title: Sporadic Alzheimer's disease begins as episodes of brain ischemia and ischemically dysregulated Alzheimer's disease genes.
abstract: The study of sporadic Alzheimer's disease etiology, now more than ever, needs an infusion of new concepts. Despite ongoing interest in Alzheimer's disease, the basis of this entity is not yet clear. At present, the best-established and accepted "culprit" in Alzheimer's disease pathology by most scientists is the amyloid, as the main molecular factor responsible for neurodegeneration in this disease. Abnormal upregulation of amyloid production or a disturbed clearance mechanism may lead to pathological accumulation of amyloid in brain according to the "amyloid hypothesis." We will critically review these observations and highlight inconsistencies between the predictions of the "amyloid hypothesis" and the published data. There is still controversy over the role of amyloid in the pathological process. A question arises whether amyloid is responsible for the neurodegeneration or if it accumulates because of the neurodegeneration. Recent evidence suggests that the pathophysiology and neuropathology of Alzheimer's disease comprises more than amyloid accumulation, tau protein pathology and finally brain atrophy with dementia. Nowadays, a handful of researchers share a newly emerged view that the ischemic episodes of brain best describe the pathogenic cascade, which eventually leads to neuronal loss, especially in hippocampus, with amyloid accumulation, tau protein pathology and irreversible dementia of Alzheimer type. The most persuasive evidences come from investigations of ischemically damaged brains of patients and from experimental ischemic brain studies that mimic Alzheimer-type dementia. This review attempts to depict what we know and do not know about the triggering factor of the Alzheimer's disease, focusing on the possibility that the initial pathological trigger involves ischemic episodes and ischemia-induced gene dysregulation. The resulting brain ischemia dysregulates additionally expression of amyloid precursor protein and amyloid-processing enzyme genes that, in addition, ultimately compromise brain functions, leading over time to the complex alterations that characterize advanced sporadic Alzheimer's disease. The identification of the genes involved in Alzheimer's disease induced by ischemia will enable to further define the events leading to sporadic Alzheimer's disease-related abnormalities. Additionally, knowledge gained from the above investigations should facilitate the elaboration of the effective treatment and/or prevention of Alzheimer's disease.
authors.affiliation: Laboratory of Ischemic and Neurodegenerative Brain Research, Mossakowski Medical Research Centre, Polish Academy of Sciences, Pawińskiego 5 Str., 02-106, Warsaw, Poland, pluta@cmdik.pan.pl.
authors.forename: Ryszard
authors.initials: R
authors.lastname: Pluta
authors.forename: Mirosław
authors.initials: M
authors.lastname: Jabłoński
authors.forename: Marzena
authors.initials: M
authors.lastname: Ułamek-Kozioł
authors.forename: Janusz
authors.initials: J
authors.lastname: Kocki
authors.forename: Judyta
authors.initials: J
authors.lastname: Brzozowska
authors.forename: Sławomir
authors.initials: S
authors.lastname: Januszewski
authors.forename: Wanda
authors.initials: W
authors.lastname: Furmaga-Jabłońska
authors.forename: Anna
authors.initials: A
authors.lastname: Bogucka-Kocka
authors.forename: Ryszard
authors.initials: R
authors.lastname: Maciejewski
authors.forename: Stanisław J
authors.initials: SJ
authors.lastname: Czuczwar
mesh_terms: D000544:Alzheimer Disease / Q000209:etiology* / Q000235:genetics*; D016229:Amyloid beta-Peptides / Q000378:metabolism; D000818:Animals; D001812:Blood-Brain Barrier / Q000473:pathology; D002545:Brain Ischemia / Q000150:complications* / Q000235:genetics / Q000473:pathology; D003704:Dementia / Q000209:etiology / Q000235:genetics / Q000473:pathology; D005786:Gene Expression Regulation; D006801:Humans
chemical_list: D016229:Amyloid beta-Peptides