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• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/21—Esters, e.g. nitroglycerine, selenocyanates
  • A61K31/215—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids
  • A61K31/216—Esters, e.g. nitroglycerine, selenocyanates of carboxylic acids of acids having aromatic rings, e.g. benactizyne, clofibrate
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/045—Hydroxy compounds, e.g. alcohols; Salts thereof, e.g. alcoholates
  • A61K31/07—Retinol compounds, e.g. vitamin A
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
  • A61K31/19—Carboxylic acids, e.g. valproic acid
  • A61K31/192—Carboxylic acids, e.g. valproic acid having aromatic groups, e.g. sulindac, 2-aryl-propionic acids, ethacrynic acid 
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
  • A61K31/19—Carboxylic acids, e.g. valproic acid
  • A61K31/194—Carboxylic acids, e.g. valproic acid having two or more carboxyl groups, e.g. succinic, maleic or phthalic acid
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
  • A61K31/19—Carboxylic acids, e.g. valproic acid
  • A61K31/195—Carboxylic acids, e.g. valproic acid having an amino group
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K31/00—Medicinal preparations containing organic active ingredients
  • A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
  • A61K31/19—Carboxylic acids, e.g. valproic acid
  • A61K31/20—Carboxylic acids, e.g. valproic acid having a carboxyl group bound to a chain of seven or more carbon atoms, e.g. stearic, palmitic, arachidic acids
  • A61K31/203—Retinoic acids ; Salts thereof
• • A—HUMAN NECESSITIES
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  • A61K45/00—Medicinal preparations containing active ingredients not provided for in groups A61K31/00 - A61K41/00
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  • A61P25/00—Drugs for disorders of the nervous system
  • A61P25/28—Drugs for disorders of the nervous system for treating neurodegenerative disorders of the central nervous system, e.g. nootropic agents, cognition enhancers, drugs for treating Alzheimer's disease or other forms of dementia
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
  • A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
• • A—HUMAN NECESSITIES
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  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0019—Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0053—Mouth and digestive tract, i.e. intraoral and peroral administration
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
  • A61K9/00—Medicinal preparations characterised by special physical form
  • A61K9/0012—Galenical forms characterised by the site of application
  • A61K9/0085—Brain, e.g. brain implants; Spinal cord

Definitions

• TITLE COMPOSITIONS AND METHODS FOR STIMULATING
• the present invention generally relates to compositions and methods for stimulating astroglial uptake and degradation of amyloid- ⁇ protein aggregates.
• One aspect of the invention provides a method of preventing or treating Alzheimer's disease including administrating a clinically effective amount of combination of vitamin A or a derivative thereof and an agonist of proliferator-activated receptor a ("PPARa”) to a human or veterinary subject in need of such treatment.
• PPARa proliferator-activated receptor a
• Alzheimer's disease is progressive neurodegenerative disease with classic memory impairment and cognitive disorder.
• the pathological hallmarks of Alzheimer's disease are presence of senile plaques (SPs), composed of oligomeric amyloid beta ( ⁇ 40/42) and formation neurofibrillary tangles (NFTs), originating from Tau hyper-phosphorylation, in the cortex and hippocampus of brain (1 ,2).
• SPs senile plaques
• NFTs neurofibrillary tangles
• Tau hyper-phosphorylation Tau hyper-phosphorylation
• the abnormal accumulation of ⁇ and formation NFTs induces neuro-inflammation and subsequent neuronal loss, which is the primary cause of Alzheimer's disease (3).
• Aggregate prone ⁇ 40/42 fragments are generated by the sequential activity of ⁇ - and ⁇ -secretase on amyloid precursor protein (APP), whereas the action of a-secretase produces soluble APP (sAPP) fragments that are not prone to aggregation (4,5).
• APP amyloid precursor protein
• sAPP soluble APP
• a-secretase is mainly associated to the plasma membrane, whereas majority of ⁇ -secretase is present in the endosomal-lysosomal compartments (6,7).
• some of the cathepsins (D and E) could exhibit ⁇ -/ ⁇ - secretase like activity (8).
• the processing of APP could happen in either secretory pathway or endosomal- lysosomal pathway.
• Newly synthesized APP could be either be delivered to plasma membrane where it is processed mainly by a-secretase (secretory pathway), or occasionally the APPs are recycled back into endosomes by endocytosis, where it could be processed by ⁇ - and ⁇ -secretase (endosomal- lysosomal pathway) producing ⁇ fragments (9,10).
• the present invention provides a method for reducing amyloid- ⁇ protein aggregates in the brain of a subject including administering to the subject in need of such treatment a composition including a therapeutically effective amount of a combination of an agonist of proliferator- activated receptor a ("PPARa") and vitamin A or a derivative thereof.
• PPARa proliferator- activated receptor a
• the agonist is an amphipathic carboxylic acid.
• the agonist is clofibrate, gemfibrozil, ciprofibrate, bezafibrate, clinofibrate or fenofibrate.
• the composition can also include at least one pharmaceutically acceptable carrier.
• the therapeutically effective amount is an amount that stimulates the uptake of amyloid- ⁇ protein by astrocytes present in the brain. In yet another embodiment, the therapeutically effective amount is an amount that stimulates degradation of amyloid- ⁇ protein by such astrocytes.
• the subject may be a human subject, for example, a human subject exhibiting symptoms of Alzheimer's disease.
• the composition may be administered orally.
• the composition is administered by a subcutaneous, intra-articular, intradermal, intravenous, intraperitoneal or intramuscular route.
• the composition is administered directly to the central nervous system.
• Another expect of the invention provides a method for reducing amyloid- ⁇ protein aggregates in the brain of a subject's brain including administering a composition including a therapeutically effective amount of an agonist of proliferator-activated receptor a ("PPARa") to the subject.
• the agonist is an amphipathic carboxylic acid.
• the agonist may be, for example, clofibrate, gemfibrozil, ciprofibrate, bezafibrate, clinofibrate or fenofibrate..
• Figures 1 (A-B) illustrate that GFB and RA treatment enhances ⁇ uptake in mouse primary astrocytes:
• Figure 1 (A) mouse primary astrocytes were treated for 24hrs with GFB and RA, followed by incubation with 500nM oligomeric FAM-tagged ⁇ (1 -42) for 15', 30', 45' 1 hr, 2hr, 4hr, 8hr.
• ⁇ uptake assay was performed as described herein. Data is represented a percentage change compared to DMSO treated control.
• Figure 1 (B) shows microscope photographs showing mouse primary astrocytes treated with GFB and RA and incubated with 500nM HF- ⁇ (1 -42) and 75nM Lysotracker Red before observation.
• S cale bar 20 ⁇ .
• Figures 2 (A-C) illustrate the effect of HSPG, TFEB and LDLR on
• FIG. 2(A) Mouse primary astrocytes were treated with DMSO or GFB-RA, followed by treatment with diluent of Heparin (100 ⁇ g/ml) and further incubated in 500nM FAM- ⁇ for 4hrs. ⁇ uptake assay was performed and data is represented as percentage change w.r.t untreated control.
• Figures 3(A-D) illustrate that GFB and RA treatment enhances ⁇ degradation in mouse primary astrocytes:
• ⁇ degradation assay was performed as described in Methods section. Data was represented a
• Figure 4(A-E) illustrates the role of PPARa and PPAR ⁇ in ⁇ uptake and degradation in mouse primary astrocytes.
• Figure 4(A) Mouse primary astrocytes isolated from PPARa(-/-), PPAR ⁇ (-/-) and WT animals were isolated, treated with GFB-RA or DMSO, followed by incubation with 500nM FAM- ⁇ and subjected to ⁇ uptake assay. Data was compared to DMSO- treated WT control and represented as percentage change. p * ⁇ 0.05 w.r.t control; ns-not significant.
• Figure 4(B) Mouse primary astrocytes isolated from PPARa(-/-), PPARp(-/-) and WT animals were isolated, treated with GFB-RA, followed by incubation with 500nM FAM- ⁇ for 4hrs, washed in ⁇ free media for 6hrs and subjected to ⁇ degradation assay. Analysis of data is described in detail in Discussion. p * ⁇ 0.05 w.r.t control; ns-not significant.
• Figures 5 (A-F) illustrate that GFB and RA treatment increased lysosomal activity as well as autophagic flux:
• Figures 5(A-B) Mouse primary astrocytes were either untransfected, transfected with scrambled siRNA or Tfeb siRNA and treated with DMSO or GFB and RA. Whole cell extract was prepared and subjected to cathepsin assay for CtsB (A) and CtsD (B)
• Figure 5(B) Whole cell extract from cells treated with DMSO or GFB-RA was used to perform immunoblot for the levels of CtsB and CtsD.
• Figure 5(D) Densitometric analysis of the immunoblot, normalized to ⁇ -Actin.
• Figure 5(E) Mouse primary astrocytes were treated with DMSO or GFB-RA, in presence of absence of 100nM Bafilomycin A1 , or 500nM oligomeric ⁇ . Whole cell extract was subjected to immunoblot for the levels of LC3 and p62.
• Figure 5(F) Densitometric analysis of the immunoblot, normalized to ⁇ -Actin. p* ⁇ 0.05 w.r.t control; ns-not significant. All data are representative of the mean ⁇ SEM of three independent experiments.
• Figure 6 shows a test for bleed through signals in different IF channels.
• Mouse primary astrocytes were cultured in DMEM/F12 media and stained separately with LysoTracker Red (top panel) and ⁇ 647- ⁇ (bottom panel). Dapi is used to stain nuclei. The cells were observed under IF
• therapeutic effect means an effect which induces, ameliorates or otherwise causes an improvement in the pathological symptoms, disease progression or physiological conditions associated with or resistance to succumbing to a disorder, for example the aggregation of amyloid- ⁇ protein in the brain of a human or veterinary subject.
• therapeutically effective amount as used with respect to a drug means an amount of the drug which imparts a therapeutic effect to the human or veterinary patient.
• Alzheimer's disease is the most common human
• neurodegenerative disease resulting in progressive neuronal death and memory loss.
• Neuropathologically the disease is characterized by the presence of both neurofibrillary tangles and neuritic plaques composed of aggregates of amylold- ⁇ ( ⁇ ) protein, a 40-43 amino acid proteolytic fragment.
• ⁇ amylold- ⁇
• Astrocytes are the major cell type in the brain, and may be utilized for breaking down amyloid plaques even in advanced
• compositions including a therapeutically effective amount of an agonist of proliferator-activated receptor a ("PPARa") stimulates the uptake and degradation of amyloid- ⁇ ( ⁇ ) in astrocytes.
• the composition may also include vitamin A or a derivative thereof.
• the agonist can be an amphipathic carboxylic acid.
• the agonist is clofibrate, gemfibrozil, ciprofibrate, bezafibrate, clinofibrate or fenofibrate.
• the composition includes a combination of gemfibrozil and retinoic acid.
• Gemfibrozil an FDA-approved lipid-lowering, and vitamin A derivative retinoic acid stimulate the uptake and degradation of amyloid- ⁇ ( ⁇ ) in astrocytes.
• Low density lipoprotein receptor (LDLR) plays an Important role in the uptake, whereas, TFEB mediated induction in lysosomal activity is critical for the degradation.
• Gemfibrozil and retinoic acid treatment also increased the autophagic flux and lysosomal activity in astrocytes as observed from increased LC3-1 1 formation and Increased cathepsin (B/D) activity, respectively.
• Gemfibrozil an agonist of peroxisome proliferator-activated receptor a (PPARa) alone and in conjunction with all-trans-retinoic acid (RA) is capable of enhancing TFEB in brain cells.
• compositions including an agent that is proliferator-activated receptor a
• the agonist is an amphipathic carboxylic acid.
• the agonist may be clofibrate, gemfibrozil, ciprofibrate, bezafibrate, clinofibrate or fenofibrate.
• compositions including a combination of an agent that is proliferator-activated receptor a ("PPARa”) or an agonist of PPARa and vitamin A or a derivative thereof.
• the pharmaceutical composition includes gemfibrozil and retinoic acid.
• compositions can be in the form of, for example, tablets, pills, dragees, hard and soft gel capsules, granules, pellets, aqueous, lipid, oily or other solutions, emulsions such as oil-in-water emulsions, liposomes, aqueous or oily suspensions, syrups, alixiers, solid emulsions, solid dispersions or dispersible powders.
• the agent may be admixed with commonly known and used adjuvants and excipients, for example, gum arabic, talcum, starch, sugars (such as, e.g., mannitose, methyl cellulose, lactose), gelatin, surface-active agents, magnesium stearate, aqueous or non-aqueous solvents, paraffin derivatives, cross-linking agents, dispersants, emulsifiers, lubricants, conserving agents, flavoring agents (e.g., ethereal oils), solubility enhancers (e.g., benzyl benzoate or benzyl alcohol) or bioavailability enhancers (e.g. GELUCIRE).
• the agent may also be dispersed in a microparticle, e.g. a nanoparticulate, composition.
• the agent or pharmaceutical compositions of the agent can be dissolved or suspended in a physiologically acceptable diluent, such as, e.g., water, buffer, oils with or without solubilizers, surface-active agents, dispersants or emulsifiers.
• a physiologically acceptable diluent such as, e.g., water, buffer, oils with or without solubilizers, surface-active agents, dispersants or emulsifiers.
• oils for example and without limitation, olive oil, peanut oil, cottonseed oil, soybean oil, castor oil and sesame oil may be used.
• the agent or pharmaceutical compositions of the agent can be in the form of an aqueous, lipid, oily or other kind of solution or suspension or even administered in the form of liposomes or nano-suspensions.
• the pharmaceutical composition may be administered by any method that allows for the delivery of a therapeutic effective amount of the agent to the subject.
• Modes of administration can include, but are not limited to oral, topical, transdermal and parenteral routes, as well as direct injection into a tissue and delivery by a catheter.
• Parenteral routes can include, but are not limited to subcutaneous, intradermal, intra-articular, intravenous, intraperitoneal and intramuscular routes.
• the route of administration is by topical or transdermal administration, such as by a lotion, cream, a patch, an injection, an implanted device, a graft or other controlled release carrier.
• Routes of administration include any route which directly delivers the
• composition to the systemic circulation e.g., by injection
• administration can be by delivery directly to the central nervous system.
• One embodiment of the method of the invention includes administering the composition in a dose, concentration and for a time sufficient to prevent the development of, or to lessen the extent of Alzheimer's disease.
• the invention includes administering the composition in a dose, concentration and for a time sufficient to reduce amyloid- ⁇ protein aggregates in the brain of a subject.
• the invention includes administering the composition in a dose, concentration and for a time sufficient to stimulate the uptake of amyloid- ⁇ protein aggregates by astrocytes in the brain of a subject.
• the invention includes administering the composition in a dose, concentration and for a time sufficient to stimulate degradation of amyloid- ⁇ protein aggregates by astrocytes in the brain of a subject.
• compositions include administering systemically the composition in a dose between about 0.1 micrograms and about 100 milligrams per kilogram body weight of the subject, between about 0.1 micrograms and about 10 milligrams per kilogram body weight of the subject, between about 0.1 micrograms and about 1 milligram per kilogram body weight of the subject.
• the composition can be administered in a single daily dose or in multiple doses per day. This treatment method may require administration over extended periods of time.
• the amount per administered dose or the total amount administered will be determined by the physician and will depend on such factors as the mass of the patient, the age and general health of the patient and the tolerance of the patient to the compound.
• Tfeb primer Fwd: 5'-aacaaaggcaccatcctcaa-3' SEQ ID NO.: 1 ; Rev: 5'-cagctcggccatattcacac-3' SEQ ID NO.: 2
• Ldlr primer was purchased from SantaCruz Biotechnology (Cat. No. sc-35803-PR). Amplified products were electrophoresed on 2% agarose gels and visualized by ethidium bromide staining. Glyceraldehyde-3-phosphate dehydrogenase (Gapdh) mRNA was used as a loading control to ascertain that an equivalent amount of cDNA was synthesized from each sample.
• the mRNA quantification was performed using the ABI-Prism7700 sequence detection system using SYBR Select master mix.
• the mRNA expression of the targeted genes was normalized to the level of Gapdh mRNA and data was processed by the ABI Sequence Detection System 1 .6 software.
• membranes were incubated overnight at 4°C under shaking conditions with the following 1 ° antibodies; CtsB (Cell Signalling Technology, 1 :1000), CtsD (Cell Signalling Technology, 1 :1000), LC3 (Novus, 1 :500), p62 (Abeam, 1 :500) and ⁇ -actin (Abeam, 1 : 1000).
• CtsB Cell Signalling Technology, 1 :1000
• CtsD Cell Signalling Technology, 1 :1000
• LC3 Novus, 1 :500
• p62 Abeam, 1 :500
• ⁇ -actin Abeam, 1 : 1000
• the wells were incubated at 37°C with 500nM oligomeric FAM-tagged ⁇ (1 -42) for appropriate time-points. Finally the ⁇ - containing medium was removed and wells were gently washed with normal media, followed by quenching of extracellular ⁇ with 100 ⁇ 0.2% trypan blue in PBS for 2mins. After aspiration the fluorescence was measured Ex./Em. of 485/535 in Victor X2 microplate reader (Perkin Elmer). The wells were further incubated with100 ⁇ 50 ⁇ g/ml Hoechst 33342 dye in PBS for 30mins and fluorescence was measured Ex./Em. of 360/465nm (23). The ⁇ fluorescence was normalized to Hoechst fluorescence to account for cell number variability if any.
• Mouse primary astrocytes were cultured on square coverslips placed in 6 well plates. After treatment cells were incubated with 500nM of oligomeric HF-647-tagged ⁇ (1 -42). For degradation study, the cells were further allowed to grow in normal media, after removal of ⁇ containing media. After incubation, cells were further incubated in media containing 75nM
• Mouse primary astrocytes were cultured, treated and lysed in 100 mM sodium acetate, pH 5.5, with 2.5 mM EDTA, 0.01 % Triton X-100, and 2.5 rriM DTT.
• Protein blots were analyzed using ImageJ (NIH, Bethesda, MD) and bands were normalized to their respective ⁇ -actin loading controls.
• Immunofluorescence quantification data are representative of the average fold change with respect to control for at least 25 different images per condition from three independent set of experiments.
• Example 1 1 - GFB and RA treatment enhancement of ⁇ uptake in mouse primary astrocytes:
• the in vitro assay is a robust technique that can quantitatively measure the signal intensity of FAM-tagged ⁇ (1 -42) from inside the cell.
• the cells were treated with GFB-RA and further incubated with ⁇ - ⁇ (1 -42) for various time points (15', 30', 45', 1 hr, 2hr, 4hr and 8hr).
• the signal intensity of ⁇ was first normalized to that of Hoechst, to account for the variability in cell number in each well, if any. Then the normalized ⁇ signals of GFB-RA treated samples were compared to their DMSO treated counterparts and percentage change in the ⁇ signal was calculated for each time point.
• ⁇ signal co-localized with the LysoTracker signal, indicating that the ⁇ taken up by the cells were residing in the acidic vesicles inside the cell (late endosomes or lysosomes) (Fig. 1 B). Since the patterns of ⁇ signal and LysoTracker signal were expected to be similar, we incubated cells separately with LysoTracker and HF-647- ⁇ and tested all channels for any bleed through signals. As expected, only LysoTracker showed slight signal overlap between CY2 and CY3 channels, but there was no significant bleed through signal in any other channel for HF-647- ⁇ apart from its true signal in CY5 channel (Fig. 6).
• ⁇ could be taken up through micropinocytosis assisted by heparan sulfate proteoglycans (HSPGs) (26). Therefore, to elucidate the mechanism of GFB-RA mediated enhancement of ⁇ uptake, we performed ⁇ uptake assay in presence of Heparin (inhibitor of HSPGs) first. Cells treated with GFB-RA in presence of heparin showed -40% increase in ⁇ uptake compare to -80% in GFB-RA treated cells in absence of heparin (Fig. 2A). Although, this reduction in the uptake level is statistically significant, but still there was about 40% uptake even in presence of heparin, which indicates that other factors may also be responsible for the uptake process.
• Heparin inhibitor of HSPGs
• PPARa plays a key role mediating the transcriptional activation of
• TFEB and subsequent enhancement in lysosomal biogenesis Wwe tested the absence of PPARa and PPAR ⁇ affects the regulation of ⁇ uptake and degradation in mouse primary astrocytes.
• Cells isolated from WT, PPARa(-/-) and PPAR ⁇ (-/-) animals were treated with GFB and RA and further incubated with ⁇ - ⁇ (1 -42) (for in vitro assay) and HF-647- ⁇ along with LysoTracker Red (for microscopy).
• the ⁇ signals were normalized to Hoechst signal to account for any variability in cell number.
• the cells from WT and both knockout animals were treated, incubated with ⁇ and further allowed to grow in ⁇ -free media for 6hrs.
• the normalized ⁇ signal for GFB- RA treated astrocytes for each of the cell types, either with or without the 6hr wash, were first compared to their respective DMSO-treated controls. Then percentage change of intracellular ⁇ signals in 6hr washed GFB-RA treated cells (previously normalized to their DMSO treated controls) were calculated with respect to Omin washed GFB-RA treated cells (previously normalized to their DMSO-treated controls) for each cell types.
• LDLR Apolipoprotein E
• LDLR overexpression has been also been shown to facilitate the rate of brain-to-blood transport of cerebral ⁇ , thereby enhancing clearance of pathologic ⁇ from brain (30).
• LDLR is deleted in 5XFAD mouse model of Alzheimer's disease (5XFAD/LDLR-/-)
• amyloid beta deposition and reduced glial inflammatory response, which indicate the role the LDLR in gliosis and ⁇ clearance, independent of ApoE (31 ).
• expression of LDLR, another candidate for ⁇ uptake is also regulated via SREBP2 by activation of PPARa.
• Fenofibrate (FF), another fibrate that belongs to the same class as gemfibrozil has been shown to upregulate hepatic LDLR expression in a PPARa- SREBP2 mediated pathway (32).
• GFB which is a well known activator of PPARa
• LDLR expression in WT cells but not in PPARa(-/-) cells.
• knockdown of LDLR in astrocytes attenuated the enhancement of ⁇ uptake.
• the degradation assay was also performed in similar fashion. Only this time, the cells were allowed to grow in ⁇ -free media for various time points prior to the measurement of signal. Inhibition of lysosomal activity by BafA1 or silencing of TFEB showed reduced degradation of ⁇ , which reinforced the role of lysosome in degradation of ⁇ (1 -42). However, when we assayed for ⁇ degradation in WT, PPARa(-/-) and PPARp(-/-) cells, the calculations were a bit more complicated. In this case, we had three different cell types (WT, PPARa(-/-) and PPARp(-/-)) which respond differentially to GFB-RA treatment in terms of ⁇ uptake. So, for proper assessment of degradation, the levels of ⁇ , post 6hr wash, had to be compared with the fold change in ⁇ prior to wash (0' wash), individually, for each type of GFB-RA treated cells.
• the activity of lysosome was measured by monitoring the activity of two of its hydrolases, Cathepsin B and D.
• CtsB and CtsD are two well-known direct targets of TFEB, so as expected we observed increased activity and levels of the enzymes.
• the beta-amyloid fragments generated by lysosomal hydrolases are subsequently degraded by the cathepsins (CtsB & D) (8). Inhibition of cathepsins cause a rapid buildup of ⁇ fragments, on the other hand it has been shown that increased cathepsin activity results in effective degradation of ⁇ and reduction in ⁇ plaques (33).
• Microtubule associated protein 1 (MAPI ) light chain 3 (MAP-LC3 or simply LC3) exists as a free soluble form (LC3-I), which is covalently conjugated to phosphatidylethanolamine (LC3-II) by the enzymatic action of Atg4 (35,36). Signals leading to induction of autophagy trigger the conversion. LC3-II remains bound to the autophagosome membrane and is essential for the de novo production of autophagic vacuole (37,38). Monitoring the changes in the levels of LC3-I/II is considered to be a simple and effective way to monitor autophagy induction (10). However, mere increase in the levels of LC3-II does not necessarily indicate complete autophagy. LC3-II itself is degraded in the later stages of autophagic degradation, which makes the interpretation of LC3 immunoblot results more complex.
• a wide array of receptors like complement receptor 1 (CR1 ), scavenger receptors (SR-A), CD36, receptor for advanced glycosylation endproducts (RAGE), toll-like receptors (TLRs), transforming growth factor betal (TGF-beta1 ), triggering receptor expressed on myeloid cells 2 (TREM2), etc. has been identified on the surface of microglia that interacts with extracellular ⁇ and induces signalling mechanisms leading to ⁇ uptake and degradation (48-51 ).
• CR1 complement receptor 1
• SR-A scavenger receptors
• CD36 receptor for advanced glycosylation endproducts
• RAGE receptor for advanced glycosylation endproducts
• TLRs toll-like receptors
• TGF-beta1 transforming growth factor betal
• TGF-beta1 transforming growth factor betal
• TGF-beta1 triggering receptor expressed on myeloid cells 2
• astrocytes The role of astrocytes in ⁇ clearance and degradation is also considered beneficial, as astrocytes internalize ApoE- ⁇ complexes from extracellular space and subsequently degrades them or secretes them in perivascular spaces (52-54).
• Astrocytes are also capable of degrading ⁇ by enzymatic action of NEP, matrix metalloproteinase-9 (MMP-9), or insulin-degrading enzyme (IDE) (55-60).
• MMP-9 matrix metalloproteinase-9
• IDE insulin-degrading enzyme
• prolonged exposure to pathologic ⁇ renders astrocytes incapable of handling such huge amount of ⁇ cargo and results in ⁇ accumulation in astrocytes (61 ,62).
• enhancement of lysosomal biogenesis has been shown to play a critical role in ⁇ internalization and degradation.
• Adeno-associated virus (AAV) carrying TFEB gene driven by glial fibrilary acidic protein (GFAP) promoter or CMV-promoter was administered by stereotactic injection into hippocampus of APP/PS1 mice, which are specifically targeted to astrocytes or neurons, respectively.
• TFEB overexpression leads to induction in lysosomal biogenesis and eventually results in enhanced uptake and clearance of ⁇ from the interstitial fluids by astrocytes and enhanced processing of APP by neurons, that reduces ⁇ production (23,63).
• Low-density lipoprotein receptor represents an apolipoprotein E- independent pathway of Abeta uptake and degradation by astrocytes. J Biol
• 3/MAP1 LC3B is cleaved at its carboxyl-terminal Met121 to expose Gly120 for lipidation and targeting to autophagosomal membranes. J Biol Chem 279,
• TGF-beta1 promotes microglial amyloid-beta clearance and reduces plaque burden in transgenic mice. Nat Med 7, 612-618
• Insulin-degrading enzyme regulates the levels of insulin, amyloid beta- protein, and the beta-amyloid precursor protein intracellular domain in vivo.

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