Le mauvais repliement et l’agrégation des protéines représentent une cause fondamentale des pathologies amyloïdes. Des dépôts de protéines sous la forme de fibrilles amyloïdes sont une composante caractéristique de plus de vingt maladies neurodégénératives incluant la maladie d’Alzheimer, la maladie de Parkinson et la maladie d’Huntington. Des nanotubes composés de peptides-α -D,L cycliques synthétiques peuvent mimer les propriétés structurelles et biochimiques des protéines amyloïdes. L’introduction de résidus aza-aminés dans des peptides α -D,L cycliques a été étudiée dans le but d’augmenter les interactions hydrogènes intermoléculaires entre les différents macrocycles superposés composant le nanotube. Les peptides aza-α-D,L cycliques devraient aussi posséder une meilleure capacité d’interaction avec les feuillets des oligomères amyloïdes. Le peptide d’intérêt CP-2 possède la séquence [l-J-w-H-s-K], où les lettres minuscules et majuscules font référence respectivement aux acides aminés D et L, les crochets indiquent une structure cyclique et la lettre « J » représente la norleucine. En exploitant la capacité des semicarbazides d’accroitre les ponts hydrogènes intermoléculaires, nous avons remplacés successivement chacun des acides aminés de la séquence CP-2 par un résidu aza-glycine, obtenant une librairie d’azapeptides cycliques. Ces peptides ont été testés pour leur propriété neuroprotectrice contre les amyloïdes en utilisant un essai de viabilité cellulaire (essai MTT). Le peptide où la D-serine a été remplacée par une aza-glycine, CP-2 (4), s’est avéré plus efficace que CP-2. Il s’agit du premier exemple d’introduction d’un résidu aza-aminé dans un peptide α-D,L cyclique, et ces résultats pourraient être extrapolés à d’autres peptides α-D,L cycliques d’intérêt thérapeutique. / Protein misfolding and aggregation are the fundamental causes of amyloid diseases. Deposits of proteins in the form of amyloid fibrils and plaques are the characteristic features of more than twenty degenerative conditions, including Alzheimer’s, Parkinson’s, and Huntington’s diseases. Synthetic cyclic D,L-α-peptide nanotubes can mimic the structural and biochemical properties of amyloid proteins. The introduction of aza-residues into cyclic D,L-α-peptides was studied to enhance intermolecular hydrogen bonding between stacked rings within the tube structures. The resulting cyclic aza-D,L-α-peptides were also expected to exhibit enhanced propensity to interact with the sheet structures of amyloid oligomers. The lead peptide CP-2 features the sequence [l-J-w-H-s-K] in which lower and upper-case letters indicate D- and L-amino acids, respectively, square brackets designate a cyclic structure, and J denotes norleucine. There are no reports for introduction of aza-residues into cyclic D,L-α-peptides. Considering the potential for semicarbazides to enhance intermolecular hydrogen bonding, we performed an aza-glycine scan of the CP-2 sequence by preparing a focused library of azapeptides. All the cyclic aza-glycine peptides were tested for neuroprotective activity against amyloid using cell viability assay (MTT assay). The aza-glycine replacing D-serine i.e., [azaG2]-CP-2 (4) was found to be more potent than CP-2. This is the first example of introducing an aza-amino residue into a cyclic D, L-α-peptide, and these results could be extrapolated to other cyclic D, L-α-peptides of therapeutic interest.

Alzheimer’s disease (AD) is a major cause of the rapidly growing and crushing aging challenge that threatens to economically undermine today’s healthcare system. AD prevalence will grow to over 100 million cases in 2050. AD is incurable but can be prevented. Therefore, the most viable solution may be to detect very early signs of AD (presymptomatically) in citizens-at-risk and to intervene in time to reduce AD risk or prevent it entirely. The present project will refine and validate two breakthrough innovations for AD detection and AD prevention and commercialize them as a one-stop digital medical device, named ‘AD Detect & Prevent’. The first innovation is a highly sensitive cognitive assessment method recently pioneered by a group of researchers that has been shown to detect subtle presymptomatic stage cognitive decline specific to AD. This will be integrated with the second innovation – a digital AD prevention programme delivered on an award-winning computerized cognitive training and rehabilitation platform (app + web) that uses high intensity immersive and adaptive ‘neurogames’ and audio-based therapy for behavioural intervention, designed for strengthening core cognitive functions, building cognitive reserve, changing lifestyle and thus reducing the overall AD risk in individuals. The detection and prevention methods will undergo vigorous scientific validation, and the ambition is to create and become the global standard of care for precise presymptomatic detection of AD and effective AD prevention.

L’objectif de ce travail de thèse était d’évaluer l’état des processus de récupération en mémoire dans la maladie d’Alzheimer afin de développer des programmes de prise en charge cognitive novateurs. Les deux premières études ont porté sur la caractérisation de ces processus à travers l’évaluation des performances de patients avec une maladie d’Alzheimer à des tâches de reconnaissance mnésique. Les deux études suivantes se sont intéressées au développement de programmes d’intervention cognitive ayant pour objectif de réduire les troubles cognitifs et leur retentissement, l’un en améliorant les processus cognitifs altérés à partir d’un entraînement cognitif appliquant la répétition-lag procédure et l’autre, en sollicitant les processus cognitifs préservés à partir d’un apprentissage par des techniques de réhabilitation cognitive, à recourir à l’utilisation d’aides externes. Les résultats ont mis en évidence une détérioration sélective des processus de reconnaissance chez les patients à un stade léger de la maladie ; la recollection serait particulièrement altérée alors que la familiarité resterait préservée. De plus, le déficit des capacités de reconnaissance de la source serait lié à l’altération des processus stratégiques de reconnaissance de la source, les processus associatifs resteraient préservés. Ensuite, le programme d’entraînement cognitif expérimental s’est révélé efficace, des gains cognitifs ont été objectivés à des tâches cognitives de transfert. De même, le programme de réhabilitation cognitive par le biais d’un apprentissage combinant les techniques de la récupération espacée et de l’apprentissage sans erreur a permis de réduire l’impact des troubles cognitifs dans la vie quotidienne / The main objective of this thesis was to evaluate retrieval memory processes in Alzheimer’s disease in order to develop innovative cognitive interventions. The first two studies focused on the characterization of these processes through performance evaluation of patients with Alzheimer’s disease in recognition memory tasks. The next two studies became interested in development of cognitive intervention programs aimed at reducing cognitive impairment and their impact. One tries to improve impaired cognitive processes from a cognitive training using the repetition-lag procedure and the other one uses different cognitive rehabilitation techniques that involve preserved cognitive processes to learn to resort to the use of external aids. The results showed a selective deficit in recognition processes in patients with a mild stage of Alzheimer’s disease, recollection would be particularly affected as familiarity remains preserved. In addition, source recognition deficit could be explained by a specific alteration of source recognition strategic processes whereas associative processes should remain preserved. Secondly, the experimental cognitive training program was effective, cognitive gains were objectified in transfer tasks. Similarly, the cognitive rehabilitation program using spaced retrieval technique and errorless learning has reduced the impact of cognitive impairment in everyday life

La recherche sur la maladie d’Alzheimer (MA) est concentrée, en grande partie, sur l’étude de ses principales caractéristiques histologiques, les plaques β-amyloïdes (Aβ) et les enchevêtrements neurofibrillaires. Cependant, les thérapies ciblant directement ces caractéristiques n’empêchent pas la progression de la MA. En plus de ces caractéristiques, la génétique a mis en évidence l’implication du métabolisme des lipides et de la réponse immunitaire dans la MA. Les perturbations du métabolisme lipidique est le prédicteur génétique le plus puissant du développement de la MA, mais ses mécanismes restent un mystère. Des travaux récents dans notre laboratoire ont montré que les triglycérides s’accumulent dans le cerveau des patients atteints de MA et des souris 3xTg, un modèle murin de la MA. Chez les souris 3xTg, ces triglycérides sont enrichis en acide oléique (AO), un acide gras monoinsaturé, et l’inhibition de l’enzyme de synthèse de l’AO, le stéaryle-CoA désaturase (SCD), réduit leur accumulation et contrecarre la perte précoce de la neurogenèse hippocampique et les troubles de mémoire. Nous avons donc testé si l’inhibition de la SCD peut inverser les changements dans le transcriptome et rétablir la fonction de l’hippocampe chez les souris 3xTg symptomatiques. En comparant aux souris contrôles, l’hippocampe de souris 3xTg possède des altérations transcriptomiques impliquées dans les processus reconnus pour être perturbés dans la MA. Leur hippocampe a également montré une baisse significative des épines dendritiques. De manière remarquable, les données de séquençage de l’ARN montrent que le traitement des souris 3xTg pendant un mois avec un inhibiteur de la SCD a sauvé des gènes liés à l’immunité et aux synapses. Les analyses tissulaires ont révélé que ce traitement a conduit à des améliorations de la densité des épines dendritiques. Nous avons également établi un modèle de microglie en culture et nos données préliminaires suggèrent que les oligomères Aβ pourrait être responsable de perturbations du métabolisme des lipides chez les microglies. En somme, ces études soulignent le potentiel d’un nouveau médicament ciblant SCD pour le traitement de la MA. / Alzheimer’s disease (AD) research has mainly focused on studying its main histological hallmarks, β-amyloid (Aβ) plaques, and neurofibrillary tangles. However, therapies directly targeting these hallmarks do not prevent AD progression. In addition to these hallmarks, genetics have highlighted the implication of lipid metabolism and immunity in AD. Disturbances in lipid metabolism are the single strongest genetic predictor of developing AD, but the underlying mechanisms remain poorly understood. Recent work in our laboratory showed that triglycerides accumulate in the brains of both AD patients and 3xTg mice, a mouse model of AD. In 3xTg mice, these triglycerides are enriched with monounsaturated fatty acid oleic acid (OA), and the inhibition of the OAsynthesizing enzyme stearoyl-CoA desaturase (SCD) reduced their accumulation and counteracts the early loss of hippocampal neurogenesis and memory deficits. Here, we tested whether SCD inhibition can reverse changes in the transcriptome and rescue hippocampal function in symptomatic 3xTg mice. Compared to their strain controls, the hippocampus of middle-aged, preplaque 3xTg mice showed transcriptomic alterations involved in processes recognized to be disrupted in AD. Their hippocampus also displayed significant reduction in dendritic spines. Remarkably, RNA sequencing data show that treatment of middle-aged 3xTg mice for one month with an SCD inhibitor rescued genes related to immunity and synapses. Tissue analyses revealed that this treatment led to improvements in dendritic spine density. We also established a model of microglia in culture and our preliminary data suggest that Aβ oligomers may be responsible for disruptions in microglial lipid metabolism. Together, these studies shed light on the potential of a novel drug target SCD for the treatment of AD.

Taking medication at the prescribed times is very important for people with mental issues like schizophrenia, dementia Alzheimer’s and depression. But their condition itself keeps them from doing so. They are either forgetful or choose not to take the pills intentionally. This could lead to missing dosage or overdosing both of which are dangerous to the person’s health. Hence a pill box that monitors the dosage and keeps them from being able to access the pills at undesired times is needed. The aim of the thesis is to design such a pill box for the company Victrix AB in Stockholm, Sweden, by expanding on their current pill box, Dosis. In the project, the locking mechanism to keep the lids closed was rigorously designed in phases after understanding the user conditions. The end result is a locked daily pill box that is ergonomic to use for people of all ages, mental and physical conditions. The product sets itself apart from its competitors by being compact, less medical looking and very easy to use. / Att ta mediciner vid föreskrivna tidpunkter är mycket viktigt för personer med psykiska problem som schizofreni, alzheimers, demens och depressioner. Dock kan deras tillstånd hindra dem från att göra det. De är antingen glömska eller så väljer de att inte ta medicinen avsiktligt. Sådant beteende kan leda till saknad dosering eller överdosering, vilka båda är farliga för personens hälsa. Därmed behövs en pillerask som övervakar doseringen och hindrar dem från att komma åt pillerna vid oönskade tidpunkter. Syftet med examensarbetet har varit att designa en sådan pillerask för företaget Victrix AB i Stockholm, Sverige, genom att utöka sin nuvarande ask, Dosis. I projektet designades låsmekanismen noggrant i faser, genom en ökad förståelse av användarförhållandena, för att hålla locken stängda,. Slutresultatet blev en låst daglig pillerask som är ergonomisk för personer i olika åldrar med mentala och fykiska problem. Produkten skiljer sig från dess konkurrenter genom att vara kompact, inte ha ett typiskt medicinskt utseende samt mycket enkel att använda.

La maladie d’Alzheimer (MA) représente la cause la plus importante de la démence, pourtant la cause de la MA reste toujours inconnue. Des données récentes suggèrent que la protéine BMI1 joue un rôle protecteur contre la MA et un rôle essentiel dans l’intégrité de l’hétérochromatine constitutive (hét-c) – les régions génomiques inactives au niveau de la transcription. Les niveaux de BMI1 et d’hét-c sont diminués dans les cerveaux de patients atteints de la MA, et des modèles de déficience de BMI1 in vivo et in vitro reproduisent des phénotypes canoniques de la MA. Nous avançons l’hypothèse que la perturbation de l’hét-c, effectuée par l’inactivation de gènes impliqués dans son intégrité, induira trois phénotypes canoniques de la MA : l’amyloïdopathie, la tauopathie et l’apoptose. Les knock-out (KO) de ces gènes se réalisent individuellement via le système CRISPR-Cas9 dans des neurones humains in vitro. Huit des 38 conditions de KO manifestent une perturbation d’hét-c, analysée par Western Blot; six manifestent une amyloïdopathie, deux manifestent une tauopathie et quatre manifestent des niveaux élevés d’apoptose, analysés par microscopie confocale et immunofluorescence. Les conditions de KO de gènes impliqués dans les domaines associés à la lamine manifestent plusieurs ou tous ces phénotypes de la MA. Ces résultats peuvent suggérer une nouvelle théorie qui expliquerait la cause de la MA : la dérépression de ces domaines induit l’activation des long interspersed elements (LINEs) dont leur dérépression cause des dommages à l’ADN et une réponse immunitaire innée aboutissant à un état sénescent et pro-inflammatoire qui entraîne la neurodégénérescence. / Alzheimer’s Disease (AD) represents the number one cause of dementia, however the cause of AD remains unknown. Recent data suggest that the protein BMI1 plays a protective role against AD and an essential role in the integrity of constitutive heterochromatin (c-het) – transcriptionally inactive, genomic regions. The levels of BMI1 and c-het are diminished in brains of AD patients, and models of BMI1 deficiency in vivo and in vitro reproduce canonical phenotypes of AD. We hypothesize that the disruption of c-het, brought about by inactivating genes implicated in its integrity, will induce three canonical phenotypes of AD: amyloidopathy, tauopathy and apoptosis. These gene knock-outs (KO) are carried out individually via the CRISPR-Cas9 system in human neurons in vitro. Eight of the 38 KO conditions present a disruption of c-het, analysed by Western Blot; six present amyloidopathy, two present tauopathy and four present elevated levels of apoptosis, analysed by confocal microscopy and immunofluorescence. The KO conditions of genes implicated in lamina-associated domains present some or all these AD phenotypes. These results may suggest a novel theory that would explain the cause of Alzheimer’s Disease: the derepression of these domains induces the activity of long interspersed elements (LINEs) which causes DNA damage and an innate immune response, culminating in a pro-inflammatory state of cellular senescence which leads to neurodegeneration.

Alzheimer’s disease is a neurodegenerative disease that affects approximately 6% of the global population aged over 65 and is forecasted to become even more prevalent in the future. Accurately diagnosing the disease in an early stage can play a large role in improving the quality of life for the patient. One key development for performing this diagnosis is applying machine learning to perform computer-aided diagnosis. Current research in the field has been focused on removing assumptions about the used data sets, but in doing so they have often discarded objective metadata such as the patient’s age, sex or priormedical history. This study aimed to investigate the effect of including such metadata as additional input features to neural networks used for diagnosing Alzheimer’s disease through binary classification of magnetic resonance imaging scans. Two similar neural networks were developed and compared, one with these additional features and the other without them. Including the metadata led to significant improvements in the network’s classification accuracy, and should therefore be considered in future computer-aided diagnostic systems for Alzheimer’s disease. / Alzheimers sjukdom är en form av demens som påverkar ungefär 6% av den globala befolkningen som är äldre än 65 och förutspås bli ännu vanligare i framtiden. Tidig diagnos av sjukdomen är viktigt för att säkerställa högre livskvalitet för patienten. En viktig utveckling inom fältet är datorstödd diagnos av sjukdomen med hjälp av maskininlärning. Dagens forskning fokuserar på att ta bort subjektiva antaganden om datamängden som används, men har ofta även förkastat objektiv metadata såsom patientens ålder, kön eller tidigare medicinska historia. Denna studier ämnade därför undersöka om inkluderandet av denna metadata ledde till bättre prestanda hos neuronnät som används för datorstödd diagnos av Alzheimers genom binär klassificering av bilder tagna med magnetisk resonanstomografi. Två snarlika neuronnät utvecklades och jämfördes, med skillnaden att den ena även tog metadata om patienten som indata. Inkluderandet av metadatan ledde till en markant ökning i neuronnätets prestanda, och bör därför övervägas i framtida system för datorstödd diagnos av Alzheimers sjukdom.

Aggregation of microtubule-associated protein tau is involved in the pathology of several neurodegenerative diseases, including Alzheimer’s disease. The affibody TP4 has been shown to inhibit this aggregation process, and its target-binding positions were previously grafted onto a dimeric affibody scaffold, creating the sequestrin seqTP4. This project constitutes a part of the affinity maturation process of seqTP4, using two different bacterial display methods. An error-prone PCR library was first expressed on Staphylococcus carnosus cells for selection of variants with improved tau-binding properties, resulting in a library of 1.4×107 transformants. Flow cytometric tests indicated difficulties in the setup due to nonspecific interactions, and whereas several different approaches to alleviate the problems were investigated, two cell sorting attempts were ultimately unsuccessful. Subcloning of seqTP4 and the library to an Escherichia coli surface display vector resulted in functional surface expression of seqTP4 on E. coli JK321 and BL21 cells, and a BL21 library size of 1.6×109 transformants. An initial flow cytometric test of this library indicates the presence of improved tau-binding variants, paving the way for future cell sorting. / Aggregering av mikrotubuli-associerat protein tau är involverad i patologin av flera neurodegenerativa sjukdomar, däribland Alzheimers sjukdom. Affibodymolekylen TP4 har visat sig inhibera denna aggregeringsprocess, och överföring av dess målbindande positioner till ett dimeriskt affibodyprotein har tidigare gett upphov till seqTP4, en så kallad sequestrin. Detta projekt utgör ett led i processen att affinitetsmaturera seqTP4, med hjälp av två olika metoder för presentation av proteiner på ytan av bakterieceller. Ett error-prone PCR-bibliotek uttrycktes först på ytan av Staphylococcus carnosus-celler för selektion av varianter med ökad affinitet för tau, vilket resulterade i ett bibliotek av 1.4×107 transformanter. Flödescytometriska tester tydde på svårigheter i detta upplägg på grund av ospecifika interaktioner, och emedan flera olika angreppssätt för att förmildra dessa problem undersöktes, misslyckades slutligen två cellsorteringsförsök. Omkloning av seqTP4 och biblioteket till en vektor för ytpresentation på Escherichia coli resulterade i funktionellt ytuttryck av seqTP4 på E. coli JK321- och BL21-celler, och ett BL21-bibliotek bestående av 1.6×109 transformanter. Ett första flödescytometriskt test av detta bibliotek tyder på närvaron av varianter med förbättrad förmåga att binda tau, och vägen ligger nu relativt öppen för cellsortering.

Bakgrund: Demens förekommer i många former och yttras på olika sätt i ett degenerativt förlopp. Globalt lider 55 miljoner människor av denna sjukdom. En majoritet av befolkningen blir alltmer äldre och behovet av omsorg ökar med avsaknad av tillräckligt med platser på särskilda boenden. Omsorgen sköts mer i det ordinära boendet med involvering av anhöriga vars tillvaro belastas och välbefinnande successivt försämras. Syfte: Belysa anhörigas upplevelser tiden efter att deras demenssjuke familjemedlem flyttat till särskilt boende. Metod: En litteraturöversikt av enbart kvalitativ forskning. Sökning av artiklar genomfördes i databaserna Cinahl och MedLine. En manifest kvalitativ innehållsanalys valdes av de 13 artiklar som ingick. Det analyserade materialet baserades på intervjuer. Resultat: Analysen av de anhörigas upplevelser resulterade i 3 teman. ”Emotionell belastning”, ”En ökad finansiell utmaning” och ”En harmonisk tillvaro”. I dessa teman framkommer ökad ensamhet, sorg, skuldkänslor, oroat samvete samt ekonomiska svårigheter. Slutsats: Tiden efter den närstående residerat i ny boendeform befinner sig anhöriga i en omvälvande fas i livet med stor omställning. En ofta redan tumult och svårt belastad tillvaro, övergår i ett skede med nya emotionellasvårigheter. / Background: Dementia manifests itself in different ways in the degenerative process. Globally, 55 million people suffer from this disease. A majority of the population is getting older and the need for care increases with the lack of nursing home facilities. Homebased care of dementia is more prevalent. Informal caregivers are commonly involved in care which gradually decreases their well-being. Aim: Elucidate informal caregivers’ experiences after nursing home admission of their relative with dementia. Method: A literature review of qualitative research. Articles were searched in the databases Cinahl and MedLine. A manifest qualitative content analysis was selected of the 13 articles that were included. The analyzed data was based on interviews. Results: The analysis of the relatives' experiences resulted in 3 themes. "Emotional burden", "An increased financial challenge" and "A harmonious existence". These themes identified increased loneliness, grief, guilt, troubled conscience and financial difficulties. Conclusion: Relatives are in an upheaval phase in life with major adjustment after their family member with dementia resides in the nursing home. An often already tumultuous and heavily burdened existence transitions into a stage with new emotional difficulties.

The deposition of β-amyloid peptides and of α-synuclein proteins is a neuropathological hallmark in the brains of Alzheimer’s disease (AD) and Parkinson’s disease (PD) subjects, respectively. However, there is accumulative evidence that both proteins are not exclusive for their clinical entity but instead co-exist and interact with each other. Here, we investigated the presence of a newly identified, pyroglutamate79-modified α-synuclein variant (pGlu79-aSyn)—along with the enzyme matrix metalloproteinase-3 (MMP-3) and glutaminyl cyclase (QC) implicated in its formation—in AD and in the transgenic Tg2576 AD mouse model. In the human brain, pGlu79-aSyn was detected in cortical pyramidal neurons, with more distinct labeling in AD compared to control brain tissue. Using immunohistochemical double and triple labelings and confocal laser scanning microscopy, we demonstrate an association of pGlu79-aSyn, MMP-3 and QC with β-amyloid plaques. In addition, pGlu79-aSyn and QC were present in amyloid plaque-associated reactive astrocytes that were also immunoreactive for the chaperone heat shock protein 27 (HSP27). Our data are consistent for the transgenic mouse model and the human clinical condition. We conclude that pGlu79-aSyn can be generated extracellularly or within reactive astrocytes, accumulates in proximity to β-amyloid plaques and induces an astrocytic protein unfolding mechanism involving HSP27.