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Amyloid Diseases: Abnormal Protein Aggregation in Neurodegeneration

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Amyloid Diseases: Abnormal Protein Aggregation in Neurodegeneration Proc. Natl. Acad. Sci. USA Vol. 96, pp. 9989–9990, August 1999 From the Academy This paper is a summary of a session presented at the tenth annual symposium on Frontiers of Science, held November 19–21, 1998, at the Arnold and Mabel Beckman Center of the National Academies of Sciences and Engineering in Irvine, CA. Amyloid diseases: Abnormal protein aggregation in neurodegeneration EDWARD H. KOO*, PETER T. LANSBURY,JR.†, AND JEFFERY W. KELLY‡ *Department of Neurosciences, University of California at San Diego, La Jolla, CA 92093; †Center for Neurologic Diseases, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115; and ‡The Skaggs Institute of Chemical Biology and Department of Chemistry, The Scripps Research Institute, La Jolla, CA 92037 Alzheimer’s disease (AD) and Parkinson’s disease are the most The 9-aa peptide (A␤34–42), derived from the C-terminal se- common forms of age-related neurodegenerative disorders. The quence of the minor component A␤42, forms unusually stable pathogenesis of these and other neurodegenerative diseases and highly ordered fibrils (2). These unusual properties suggested remains unclear, and effective treatments are currently lacking. that the process of fibril assembly is a highly ordered (entropically However, recent studies from three diverse disciplines, neuropa- expensive) one and that the A␤ C terminus is a critical determi- thology, genetics, and biophysics, have begun to converge on a nant of its rate. Moreover, it was demonstrated that fibril forma- novel target for therapeutic attack: ordered protein aggregation. tion is a nucleation-dependent process, resembling, in some ways, Indeed, abnormal protein aggregation characterizes many, if not crystallization. Specifically, supersaturated solution of amyloid all, neurodegenerative disorders, not just AD and Parkinson’s peptides were metastable, but immediate fibril formation could disease, but also Creutzfeldt–Jakob disease, motor neuron dis- be ‘‘seeded’’ by addition of a small amount of preformed amyloid eases, the large group of polyglutamine disorders, including fibrils comprising the identical peptide (3). The time required to Huntington’s disease (1), as well as diseases of peripheral tissue nucleate A␤40 fibrils was shown to be significantly longer than like familial amyloid polyneuropathy (FAP). Many of these that to nucleate A␤42 fibrils, but the former process could be deposits were originally identified by their histochemical staining seeded by preformed A␤42 fibrils (2). property, hence their designation as amyloid (starch-like). Sub- The importance of the A␤42 form was confirmed by the sequently, it was learned that amyloid deposits contain extremely finding that selective elevation of A␤42 level occurs in all three insoluble protein fibrils that share similar morphological features early-onset FAD genes identified to date: amyloid precursor (80- to 150-Å fibrils) but comprise many different proteins with protein, presenilin-1, and presenilin-2 (4). These data provide no obvious sequence similarity. This review will focus on bio- a satisfying scenario to explain the early-onset forms of AD, physical studies of protein aggregation in AD and FAP, where but not the common sporadic forms of AD (Ͼ95% of cases) mechanistic models connecting pathological and genetic data to where consistent elevation of A␤42 has not been reported. clinical disease are beginning to emerge. These two examples Interestingly, in a small group of patients with severe head illustrate two ends of the biophysical spectrum: in one (AD), a injury, a recognized risk factor for AD, short-lived elevation of flexible peptide is poised to form fibrils, whereas in the other A␤42 levels was noted in the first week after head injury (5). (FAP), a stable globular tetramer must dissociate and partially Although transient, it is possible that this effect is sufficient to unfold before forming a new stable fibril structure. produce A␤42 fibril seeds responsible for later disease. Disease-Linked Mutations Localize to Fibril-Forming Pro- A␤ Protofibrillar Intermediates. The simplest version of a teins. The correlation and colocalization of protein fibrils with nucleation-dependent polymerization process involves two stable tissue degeneration suggests that fibrillization either contrib- states, the monomeric protein and the fibril (2). Once the critical utes to cell death or is an inseparable epiphenomenon. Recent concentration of monomer is reached, an equilibrium between genetic studies support the former possibility. Mutations that monomer and fibril is rapidly established. This simple mechanism cause Huntington’s disease, Creutzfeldt–Jakob disease, and has been proposed to explain the polymerization of sickle-cell FAP are localized to the genes encoding the fibril-forming hemoglobin to produce the intracellular fibrils that lead to proteins huntington, prion protein, and transthyretin, respec- erythrocyte deformation (sickling) (6). Early kinetic studies of tively. In AD and Parkinson’s disease as well, rare, early-onset A␤ fibrillation appeared to be consistent with this simple mech- forms have been linked to mutations in the fibril-forming anism, because an intermediate species was not detected (2). proteins [amyloid ␤-protein (A␤, see below) or its precursor, ␣ However, the situation changed when atomic force microscopy amyloid precursor protein and -synuclein, respectively]. Thus, analysis was carried out, a technique providing three-dimensional increasing evidence favors the postulate that protein fibrilli- information about species adsorbed to surfaces without the need zation is an early and critical process in all of these diverse for extensive sample preparation. Initial studies using microfab- diseases (although the fibril itself may not be the culprit). It ricated silicon tips with 5- to 10-nm resolution demonstrated follows that inhibition of fibril formation could be a viable discrete but transient intermediate A␤ species, designated pro- therapeutic strategy. Therefore, it is critical to develop an tofibrils (7). The intermediate protofibril is Ϸ40% the height of understanding of the process of fibril formation at a molecular the product fibril (3.5 nm vs. 8 nm). It appears very early in the level. process and disappears as fibrils appear (7–9). Protofibrils rarely AD-Associated Amyloid. Amyloid isolated from AD brain reached lengths Ͼ400 nm (far shorter than the shortest observed tissue consists predominantly of a family of polypeptides desig- fibrils), explaining the failure to detect them by classical light- nated A␤ to indicate their source (amyloid plaque) and their scattering methods (Fig. 1). Under certain conditions (low tem- secondary structure within the plaque-derived fibrils (␤-sheet). Abbreviations: AD, Alzheimer’s disease; FAP, familial amyloid poly- PNAS is available online at www.pnas.org. neuropathy; A␤, amyloid ␤-protein. 9989 Downloaded by guest on September 28, 2021 9990 From the Academy: Koo et al. Proc. Natl. Acad. Sci. USA 96 (1999) increasing complexity, which ultimately become amyloid fibrils (12). It is the oligomeric intermediates that are currently the key suspect in the etiology of neurodegenerative diseases. The extensive biophysical studies carried out thus far on transthyretin have significantly increased our understanding of the mechanism by which this protein is converted from its normally soluble state into amyloid fibrils (18). This information makes it possible to envision novel therapeutic strategies to intervene in transthyretin and related amyloid fibril formation processes and importantly to critically test the amyloid hypothesis, which implies that amyloid fibril formation causes these diseases. Knowing that the rate-determining step of transthyretin amyloid fibril formation is tetramer dissociation, we explored the possi- bility that small-molecule inhibitors that bound to the normally folded tetramer by using the unoccupied thyroxine binding site would make both the kinetics and thermodynamics less favorable for dissociation to the alternatively folded monomer (19–21). In in vitro systems, this strategy is effective for both the wild-type FIG. 1. Atomic-force microscopy of A␤1–40 demonstrating assem- protein and all of the FAP variants evaluated thus far. In addition, bly of amyloid fibrils from protofibrils. Preincubated A␤1–40 (100 biophysical studies suggest that small molecules binding to and ␮M) was seeded with preformed fibrils amounting to Ϸ1% of the intercepting the monomeric amyloidogenic intermediate could initial A␤1–40 concentration. The aggregates were analyzed 7 days also arrest the amyloid fibril formation process, although active later. In this image, protofibrils appear as smaller and more flexible compounds have yet to be discovered. aggregates (Ϸ4 nm in height) whereas the amyloid fibrils are substan- Ϸ ϭ In summary, recent biophysical studies have provided im- tially longer and more rigid ( 8 nm). (Bar 200 nm.) [Reproduced portant insights into the mechanisms of amyloid fibril forma- with permission from ref. 8 (Copyright 1997).] tion. In turn, this information may prove to be essential in the perature, low salt, no agitation), protofibril elongation is well development of new therapeutic strategies that will allow us to behaved. The transition from protofibrils to fibrils, however, was critically test the amyloid hypothesis in both animal models and sudden, unpredictable, and accelerated by the addition of small in human neurodegenerative diseases. amounts of seed fibrils
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