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2017 ; 24
(1
): 47
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Drug candidates in clinical trials for Alzheimer s disease
#MMPMID28720101
Hung SY
; Fu WM
J Biomed Sci
2017[Jul]; 24
(1
): 47
PMID28720101
show ga
Alzheimer's disease (AD) is a major form of senile dementia, characterized by
progressive memory and neuronal loss combined with cognitive impairment. AD is
the most common neurodegenerative disease worldwide, affecting one-fifth of those
aged over 85 years. Recent therapeutic approaches have been strongly influenced
by five neuropathological hallmarks of AD: acetylcholine deficiency, glutamate
excitotoxicity, extracellular deposition of amyloid-? (A? plague), formation of
intraneuronal neurofibrillary tangles (NTFs), and neuroinflammation. The lowered
concentrations of acetylcholine (ACh) in AD result in a progressive and
significant loss of cognitive and behavioral function. Current AD medications,
memantine and acetylcholinesterase inhibitors (AChEIs) alleviate some of these
symptoms by enhancing cholinergic signaling, but they are not curative. Since
2003, no new drugs have been approved for the treatment of AD. This article
focuses on the current research in clinical trials targeting the
neuropathological findings of AD including acetylcholine response, glutamate
transmission, A? clearance, tau protein deposits, and neuroinflammation. These
investigations include acetylcholinesterase inhibitors, agonists and antagonists
of neurotransmitter receptors, ?-secretase (BACE) or ?-secretase inhibitors,
vaccines or antibodies targeting A? clearance or tau protein, as well as
anti-inflammation compounds. Ongoing Phase III clinical trials via passive
immunotherapy against A? peptides (crenezumab, gantenerumab, and aducanumab) seem
to be promising. Using small molecules blocking 5-HT(6) serotonin receptor
(intepirdine), inhibiting BACE activity (E2609, AZD3293, and verubecestat), or
reducing tau aggregation (TRx0237) are also currently in Phase III clinical
trials. We here systemically review the findings from recent clinical trials to
provide a comprehensive review of novel therapeutic compounds in the treatment
and prevention of AD.