Novel treatments for neuropsychiatric symptoms in Alzheimers Disease (AD): targeting inflammatory injury using three translational anti-inflammatory strategies in a new AD model.

阿尔茨海默病（AD）影响八分之一的美国人，并且是美国第六大死亡原因。 近25万的AD患者是退伍军人，最近的研究表明， 患AD的风险增加60%。行为变化，如激动和攻击，混乱， 和戏剧性的性格变化，称为神经精神症状（NP 40）是AD患者中非常普遍的， 对护理人员来说极具挑战性，给那些护理人员带来了巨大的情感和经济负担 对于AD患者，目前用于AD的药物治疗，如抗精神病药，镇静/催眠药， 抗焦虑药和抗抑郁药，往往有显着的副作用，超过了这些好处， 治疗。因此，开发更好的治疗方法来治疗AD患者是至关重要的。一般 在精神病学文献中，有一种新兴的观点认为炎症可能是导致精神分裂症的病因学的关键因素。 精神疾病，包括情绪障碍、重性抑郁症、创伤后应激障碍（PTSD），以及 甚至是精神分裂症炎症过程是如何导致AD的神经精神症状的， 本文研究了AD患者的神经精神表现发生在进行性 神经退行性疾病-AD的特征-本身会产生大量炎症，所以我们 我认为，了解炎症在阿尔茨海默病中的作用是至关重要的，特别是在AD的背景下， 这个应用程序的目标。 这种应用是基于一种新兴的想法，即大脑炎症可能有助于精神疾病。 包括抑郁症，创伤后应激障碍（PTSD），甚至精神分裂症。我们提出 治疗AD患者的神经炎症将预防或减少神经精神疾病的假设 症状，如激动，侵略和冷漠，有可能找到替代品和更好的 治疗退伍军人与这些难以治疗的，往往是毁灭性的行为症状的AD。 这项资助的前提是基于文献，我们公布的数据和新的初步数据，这些数据表明 针对白细胞介素-6（IL-6）信号传导的抗炎治疗将是有效的， in attenuating衰减pronunciation干扰in relevant相关models模型.目标1将询问炎症的证据是否预示风险增加 在一种新的AD小鼠模型（Riken研究所最近开发的hAPP基因敲入小鼠）中， 已知表现出进行性脑炎症-并将表征老年AD小鼠在行为上的表现 与人类相关的任务。与行为相关的炎症标志物包括血清C- 反应蛋白和IL-6，它们与许多精神疾病状态密切相关。此外，本发明还提供了一种方法， 通过定量活化的星形胶质细胞（GFAP）和小胶质细胞的数量来评估神经炎症 （Iba 1）使用三个年龄的脑切片的共聚焦荧光成像：5，12和18个月。雄性和 女性将被研究。目的2将检验三种靶向IL-6和IL-10的抗炎策略的假设。 下游信号传导将减少这些小鼠的行为。治疗包括：西妥昔单抗 （Sylvant），一种临床批准的抗IL-6免疫疗法; Dismutazyme是一种小分子催化超氧化物歧化酶模拟物，在小鼠和非小鼠中显示出有效性。 人类灵长类动物我们的目标是确定这些抗炎治疗是否能预防或减少 在AD.最终，如果减少大脑炎症的治疗可以预防或减少AD的发病率， 患者，这可以支持替代或辅助治疗的发展，以传统的药物正在使用， 从而提高AD患者的生活质量，减轻AD患者的生活负担。最后，结果 这项研究可能表明，炎症的生物标志物可以作为预测乳腺癌风险的指标， 改善AD患者临床研究的风险分层。

Alzheimer’s disease (AD) affects 1 in 8 Americans, and is the sixth leading cause of death in the United States. Nearly a quarter of a million of those living with AD are Veterans, and recent studies have shown that Veterans have a 60% increased risk of developing AD. Behavioral changes, such as agitation and aggression, confusion, and dramatic personality changes, termed neuropsychiatric symptoms (NPS) are highly prevalent in AD patients, and are extremely challenging for caregivers, placing significant emotional and financial burdens on those caring for patients with AD, yet current pharmacological treatments for NPS, such as antipsychotics, sedative/hypnotics, anxiolytics, and antidepressants, often have significant adverse effects that outweigh the benefits of these treatments. Thus, it is critical to develop better therapeutic approaches to NPS in AD patients. In the general psychiatric literature, there is an emerging idea that inflammation may be a critical contributor to the etiology of psychiatric conditions including mood disorder, major depression, post-traumatic stress disorder (PTSD), and even schizophrenia. How inflammatory processes contribute to neuropsychiatric symptoms in AD has not yet been studied. Neuropsychiatric manifestations in AD patients occur in the context of a progressive neurodegenerative disease – the characteristic of AD - which produces substantial inflammation, itself, so we believe it is critical to understand the role of inflammation in NPS specifically in the context of AD, the ultimate goal of this application. This application is based on the emerging idea that brain inflammation may contribute to psychiatric conditions including depression, post-traumatic stress disorder (PTSD), and even schizophrenia. We propose the hypothesis that treating neuroinflammation in AD patients will prevent or decrease neuropsychiatric symptoms such as agitation, aggression, and apathy, with the potential of finding alternative and better treatments for Veterans with these difficult-to-treat and often devastating behavioral symptoms of AD. The premise for this grant is based on the literature, our published data, and new preliminary data, which show that anti-inflammatory treatment treatments directed at interleukin-6 (IL-6) signaling, specifically, will be effective in attenuating NPS in relevant models. Aim 1 will ask whether evidence of inflammation predicts increased risk of NPS in a new mouse model of AD (the hAPP knockin mice recently developed at the Riken Institute) - mice known to exhibit progressive brain inflammation - and will characterize how aged AD mice perform on behavioral tasks relevant to human NPS. Markers of inflammation to be correlated with behavior will include serum C- reactive protein and IL-6, which have been strongly associated with many psychiatric disease states. In addition, neuroinflammation will be assessed by quantifying the number of activated astrocytes (GFAP) and microglia (Iba1) using confocal fluorescence imaging of brain slices at three ages: 5, 12, and 18 months. Males and females will be studied. Aim 2 will test the hypothesis that three anti-inflammatory strategies targeting IL-6 and downstream signaling will reduce NPS behaviors in these same mice. Treatments will include: siltuximab (Sylvant), a clinically approved anti-IL-6 immunotherapy; Apocynin, a NADPH oxidase inhibitor; and Dismutazyme, a small molecule catalytic superoxide dismutase mimetic, shown to be effective in mice and non- human primates. The goal will be to determine whether these anti-inflammatory treatments prevent or reduce NPS in AD. Ultimately, if treatments which reduce inflammation in the brain prevent or decrease NPS in AD patients, this could support development of alternative or adjunct treatments to conventional drugs being used, thus improving the quality of life and decreasing the burden of NPS in patients living with AD. Finally, results from this study may suggest that biomarkers of inflammation could be used as predictors of NPS risk, thus improving risk stratification for clinical studies on NPS in AD.