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Alzheimer Disease - New Drugs, Markets and Companies
Jain PharmaBiotech, Nov 2009, Pages: 505
Executive Summary
1. Clinical Features, Epidemiology and Pathology
Introduction Historical aspects Clinical features of Alzheimer disease Seven stages of Alzheimer disease AD as a terminal illness Detection of AD in the preclinical phase Differentiation of AD from other dementias Differentiation of AD from non-dementing disorders Cerebral insufficiency and AD Memory deficits and preclinical AD Mild cognitive impairment Diagnostic criteria of AD Epidemiology Epidemiology of aging Epidemiology of dementia Epidemiology of AD Prevalence of AD according to age Mortality in AD Pathophysiology of AD Cerebral atrophy and neuronal loss Neuritic plaques and neurofibrillary tangles Sp proteins as markers of neuronal death in AD Role of tau in the pathogenesis of AD Amyloid precursor protein Relation of APP mutations to CNS disorders Relation of APP to Aß deposits and pathogenesis of AD APP intracellular domain Role of secretases in amyloid cascade Role of exosomal proteins Role of nicastrin Neurotixicity of Ab deposits Relation of Aß deposits to synaptic activity Dysfunction of TGF-ß signaling accelerates Aß deposition Role of TMP21 in presenilin complexes and Ab formation Role of Ab dimers in the pathogenesis of AD Structure–neurotoxicity relationships of Aß oligomers Ab deposit and clearance Impairment of mitochondrial energy metabolism Ab-binding alcohol dehydrogenase links AD to mitochondrial toxicity Neural thread protein Loss of synaptic proteins AD and Down syndrome Overlapping pathologies of AD and Parkinson disease AD and age-related macular degeneration Myelin hypothesis of AD Blood-brain barrier in AD Blood vessel damage in AD Loss of serotonin 1A receptors in the brain Factors in pathogenesis of AD Astrocytes and AD Axonal transport failure in AD Cell-cycle hypothesis Creatine and AD Disturbances of interaction of nervous system proteins DENN/MADD expression and enhanced pro-apoptotic signaling in AD Gonadotrophins and AD Glutamate transport dysfunction in AD Innate immune system and AD Insulin, diabetes and AD Mechanisms underlying cognitive deficits in AD Monoamine oxidase and AD Neuroinflammation and AD Neurotransmitter deficits Neurotrophic factors NF-kB signaling and the pathogenesis of neurodegeneration Nitric oxide and AD Nogo receptor pathway Oxidative stress and AD Prostaglandins and AD Quinolinic acid and AD Retromer deficiency Serotonin and AD Spherotoxin Synaptic failure in AD Transmission of AD Ubiquitin-proteasome system in pathogenesis of AD Risk factors in the etiology of AD Aging and developmental abnormalities of the cholinergic system Cholesterol, dietary lipids, and Ab Exposure to magnetic fields Family history of AD Homocysteine and AD Level of education/type of job and risk of AD Metals and AD Obesity Proneness to psychological distress and risk of AD Sleep deprivation Traumatic brain injury and AD Vascular risk factors for AD Vitamin B12 and folate AD versus non-dementing changes in the aging brain AD and cognitive impairment with aging Pathomechanism of memory impairment and AD Concluding remarks on pathophysiology of AD Genetics of AD Familial AD Presenilins and calcium channel leak in pathogenesis of familial AD Late onset AD Genomics of AD Introduction to genomics Genes associated with Alzheimer disease AlzGene database ApoE gene ApoE genotype and nitric oxide APOE genotype and age-related myelin breakdown ApoE receptor interaction with NMDA receptor ApoE and ApoER2 ApoE receptor LR11 as regulator of Ab Arctic mutation CALHM1 polymorphism and AD CLU, CRI and PICALM CYP46 and risk for AD DAPK1 gene variants and AD Genetic variants associated with late-onset AD LRRTM3 as a candidate gene for AD OGG1 mutations associated with AD SORL1 gene in AD TOMM40 gene and risk of AD Molecular neuropathology AD as a polygenic disorder Proteomics of AD Introduction Application of proteomic technologies to study AD Protein misfolding in AD Common denominators of AD and prion diseases Amyloid fibrils as a common feature of AD and prion diseases FE65 proteins and AD
2. Diagnostic Procedures for Alzheimer Disease
Importance of the diagnosis of Alzheimer disease Methods of diagnosis of AD Self-administered olfactory test Neuropsychological testing Assessment and evaluation 7-minute screen 15-point risk index Measurement of aggregation in anterior segment of the eye Activities of Daily Living Alzheimer Disease Cooperative Study CDR-SOB score Clinician's Interview-Based Impression of Change Resource Utilization in Dementia Battery DETECTä System Electrophysiology EEG-based bispectral index Event-related potentials Early detection of cataract associated with AD Laboratory methods for diagnosis of AD Monitoring of synthesis and clearance rates of Ab in the CSF Molecular diagnostics for AD Genetic tests for AD ApoE genotyping Gene expression patterns in AD Molecular fingerprinting of the immune system in AD Microarray-based tests for AD Monoclonal antibody-based in vitro diagnosis of AD from brain tissues Biomarkers of AD The ideal biomarker for AD CSF biomarkers of AD CSF sulfatide as a biomarker for AD Glycerophosphocholine as CSF biomarker in AD Protein biomarkers of AD in CSF Amyloid precursor protein Tau proteins in CSF Tests for the detection of Ab in CSF Tests combining CSF tau and Ab Urine tests for AD Blood tests for AD Blood Ab levels Blood test for AD based on heme oxygenase-1 Blood test for AD based on RNA hybridization GSK-3 elevation in white blood cells Lymphocyte Proliferation Test Protein kinase C in red blood cells Tests based on protein biomarkers in blood A skin test for early detection of AD Nanotechnology to measure Ab-derived diffusible ligands Simultaneous measurement of several biomarkers for AD Plasma biomarkers of drug response in AD Concluding remarks about biomarkers for AD Imaging in AD Computed tomography Magnetic resonance imaging Arterial spin labeling with MRI Magnetic resonance microscopy Magnetic resonance spectroscopy Single photon emission computed tomography and modifications Positron emission tomography In vivo imaging of Ab deposits by PET In vivo detection of Ab plaques by MRI Imaging agents for Ab and neurofibrillary tangles Targeting of a chemokine receptor as biomarker for brain imaging Radioiodinated clioquinol as a biomarker for Aß Imaging neuroinflammation in AD Preclinical diagnosis of AD Meta-analysis of literature on imaging in AD Alzheimer Disease Neuroimaging Initiative Concluding remarks on imaging for diagnosis of AD Diagnosis of MCI and prediction of AD Diagnosis of MCI Computer-Administered Neurophychological screen for MCI Infrared eye-tracking technology to detect MCI PET for detection of MCI MRI for detection of MCI Presymptomatic detection of AD PredictAD project Use of biomarkers to predict AD in patients with MCI Biochemical biomarkers in CSF for prediction of AD Structural MRI biomarkers for prediction of AD Magnetoencephalography for detection of MCI and AD Concluding remarks about prediction of AD in MCI Ethical aspects of diagnostics for AD Genetic testing for AD Ethical issues of brain imaging in AD Companies involved in diagnosis of AD
3. Management of Alzheimer Disease
Introduction Cholinergic approaches Mechanism of action of cholinesterase inhibitors Choline and lecithin Donepezil Rivastigmine Galantamine Duration of treatment with ChE inhibitors Comparative studies of ChE inhibitors Donepezil versus rivastigmine Donepezil versus galantamine An assessment and future prospects of anticholinergic therapies Neuroprotection in Alzheimer's disease Memantine Combination of memantine with ChE inhibitors Monoamine oxidase inhibitors Selegiline Synaptoprotection in AD Drugs for noncognitive symptoms in AD Antidepressants Antipsychotics ChE inhibitors for behavioral and psychological disorders in AD Concluding remarks and other drugs for agitation in AD Sensory stimulation Non-pharmacological treatments of AD Management of memory loss in AD Application of electrical fields for improvement of cerebral function in AD Vagal nerve stimulation Cerebrospinal fluid shunting Omental transposition Microchip-based hippocampal prosthesis for AD Nutritional therapies for AD Cocktail of dietary supplements for AD Docosahexaenoic acid Nicotinamide for the treatment of AD Omega-3 fatty acids Preventing decline of mental function with aging and dementia Prevention of Alzheimer disease Mental training Physical exercise Higher level of conscientiousness and decreased risk of AD Caloric restriction Nutritional factors in prevention of AD Grapes and red wine Black and green teas Caffeine Drugs to prevent Alzheimer disease Preimplantation genetic diagnosis of inherited Alzheimer disease Presymptomatic detection of AD Management of mild cognitive impairment Management of Down syndrome Guidelines for use of anti-dementia drugs in clinical practice General care of the Alzheimer disease patients Strategies for the management of Alzheimer disease
4. Research in Alzheimer Disease
Introduction Animal models of Alzheimer disease Lesional models Cerebroventricular injection of Ab in rats Lentiviral vector-based models of amyloid pathology AAV-mediated gene transfer to increase hippocampal Ab Transgenic mouse models Quantitative assessment of amyloid load in transgenic models In vivo magnetic resonance microimaging in transgenic models of AD Transgenic model of AD with suppression of Aß production Transgenic AD11 anti-NGF mice Genetically altered mice with deficiency of vesicular ACh transporter Limitations of mouse models of Alzheimer disease Cholesterol-fed rabbits as models for AD Zebrafish model for AD Transgenic invertebrate models of Alzheimer disease Drosophila model of AD Caenorhabditis elegans Alzheimer disease model Cell systems for AD research In vitro neuronal cell Lines Single-gene expression system for use in cell culture Transgenic cells In silico models Estimation of progression rates of Alzheimer disease Clinical trial methods in Alzheimer disease Molecular imaging as a guide to drug development Use of MRI and PET in clinical trials Cognitive-function assessment in clinical trials Clinical trials in mild cognitive impairment Research in AD as a basis for future therapies Use of microarrays for studying pathogenesis of AD Computational brain mapping in AD Study of neurogenesis in AD Study of 3D structure of Ab Solid-state NMR to study precursors of Ab Research in Alzheimer disease at academic centers Role of NIH in AD research NIH Clinical Trials Database for AD Alzheimer Research Consortium The National Institute on Aging and AD research
5. Drug Discovery & Development for Alzheimer Disease
Introduction Categories of drugs in development for AD Memory-enhancing drugs Enhancing memory by drugs that block eIF2a phosphorylation Drugs based on cholinergic approaches AP2238 Butyrylcholinesterase inhibitors Donepezil-tacrine hybrids Drugs modulating gamma-aminobutyric acid receptors Ganstigmina Methanesulfonyl fluoride Muscarinic receptor modulators Muscarinic M1 agonists Muscarinic M2 antagonists Nicotine and nicotinic receptor modulators Nicotine Nicotinic receptor modulators GTS21 Ispronicline JWB1-84-1 Neuropeptide/neurotransmitters Somatostatin release enhancers Glutamate receptor modulators Physiology and pharmacology of glutamate receptors NMDA receptor ion channel complex Metabotropic glutamate receptors Glutamate receptor modulators as potential therapeutics for AD Non-competitive NMDA modulators AMPA modulators Drugs affecting multiple neurotransmitters Ensaculin NS2330 RS-1259 Lecozotan Vaccines for AD Active immunization with Ab AN-1792 vaccine Complications in clinical trials with AN-1792 Effects of Ab vaccine on the brain Strategies to avoid undesirable effect of Ab vaccination Passive immunization in AD with monoclonal antibodies Delivery of the passive antibody directly to the brain Systemic injection of MAbs to treat AD Combination of Ab immunotherapy and CD40-CD40L blockade Shaping the immune responses elicited against Ab Gene vaccination Modified Ab nasal vaccine Transdermal Ab vaccination Other vaccines for AD Nasal vaccination with ProteosomeÔ adjuvant T-cell vaccination with glatiramer acetate adjuvant Early start of immunotherapy to clear Ab plaques Reversal of cholinergic dysfunction by anti-Ab antibody Immune modulation via TRL9 to reduce Ab Mechanisms by which Ab antibodies reduce amyloid accumulation in the brain Perspectives on vaccines for AD Companies involved in AD vaccines Inhibition of amyloid precursor protein aggregation Secretase inhibitors Neuroprotection by a-secretase cleaved APP b-secretase inhibitors g-secretase inhibitors Substrate-targeting by ?-secretase modulators Amyloid-derived diffusible ligands GABA receptor modulation by etazolate and APP processing Depletion of serum amyloid P Trojan-horse approach to prevent build-up of Ab aggregates Drugs that inhibit the formation of Ab 22R-hydroxycholesterol Acylaminopyrazole Antihypertensive drugs Valsartan Chelation therapy for AD Clioquinol and PBT2 Copper chelation by FKBP52 Zinc chelation from amyloid plaques Next generation multifunctional chelating agents for AD Tetrahydrocannabinol NSAIDs Flurbiprofen analogs with Ab42-lowering action Nitric oxide-donating NSAIDs In vivo demonstration of the effects of NSAIDs on brain in AD Imatinib mesylate Laminin Paclitaxel Phenserine Tolserine Platinum-based inhibitors of Ab Heparin and its derivatives A reassessment of the role of heparin in AD Enoxaparin Heparan sulfate Scyllo-cyclohexanehexol Ubiquitin C-terminal hydrolase L1 Drugs to prevent the formation of NFTs Tau suppression ApoE4 as a therapeutic target in AD Strategies to enhance clearance of Ab Removal of Ab deposits by nanotechnology Enhanced PKC? activity promotes clearance of Ab Role of matrix metalloproteinases in clearance of Ab Small molecule DAPH for clearance of amyloid Clearance of Aß across the blood-brain barrier Therapeutics to reverse cerebral Ab deposits 4,5-dianilinophthalimide for disruption of Ab1-42 fibrils ABCA1 overexpression to lower amyloid deposits b-sheet breakers Blocking ApoE/Ab interaction to reduce Ab plaques Inhibitors of Ab dehydrogenase Intravenous immune globulin Meptides SAN-61 for cleavage of fibril and soluble amyloid Serum amyloid P component depletion Companies developing Ab-directed therapeutics for AD Antiinflammatory and antimicrobial drugs Dapsone Antimicrobial drugs against C. pneumoniae PPAR-gamma agonists Inhibitors of neuroinflammation Cyclophosphamide Etanercept MW01-5-188WH VP015 Antidiabetic drugs Rosiglitazone Pioglitazone Nootropics Acetyl-L-carnitine Cerebrolysin Ergot derivatives Lisuride Dihydroergocryptine Neuroprotective effect drugs not primarily developed for AD Angiotensin-converting enzyme inhibitors Dimebolin Drugs acting on estrogen receptors Estrogen Raloxifene Neurosteroids Pregnenolone sulfate Dehydroepiandrosterone Lithium MAO-B inhibitors Ladostigil tartrate Memoquin Methylene blue Nimodipine Testosterone Valproic acid Future prospects of neuroprotection in AD Targeting Cdk5 pathway Antioxidants Colostrinin Curcumin Melatonin Synthetic catalytic scavengers Dehydroascorbic acid Omega-3 fatty acids Vitamins Vitamin E as antioxidant Vitamins to lower homocysteine Folic acid Aminopyridazines Nanobody-based drugs for AD Nitric oxide based therapeutics for AD Nitric oxide mimetics iNOS inhibitors for AD Novel drugs for AD from natural resources Berberine chloride Centella asiatica Ginko biloba Gilatide (from saliva of the Gila monster) Huperzine-A Hyperforin Melissa officinalis Nostocarboline derived from cyanobacteria PTI-00703 Salvia Securinega suffruticosa Withania somnifera ZT-1 Cholesterol and AD Role of statins in reducing the risk of Alzheimer disease Neuroprotective effect of statins unrelated to cholesterol lowering ACAT inhibitors Role of gene for cholesterol ester transfer protein Cholesterol 24S-hydroxylase as a drug target for AD Selectively increase of ApoA-I production Neurotrophic factors Activity-dependent neuroprotective protein Brain derived neurotrophic factor Insulin-like growth factor-1 Nerve growth factor Neotrofin (AIT-082) Limitations of the use of NTFs for AD Role of serotonin modulators in AD Xaliproden 5-HT1A receptor antagonists 5-HT6 antagonists 5-HT4 receptor agonists PRX-03140 Cell therapy for AD Stem cell transplantation for AD Potential benefits of grafting NSCs in AD NSCs improve cognition in AD via BDNF Drugs for enhancing neuronal differentiation of implanted NSCs Implantation of encapsulated cells for delivering NGF Gene therapy for AD ApoE gene therapy Humanin gene therapy Neprilysin gene therapy NGF gene therapy Targeting plasminogen activator inhibitor type-1 gene Antisense approaches to AD RNAi approaches to AD Combined therapeutic approaches to AD Drug delivery for Alzheimer disease Delivery of thyrotropin-releasing hormone analogs by molecular packaging Nanoparticle-based drug delivery for Alzheimer’s disease Transdermal drug delivery in Alzheimer's disease Transdermal rivastigmine Intranasal delivery of therapeutics for AD Intranasal delivery of tacrine Intranasal delivery of nerve growth factor to the brain Circadian rhythms and timing of cholinesterase inhibitor therapy Clinical trials for AD Drugs for AD that were discontinued in clinical trials Evaluation of clinical trials of AD Monitoring of cognitive function during clinical trials Drug discovery for AD Genomics-based drug discovery Proteomics and drug discovery for AD High through screening for AD drug candidates Drugs acting on signaling pathways Activation of GTPase signaling by Cytotoxic Necrotizing Factor 1 Drugs to reverse inhibition of the PKA/CREB pathway in AD Inhibition of the CD40 signaling pathway JNK pathway as a target Mitogen-activated protein kinase pathway as target Protein kinase C activators Small molecule compounds binding to neurotrophin receptor p75NTR Targeting Vav in tyrosine kinase signaling pathway Novels targets/receptors for AD drug discovery Activation of cerebral Rho GTPases Blockade of TGF-b-Smad2/3 signaling in peripheral macrophages Blockers of Aß calcium channel Casein kinase 1 Cyclin-dependent kinase-5 Heat shock protein 90 inhibitors Histone deacetylase 1 Inactivation of aph-1 and pen-2 reduces APP cleavage NF-kB inhibitors Kinases and phosphatases as targets for AD therapeutics Phosphodiesterase inhibitors Pin 1 as a target in AD Protein phosphatase 5 as a neuroprotective in AD Src homology-containing protein-1 inhibitors Targeting GABAergic system Pharmacogenomics of Alzheimer disease Personalized therapy of AD Genotyping and AD therapeutics Biomarkers of AD/companion diagnostics for cholinesterase inhibitors Regulatory aspects of drug development for AD EMEA guidelines for drug development for AD Concluding remarks and future prospects of drugs for AD
6. Markets & Finances of AD Care
Introduction Pharmacoeconomics of treatment of AD Quality of Life in relation to economics of AD Costs associated with Alzheimer disease Pharmacoeconomics of donepezil Pharmacoeconomics studies using rivastigmine Pharmacoenonomics studies using galantamine A comparison of pharmacoenonomics outcomes with different ChE inhibitors Pharmacoenonomics studies using memantine Patterns of AD care in major markets Care of AD patients in the US Cost of care Medicare and AD Patterns of practice in AD care Opinions of physicians’ organizations on drugs for dementia Care of AD patients in the UK Cost of care Patterns of practice in AD care Retraction of NICE recommendations to NHS Care of AD patients in Germany Care of AD patients in France Care of AD patients in Italy Care of AD patients in Spain Care of AD patients in Japan Markets for AD diagnostics Markets for AD therapeutics Geographical markets for AD Markets for currently approved drugs for AD Markets for generic AD drugs Future growth of AD market Statins Limitations of AD drug development by the biotechnology industry Unmet needs in the management of AD Drivers of AD markets Increase of the aged populations Increase in the number of approved drugs for AD Limitations of the current therapies Improvements in diagnosis Increasing awareness of the disease
7. Companies
Introduction Profiles of companies Collaborations
8. References
Tables
Table 1-1: Historical landmarks relevant to Alzheimer disease Table 1-2: Clinical features of Alzheimer disease Table 1-3: Non-Alzheimer dementias Table 1-4: NINCDS-ADRDA Criteria for diagnosis of Alzheimer disease Table 1-5: Relation of mutations in amyloid precursor protein to CNS disorders Table 1-6: Risk factors for Alzheimer's disease Table 1-7: Genes linked to AD Table 1-8: Abnormalities of expression of brain proteins in Down's syndrome and AD Table 2-1: Classification of methods of diagnosis of Alzheimer disease Table 2-2: Neuropsychological test batteries and scales for Alzheimer's disease Table 2-3: Available molecular diagnostic tests for Alzheimer disease Table 2-4: Classification of biomarkers of AD in blood and CSF Table 2-5: Characteristics of an ideal biomarker for Alzheimer disease Table 2-6: Companies involved in the diagnosis of Alzheimer disease Table 3-1: Classification of treatments for Alzheimer disease Table 3-2: Cholinergic approaches used in the treatment of Alzheimer disease Table 3-3: Categories of neuroprotective agents for Alzheimer disease Table 3-4: Strategies for prevention of Alzheimer disease Table 3-5: Guidelines for the treatment of dementia Table 4-1: Transgenic mouse models of Alzheimer disease Table 5-1: Classification of therapies in development for Alzheimer disease Table 5-2: Drugs for AD targeting nACh receptors Table 5-3: Ionotropic glutamate receptors Table 5-4: Classification of mGluRs Table 5-5: Glutamate receptor modulators as potential therapeutic agents in AD Table 5-6: Companies involved in developing vaccines for AD Table 5-7: Companies developing Ab-directed therapeutics for AD Table 5-8: Innovative neuroprotective approaches for Alzheimer disease Table 5-9: Herbal therapies for AD Table 5-10: Novel drug delivery methods for Alzheimer disease therapies Table 5-11: Clinical trials in Alzheimer disease Table 5-12: Discontinued, failed or inconclusive clinical trials of Alzheimer disease Table 6-1: Direct and indirect costs associated with Alzheimer disease Table 6-2: Prevalence of AD in major markets 2008-2018 Table 6-3: AD market values from 2008-2018 in the seven major world markets Table 6-4: Markets for currently approved AD drugs 2008-2018 Table 6-5: Potential markets for drugs in development 2008-2018 Table 6-6: Limitations of AD drug discovery and development by the biotechnology industry Table 6-7: Factors that drive AD markets Table 7-1: Major players in Alzheimer's disease therapeutics Table 7-2: Collaborations relevant to Alzheimer disease
Figures
Figure 1-1: Percentages of world population of people over the age of 65 according to more developed and less developed portions - 2000 to 2050 Figure 1-2: Prevalence of different types of dementia Figure 1-3: Mechanisms of Aß clearance Figure 1-4: Nitric oxide neurotoxicity and neuroprotection in relation to Alzheimer disease Figure 1-5: Oxidative stress and Alzheimer disease Figure 1-6: Role of proteosome inhibition in Aß generation and neurodegeneration Figure 1-7: Pathomechanism of AD Figure 3-1: Metabolism of acetylcholine Figure 3-2: Neuroprotective effective of galantamine in AD Figure 3-3: Strategies for the management of Alzheimer disease Figure 5-1: NMDA receptor ion channel complex Figure 5-2: Neurotoxicity due to misfolding of Ab1-42 Figure 5-3: Role of proteomics in drug discovery and development for Alzheimer disease Figure 6-1: Unmet needs in the management of Alzheimer disease
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