of presenilin 1 (PS1) and presenilin 2 (PS2) in human normal and Alzheimer disease (AD) brains were investigated using antibodies to specific N-terminal peptides of PS1 (Alzh14A and Alzh14B) and PS2 (Alzh1A-AB). The antibodies to peptides Alzh14A (Alzh14A-AB) and Alzh14B (Alzh14B-AB) detected the full-length protein (approximately 63 kDa) and the N-terminal-processed fragment (36 kDa) of PS1, while the Alzh1A-AB detected mainly the N-terminal-processed fragment (36 kDa) of PS2. Immunofluorescent staining detected by confocal microscopy suggested that both native PS1 and PS2 are localized mainly in the Golgi/ER apparatus. Immunohistochemical studies of human temporal lobes from 2 normal and 5 sporadic Alzheimer brains revealed high levels of PS1 and PS2 expression in the granule cell layer and pyramidal neurons of the hippocampus. Strong immunoreactivity was found in reactive astrocytes and neurofibrillary tangles of all 5 Alzheimer brains. In contrast, only 2 sporadic Alzheimer brains showed presenilin-positive neuritic plaques. These observations suggest that presenilins may be involved in the pathology of some cases of sporadic AD.

Alzheimer Disease↗

Immunohistochemical study of microglia in the Creutzfeldt-Jakob diseased brain.

Immunohistochemical techniques have been used to investigate microglial reaction in Creutzfeldt-Jakob diseased (CJD) brains. Autopsy cases of six patients with CJD and age-matched controls were studied. Formalin-fixed, paraffin-embedded brain tissue samples were stained with antibodies against major histocompatibility complex (MHC) class II antigen (Ag), leukocyte common antigen (LCA), CDw75, CD68 and glial fibrillary acidic protein. Of the patients with CJD, two with a subacute spongiform encephalopathic type and short-survival periods after onset of the disease showed an increased number of reactive microglia labeled with anti-MHC class II Ag or LCA in the affected cerebral cortex. In advanced cases of the panencephalopathic type of CJD, in which both cerebral atrophy and astrocytosis were marked, the increase of reactive microglia was small. Some vacuoles developing in the neuropil of the CJD patients were surrounded by MHC class II Ag- or LCA-immunoreactive microglial cells. The number of ramified microglia in the affected lesions was decreased, although their number in the hippocampus was not affected. These results indicate that microglia can frequently be involved in the process of CJD and may be activated at the early stage of the disease.

Aged↗

Synthesis and amyloid binding properties of rhenium complexes: preliminary progress toward a reagent for SPECT imaging of Alzheimer's disease brain.

The definitive diagnosis of Alzheimer's disease (AD) requires the detection of amyloid plaques in postmortem brain. Although the amount of fibrillar amyloid roughly correlates with the severity of symptoms at the time of death, the temporal relationship between amyloid deposition, neuronal loss, and cognitive decline is unclear. To elucidate this relationship, a noninvasive, practical method for the quantitation of brain amyloid deposition is required. We describe herein the initial stages of a strategy to accomplish this goal by single photon computed tomographic imaging. The amyloid-binding dye Congo Red was modified to allow its conjugation to the monoamine-monoamide bis(thiol) ligand. This ligand complexes technetium(V) in its neutral oxo form. A biphenyl-containing building block was conjugated to the protected ligand, and the product was coupled to the relevant aromatic compounds. Rhenium oxo complexes, which are isosteric, but nonradioactive, analogues of the potential imaging agent technetium oxo complexes, were synthesized. These complexes bound to Abeta amyloid fibrils produced in vitro and stained amyloid plaques and vascular amyloid in AD brain sections.

Alzheimer Disease↗

The neuropsychiatry of subcortical ischemic brain disease.

The subcortical regions of the brain, by virtue of their extensive connections to neocortical and limbic structures, play an important role in the regulation of neurobehavioral functions such as mood, memory, and affect. Compromise of the blood supply to the subcortex and its connections result in behavioral syndromes that often include disturbances in cognition and mood. The extent of the underlying vascular pathology and the precise circuits compromised, in general, determine the nature of the behavioral problems. The neurobiologic mechanisms responsible for these behaviors are complex and clinical management is symptomatic and largely aimed at treating the primary clinical features with appropriate pharmacologic and behavioral approaches.

Behavior Therapy↗

Up-regulated production and activation of the complement system in Alzheimer's disease brain.

We used reverse transcriptase-polymerase chain reaction and Western blotting techniques to measure the levels of complement mRNAs and their protein products in Alzheimer's disease (AD) brain compared with non-AD brain. mRNAs for C1q, C1r, C1s, C2, C3, C4, C5, C6, C7, C8, and C9 were detected in the 11 regions of brain that were investigated. The mRNA levels were markedly up-regulated in affected areas of AD brain. In the entorhinal cortex, hippocampus, and midtemporal gyrus, which had dense accumulations of plaques and tangles, C1q mRNA was increased 11- to 80-fold over control levels, and C9 mRNA 10- to 27-fold. These levels were substantially higher than in the livers of the same cases. Western blot analysis of AD hippocampus established the presence of all of the native complement proteins as well as their activation products C4d, C3d, and the membrane attack complex. These data indicate that high levels of complement are being produced in affected areas of AD brain, that full activation of the classical complement pathway is continuously taking place, and that this activation may be contributing significantly to AD pathology.

Adult↗

Microvessels from Alzheimer's disease brains kill neurons in vitro.

Understanding the pathogenesis of Alzheimer's disease is of widespread interest because it is an increasingly prevalent disorder that is progressive, fatal, and currently untreatable. The dementia of Alzheimer's disease is caused by neuronal cell death. We demonstrate for the first time that blood vessels isolated from the brains of Alzheimer's disease patients can directly kill neurons in vitro. Either direct co-culture of Alzheimer's disease microvessels with neurons or incubation of cultured neurons with conditioned medium from microvessels results in neuronal cell death. In contrast, vessels from elderly nondemented donors are significantly (P<0.001) less lethal and brain vessels from younger donors are not neurotoxic. Neuronal killing by either direct co-culture with Alzheimer's disease microvessels or conditioned medium is dose- and time-dependent. Neuronal death can occur by either apoptotic or necrotic mechanisms. The microvessel factor is neurospecific, killing primary cortical neurons, cerebellar granule neurons, and differentiated PC-12 cells, but not non-neuronal cell types or undifferentiated PC-12 cells. Appearance of the neurotoxic factor is decreased by blocking microvessel protein synthesis with cycloheximide. The neurotoxic factor is soluble and likely a protein, because its activity is heat labile and trypsin sensitive. These findings implicate a novel mechanism of vascular-mediated neuronal cell death in Alzheimer's disease.

Alzheimer Disease↗

An immunochemical study of the pyruvate dehydrogenase deficit in Alzheimer's disease brain.

The activity of the pyruvate dehydrogenase complex (PDHC; EC 1.2.4.1, EC 2.3.1.12, and EC 1.6.4.3) was reduced to about 30% of control values in histologically unaffected occipital cortex of the brains of patients with Alzheimer's disease, as well as in histologically affected frontal cortex. In contrast, activity of another mitochondrial enzyme, glutamate dehydrogenase, was normal. Neither age nor time until postmortem study correlated significantly with PDHC activity in either Alzheimer or control samples, and PDHC was not inactivated significantly on incubation with homogenates of either Alzheimer or control brain. Antibodies against the highly purified bovine PDHC inhibited Alzheimer and control PDHC equally per unit of enzyme activity. Immunoblots also indicated that the PDHC antigens were not different in normal and Alzheimer brains. This antibody, however, inhibited Alzheimer PDHC more effectively than it did control PDHC, based on milligrams of protein, suggesting a reduced amount of normal PDHC protein. Other data suggest that the PDHC deficiency is related to mitochondrial damage and to impaired calcium homeostasis in Alzheimer nerve cells, which may then mediate a variety of other cellular impairments.

Aged↗