Alzheimers Disease Biomarkers, 2009
This report gives a comprehensive and up-to-date review of Alzheimers disease (AD) biomarkers. Recent years have seen significant advances in this field. Whilst considerable effort has focused on Aβ and tau related markers, a substantial number of other molecules have been identified, that may offer new opportunities.
Alzheimers Disease - A high profile disease with few diagnostic tools: In 2005, the global prevalence of dementia was estimated at 25 million, with more than 4 million new cases occurring each year. It is also calculated that the number of people affected will double every 20 years, to 80 million by 2040, if a cure is not found. More than 50% of dementia cases are due to AD. Today, approximately 5 million individuals in the US suffer from AD, representing one in eight people over the age of 65. Direct and indirect costs of AD and other forms of dementia in the US are around $150 billion annually. Worldwide, costs for dementia care are estimated at $315 billion annually.
Despite significant research into this debilitating and ultimately fatal disease, advances in the development of diagnostic tests for AD and moreover, effective treatments, remain elusive.
Alzheimer's disease is the most common cause of dementia, yet its clinical diagnosis remains uncertain until an eventual post-mortem histopathology examination is carried out. Currently, therapy for patients with Alzheimer disease only treats the symptoms; however, it is anticipated that new disease-modifying drugs will soon become available. The urgency for new and effective treatments for AD is matched by the need for new tests to detect and diagnose the condition. Uncertainties in the diagnosis of AD mean that the disease is often undiagnosed and under treated. Moreover, it is clear that clinical confirmation of AD, using cognitive tests, can only be made after substantial neuronal cell loss has occurred; a process that may have taken place over many years. Poor response to current therapies may therefore, in part, reflect the fact that such treatments are generally commenced only after neuronal damage has occurred. The absence of tests to detect or diagnose presymptomatic AD also means that there is no standard that can be applied to validate experimental findings (e.g. in drug discovery) without performing lengthy studies, and eventual confirmation by autopsy.
These limitations are focusing considerable effort on the identification of biomarkers that advance understanding of the pathogenesis of AD and how the disease can be diagnosed in its early stages and treated. It is hoped that developments in these areas will help physicians to detect AD and guide therapy before the first signs of neuronal damage appears. The last 5-10 years have seen substantial research into the pathogenesis of AD and this has lead to the identification of a substantial number of AD biomarkers, which offer important insights into this disease. This report brings together the latest advances in the identification of AD biomarkers and analyses the opportunities they offer in drug R&D and diagnostics.
This Report : Identifies 60 candidate Alzheimer's (AD) biomarkers and their associated studies. Of these, 49 are single species or single parameters, 7 are combinations or panels and 4 involve the measurement of two species or parameters or their ratios. These include proteins, genes, image-based parameters, small molecules, proteins + genes. Of these, 30 relate to species identified in CSF and 19 were found in the blood. These candidate may be classified on the basis of their diagnostic utility, namely those which:
i) may allow AD to be detected when the disease has developed
ii) may allow early detection of AD
iii) may allow AD to be predicted before the disease has begun to develop
Biomarkers: AD biomarkers identified in this report show significant diversity, however of the 60 described, 18 are associated with amyloid beta (Aβ) and 9 relate to Tau. The remainder of the biomarkers fall into a number of different groups. Of these, some are associated with other hypotheses on the pathogenesis of AD however the vast majority are individually unique and not obviously linked with other markers. Analysis and discussion presented in this report includes summaries of the studies and clinical trials that have lead to the identification of these markers. Where it has been calculated, diagnostic sensitivity, specificity and the capacity of these markers to differentiate patients with suspected AD from healthy controls and individuals believed to be suffering from other neurodegenerative conditions, have been indicated. These findings are discussed in relation to existing hypotheses on the pathogenesis of the AD and the current drug development pipeline. Many uncertainties remain in relation to the pathogenesis of AD, in diagnosing and treating the disease and many of the studies carried out to identify disease markers are at an early stage and will require confirmation through larger and longer investigations. Nevertheless, significant advances in the identification of AD biomarkers have now been made. Moreover, whilst much of the research on AD biomarkers has focused on amyloid and tau related species, it is evident that a substantial number of other species may provide important opportunities.
Purpose of Report: To provide a comprehensive review of important and recently discovered candidate biomarkers of AD, in particular those with potential to reliably detect the disease or with utility in clinical development, drug repurposing, in studies of the pathogenesis and in monitoring drug response and the course of the disease. Other key goals were to identify markers that support current pipeline developments, indicate new potential drug targets or which advance understanding of the pathogenesis of this disease.
Table of Contents
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1. Background |
3 |
| 2. Biomarkers in Cerebrospinal Fluid (CSF): Detection of Alzheimer’s Disease | 15 |
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3. Biomarkers in Blood: Detection of Alzheimer’s Disease |
28 |
| 4. Biomarkers in Cerebrospinal Fluid (CSF): Prediction of Alzheimer’s Disease | 34 |
| 5. Biomarkers in Blood: Prediction of Alzheimer’s Disease | 40 |
| 6. Genetic Markers in Alzheimer’s Disease | 47 |
| 7. Image-Based Biomarkers in Alzheimer’s Disease | 53 |
| 8. Other Biomarkers in Alzheimer’s Disease | 61 |
| 9. Discussion | 66 |
| References | 98 |
| Tables | |
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Table 1. Drugs used in the treatment of Alzheimer’s Disease. |
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| Table 2. The Detection of Alzheimer’s Disease: Biomarkers in CSF | |
| Table 3. The Detection of Alzheimer’s Disease: Biomarkers in blood | |
| Table 4. The Prediction of Alzheimer’s Disease: Biomarkers in CSF | |
| Table 5. The Prediction of Alzheimer’s Disease: Biomarkers in blood | |
| Table 6. Alzheimer’s Disease: Genetic biomarkers | |
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Table 7. Summary of Alzheimer’s Disease biomarkers (n=60) classified according to source of origin ( CSF, Blood, Image-Based or Other) and utility (i.e. predictive (P), early-stage (E) or diagnostic stage (D). References are indicated in superscript. |
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| Table 8. Drug repurposing studies in the Alzheimer’s Disease field | |
| Figures | |
| Figure 1. Overview of Alzheimer’s Disease Biomarkers | |
| Figure 2. Sources of Alzheimer’s Disease Biomarkers | |
| Figure 3. Classes of Alzheimer’s Disease Biomarkers | |
| Figure 4. Alzheimer’s Disease Biomarker Groups |
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