Une des caractéristiques histopathologiques de la maladie d'Alzheimer (AD) est la présence de plaques amyloïdes formées par les peptides amyloïdes β (Aβ) de 40 et 42 résidus, qui sont les produits de clivage par des protéases de l'APP. Afin de comprendre le rôle des variations structurelles du TM dans le traitement de l'APP, les peptides APP_TM4K ont été étudiés dans la bicouche lipidique en utilisant l’ATR-FTIR et ssNMR. Tandis que la structure secondaire globale du peptide APP_TM4K est hélicoidale, hétérogénéité de conformation et d'orientation a été observée pour le site de clivage γ et , que peuvent avoir des implications dans le mécanisme de clivage et donc dans la production d’Aβ. Les peptides Aβ s'agrègent pour produire des fibrilles et aussi de manière transitoire d'oligomères neurotoxiques. Nous avons constaté qu'en présence de Ca2+, l’Aβ (1-40) forme de préférence des oligomères, tandis qu'en absence de Ca2+ l'Aβ (1-40) s’agrège sous forme de fibrilles. Dans les échantillons sans Ca2+, l’ATR-FTIR révèle la conversion des oligomères en feuillets β antiparallèles en la conformation caractéristique des fibrilles en feuillets β parallèles. Ces résultats nous ont amené à conclure que les Ca2+ stimulent la formation d'oligomères d'Aβ (1-40), qui sont impliqués dans l’AD. Les positions et une orientation précise de deux nouveaux médicaments puissants modulateurs de la γ-sécrétase - le benzyl-carprofen et le sulfonyl-carprofen  dans la bicouche lipidique, ont été obtenus à partir des expériences des ssNMR. Ces résultats indiquent que le mécanisme probable de modulation du clivage par la y-sécrétase est une interaction directe avec le domaine TM de l’APP. / A histopathological characteristic of Alzheimer’s disease (AD) is the presence of amyloid plaques formed by amyloid β(A) peptides of 40 and 42 residues-long, which are the cleavage products of APP by proteases. To understand the role of structural changes in the TM domain of APP, APP_TM4K peptides were studied in the lipid bilayer using ATR-FTIR and ssNMR. While the overall secondary structure of the APP_TM4K peptide is helical, conformational and orientational heterogeneity was observed for the y- and for the -cleavage sites, which may have implications for the cleavage mechanism and therefore the production of Aβ. Starting from its monomeric form, Aβ peptides aggregate into fibrils and / or oligomers, the latter being the most neurotoxic. We found that in the presence of Ca2 +, Aβ (1-40) preferably forms oligomers, whereas in the absence of a2 + Aβ (1-40) aggregates into fibrils. In samples without Ca2 +, ATR-FTIR shows conversion from antiparallel β sheet conformation of oligomers into parallel β sheets, characteristic of fibrils. These results led us to conclude that Ca2 +stimulates the formation of oligomers of Aβ (1-40), that have been implicated in the pathogenesis of AD. Position and precise orientation of two new drugs  powerful modulators of γ-secretase  benzyl-carprofen and carprofen sulfonyl  in the lipid bilayer were obtained from neutron scattering and ssNMR experiments. These results indicate that carprofen-derivatives can directly interact with APP. Such interaction would interfere with proper APP-dimer formation, which is necessary for the sequential cleavage by β -secretase, diminishing or greatly reducing Aβ42 production.

Introdução: segundo a literatura, sais de lítio podem produzir redução da função renal. A magnitude dessa informação é debatível, uma vez que não há estudo clínico randomizado e controlado entre usuários de lítio, em sua maioria pacientes com depressão ou transtorno bipolar. A possibilidade do uso do lítio para o tratamento da demência de Alzheimer prodrômica reforça a necessidade de maior investigação de efeitos adversos atribuídos ao lítio, especialmente com relação à função renal. Objetivos: avaliar a segurança da utilização do lítio em baixa dosagem com relação à função renal de pacientes idosos. Como objetivos secundários serão avaliadas: a segurança clínica através de exame e questionário específico, as funções tireoidiana, imunológica e o metabolismo glicêmico. Métodos: estudo randomizado e placebo controlado de 2 anos, seguido de fase aberta por mais 2 anos. Foram avaliados 59 idosos com comprometimento cognitivo leve com seguimento mínimo de dois anos (fase controlada). A função renal foi estimada através das fórmulas aMDRD e CKD- EPI, a partir de exames laboratoriais e dados clínicos coletados durante o estudo. As funções tireoidiana, imunológica e glicêmica foram avaliadas respectivamente através de TSH, T4 livre, leucócitos total, neutrófilos, linfócitos, glicemia e insulinemia de jejum, e HOMA-IR. A segurança clínica foi avaliada através de entrevista sistemática realizada a cada 3 meses, utilizando exame físico e a escala UKU para efeitos adversos. Resultados: não houve piora da função renal com o uso do lítio (litemia entre 0,25-0,5 mmol/l) tanto pela aMDRD (p=0,453) como pela CKD-EPI (p=0,181). Houve aumento significativo de neutrófilos (p=0,038) e do TSH (p=0,034). O grupo lítio apresentou incidência significativamente maior de diabetes mellitus (p=0,037) e arritmias (p=0,028), maior ganho de peso (p=0,015), mais sintomas na escala UKU (p=0,045), e maior interferência dos efeitos adversos do lítio em atividades diárias (p<0,001). Houve correlação entre a opinião de médico e do paciente nas interferências das atividades diárias atribuídas aos sintomas adversos (p<0,001). Conclusões: o uso de lítio em baixa dose não alterou a função renal, produziu alterações no sistema imunológico e tireoidiano sem impacto clínico, e foi seguro clinicamente. As razões do aumento de incidência de diabetes e arritmias merecem investigação posterior / Introduction: according to the literature, lithium salts may produce a reduction in kidney function. The magnitude of this information is debatable because there is no randomized and controlled clinical trial among lithium users, being mostly patients with depression or bipolar disorder. The possibility of using lithium for the treatment of prodromal Alzheimer\'s disease dementia increases the need for further investigation of adverse effects attributed to lithium, especially regarding to renal function. Objectives: To evaluate the safety of using low-dose lithium with respect to renal function in elderly patients. Secondary objectives were the evaluation of the clinical safety through specific questionnaire and clinical assessment, and to assess thyroid, immunological and glycemic function. Methods: a randomized and placebo controlled study for 2 years, followed by an open label follow-up of 2 years. We evaluated 59 elderly patients with mild cognitive impairment with accomplishment of at least two years of the controlled phase. Renal function was estimated by the aMDRD and CKD-EPI equation, and by laboratory and clinical data collected during the trial. The thyroid, immunological and glycemic functions were respectively evaluated by TSH, free T4, leukocyte count, neutrophil count, lymphocyte count, fasting plasma glucose and insulin, and the HOMA-IR. The clinical safety was evaluated through systematic examination performed every 3 months, with physical examination, clinical interview and UKU scale for adverse effects. Results: There was no decline of renal function with the use of lithium (litemia between 0.25-0.5 mmol/l) both in the aMDRD (p=0.453) and CKD-EPI (p=0.181) equations. A significant increase of neutrophils (p=0.038) and TSH (p=0.034) were observed. The lithium group showed significantly higher incidence of diabetes mellitus (p=0.037), arrhythmias (p=0.028), weight gain (p=0.015), more symptoms of UKU scale (p=0.045), and greater interference from the adverse effects of lithium during daily activities (p<0.001). There was an observed correlation between the opinion of the attending physician and the patient in respect to the interference in daily activities secondary to the adverse symptoms (p<0.001). Conclusions: The use of lithium in low doses did not result in renal function impairment, produced subtle changes in the immunological system and thyroid function, and was clinically safe for adverse effects. The reasons for the increased incidence of arrhythmias and diabetes mellitus deserve further investigation

A inibição do transporte axonal é um evento que ocorre prematuramente no curso das doenças neurodegenerativas, inclusive antes da formação dos agregados proteicos, os quais estariam envolvidos no processo fisiopatológico das doenças neurodegenerativas. No presente estudo avaliou-se a hipótese de que alterações no transporte de mitocôndrias ocorrem antes da formação dos agregados proteicos envolvidos em neurodegeneração, devido a desregulação dos níveis citoplasmáticos de Ca2+ e o envolvimento da modulação do transporte mitocondrial provido pela proteína Miro neste cenário. Utilizaram-se dois modelos experimentais: o primeiro utilizando a exposição à rotenona em culturas primárias de neurônios do locus coeruleus, hipocampo e substância negra de ratos, e o segundo utilizando neurônios derivados de células tronco de pluripotência induzida (iPSC), isogênicas humanas contendo mutações que levam à deleção do exon 9 da (deltaE9) no gene da presenilina 1 (PS1), o qual apresenta aumento da síntese do peptídeo beta-amiloide com 42 aminoácidos (Abeta42), sem a formação de agregados proteicos. Os resultados mostram disfunções nos níveis citoplasmáticos de Ca2+ em ambos modelos. A mobilidade mitocondrial alterou-se no hipocampo, locus coeruleus e substância negra após exposição à rotenona. No entanto, a direção das alterações observadas não se correlacionaram com os níveis de Ca2+, de acordo com o já descrito na literatura. Não houve alteração da mobilidade mitocondrial, nem nos níveis de Miro1, nos neurônios derivados de iPSC. Em conclusão, o presente estudo demonstrou que alterações nos níveis citoplasmáticos de Ca2+ ocorrem antes e durante a formação de agregados proteicos, o que pode ser importante para a etiologia de doenças neurodegenerativas. Foi também demonstrado que mudanças na mobilidade mitocondrial, acompanhadas por alterações nas concentrações intracelulares de Ca2+, em níveis fisiológicos, ocorrem de forma independente dos níveis da proteína Miro1 em culturas de células. Porém são necessários novos estudos a fim de relacionar alterações na mobilidade mitocondrial e a indução da neurodegeneração / The axonal transport impairment occurs early in neurodegenerative diseases, even before the formation of protein aggregates, which are related with the neuropathophysiology mechanism in neurodegenerative diseases. In this study, we evaluate the hypothesis that disruptions in mitochondria transport occurs before the formation of protein aggregate related with neurodegeneration, triggered by dysregulations in cytosolic Ca2+ levels and the involvement of Miro Ca2+ dependent mechanism of mitochondria trafficking modulation. We employed two experimental models, first using rotenone exposure in primary neuronal cell cultures from locus coeruleus, substantia nigra and hippocampus of newborn rats. Second, using isogenic human neurons derived from induced pluripotent stem cells (iPSCs), harboring mutations, those induce exon 9 deletion (deltaE9) in Presenilin 1 (PS1) gene, and showing increased synthesis of amyloid beta peptide with 42 amino acids (betaA42) without the formation of protein aggregates. We found abnormalities in cytosolic Ca2+ levels in both experimental models, mitochondria trafficking were altered in hippocampus, substantia nigra and locus coeruleus. However, the pattern of mitochondria trafficking alterations did not correlate with cytosolic Ca2+ levels, accordingly with the data that was already published. We did not find alterations in mitochondria trafficking or Miro1 levels in neurons derived from iPSC. In conclusion, our finds demonstrated aberrant cytosolic Ca2+ levels before and during protein aggregation, which may be important for the etiology of neurodegenerative diseases. In addition, this dysfunction in mitochondria trafficking happens after changes in cytosolic Ca2+ levels, in physiological range, independent of Miro1 levels in primary neurons cell cultures. Therefore, new studies need to be done, aiming to elucidate the relation between mitochondria trafficking dysfunctions and the induction of neurodegeneration process.

La gestion de cas est une pratique professionnelle qui s’implante actuellement en France, en particulier dans le domaine des soins aux personnes âgées en perte d’autonomie. Les « gestionnaires de cas » interviennent auprès de personnes âgées vivant à domicile dont la situation est jugée particulièrement complexe sur le plan médical et social. Ils ont pour mission d’évaluer les besoins des personnes suivies, de mettre en place les soins et les aides nécessaires, et d’assurer un suivi à long terme. Ils participent au processus d’intégration de l’organisation des soins en identifiant les dysfonctionnements au niveau de leur territoire, dans le cadre du « dispositif MAIA ». L’apparition de cette nouvelle pratique professionnelle soulève des enjeux éthiques spécifiques, du fait du positionnement particulier des gestionnaires de cas vis-à-vis des personnes accompagnées et de leur rôle nouveau dans le système de soins. L’objectif de ce travail est de proposer un cadre cohérent pour penser l’éthique de la gestion de cas, à partir de l’analyse des valeurs, des attitudes et des pratiques des gestionnaires de cas. Notre approche méthodologique s’appuie sur une recherche qualitative permettant un dialogue permanent entre faits observés et constructions théoriques, selon les principes de l’éthique empirique intégrée. Notre recueil de données comprend des entretiens approfondis avec des gestionnaires de cas, des entretiens semi-structurés avec les « pilotes » qui les encadrent, des groupes de discussions et un questionnaire écrit. L’étude française est complétée par une étude de cas visant à évaluer les conséquences sur l’éthique des professionnels d’un contexte organisationnel différent, à partir de groupes de discussion réalisés au Québec (Sherbrooke) et en Allemagne (Greifswald). L’analyse des données nous a amené à reconnaitre l’individualisation de la relation comme une valeur phare de la gestion de cas. L’engagement des professionnels dans une relation soignante leur permet de faire face aux conflits de valeurs que crée leur double mission de protéger des personnes vulnérables et de respecter leurs choix. Les gestionnaires de cas s’appuient en effet sur cette relation pour négocier avec la personne accompagnée un projet de soin qui fasse sens dans son histoire de vie. Cette individualisation de la relation entre en tension avec la nécessaire à une organisation du système de soins juste et efficiente. Le développement d’une éthique professionnelle spécifique à la gestion de cas nécessite donc de penser conjointement le rôle clinique du gestionnaire de cas, vis-à-vis des personnes accompagnés, et son rôle institutionnel. L’équilibre entre ces deux rôles est à construire dans le cadre d’une éthique organisationnelle, compatible avec l’éthique des professionnels et garante des droits des personnes accompagnées, propre à chaque système de santé. / Case management is a professional practice currently implemented in France. It is addressed to elderly persons living in community whose social and medical situation is regarded as particularly complex. Case managers have to assess needs in order to plan and coordinate necessary services. They assure a long term intensive follow-up. Furthermore, they promote the integration of the health care system by identifying malfunctions on their territories, as expected by the “MAIA” model. The emergence of this new practice raises specific ethical challenges, because of case managers’ two missions, patient-centered and system-centered. The aim of this study is to propose a coherent framework for case management ethics, based upon an analysis of case managers’ values, attitudes and practices. This study is based on one qualitative inquiry, allowing a continuous dialogue between observed facts and ethical theories, according to the approach of integrated empirical ethics. Our data collection contains in-depth interviews with case managers, semi-standardized interviews with some of their “pilots”, focus groups and a written questionnaire. This French survey is completed with a “case study” in order to assess the consequences of different organizational contexts on professionals’ ethics. We have therefore performed focus groups in Canada (Sherbrooke) and Germany (Greifswald). Our data analysis leads us to identify the individualization of relationships as a core value of case management. The commitment of the professionals in a care relationship helps them to face the dilemma between client’s protection and client’s empowerment. They rely on this relationship to negotiate with the client a care project that makes sense in terms of his/her life story. However, this individualized relationship can conflict with the standardization, necessary for the equity and the effectiveness of the health care system. Hence, the development of a professional ethics for case managers implies handling both, their clinical client-centered role and their systemic role. The balance between these two missions has to be elaborated in terms of an organizational ethics, consistent with the ethics of the professionals and guaranteeing the respect of the clients’ right, specific to each health care system.

Ces dernières années, de nombreuses études ont prouvé que la protéine précurseur de l'amyloïde (APP) joue un rôle clé dans le processus de formation de la mémoire, le développement des connexions synaptiques et la régulation de la force synaptique. L’importance d’APP naît du fait que son clivage protéolytique produit le peptide bêta-amyloïde (Aβ), considéré comme l'un des facteurs cruciaux dans le développement de la maladie d'Alzheimer. Les recherches se sont donc concentrées sur Aβ plutôt que sur le domaine intracellulaire APP (APP-ICD). Récemment, il a été démontré qu’APP-ICD affecte l'induction de la plasticité synaptique, et Aβ à haute concentration est connu pour induire une dépression synaptique. Ici, nous montrons qu’APP-ICD et Aβ fonctionnent ensemble et induisent une dépression synaptique en modifiant la transmission synaptique par effet additif. L’activation de la caspase-3 clivant APP-ICD est nécessaire pour la dépression à long terme. Nous constatons que l’activation de la caspase-3 et son site de clivage d’APP-ICD, ainsi que le clivage d’APP par la gamma-sécrétase sont nécessaires à la dépression synaptique dépendante d’Aβ. La microglie assure la clairance d’Aβ et certains effets de plasticité. Nous démontrons qu’elle médie partiellement la dépression synaptique dépendante d’Aβ. Les mécanismes par lesquels APP-ICD et Aβ médient la dépression synaptique ne sont pas connus. Ici, nous discutons de pistes possibles pour la recherche future, notamment des changements dans l'homéostasie du calcium en tant que cible thérapeutique potentielle. Comprendre comment APP-ICD et Aβ travaillent ensemble pour induire une dépression synaptique aiderait à développer de meilleurs traitements pour la maladie d'Alzheimer. / In recent years, more and more evidence has proven that the amyloid precursor protein (APP) plays a key role in the process of memory formation, the development of synaptic connections, and the regulation of synaptic strength. APP rose to prominence since its proteolytic cleavage produces the amyloid-beta (Aβ) peptide, which is believed to be one of the crucial factors in the development of Alzheimer disease. Therefore, most of the research focused on Aβ, while APP intracellular domain (APP-ICD) received much less attention. In a recent study, APP-ICD was shown to affect the induction of synaptic plasticity, and Aβ at high concentration is known to induce synaptic depression. Here we show that APP-ICD works together with Aβ to induce synaptic depression, meaning they have an additive effect that changes synaptic transmission. Caspase-3 cleaves APP-ICD, and its activation is required for long-term depression. We found that the caspase-3 cleavage site of APP-ICD and caspase-3 activation are needed for Aβ-dependent synaptic depression. We also show that cleavage of APP by gamma-secretase is needed for the effect. Microglia mediate clearance of Aβ as well as some plasticity effects. We demonstrate that microglia partially mediate Aβ-dependent synaptic depression. The mechanisms of how APP-ICD and Aβ mediate synaptic depression are not known, here, we discuss possible avenues for future research, specifically changes in calcium homeostasis as a potential therapeutic target. Hence, understanding how APP-ICD and Aβ work together to induce synaptic depression would aid in developing better treatments for Alzheimer disease.

No description available.

[pt] O envelhecimento em todo o mundo é um dos maiores desafios da saúde. Nesse contexto, condições clínicas como demências e Comprometimento Cognitivo Leve (CCL) também aumentam suas prevalências. A causa de demência mais frequente e estudada é demência de Alzheimer (DA). Tradicionalmente, DA é caracterizada pelo déficit precoce na memória episódica. Entretanto, estudos atuais mostram que a DA apresenta heterogeneidade neuropsicológica e alguns pacientes apresentam déficits cognitivos precoces não-amnésticos. Essas apresentações são chamadas por alguns autores de DA atípica. Dessa forma, a primeira parte dessa tese dedicou-se a estudar a heterogeneidade neuropsicológica na DA através de dois estudos: uma revisão sistemática sobre heterogeneidade neuropsicológica na DA (publicado) e um estudo de casos sobre perfis típico e atípico na DA (publicado). A revisão sistemática tornou-se necessária já que foi a primeira revisão sistemática publicada sobre o tema. Os achados dos dois estudos mostraram que aspectos atípicos na DA precisam ser mais explorados, já que DA não é uma condição homogênea. Compreender esses perfis cognitivos na DA irá interferir nos métodos diagnósticos e intervenções terapêuticas, seja farmacológica ou comportamental. A segunda parte dessa tese explora esses aspectos atípicos em três amostras: envelhecimento normal, CCL e AD. Assim, um estudo transversal foi realizado para comparar medidas de velocidade de processamento (VP), controle inibitório e automonitoramento nas três amostras. Os resultados desse estudo mostram que medidas de VP podem ser indicadores precoces do declínio cognitivo envelhecimento. Ao comparar CCL com o grupo de envelhecimento saudável, os dados mostram diferença nas medidas de VP e erros cometidos nos testes de VP. Entretanto, as duas amostras não apresentaram diferenças nas medidas de funções executivas (FEs) e nas medidas de funcionalidade. CCL versus AD mostraram diferenças nas medidas de VP, funções executivas e funcionalidade. Dessa forma, esse estudo traz resultados relevantes para o diagnóstico precoce de CCL e novas diretrizes para o cenário clínico e pesquisa. Além disso, na segunda parte desta tese foi realizado um artigo sobre acurácia diagnóstica das medidas de VP nos casos de CCL e AD. A literatura mostra falta de estudos sobre diferenças nas medidas de VP no envelhecimento e parâmetros diagnósticos dos instrumentos de VP. Esse estudo mostrou que medidas de VP apresentam habilidades discriminativas, para DA e CCL. Esses dados são necessários, já que apresentamos um cenário de escassez de instrumentos com elevados parâmetros diagnósticos para medidas de VP no envelhecimento. Esse cenário torna-se ainda mais drástico, quando falamos de Brasil. / [en] Aging is a major healthcare challenge worldwide. With aging, the prevalence of conditions such as dementia and Mild Cognitive Impairment increase. The most frequent and studied cause of dementia is Alzheimer s dementia (AD). Traditionally, AD is characterized by early deficit in episodic memory. However, current studies show that AD presents heterogeneity in clinical manifestations, especially cognitive manifestations. Thus, some patients present a non-amnestic cognitive profile. These profiles are called by some authors as atypical AD. The first part of this thesis was aimed at studying the neuropsychological heterogeneity in AD by means of 2 studies: a systematic review on neuropsychological heterogeneity in AD (published) and cases of study with typical and atypical AD patients (published). The systematic review was necessary, as it was the first published review about the topic. The findings of the two studies show that atypical aspects in AD need to be further explored, since AD is not a homogeneous condition. Understanding these cognitive profiles in AD will interfere in diagnostic methods and therapeutic interventions, either pharmacological or behavioral ones. The second part of this thesis explores atypical aspects in three samples: normal aging, MCI and AD. Thus, a cross-sectional study was conducted to compare measures of processing speed (PS), inhibitory control, working memory and cognitive flexibility in the three samples. The results of this study showed that PS measures may be early indicators of cognition decline in aging. MCI versus normal aging showed differences in PS measures and errors in tests of PS. However, these samples did not show differences in executive function measures (EFs) and functional measures. Nevertheless, MCI versus AD show differences in PS measures, executive functions and functionality. Thus, this study showed relevant results for the diagnosis process of MCI and new guidelines for clinical settings and research. In addition, in the second part of this thesis an article was written on diagnostic accuracy of the PS measures used in cases of MCI and AD. The literature shows a lack of studies on differences in PS measures in aging and diagnostic parameters of PS instruments. This study showed that PS measures present discriminative abilities in AD and MCI. These data are important, as there is a lack of diagnostic tools for PS in aging, especially in the Brazilian scenario.

yes / To determine whether jugular venous reflux (JVR) is associated with cerebral white matter changes (WMCs) in individuals with Alzheimer's disease (AD), we studied 12 AD patients 24 mild cognitive impairment (MCI) patients, and 17 elderly age- and gender-matched controls. Duplex ultrasonography and 1.5T MRI scanning was applied to quantify cerebral WMCs [T2 white matter (WM) lesion and dirty-appearing-white-matter (DAWM)]. Subjects with severe JVR had more frequently hypertension (p = 0.044), more severe WMC, including increased total (p = 0.047) and periventricular DAWM volumes (p = 0.008), and a trend for increased cerebrospinal fluid volumes (p = 0.067) compared with the other groups. A significantly decreased (65.8%) periventricular DAWM volume (p = 0.01) in the JVR-positive AD individuals compared with their JVR-negative counterparts was detected. There was a trend for increased periventricular and subcortical T2 WMC lesion volumes in the JVR-positive AD individuals compared with their JVR-negative counterparts (p = 0.073). This phenomenon was not observed in either the control or MCI groups. In multiple regression analysis, the increased periventricular WMC lesion volume and decreased DAWM volume resulted in 85.7% sensitivity and 80% specificity for distinguishing between JVR-positive and JVR-negative AD patients. These JVR-WMC association patterns were not seen in the control and MCI groups. Therefore, this pilot study suggests that there may be an association between JVR and WMCs in AD patients, implying that cerebral venous outflow impairment might play a role in the dynamics of WMCs formation in AD patients, particularly in the periventricular regions. Further longitudinal studies are needed to confirm and validate our findings.

No / Hyperphosphorylated tau plays an important role in the formation of neurofibrillary tangles in brains of patients with Alzheimer's disease (AD) and related tauopathies and is a crucial factor in the pathogenesis of these disorders. Though diverse kinases have been implicated in tau phosphorylation, protein phosphatase 2A (PP2A) seems to be the major tau phosphatase. Using murine primary neurons from wild-type and human tau transgenic mice, we show that the antidiabetic drug metformin induces PP2A activity and reduces tau phosphorylation at PP2A-dependent epitopes in vitro and in vivo. This tau dephosphorylating potency can be blocked entirely by the PP2A inhibitors okadaic acid and fostriecin, confirming that PP2A is an important mediator of the observed effects. Surprisingly, metformin effects on PP2A activity and tau phosphorylation seem to be independent of AMPK activation, because in our experiments (i) metformin induces PP2A activity before and at lower levels than AMPK activity and (ii) the AMPK activator AICAR does not influence the phosphorylation of tau at the sites analyzed. Affinity chromatography and immunoprecipitation experiments together with PP2A activity assays indicate that metformin interferes with the association of the catalytic subunit of PP2A (PP2Ac) to the so-called MID1-alpha4 protein complex, which regulates the degradation of PP2Ac and thereby influences PP2A activity. In summary, our data suggest a potential beneficial role of biguanides such as metformin in the prophylaxis and/or therapy of AD.

No / AIMS/HYPOTHESIS: We previously demonstrated that animals fed a high-fat (HF) diet for 10 weeks developed insulin resistance and behavioural inflexibility. We hypothesised that intervention with metformin would diminish the HF-feeding-evoked cognitive deficit by improving insulin sensitivity. METHODS: Rats were trained in an operant-based matching and non-matching to position task (MTP/NMTP). Animals received an HF (45% of kJ as lard; n = 24), standard chow (SC; n = 16), HF + metformin (144 mg/kg in diet; n = 20) or SC + metformin (144 mg/kg in diet; n = 16) diet for 10 weeks before retesting. Body weight and plasma glucose, insulin and leptin were measured. Protein lysates from various brain areas were analysed for alterations in intracellular signalling or production of synaptic proteins. RESULTS: HF-fed animals developed insulin resistance and an impairment in switching task contingency from matching to non-matching paradigm. Metformin attenuated the insulin resistance and weight gain associated with HF feeding, but had no effect on performance in either MTP or NMTP tasks. No major alteration in proteins associated with insulin signalling or synaptic function was detected in response to HF diet in the hypothalamus, hippocampus, striatum or cortex. CONCLUSIONS/INTERPRETATION: Metformin prevented the metabolic but not cognitive alterations associated with HF feeding. The HF diet protocol did not change basal insulin signalling in the brain, suggesting that the brain did not develop insulin resistance. These findings indicate that HF diet has deleterious effects on neuronal function over and above those related to insulin resistance and suggest that weight loss may not be sufficient to reverse some damaging effects of poor diet.