Restoring cholinergic dysfunction has been a primary means of improving the cognitive decline in AD because four of the five Food and Drug Administration–approved drugs are acetylcholinesterase inhibitors, with the notable exception of memantine.
2- Mangialasche F.
- Solomon A.
- Winblad B.
- Mecocci P.
- Kivipelto M.
Alzheimer's disease: clinical trials and drug development.
Acetylcholinesterase inhibitors provide mild symptomatic relief but eventually lose efficacy over time, most likely because they are not disease-modifying agents.
1- Querfurth H.W.
- LaFerla F.M.
Alzheimer's disease.
Alternatively, recent evidence
3M1 muscarinic agonists target major hallmarks of Alzheimer's disease: the pivotal role of brain M1 receptors.
, 4- Wess J.
- Eglen R.M.
- Gautam D.
Muscarinic acetylcholine receptors: mutant mice provide new insights for drug development.
indicates that stimulation of muscarinic acetylcholine receptors, in particular the M
1 receptor (M
1R), restores cognition and attenuates AD-like pathological features in several different animal models, rendering it an attractive therapeutic approach for AD. The M
1R is the most abundant muscarinic acetylcholine receptor subtype in the cerebral cortex and hippocampus, the two main brain regions that develop amyloid plaques and neurofibrillary tangles.
5- Levey A.I.
- Kitt C.A.
- Simonds W.F.
- Price D.L.
- Brann M.R.
Identification and localization of muscarinic acetylcholine receptor proteins in brain with subtype-specific antibodies.
Although some studies have demonstrated that the abundance of M
1R remains relatively unchanged, other reports have shown reduced and elevated M
1R levels in the AD brain.
6- Mash D.C.
- Flynn D.D.
- Potter L.T.
Loss of M2 muscarine receptors in the cerebral cortex in Alzheimer's disease and experimental cholinergic denervation.
, 7- Tsang S.W.
- Lai M.K.
- Kirvell S.
- Francis P.T.
- Esiri M.M.
- Hope T.
- Chen C.P.
- Wong P.T.
Impaired coupling of muscarinic M1 receptors to G-proteins in the neocortex is associated with severity of dementia in Alzheimer's disease.
, 8- Flynn D.D.
- Ferrari-DiLeo G.
- Levey A.I.
- Mash D.C.
Differential alterations in muscarinic receptor subtypes in Alzheimer's disease: implications for cholinergic-based therapies.
, 9- Shiozaki K.
- Iseki E.
- Hino H.
- Kosaka K.
Distribution of m1 muscarinic acetylcholine receptors in the hippocampus of patients with Alzheimer's disease and dementia with Lewy bodies: an immunohistochemical study.
, 10- Svensson A.L.
- Alafuzoff I.
- Nordberg A.
Characterization of muscarinic receptor subtypes in Alzheimer and control brain cortices by selective muscarinic antagonists.
Such discrepancies arise from differences in the handling of the samples, the brain regions selected for study, and the method of measuring receptor binding. Corrections for regional brain atrophy and the relative involvement of receptor subtypes are often undefined. Thus, additional studies are necessary to clarify how the activity and levels of M
1R are changed in the AD brain.
Preclinical data have demonstrated that activation of M
1R elevates soluble amyloid precursor protein (APP)α, decreases Aβ and tau pathological features, and blocks Aβ-induced neurotoxicity
in vitro.
11- Nitsch R.M.
- Slack B.E.
- Wurtman R.J.
- Growdon J.H.
Release of Alzheimer amyloid precursor derivatives stimulated by activation of muscarinic acetylcholine receptors.
, 12- Sadot E.
- Gurwitz D.
- Barg J.
- Behar L.
- Ginzburg I.
- Fisher A.
Activation of m1 muscarinic acetylcholine receptor regulates tau phosphorylation in transfected PC12 cells.
, 13- Haring R.
- Fisher A.
- Marciano D.
- Pittel Z.
- Kloog Y.
- Zuckerman A.
- Eshhar N.
- Heldman E.
Mitogen-activated protein kinase-dependent and protein kinase C-dependent pathways link the m1 muscarinic receptor to beta-amyloid precursor protein secretion.
, 14- Jones C.K.
- Brady A.E.
- Davis A.A.
- Xiang Z.
- Bubser M.
- Tantawy M.N.
- Kane A.S.
- Bridges T.M.
- Kennedy J.P.
- Bradley S.R.
- Peterson T.E.
- Ansari M.S.
- Baldwin R.M.
- Kessler R.M.
- Deutch A.Y.
- Lah J.J.
- Levey A.I.
- Lindsley C.W.
- Conn P.J.
Novel selective allosteric activator of the M1 muscarinic acetylcholine receptor regulates amyloid processing and produces antipsychotic-like activity in rats.
Also, treatment with the selective M
1R agonist AF267B reduces the Aβ levels in the cerebrospinal fluid and cerebrovasculature in rabbits.
15- Beach T.G.
- Walker D.G.
- Potter P.E.
- Sue L.I.
- Fisher A.
Reduction of cerebrospinal fluid amyloid beta after systemic administration of M1 muscarinic agonists.
, 16- Beach T.G.
- Walker D.G.
- Potter P.E.
- Sue L.I.
- Scott S.
- Layne K.J.
- Newell A.J.
- Poston M.E.
- Webster S.D.
- Durham R.A.
- Emmerling M.R.
- Honer W.G.
- Fisher A.
- Roher A.E.
Immunotoxin lesion of the cholinergic nucleus basalis causes Abeta deposition: towards a physiologic animal model of Alzheimer's disease.
Evidence from our laboratory shows that long-term treatment with this compound reverses cognitive impairments and decreases Aβ and tau pathological features in the 3xTgAD mice.
17- Caccamo A.
- Oddo S.
- Billings L.M.
- Green K.N.
- Martinez-Coria H.
- Fisher A.
- LaFerla F.M.
M1 receptors play a central role in modulating AD-like pathology in transgenic mice.
Similarly, the administration of the muscarinic agonist RS86 to rats decreases APP levels in the cortex and hippocampus and increases the APPα level in the cerebrospinal fluid.
18- Lin L.
- Georgievska B.
- Mattsson A.
- Isacson O.
Cognitive changes and modified processing of amyloid precursor protein in the cortical and hippocampal system after cholinergic synapse loss and muscarinic receptor activation.
, 19- Seo H.
- Ferree A.W.
- Isacson O.
Cortico-hippocampal APP and NGF levels are dynamically altered by cholinergic muscarinic antagonist or M1 agonist treatment in normal mice.
Corroborating these findings, genetic deletion of M
1R has recently increased Aβ pathological features in APP
Swe/Ind mice.
20- Davis A.A.
- Fritz J.J.
- Wess J.
- Lah J.J.
- Levey A.I.
Deletion of M1 muscarinic acetylcholine receptors increases amyloid pathology in vitro and in vivo.
Because of the beneficial effects of M
1R agonists in transgenic models, additional studies are necessary to establish the molecular mechanisms through which M
1R promotes its neuroprotective effect to justify the translational applicability of using M
1R agonists as a therapeutic intervention for AD.
Materials and Methods
Animals
Homozygous M
1R
−/− mice
21- Anagnostaras S.G.
- Murphy G.G.
- Hamilton S.E.
- Mitchell S.L.
- Rahnama N.P.
- Nathanson N.M.
- Silva A.J.
Selective cognitive dysfunction in acetylcholine M1 muscarinic receptor mutant mice.
were bred with either homozygous 3xTgAD mice harboring a PS1
M146V knock-in and APP
Swe and tau
P301L transgenes
23- Oddo S.
- Caccamo A.
- Shepherd J.D.
- Murphy M.P.
- Golde T.E.
- Kayed R.
- Metherate R.
- Mattson M.P.
- Akbari Y.
- LaFerla F.M.
Triple-transgenic model of Alzheimer's disease with plaques and tangles: intracellular Abeta and synaptic dysfunction.
or heterozygous Tg-SwDI mice that contain the Swedish and the vasculotropic Dutch and Iowa APP mutations.
22- Davis J.
- Xu F.
- Deane R.
- Romanov G.
- Previti M.L.
- Zeigler K.
- Zlokovic B.V.
- Van Nostrand W.E.
Early-onset and robust cerebral microvascular accumulation of amyloid beta-protein in transgenic mice expressing low levels of a vasculotropic Dutch/Iowa mutant form of amyloid beta-protein precursor.
The offspring were intercrossed to yield 3xTgAD
+/+/M
1R
−/− (3xTgAD-M
1R
−/−) mice and Tg-SwDI
+/−/M
1R
−/− (Tg-SwDI–M
1R
−/−) mice. Nine-month-old Tg-SwDI and Tg-SwDI–M
1R
−/− mice and 18-month-old 3xTgAD and 3xTgAD-M
1R
−/− mice were used in the experiments. Age-matched nontransgenic (nTg) and M
1R
−/− mice were used as controls. All animals had a C57Bl6/129SvJ background. No obvious histological changes were apparent in the brains of mice lacking the M
1R. In addition, no changes in the expression levels and distribution of acetylcholine receptors M
2-M
5 were found in M
1R
−/− mice compared with nTg mice. Behavioral, neuropathological, and neurochemical changes in M
1R
−/− mice have been reviewed elsewhere.
4- Wess J.
- Eglen R.M.
- Gautam D.
Muscarinic acetylcholine receptors: mutant mice provide new insights for drug development.
All procedures used in the present study followed the Principles of Laboratory Animal Care from NIH publication 85–23 and were approved by the University of California, Irvine, Institutional Animal Care and Use Committee.
Open Field
For open field activity testing, mice were individually placed in the center of a novel open field environment (45 × 45 × 30 cm) and allowed to explore for 5 minutes. The total distance moved in the open field was monitored with the EthoVision XT video-tracking system (Noldus Information Technology, Leesburg, VA).
Social Recognition
Each mouse was housed individually for 4 days to establish territorial dominance. A juvenile male mouse was used as the intruder. To test for social recognition, the intruder was placed inside a wire cylinder and introduced into the test cage. In the habituation session, mice were allowed to explore the empty wire cylinder for 10 minutes. Subsequently, the intruder mouse was placed into the cylinder and the tested mouse was allowed to freely explore it for 5 minutes. The entire procedure was repeated five times. After the fifth exposure to the same intruder, a novel intruder was added to the wire cylinder. The experiment was videotaped, and the social interaction was measured as the amount of time that animals spent sniffing through the holes of the cylinder (latency).
Novel Object Recognition
Before testing, each mouse was habituated to an empty Plexiglas arena (45 × 25 × 20 cm) for 3 consecutive days. On the first day of testing, mice were exposed to two identical objects placed at opposite ends of the arena for 5 minutes. Twenty-four hours later, mice were presented for 5 minutes with one of the familiar objects and a novel object of similar dimensions. The arena and the stimulus objects were cleaned thoroughly between trials to ensure the absence of olfactory cues. If an animal did not explore both objects during the training phase, the test was not scored during the test phase. In the scoring procedure, because some mice exhibited freezing or fearful behavior on introduction to the chamber, scoring did not start until the mice physically moved from their initial starting position, which was always in the corner closest to the familiar object. Exploration counted if the mouse's head was within 2.54 cm of the object, with its neck extended and vibrissae moving. Simple proximity, chewing, or standing on the object did not count as exploration. All exploratory segments and tests were videotaped for scoring purposes. The recognition index represents the percentage of the time that mice spend exploring the novel object.
Morris Water Maze
The apparatus used for the water maze task was a circular aluminum tank (1.2-m diameter) painted white and filled with water maintained at 22°C ± 2°C (mean ± SEM). The tank was located in a test room containing various prominent visual cues. To reduce stress, mice were placed on the platform for 10 seconds before the first training trial. Mice were trained to swim to a 14-cm-diameter circular clear Plexiglas platform submerged 1.5 cm beneath the surface of the water and invisible to the mice while swimming. The platform was located in a fixed position, equidistant from the center and the wall of the tank. Mice were subjected to four training trials per day (intertrial interval, 5 minutes). During each trial, mice were placed into the tank at one of four designated start points in a pseudorandom order. Mice were allowed to find and escape onto the submerged platform. If they failed to find the platform within 60 seconds, they were manually guided to the platform and allowed to remain there for 10 seconds. Mice were trained for as many days as needed to reach the training criterion of 25 seconds (escape latency). To control for overtraining, probe trials were run for each group, both as soon as they reached group criterion and after all groups had reached criterion. However, the training session was interrupted if mice did not reach the training criterion within 8 days. The probe trial was assessed 24 hours after the last training session and consisted of a 60-second free swim in the pool without the platform. Performance was monitored with the EthoVision XT video-tracking system.
Contextual Fear Conditioning
During training, mice were placed in the fear conditioning chamber (San Diego Instruments, San Diego, CA) and allowed to explore for 2 minutes before receiving three electric foot shocks (duration, 1 second; intensity, 0.2 mA; intershock interval, 2 minutes). Animals were returned to the home cage 30 seconds after the last foot shock. Twenty-four hours later, behavior in the conditioning chamber was video recorded during 5 minutes and subsequently analyzed for freezing, which was defined as the absence of all movement except for respiration.
Tissue Preparation
Mice were deeply anesthetized with sodium pentobarbital and euthanized by perfusion transcardially with 0.1 mol/L PBS solution (pH 7.4). The right brain hemispheres were fixed for 48 hours in 4% paraformaldehyde and cryoprotected in 30% sucrose for immunohistochemical (IHC) analysis. Frozen brains were sectioned coronally into 40 μmol/L sections using a Leica SM2010R freezing microtome (Leica Microsystems, Bannockburn, IL), serially collected in cold 0.02% sodium azide, and stored at 4°C. The left hemispheres were snap frozen on dry ice and subject to protein extraction sequentially using the T-PER tissue protein extraction reagent (Thermo Scientific, Rockford, IL) and 70% formic acid. The supernatant was divided and stored at −80°C. The protein concentration in the supernatant was determined using the Bradford assay.
Immunoblotting
Equal protein amounts were separated on a 4% to 12% SDS-PAGE gradient, transferred to a nitrocellulose membrane, and incubated overnight with primary antibody at 4°C. The following primary antibodies were used in this study: c-Fos (9F6) (1:1000), cAMP response element binding (CREB; 48H2) (1:1000), p-CREB (S133) (87G3) (1:1000), p-glycogen synthase kinase (GSK) 3β (S9) (5B3) (1:3000), postsynaptic density protein 95 (PSD-95, 1:1000) (Cell Signaling Technology, Danvers, MA), human APP-CT20 (751-770) (1:5000), disintegrin and metalloproteinase domain-containing protein (ADAM)10 (735-749) (1:1000), ADAM17 (TACE, 807-823) (1:1000), β-site APP cleaving enzyme (BACE) 1 (485-501) (1:1000), GSK3αβ (1H8) (1:1000), CDK5 (268-283) (1:1000) (Calbiochem, San Diego, CA), human tau (HT7) (159-163) (1:5000), phospho-tau AT8 (p-S202/T205) (1:1000), p-tau AT100 (p-S212/T214) (1:1000), p-tau AT270 (p-T181) (1:1000) (Thermo Scientific), p-tau paired helical filament (PHF)-1 (p-S396/S404) (1:1000) (a gift from Dr. Peter Davies, Albert Einstein College of Medicine, Manhasset, NY), Aβ1-16 (6E10) (1:1000) (Covance Research Products, Denver, PA), PP2A (FL-309) (1:1000), p35 (N-20) (1:200), and glyceraldehyde-3-phosphate dehydrogenase (FL335) (1:5000) (Santa Cruz Biotechnology, Santa Cruz, CA). After washing, the membranes were incubated with adjusted secondary antibodies coupled to horseradish peroxidase. The immunocomplexes were visualized using the SuperSignal West Pico Kit (Thermo Scientific). Band density measurements were obtained using ImageJ 1.36b imaging software (NIH, Bethesda, MD).
ELISA Analyses
For the determination of Aβ levels, T-PER soluble fractions were loaded directly onto enzyme-linked immunosorbent assay (ELISA) plates, whereas the formic acid supernatants (insoluble fractions) were diluted 1:20 in a neutralization buffer (1 mol/L Tris base and 0.5 mol/L NaH2PO4) before loading. MaxiSorp immunoplates (Nunc, Rochester, NY) were coated with mAb20.1 antibody (a gift from Dr. William E. Van Nostrand, Stony Brook University, Stony Brook, NY) at a concentration of 25 μg/mL in coating buffer (0.1 mol/L Na2CO3, pH 9.6) and blocked with 3% bovine serum albumin (BSA). Standard solutions for both Aβ40 and Aβ42 were made in the antigen capture buffer (20 mmol/L NaH2PO4, 2 mmol/L EDTA, 0.4 mol/L NaCl, 0.05% 3-[(3-cholamidopropyl)dimethylammonio]propanesulfonate, and 1% BSA, pH 7.0) and loaded onto ELISA plates in duplicate. Samples were then loaded (in duplicate) and incubated overnight at 4°C. Plates were then washed and probed with either horseradish peroxidase–conjugated anti-Aβ40 (C49) or anti-Aβ42 (D32) (a gift from Dr. Vitaly Vasilevko and Dr. David H. Cribbs, University of California, Irvine) overnight at 4°C. The chromogen was 3,3′,5,5′-tetramethylbenzidine, and the reaction was discontinued with 30% phosphoric acid. The plates were read at 450 nm using a plate reader (Molecular Dynamics, Sunnyvale, CA). The readings were then normalized to protein concentrations of the samples.
The levels of tumor necrosis factor-α and IL-1β in the T-PER soluble fractions were measured using commercially available ELISA kits (Thermo Scientific), according to the manufacturer's instructions.
IHC Analyses
Antigen retrieval was optimized using a 90% formic acid solution for 7 minutes for Aβ staining. Free-floating sections were pretreated with 3% hydrogen peroxide and 10% methanol in Tris-buffered saline (TBS) for 30 minutes to block endogenous peroxidase activity. After a TBS wash, sections were incubated once in 0.1% Triton X-100 (Fisher Scientific, Pittsburgh, PA) in TBS for 15 minutes and once with 2% BSA in 0.1% Triton-X in TBS for 30 minutes. Sections were then incubated overnight at 4°C with anti-Aβ1-16 (6E10) (1:1000) (Covance Research Products), anti-phospho-tau AT100 (phospho-S212/T214) (1:1000) (Thermo Scientific), anti-glial fibrillary acidic protein (GFAP; Millipore, Billerica, MA), or anti-CD45 (IBL-3/16) (AbD Serotec, Raleigh, NC) with 5% normal serum in TBS. After the appropriate biotinylated secondary antibody (1:200 in TBS, 2% BSA, and 5% normal serum), sections were processed using the Vectastain Elite ABC reagent and 3,3′-diaminobenzidine (Vector Laboratories, Burlingame, CA), according to the manufacturer's instructions. Sections were then mounted on gelatin-coated slides, dehydrated in graded ethanol, cleared in xylene, and coverslipped with DPX mounting medium (BDH Laboratory Supplies, Poole, UK).
The immunostaining was assessed at six brain coronal levels. Specifically, six alternate 40-μm sections of the brain, with an individual distance of approximately 160 μm, were obtained between 1.34 and 2.54 mm posterior to the bregma. Images of stained hippocampal, entorhinal cortex, and amygdaloid areas were acquired using an Axiocam digital camera and AxioVision 4.6 software connected to an Axioskop 50 microscope (Carl Zeiss MicroImaging, Thornwood, NY). A threshold optical density that best discriminated staining from the background was obtained using ImageJ 1.36b imaging software. We captured eight images per section: two in the subiculum, two in the CA1, two in the entorhinal cortex, and two in the amygdala (48 images per mouse).
For GFAP and CD45 analyses, data are reported as the labeled area captured (positive pixels) divided by the full area captured (total pixels). The data represent the average value obtained by the analysis of images of the hippocampus, entorhinal cortex, and amygdala. All histological assessments were performed by an examiner blinded to sample identities.
Immunofluorescence
Sections were first blocked with 3% normal serum, 2% BSA, and 0.1% Triton X-100 in TBS for 1 hour at room temperature. By using the same buffer solution, sections were incubated overnight at 4°C with the following primary antibodies: anti-synaptophysin (SVP-38) (1:250) (Sigma-Aldrich, St Louis, MO), anti-Aβ1-16 (6E10) (1:200) (Covance Research Products), anti-collagen IV (1:250) (Fitzgerald Industries International, Acton, MA), anti-GFAP (1:1000) (Dako, Carpentaria, CA), and/or anti-Iba-1 (1:200) (Wako Chemicals, Richmond, VA). Sections were then rinsed and incubated for 1 hour with secondary Alexa Fluor–conjugated antibodies (Invitrogen, Carlsbad, CA) at room temperature. Finally, sections were mounted onto gelatin-coated slides in Fluoromount-G (Southern Biotech, Birmingham, AL) and examined under a Leica DM2500 confocal laser microscope using Leica Application Suite Advanced Fluorescence software (Leica Microsystems).
The immunofluorescence was assessed at the same brain coronal levels previously described. Confocal images were acquired by sequential scanning using a z separation of 1 μm. Three-dimensional reconstruction and three-dimensional–rendered optical sections were generated using Leica Application Suite Advanced Fluorescence software (Leica Microsystems). The vascular Aβ deposition was determined through the analysis of the colocalization of anti-Aβ1-16 (6E10) and anti-collagen IV in the hippocampus, entorhinal cortex, and amygdala. For each section, images were acquired with equal acquisition parameters for both anti-Aβ1-16 (6E10) and anti-collagen IV. Up to 20 vessels were identified using the 6E10 label and then were matched to the corresponding collagen IV staining. Image measurements were obtained using ImageJ 1.36b imaging software. The synaptophysin levels represent the average value obtained by the analysis of images of the hippocampus, entorhinal cortex, and amygdala. The integrated intensity of 6E10 plus collagen IV represents the average optical densities from all of the merged pixels measured.
Thioflavin S Staining
Sections were incubated in 0.5% thioflavin S in 50% ethanol for 10 minutes, differentiated twice in 50% ethanol, and washed in PBS solution. Staining was visualized under a confocal microscope. Image measurements were made using ImageJ 1.36b imaging software. The thioflavin S levels represent the average value obtained by the analysis of images of the hippocampus, entorhinal cortex, and amygdala.
Protein Kinase Assay
The protein kinase (PK) C and A activity levels were measured using the nonradioactive PK assay kit (Calbiochem), according to the manufacturer's instructions. In brief, a fresh half brain sample was homogenized in ice-cold 50 mmol/L Tris-HCl (pH 7.5) containing 10 mmol/L benzamidine, 5 mmol/L EDTA, and 10 mmol/L EGTA. Samples were then sonicated four times (10 seconds each) and centrifuged at 100,000 × g for 60 minutes at 4°C. Fresh supernatant was used for the PK activity assays. The protein concentration in the supernatant was determined using the Bradford assay. The peptide pseudosubstrate RFARKGSLRQKNV that can be phosphorylated by both PKC and PKA was precoated in the plate. A biotinylated monoclonal antibody that recognizes the phosphorylated form of the peptide pseudosubstrate was added to the wells and detected using horseradish peroxidase–conjugated streptavidin. The plates were read at 492 nm using a plate reader (Molecular Dynamics). The readings were then normalized to protein concentrations of the samples. The PKC or PKA activity was directly proportional to the color intensity. The use of specific assay buffer and cofactor provided by the kit enabled us to distinguish PKC and PKA activity.
Statistical Analysis
All data are expressed as the mean ± SEM. Statistical evaluation of the results was performed using one- or two-way analysis of variance. After significant analyses of variance, multiple post hoc comparisons were performed using Bonferroni's test. Some data were analyzed using the unpaired t-test. The accepted level of significance for the tests was P < 0.05. All tests were performed using the Statistica software package (StatSoft Inc., Tulsa, OK).
Discussion
Herein, we report the novel findings that ablating the M
1R disrupts PKA-CREB signaling, correlating with exacerbation of cognitive impairment. Notably, the dysregulation in cognitive function and transcriptional activity was more prominent in the 3xTgAD-M
1R
−/− and Tg-SwDI–M
1R
−/− mice, likely as a consequence of the AD-related synaptotoxicity. Moreover, APP processing was shifted toward the amyloidogenic pathway in mice with AD that lacked the M
1R, which resulted in increased amyloid deposition and neuroinflammation. 3xTgAD-M
1R
−/− mice were also marked by a more robust phosphorylation of tau protein than 3xTgAD mice, a process closely associated with GSK3β hyperactivation. The PKC activity, an enzyme linked with Aβ and tau pathological features,
31- Alkon D.L.
- Sun M.K.
- Nelson T.J.
PKC signaling deficits: a mechanistic hypothesis for the origins of Alzheimer's disease.
was significantly reduced in 3xTgAD-M
1R
−/− and Tg-SwDI–M
1R
−/− mice.
Evidence that M
1R is highly expressed in brain areas in which cholinergic synapses are proposed to mediate acquisition and storage of new information has suggested that this receptor is a fundamental player in learning and memory.
5- Levey A.I.
- Kitt C.A.
- Simonds W.F.
- Price D.L.
- Brann M.R.
Identification and localization of muscarinic acetylcholine receptor proteins in brain with subtype-specific antibodies.
, 32- Wei J.
- Walton E.A.
- Milici A.
- Buccafusco J.J.
m1-m5 muscarinic receptor distribution in rat CNS by RT-PCR and HPLC.
Advances in understanding the role of M
1R in cognition were obtained with the generation of M
1R-mutant mice.
4- Wess J.
- Eglen R.M.
- Gautam D.
Muscarinic acetylcholine receptors: mutant mice provide new insights for drug development.
Miyakawa and colleagues
24- Miyakawa T.
- Yamada M.
- Duttaroy A.
- Wess J.
Hyperactivity and intact hippocampus-dependent learning in mice lacking the M1 muscarinic acetylcholine receptor.
demonstrated that young M
1R
−/− mice performed as well as their nTg littermates in various hippocampal-dependent tasks but showed some deficits in other tasks that correlated with the degree of hyperactivity displayed. Notably, such a hyperactivity phenotype has been associated with the lack of M
1R on inhibitory interneurons in the striatum, where this receptor is normally activated by locally released acetylcholine, resulting in inhibitory projections to dopaminergic neurons in the substantia nigra pars compacta.
33- Gerber D.J.
- Sotnikova T.D.
- Gainetdinov R.R.
- Huang S.Y.
- Caron M.G.
- Tonegawa S.
Hyperactivity, elevated dopaminergic transmission, and response to amphetamine in M1 muscarinic acetylcholine receptor-deficient mice.
, 34- Kamsler A.
- McHugh T.J.
- Gerber D.
- Huang S.Y.
- Tonegawa S.
Presynaptic m1 muscarinic receptors are necessary for mGluR long-term depression in the hippocampus.
Moreover, M
1R
−/− mice showed working memory and consolidation impairment without acquisition deficit in some learning- and memory-dependent tasks.
21- Anagnostaras S.G.
- Murphy G.G.
- Hamilton S.E.
- Mitchell S.L.
- Rahnama N.P.
- Nathanson N.M.
- Silva A.J.
Selective cognitive dysfunction in acetylcholine M1 muscarinic receptor mutant mice.
The genetic deletion of M
1R also resulted in electrophysiological deficits and intracellular signaling disruption (eg, mitogen-activated protein kinase activation and phosphoinositide hydrolysis).
35- Hamilton S.E.
- Loose M.D.
- Qi M.
- Levey A.I.
- Hille B.
- McKnight G.S.
- Idzerda R.L.
- Nathanson N.M.
Disruption of the m1 receptor gene ablates muscarinic receptor-dependent M current regulation and seizure activity in mice.
, 36- Hamilton S.E.
- Nathanson N.M.
The M1 receptor is required for muscarinic activation of mitogen-activated protein (MAP) kinase in murine cerebral cortical neurons.
An outstanding finding of our study is that M
1R
−/− mice developed an age-dependent cognitive decline in tasks in which they were previously reported to be unaffected.
Although many muscarinic effects have been identified in memory circuits, including a diversity of presynaptic and post-synaptic actions in the hippocampus, the identities of the molecular subtypes and the intracellular pathways responsible for any given function remain elusive.
37Muscarinic acetylcholine receptor expression in memory circuits: implications for treatment of Alzheimer disease.
Long-term plastic changes in the brain, including those supporting learning and memory formation, are assumed to depend on permanent functional alterations in neuronal cells that require reprogramming of gene expression. Inducible transcription factors, such as c-Fos and CREB, are supposed to act as messengers in coupling short-term neuronal activity with changes at the level of gene transcription.
38Memory formation and the regulation of gene expression.
The increase of c-Fos mRNA and/or protein levels has resulted from the action of neurotransmitters on membrane receptors and seems to be induced by physiological stimuli.
39Activation of immediate early genes and memory formation.
CREB, on the other hand, is mainly activated through phosphorylation by several signaling pathways, including PKA.
40CREB: a message to remember.
Impairment of cellular signaling has been implicated in the cognitive deficits in AD.
41- Tully T.
- Bourtchouladze R.
- Scott R.
- Tallman J.
Targeting the CREB pathway for memory enhancers.
, 42- von Linstow Roloff E.
- Platt B.
Biochemical dysfunction and memory loss: the case of Alzheimer's dementia.
Our study provides clear evidence that deletion of M
1R results in impairment of c-Fos and PKA-CREB signaling in aged brain, an effect exacerbated in the AD-like mouse brain. Such data indicate that activation of M
1R may be a potential therapeutic alternative to restore learning and memory in aged and AD brains. However, additional studies are necessary to identify the intracellular pathways linked to the regulation of c-Fos and PKA-CREB and the genes that are modulated by the activation of these transcriptional factors.
Preclinical evidence has highlighted the therapeutic value of targeting the M
1R for treating AD.
43- Caccamo A.
- Fisher A.
- LaFerla F.M.
M1 agonists as a potential disease-modifying therapy for Alzheimer's disease.
Previous data indicate that the selective M
1R agonist AF267B increases the formation of the α-secretase–generated C83 fragment in the brains of young 3xTg-AD mice, whereas its levels are lower after treatment with the M
1R antagonist dicyclomine. Moreover, we reported an increase in the steady-state levels of the α-secretase enzyme ADAM17 and a decrease in the BACE1 levels in the brains of AF267B-treated versus untreated 3xTg-AD mice. Notably, BACE1 levels were significantly higher in the dicyclomine-treated mice compared with control mice.
17- Caccamo A.
- Oddo S.
- Billings L.M.
- Green K.N.
- Martinez-Coria H.
- Fisher A.
- LaFerla F.M.
M1 receptors play a central role in modulating AD-like pathology in transgenic mice.
Although a change in the steady-state levels does not always reflect changes in activity, these data, together with the changes in the levels of β-secretase C99 and α-secretase C83 fragments and in the Aβ levels, strongly suggest that the effect of Aβ pathological features in 3xTg-AD after M
1R agonist treatment are because of a shift in APP processing toward the nonamyloidogenic pathway. This hypothesis was reinforced by the recent findings in the APP
Swe/Ind mice that showed an increase in amyloidogenic APP processing and Aβ accumulation after genetic deletion of M
1R.
20- Davis A.A.
- Fritz J.J.
- Wess J.
- Lah J.J.
- Levey A.I.
Deletion of M1 muscarinic acetylcholine receptors increases amyloid pathology in vitro and in vivo.
Of great relevance, our data show, for the first time to our knowledge, that the increase in the β-secretase C99 fragment and Aβ levels induced by the M
1R genetic ablation triggers a pathological cascade that leads to exacerbated microglial and astrocytic activation, synaptic damage, and, ultimately, cognitive failure.
CAA is most commonly observed and prominent in leptomeningeal arteries but also often extends into the microvasculature of the cerebral cortex. Reduced blood flow has been reported as one of the most consistent physiological deficits in AD, contributing to ischemic brain injury, intracerebral hemorrhage, and cognitive dysfunction.
44- Bateman G.A.
- Levi C.R.
- Schofield P.
- Wang Y.
- Lovett E.C.
Quantitative measurement of cerebral haemodynamics in early vascular dementia and Alzheimer's disease.
, 45- Grabowski T.J.
- Cho H.S.
- Vonsattel J.P.
- Rebeck G.W.
- Greenberg S.M.
Novel amyloid precursor protein mutation in an Iowa family with dementia and severe cerebral amyloid angiopathy.
, 46- Natte R.
- Maat-Schieman M.L.
- Haan J.
- Bornebroek M.
- Roos R.A.
- van Duinen S.G.
Dementia in hereditary cerebral hemorrhage with amyloidosis-Dutch type is associated with cerebral amyloid angiopathy but is independent of plaques and neurofibrillary tangles.
Evidence
22- Davis J.
- Xu F.
- Deane R.
- Romanov G.
- Previti M.L.
- Zeigler K.
- Zlokovic B.V.
- Van Nostrand W.E.
Early-onset and robust cerebral microvascular accumulation of amyloid beta-protein in transgenic mice expressing low levels of a vasculotropic Dutch/Iowa mutant form of amyloid beta-protein precursor.
, 47Clearing the brain's amyloid cobwebs.
suggests that Aβ accumulates in the wall and the perivascular space of cerebral vessels and in the brains of individuals with AD because of its impaired clearance from the brain and/or imbalances between its production and clearance. This idea has been supported by the studies conducted with the Tg-SwDI mice, which develop early-onset and robust cerebral deposition of Aβ, mainly in the cerebral microvasculature, because of inefficient Aβ clearance across the blood-brain barrier.
22- Davis J.
- Xu F.
- Deane R.
- Romanov G.
- Previti M.L.
- Zeigler K.
- Zlokovic B.V.
- Van Nostrand W.E.
Early-onset and robust cerebral microvascular accumulation of amyloid beta-protein in transgenic mice expressing low levels of a vasculotropic Dutch/Iowa mutant form of amyloid beta-protein precursor.
Aβ peptides may be produced primarily within neurons; after being secreted into the interstitial space, the interstitial fluids flow into the perivascular space of local arterioles and are then transported opposite to the direction of the blood into larger arteries, where the Aβ is ultimately drained from the brain.
48- Weller R.O.
- Massey A.
- Newman T.A.
- Hutchings M.
- Kuo Y.M.
- Roher A.E.
Cerebral amyloid angiopathy: amyloid beta accumulates in putative interstitial fluid drainage pathways in Alzheimer's disease.
Interestingly, the M
1R agonist AF267B decreased vascular (eg, capillaries and arterioles) and perivascular Aβ
42 deposits in the cortex and cerebrospinal fluid of rabbits lesioned by the cholinotoxin M20.4-saporin injected into the nucleus basalis.
16- Beach T.G.
- Walker D.G.
- Potter P.E.
- Sue L.I.
- Scott S.
- Layne K.J.
- Newell A.J.
- Poston M.E.
- Webster S.D.
- Durham R.A.
- Emmerling M.R.
- Honer W.G.
- Fisher A.
- Roher A.E.
Immunotoxin lesion of the cholinergic nucleus basalis causes Abeta deposition: towards a physiologic animal model of Alzheimer's disease.
Herein, we gained further insights into the mechanisms that drive the Aβ deposition in the cerebrovasculature, showing that stimulation of amyloidogenic APP processing in the Tg-SwDI–M
1R
−/− mice culminates within increased Aβ deposits in the cerebrovasculature. To our knowledge, this is the first report comprehensively showing that reduction of Aβ generation in the brain parenchyma through M
1R stimulation may represent a promising feature for inhibiting CAA.
In the diseased brain, tau becomes abnormally hyperphosphorylated, which ultimately causes the microtubules to disassemble; the free tau molecules aggregate into paired helical filaments. Multiple lines of evidence suggest that tau hyperphosphorylation results from perturbation of cellular signaling, mainly through an imbalance in the activities of different PKs and phosphatases.
27- Medeiros R.
- Baglietto-Vargas D.
- Laferla F.M.
The role of tau in Alzheimer's disease and related disorders.
Herein, we show that M
1R specifically modulates the tau phosphorylation through the regulation of GSK3β activity. The increase in tau phosphorylation was selective because we found an increase in phosphorylated tau only at GSK3β-targeted residues after the deletion of M
1R in the 3xTgAD mice [ie, S202/T205 (detected by antibody AT8), T181 (detected by antibody AT270), and T212/S214 (detected by antibody AT100)].
49- Caccamo A.
- Oddo S.
- Tran L.X.
- LaFerla F.M.
Lithium reduces tau phosphorylation but not A beta or working memory deficits in a transgenic model with both plaques and tangles.
However, we did not find changes in tau phosphorylation at S396/404 (detected by antibody PHF-1). This site seems to be phosphorylated by GSK3β and CDK5; therefore, it is likely that combined activation of both kinases may be necessary to increase phosphorylation of the PHF-1 site.
50- Sperber B.R.
- Leight S.
- Goedert M.
- Lee V.M.
Glycogen synthase kinase-3 beta phosphorylates tau protein at multiple sites in intact cells.
, 51- Cruz J.C.
- Tseng H.C.
- Goldman J.A.
- Shih H.
- Tsai L.H.
Aberrant Cdk5 activation by p25 triggers pathological events leading to neurodegeneration and neurofibrillary tangles.
In the 3xTg-AD mice, AT270, AT180, and AT100 represent early markers of tau phosphorylation, whereas reactivity with AT8 and PHF-1 represents mid and late stages. Therefore, the M
1R modulates tau phosphorylation at the early and mid stages but not at a late marker, such as PHF-1. These data reinforce the use of M
1R agonists as potential disease-modifying therapy for AD.
17- Caccamo A.
- Oddo S.
- Billings L.M.
- Green K.N.
- Martinez-Coria H.
- Fisher A.
- LaFerla F.M.
M1 receptors play a central role in modulating AD-like pathology in transgenic mice.
The present study also provides evidence for the involvement of PKC in the molecular changes induced by M
1R loss in mice with AD. Notably, recently, disrupted coupling between M
1R and Gq protein correlated with reductions of PKC activity and
N-methyl-D-aspartate receptor density in post-mortem AD brains.
52- Tsang S.W.
- Pomakian J.
- Marshall G.A.
- Vinters H.V.
- Cummings J.L.
- Chen C.P.
- Wong P.T.
- Lai M.K.
Disrupted muscarinic M1 receptor signaling correlates with loss of protein kinase C activity and glutamatergic deficit in Alzheimer's disease.
This pathway seems to be activated on appropriate cell stimulation by acetylcholine and participates in an array of important functions within normal cellular physiology, such as regulation of downstream kinases (eg, CDK5 and GSK3β), nonamyloidogenic APP processing, and memory storage.
53- Olds J.L.
- Anderson M.L.
- McPhie D.L.
- Staten L.D.
- Alkon D.L.
Imaging of memory-specific changes in the distribution of protein kinase C in the hippocampus.
, 54- Kinouchi T.
- Sorimachi H.
- Maruyama K.
- Mizuno K.
- Ohno S.
- Ishiura S.
- Suzuki K.
Conventional protein kinase C (PKC)-alpha and novel PKC epsilon, but not -delta, increase the secretion of an N-terminal fragment of Alzheimer's disease amyloid precursor protein from PKC cDNA transfected 3Y1 fibroblasts.
, 55- Fang X.
- Yu S.
- Tanyi J.L.
- Lu Y.
- Woodgett J.R.
- Mills G.B.
Convergence of multiple signaling cascades at glycogen synthase kinase 3: edg receptor-mediated phosphorylation and inactivation by lysophosphatidic acid through a protein kinase C-dependent intracellular pathway.
Indeed, changes in PKC activity have been associated with all major AD neuropathological markers.
31- Alkon D.L.
- Sun M.K.
- Nelson T.J.
PKC signaling deficits: a mechanistic hypothesis for the origins of Alzheimer's disease.
Although the identity of the PKC isoenzyme associated with M
1R stimulation is still uncertain, most likely the PKCγ, which is abundant in the hippocampus and colocalizes with neurons expressing the M
1R, may be particularly relevant to M
1R signaling in AD.
56- Delmas P.
- Wanaverbecq N.
- Abogadie F.C.
- Mistry M.
- Brown D.A.
Signaling microdomains define the specificity of receptor-mediated InsP(3) pathways in neurons.
, 57- Rossi M.A.
- Mash D.C.
- DeToledo-Morrell L.
Spatial memory in aged rats is related to PKCgamma-dependent G-protein coupling of the M1 receptor.
However, additional studies are necessary to confirm this hypothesis.
During the past few years, evidence has accumulated that indicates M1R is a feasible therapeutic target for AD. However, because of the potential lack of M1R selectivity of several muscarinic agonists tested in previous clinical studies in patients with AD, we generated the 3xTgAD-M1R−/− and Tg-SwDI–M1R−/− mice. Our study using these models clearly shows, for the first time to our knowledge, the involvement of M1R in all key pathological changes found in AD (ie, parenchymal and cerebrovascular amyloid deposition, neurofibrillary tangles, neuroinflammation, and cognitive decline). Remarkably, our transgenic mouse models have great potential for the development of preclinical studies to further evaluate and design selective M1R agonists for treating AD. More work is required to fully elucidate the roles of M1R in aging and AD and to further identify downstream target proteins (eg, PKC isoforms). The current results, together with data in the literature, provide clear functional and molecular evidence indicating that the M1R represents a viable strategy for treating AD.