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Alzheimer's disease: the cholesterol connection

Abstract

A hallmark of all forms of Alzheimer's disease (AD) is an abnormal accumulation of the β-amyloid protein (Aβ) in specific brain regions. Both the generation and clearance of Aβ are regulated by cholesterol. Elevated cholesterol levels increase Aβ in cellular and most animals models of AD, and drugs that inhibit cholesterol synthesis lower Aβ in these models. Recent studies show that not only the total amount, but also the distribution of cholesterol within neurons, impacts Aβ biogenesis. The identification of a variant of the apolipoprotein E (APOE) gene as a major genetic risk factor for AD is also consistent with a role for cholesterol in the pathogenesis of AD. Clinical trials have recently been initiated to test whether lowering plasma and/or neuronal cholesterol levels is a viable strategy for treating and preventing AD. In this review, we describe recent findings concerning the molecular mechanisms underlying the cholesterol–AD connection.

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Figure 1: Proteolytic processing of APP.

Ivelisse Robles

Figure 2: Two possible models for apoE's role in Aβ accumulation.

Ivelisse Robles

Figure 3: Schematic view of cholesterol homeostasis in neurons and cholesterol-related targets for therapeutic treatment of AD.

Ivelisse Robles

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Acknowledgements

The work described in this review was supported by grants from the Alzheimer's Association (L.P.), the National Institute on Aging (R.E.T.), the National Institute of Neurological Disorders and Stroke (D.M.K.) and the American Health Assistance Foundation (AHAF; to D.M.K.).

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Correspondence to Dora M. Kovacs.

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Puglielli, L., Tanzi, R. & Kovacs, D. Alzheimer's disease: the cholesterol connection. Nat Neurosci 6, 345–351 (2003). https://doi.org/10.1038/nn0403-345

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