Amyloid plaques, composed of the amyloid -protein (A), are hallmark neuropathological lesions in Alzheimer disease (AD) brain. A fulfills a central role in AD pathogenesis, and reduction of A levels should prove beneficial for AD treatment. A generation is initiated by proteolysis of amyloid precursor protein (APP) by the -secretase enzyme BACE1. Bace1 knockout (Bace1 ؊/؊ ) mice have validated BACE1 as the authentic -secretase in vivo. BACE1 is essential for A generation and represents a suitable drug target for AD therapy, especially because this enzyme is up-regulated in AD. However, although initial data indicated that Bace1 ؊/؊ mice lack an overt phenotype, the BACE1-mediated processing of APP and other substrates may be important for specific biological processes. In this minireview, topics range from the initial identification of BACE1 to the fundamental knowledge gaps that remain in our understanding of this protease. We address pertinent questions such as putative causes of BACE1 elevation in AD and discuss why, nine years since the identification of BACE1, treatments that address the underlying pathological mechanisms of AD are still lacking.
Alzheimer Disease
AD2 is the most common form of dementia, afflicting over 29 million people worldwide, a figure anticipated to rise exponentially within decades. Although the etiology remains enigmatic, AD appears to be brought about by both genetic and non-genetic factors. ϳ5% of AD cases are familial (FAD), caused by autosomal dominant mutations in either APP or the PS genes. The underlying cause(s) remain elusive for the majority of sporadic AD cases, although specific risk factors have been identified and include aging, the apolipoprotein E4 allele, certain vascular diseases, and TBI (1).Several major pathologies are observed in AD, and the amyloid hypothesis states that A plays a critical early role, triggering a complex pathological cascade that leads to neurodegeneration (2). A strong genetic correlation exists between FAD and a neurotoxic form of fibrillogenic A, A42 (3). Pre-symptomatic FAD patients exhibit A42 elevations or elevations in A42 levels relative to levels of the less fibrillogenic peptide, A40, indicating that A42 may initiate pathophysiology. Patients with additional copies of the APP gene exhibit total A overproduction and develop early-onset AD (1, 4). Data point toward a critical role for A42 in AD etiology, and strategies to lower brain A42 levels should be therapeutically beneficial in AD.
A GenerationA is formed from endoproteolysis of APP, a type 1 membrane protein (Fig. 1) (5). BACE1 (-site APP-cleaving enzyme 1) is essential for initiating A generation and cleaves the APP Asp ϩ1 residue to form the A N terminus, APPs, and a C-terminal fragment, C99. BACE1 cleavage of APP is a prerequisite for ␥-secretase-mediated cleavage, and C99 is proteolyzed by ␥-secretase (a protein complex containing PS), which generates an AICD and A. This imprecise cleavage produces A variants, including those ending at residues 40 ...