Sleep and Alzheimer's Disease: Accumulation of amyloid-β (Aβ) in the brain is thought to be the initiating event in the pathogenesis of Alzheimer's disease (AD). Aβ is a peptide secreted in a soluble monomeric form predominantly by neurons and its aggregation into toxic forms is concentration dependent. Synaptic activity regulates the release of Aβ in vivo. However, how physiological and environmental processes are involved in regulation of Aβ levels is not understood. Kang et al. (p. 1005 , published online 24 September), by performing sleep-wake studies in freely behaving animals concomitant with in vivo microdialysis, found that brain interstitial fluid levels of Aβ were significantly correlated with wakefulness and negatively correlated with sleep. Furthermore, relatively short-term (3 weeks) sleep deprivation markedly accelerated amyloid plaque deposition in amyloid precursor protein transgenic mice. Thus, sleep-wake behavior is linked to Aβ levels and abnormal sleep may be linked to AD pathogenesis.

In the first of our State of the Art Review series, David M. Holtzman, John C. Morris, and Alison M. Goate explore the rapid pace of Alzheimer’s disease research and the challenges to translating research breakthroughs into clinical treatments.

The apolipoprotein E (APOE) ε4 allele is the strongest genetic risk factor for late-onset, sporadic Alzheimer’s disease (AD). The APOE ε4 allele markedly increases AD risk and decreases age of onset, likely through its strong effect on the accumulation of amyloid-β (Aβ) peptide. In contrast, the APOE ε2 allele appears to decrease AD risk. Most rare, early-onset forms of familial AD are caused by autosomal dominant mutations that often lead to overproduction of Aβ₄₂ peptide. However, the mechanism by which APOE alleles differentially modulate Aβ accumulation in sporadic, late-onset AD is less clear. In a cohort of cognitively normal individuals, we report that reliable molecular and neuroimaging biomarkers of cerebral Aβ deposition vary in an apoE isoform–dependent manner. We hypothesized that human apoE isoforms differentially affect Aβ clearance or synthesis in vivo, resulting in an apoE isoform–dependent pattern of Aβ accumulation later in life. Performing in vivo microdialysis in a mouse model of Aβ-amyloidosis expressing human apoE isoforms (PDAPP/TRE), we find that the concentration and clearance of soluble Aβ in the brain interstitial fluid depends on the isoform of apoE expressed. This pattern parallels the extent of Aβ deposition observed in aged PDAPP/TRE mice. ApoE isoform–dependent differences in soluble Aβ metabolism are observed not only in aged but also in young PDAPP/TRE mice well before the onset of Aβ deposition in amyloid plaques in the brain. Additionally, amyloidogenic processing of amyloid precursor protein and Aβ synthesis, as assessed by in vivo stable isotopic labeling kinetics, do not vary according to apoE isoform in young PDAPP/TRE mice. Our results suggest that APOE alleles contribute to AD risk by differentially regulating clearance of Aβ from the brain, suggesting that Aβ clearance pathways may be useful therapeutic targets for AD prevention.