PubMed: 26813123

Title
Alzheimer's disease: Targeting the Cholinergic System.
Journal
Current neuropharmacology
Volume
14
Issue
None
Pages
101-15
Date
2016-01-01
Authors
Ribeiro FM | Guimaraes IM | Silva FR | Ferreira-Vieira TH

Evidence 93003ac313

It has been demonstrated that the cholinergic system plays a role in the learning process

Evidence 4dd645ba60

The vesicular transporter activity can be blocked by vesamicol, which is a non-competitive inhibitor

Evidence a1e803c3c5

In this work, kinetic analyses revealed that a structural motif in AChE (a hydrophobic sequence of 35 resides peptides) was able to promote amyloid formation and its incorporation into the growing Aβ-fibrils

Evidence dfeb41dd99

Interestingly, M1 receptor signaling affects several of AD major hallmarks, including cholinergic deficit, cognitive dysfunction, and tau and Aβ pathologies

Evidence fd51b6354c

However, further studies have demonstrated that nicotinic receptor activation can lead to an increase in Aβ-mediated tau phosphorylation

Evidence 8841584179

Stimulation of nicotinic receptors present at the CNS presynaptic neuronal membrane leads to an increase in presynaptic Ca2+ concentration, which may facilitate the release of a number of neurotransmitters, such as glutamate, GABA, dopamine, serotonin, norepinephrine, as well as ACh

Evidence 94311b1cf2

Moreover,nicotinic receptors can also be regulated allosterically by Ca2+

Evidence 21187ec6c6

The organophosphate compounds are irreversible AChE inhibitors that are used as insecticides and nerve gases

Evidence cca9585c7b

In a work that evaluated the function of the cholinergic system in mediating the response to stress it was found that treatment of rats with the antagonist of the nicotinic receptor, mecamylamine, attenuates the activation of the HPA axis in response to a stressor agent

Evidence fe7e2324ae

Moreover, published data indicate that ACh is involved in memory

Evidence f0db178e78

Further studies have demonstrated that endogenous acetylcholine is important for modulation of acquisition [17], encoding [18], consolidation [19], reconsolidation [20], extinction [21] and retrieval of memory

Evidence 41ce3403f7

It has been demonstrated that the role of ACh in learning and memory seems to be related to the regulation of glutamatergic neurotransmission

Evidence 51b6cdd894

Stress is another factor that can regulate ACh release in the forebrain and its function on the hypothalamic-pituitaryadrenal (HPA) system can modulate biological and emotional outcomes

Evidence cb66d96f58

Similarly, nicotine can mimic the ACh effects on the HPA axis by activating nicotinic receptors

Evidence d2bcedf4f7

ACh contributes to auditory synaptic transmission by facilitating thalamocortical communication

Evidence 47ff181576

Recent evidences also suggest the involvement of ACh in adult neurogenesis

Evidence baf5009870

When cholinergic neurons are depolarized, ACh is exocytosed from synaptic vesicles and released into the synaptic cleft, where it can activate both muscarinic and nicotinic receptors

Evidence 7c9aac530e

Choline that is released by ACh hydrolysis in the synaptic cleft is continuously reuptaken into the presynaptic cholinergic neuron by an active transport system (see Fig. 1)

Evidence bbb61a5b86

Thus, ACh can influence the strength and fidelity of various synapses and modulate overall CNS neurotransmission

Evidence 8b0c6f75a1

Because ACh has an important role in cognitive processes, the cholinergic system is pointed as an important factor in many forms of dementia, including AD

Evidence 9d67016fd4

Thus, antidotes, including doxylamine, can be used to speed enzyme regeneration

Evidence ac350fd9a9

The two best known muscarinic receptor antagonists are atropine and quinuclidinyl benzilate, which block all muscarinic receptors

Evidence 41c8923cd8

CHT1 is mainly found in cholinergic neurons [92-94] and is responsible for supplying choline for the synthesis of ACh

Evidence 01b5979808

It has been demonstrated that treatment with donepezil is associated with significant cognitive and functional benefits over the course of 12 months in patients with moderate to severe AD

Evidence 3cbadd5703

In a double-blind study designed to assess patients survival with mild to moderately severe AD, the long-term treatment (2 years) with galantamine significantly reduced mortality and cognition decline, besides improving daily live activities in mild to moderate AD patients

Evidence ba7d2924b7

In fact, memantine is able to reduce the excitotoxicity in AD

Evidence fd96a51a83

Rivastigmine has also been used for AD treatment due to its ease of use (transdermal patch) and good tolerability by patients

Evidence 02bf012cbe

Moreover, AChE inhibitors that compete for the enzyme site, as succinylcholine, are used as anesthetic adjuvants since these drugs can promote neuromuscular blockage

Evidence dcf81e32c6

Curare is the best known antagonist for nicotinic receptors, although this drug is not capable of blocking central nicotinic receptors

Evidence 590c1573d1

In a large-scale placebo-controlled clinical trial, it was demonstrated that xanomeline, a muscarinic agonist with reasonable selectivity for M1/M4 receptors, exhibits a positive effect in minimizing, in a dose-dependent manner, cognitive and psychiatric symptoms in AD, including memory deficit, mood disturbance, agitation and hallucinations

Evidence c0d1a30e56

It has been demonstrated that cholinergic synapses are particularly affected by Aβ oligomers early neurotoxicity [218, 219] and that synaptic loss is the major correlate of cognitive impairment

Evidence 26ced0577e

Moreover, AF267B treatment leads to an increase in alpha secretase, which is an enzyme that can prevent the production of Aβ peptide

Evidence 6a700bc9aa

The loss of the nucleus basalis cholinergic neurons in AD patients is severe: from about 500,000 in the healthy adult to less than 100,000 in patients displaying advanced AD

Evidence 8cb2e40b36

Experimental data using non-human primates and rodents have demonstrated that injuries introduced to basal forebrain cholinergic neurons that innervate the cortex lead to attention deficit

Evidence cc4f9a8935

All these cholinergic alterations that take place in AD closely correlates with impaired attention and memory observed in patients

Evidence 893679814f

The importance of the cholinergic neurons from the nucleus basalis of Meynert on memory is highlighted by the fact that the specific degeneration of these neurons takes place in Alzheimer’s disease (AD) and contributes to the memory loss exhibited by AD patients

Evidence d2cca42c7e

It has been demonstrated that stimulation of cholinergic neurons in precise regions of the brainstem can promote REM (rapid eye movement) sleep, dose-dependently

Evidence 4b7391e234

ACh synthesis takes place in the cytoplasm of cholinergic neurons

Evidence 8ae5655a83

Although cholinergic neurons can synthesize choline, the de novo synthesis contributes only with a very small fraction of the total choline that is needed for ACh synthesis (see Fig. 1)

Evidence f3b12ba676

Cholinergic neurons secrete AChE into the synaptic cleft, where the enzyme is normally associated with the plasma membrane (see Fig. 1)

Evidence f31a4979d7

It has been postulated that the loss of cholinergic neurons and the consequent impairment in dopaminergic transmission could be the main factors underling AD-related psychiatric symptoms

Evidence ef25aba336

Further highlighting the importance of the cholinergic system in the CNS, cholinergic neuronal loss, especially in the basal forebrain, occurs not only in AD, but also in Parkinson’s disease [190, 191], Down syndrome [192], amyotrophic lateral sclerosis [193, 194], progressive supranuclear palsy [195, 196], and olivopontocerebellar atrophy [197]

Evidence cb34434332

Cholinesterase inhibitors can increase ACh levels in the synaptic cleft and partially ameliorate cognitive symptoms, enhance quality of life and diminish caregiver burden for patients with mild to severe AD

Evidence 28e36bfe97

Furthermore, it has also been proposed that the nerve growth factor (NGF) has the potential to preserve cholinergic neurons

Evidence 5327cb1292

Moreover, previous studies have shown that treatment with NGF can counteract cholinergic atrophy and memory deficits in aged rats

Evidence c3aca28e57

It has been demonstrated that phosphorylation of nicotinic receptors by protein kinase A, protein kinase C, and tyrosine kinase can regulate receptor activity

Evidence 155f8f6c3e

Moreover, it has been shown that blocking CA3 cholinergic receptors impairs the encoding of information and memory

Evidence 9c5a55359b

In the peripheral nervous system, activation of nicotinic receptors leads to rapid synaptic transmission

Evidence 502ed65673

In the CNS, most of the nicotinic receptors are expressed at the presynaptic neuronal membrane and their main role is to regulate the release of neurotransmitters, whereas nicotinic receptors expressed in the peripheral nervous system are mainly post-synaptic

Evidence 6a90aea776

Moreover, the M1 agonist AF267B can rescue the cognitive impairment and decrease Aβ42 and tau abnormalities in the cortex and hippocampus of a mouse model of AD

Evidence d92c148973

For example, it has been shown that the benzyl quinolone carboxylic acid (BQCA), which is an M1-selective allosteric agonist, is effective in increasing spontaneous excitatory postsynaptic currents in the medial prefrontal cortex (mPFC) pyramidal cells and improving memory in a transgenic mouse model of AD

Evidence faee482c10

Moreover, the use of M2 antagonists, such as SCH-57790 and SC-72788, can lead to blockage of M2-mediated inhibition of presynaptic release of ACh, which can activate M1 and nicotinic receptors, ameliorating cognitive impairment in AD

Evidence 1b8c808ca5

Interestingly, it has been demonstrated that an increase in neuronal firing can lead to an increase in choline uptake and in the synthesis of ACh

Evidence 6632504a7f

It is possible that the presence of CHT1 in the membrane of synaptic vesicles and the consequent increase in CHT1 relocation to the plasma membrane following neuronal depolarization could explain why an increase in neuronal firing promotes increased choline reuptake and, thus, ACh synthesis

Evidence 80566c3dbd

ChAT activity is regulated by neuronal depolarization, influx of Ca2+ and phosphorylation of the enzyme by a wide variety of protein kinases

Evidence 551785ea37

The cholinergic system is involved in critical physiological processes, such as attention, learning, memory, stress response, wakefulness and sleep, and sensory information

Evidence fd147f590b

Given its widespread distribution in the brain, it is not surprising that cholinergic neurotransmission is responsible for modulating important neural functions

Evidence 48942b114e

On the other hand, the facilitation of the cholinergic transmission by using the cholinesterase inhibitors can improve attention in humans

Evidence f021bed41a

Disruption of cholinergic inputs to the cortex can impair attention and the use of instructive cues needed for decision-making related to ongoing behavior

Evidence 40ad80c169

Another important function of the cholinergic system is to regulate the sleep cycle

Evidence 17024ea322

Moreover, the interaction of the cholinergic and glutamatergic systems seems to be important not only for cognitive processes but also for neuroprotection, as it has been shown that nicotinic receptors agonists are neuroprotective in a mechanism that is Ca2+-dependent and that involves the glutamatergic system

Evidence f14eb7f656

In fact, the memory deficit and neuropathology severity observed in patients exhibiting AD highly correlate with changes in hippocampal synaptic transmission, especially with changes in synaptophysin expression, a presynaptic vesicle protein

Evidence 30953e1891

Not only nicotine, but also DMPP (1,1-Dimethyl-4- phenylpiperazinium) and cystine can act as nicotinic receptor agonists

Evidence e8607ecc93

Agonists of nicotinic ACh receptors can improve, while antagonists for the receptor impair, performance in cognitive tasks

Evidence 654c367bb5

The first selective agonist identified for muscarinic receptors was muscarine and, so far, there is no agonist available with a specific selectivity for one particular subtype of muscarinic receptor

Evidence 217d8e630d

Muscarinic receptors are G protein coupled receptors that are capable of modulating a wide variety of ion channels

Evidence bba3e21c46

As a consequence, stimulation of ACh muscarinic receptors can promote the opening or closing of Ca2+, K+, or Cl- channels, which might facilitate either depolarization or hyperpolarization, depending on the cell type where these receptors are expressed

Evidence a97b76f7ea

Activation of muscarinic receptors can block various types of K+ currents by inhibiting many resting and voltage-gated K+ channels

Evidence f0838b7728

In addition to decreasing K+ currents, muscarinic receptors located at the presynaptic region can also inhibit GABAergic neurotransmission

Evidence c7141a53e3

Two choline transporters have been identified in neurons: a ubiquitous, low-affinity, sodium-independent transporter that can only be inhibited by high concentrations of hemicholinium-3 (HC-3) (Ki of about 50 μM), and a highaffinity, sodium-dependent, HC-3-sensitive (Ki of 10-100 nM) choline transporter (CHT1)

Evidence 82f06c0a27

A molecular modeling study showed that AChE interacts with the Aβ peptide and promotes amyloid fibril formation

Evidence 3e2b9a8d6e

ACh present at the synaptic cleft is rapidly inactivated by the enzyme acetylcholinesterase (AChE), releasing choline and acetate

Evidence ca177c20e3

Furthermore, some evidences also suggest the involvement of AChE in the pathogenesis of AD

Evidence f10c5a7704

In fact, it has been shown that APP interacts with CHT1 proteins increasing their endocytosis from the cell surface [258] and that mice that display disruption of CHT1 gene expression exhibit symptoms related to ACh deficit

Evidence 01d2ccb1cb

Stimulation of Gαq coupled muscarinic receptors leads to activation of phospholipase C and formation of inositol phosphates and other second messengers, which can promote closure of K+ channels, thus facilitating cell excitability

Evidence c8744d3dff

On the other hand, stimulation of Gαq coupled muscarinic receptors generates intracellular second messengers that can facilitate N-methyl-D-aspartate (NMDA) currents

Evidence 424e9c9901

It has been demonstrated that M1 muscarinic receptors coupling to G-proteins is impaired in the neocortex of AD patients and that the extent of M1/G-protein uncoupling is related to the severity of cognitive symptoms in AD

Evidence 28e68fd5a4

It has been shown that activation of M1 receptors decreases tau hyperphosphorylation via activation of PKC and inhibition of GSK-3β

Evidence 70ef8a87b6

Activation of Gαi coupled muscarinic receptors leads to inhibition of adenylyl cyclase and reduction of cyclic adenosine monophosphate (cAMP) levels, promoting inhibition of voltage-gated Ca2+ channels and, thus, diminishing cell excitability

Evidence c273a2ec45

In addition, activation of M2 receptors can cause an increase in Aβ production

Evidence 29bbddbd30

Cholinergic nicotinic receptors expressed in muscle and ganglia are comprised of two α subunits plus each of the other three

Evidence 831aae331e

Nicotinic receptors are formed by five different subunits: α, β, δ, and γ (fetal) or ε (adult)

Evidence cfcfe59001

Interestingly, PKC can phosphorylate VAChT and regulate its vesicular localization

Evidence cc118aa37b

The enzyme choline acetyltransferase (ChAT) can synthesize ACh from choline and acetyl-coenzyme A (acetyl-CoA)

Evidence b6512ea2ed

Moreover, Huntington’s disease appears to be associated with decreased ChAT activity

Evidence 5b07e952f6

Moreover, it has been demonstrated that ChAT transcription is severely diminished in the remaining cholinergic neurons, which leads to decreased ChAT activity and progression of dementia

Evidence cc7ab4c613

On the other hand, neuronal nicotinic receptors are formed by the combination of only two types of subunits (α2-10 and β2-4)

Evidence 4bda05da79

Following that, the neurotransmitter is transported by the vesicular acetylcholine transporter (VAChT) from the cytosol into synaptic vesicles

Evidence 3285df1e44

Each molecule of ACh transported by VAChT is in exchange for two vesicular protons, which leads to the fulfill of synaptic vesicles with the neurotransmitter

Evidence 6483f3a58c

In addition, quantitative autoradiography assay revealed that choline uptake was reduced in the hippocampus of these animals and that the expression of muscarinic and nicotinic cholinergic receptors was diminished

Evidence a016ee2973

Corroborating this hypothesis, it has been demonstrated that dopamine efflux is increased in the nucleus accumbens of M4 knockout mice

Evidence dc779961e8

A VAChT knockdown mouse model, expressing about 68% less VAChT protein, shows major neuromuscular deficits

Evidence 24779e4ae0

Furthermore, cognitive impairment can take place even due to a mild decrease in VAChT protein expression (about 45%)

Evidence eedc42239e

Moreover, mice that display a disruption of CHT1 gene expression exhibit symptoms related to ACh deficit and inevitable death within an hour of birth

Evidence ff46207bc0

Importantly, the neurons that form the nucleus basalis of Meynert undergo extensive degeneration in AD

Evidence ac1c92853e

In addition to cognitive alterations, psychiatric symptoms are frequently observed in AD patients, including apathy and depression

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