New Insights into Alzheimer's Disease: Novel Pathogenesis, Drug Target and Delivery.

ABSTRACT

Alzheimer's disease (AD), the most common type of dementia, is characterized by senile plaques composed of amyloid ß protein (Aß) and neurofilament tangles derived from the hyperphosphorylation of tau protein. However, the developed medicines targeting Aß and tau have not obtained ideal clinical efficacy, which raises a challenge to the hypothesis that AD is Aß cascade-induced. A critical problem of AD pathogenesis is which endogenous factor induces Aß aggregation and tau phosphorylation. Recently, age-associated endogenous formaldehyde has been suggested to be a direct trigger for Aß- and tau-related pathology. Another key issue is whether or not AD drugs are successfully delivered to the damaged neurons. Both the blood-brain barrier (BBB) and extracellular space (ECS) are the barriers for drug delivery. Unexpectedly, Aß-related SP deposition in ECS slows down or stops interstitial fluid drainage in AD, which is the direct reason for drug delivery failure. Here, we propose a new pathogenesis and perspectives on the direction of AD drug development and drug delivery (1) aging-related formaldehyde is a direct trigger for Aß assembly and tau hyperphosphorylation, and the new target for AD therapy is formaldehyde; (2) nano-packaging and physical therapy may be the promising strategy for increasing BBB permeability and accelerating interstitial fluid drainage.