Degenerative diseases of the nervous system, such as Alzheimer's, Parkinson's and ALS, are severe, progressive and ultimately fatal. Most existing drugs for these neurodegenerative diseases only... Show moreDegenerative diseases of the nervous system, such as Alzheimer's, Parkinson's and ALS, are severe, progressive and ultimately fatal. Most existing drugs for these neurodegenerative diseases only temporarily relieve symptoms, increase mobility or relieve pain, but do not slow disease progression.This dissertation describes a method to efficiently carry out the development of new drugs that could inhibit disease progression in neurodegenerative diseases. Namely, by using pharmacodynamic biomarkers. These are signaling substances to measure the magnitude of a drug response.These biomarkers can be used in early clinical-pharmacological studies in healthy volunteers or small groups of patients to select the best drug candidates and their expected therapeutic doses as early as possible in the development stage. This helps to make informed choices to advance a potential new drug into large and expensive phase 2 and 3 (registration) studies, or conversely to discontinue development of a non-potential drug as early as possible. This biomarker method was applied in this dissertation to investigate 2 new drugs that could potentially slow disease progression in Alzheimer's and ALS (a RIPK1 inhibitor) or Parkinson's disease (a LRRK2 inhibitor). The research results from multiple early clinical-pharmacological studies in healthy volunteers and patients described in this thesis form the basis for larger phase 2 and 3 follow-up studies that have now been initiated with ALS patients and Parkinson's disease patients. Both with the goal of confirming whether these agents can indeed slow disease progression, which would represent a major breakthrough in the treatment of these conditions. Show less
Alzheimer’s disease (AD) is the most common cause of dementia and quickly becoming one of the most burdening diseases of the century. Effective treatments are still missing, partially because its... Show moreAlzheimer’s disease (AD) is the most common cause of dementia and quickly becoming one of the most burdening diseases of the century. Effective treatments are still missing, partially because its pathogenesis is still incompletely understood. This thesis explores the role of iron in AD, how it interacts with the immune system to influence disease pathogenesis and whether it could serve as potential biomarker. The first part of this thesis describes the importance of translational MRI, and how it can be used to increase our understanding of neurological diseases and help identify biomarkers. Subsequently, we used translational MRI to characterize the differences in iron accumulation in the brain between patients with AD and healthy elderly. The second part of this thesis investigated how the immune cells of the brain, microglia, interact with the accumulated iron. Using a combination of advanced multispectral immunofluorescence on brain tissue from AD patients and a human stem-cell derived microglia model, we studied the activation pattern of iron-accumulating microglia in human brains and emulated microglial iron accumulation in vitro. This enabled us to study the effect of iron on the gene expression patterns and function of the brain’s immune cells. Show less
Alzheimer’s disease (AD) is a neurodegenerative disease characterized by memory loss and declined cognitive functioning. Brain changes in AD involve grey matter atrophy and changes in brain... Show moreAlzheimer’s disease (AD) is a neurodegenerative disease characterized by memory loss and declined cognitive functioning. Brain changes in AD involve grey matter atrophy and changes in brain function. These different brain characteristics can respectively be visualized with structural and functional MRI scans. These MRI modalities have been used for AD classification, but studies typically only include a limited number of features. In this thesis we derived multiple types of features from each MRI modality, and combined those to discriminate AD patients and elderly controls. First, we showed that AD classification accuracy increases when combining multiple types of measures from a single MRI modality. This was shown for structural MRI scans in chapter 2, and for resting state fMRI scans in chapter 3. In chapter 4 we evaluated whether MRI based AD classification models can discriminate AD in a diverse clinical population as well. This worked to some extent, and it worked best using structural MRI scans. In chapter 5 we used baseline multimodal MRI scans from the same diverse clinical population to predict two-year follow-up cognitive decline. Decline was predicted above chance level for the MMSE, but not for six other neuropsychological tests. Show less
The current symptomatic treatment for cognitive dysfunction due to dementia (eg Alzheimer's disease) is moderately effective and causes dose limiting side effects. This thesis describes the phase 1... Show moreThe current symptomatic treatment for cognitive dysfunction due to dementia (eg Alzheimer's disease) is moderately effective and causes dose limiting side effects. This thesis describes the phase 1 development of new symptomatic treatments; Gln-1062 (pro-drug of galantamine) and HTL0009936 and HTL0018318 (both M1 muscarinic receptor partial agonists). Additionally, a new methodology was investigated, which can be applied when demonstrating pharmacological effects (biperiden challenge model), and a review of all biomarkers that were used to measure cholinergic effects is presented. Show less
One of the pathological hallmarks of Alzheimer's disease is amyloid‑β accumulation in the parenchymal brain tissue. Amyloid‑β is also found in the vessel wall of patients with cerebral amyloid... Show moreOne of the pathological hallmarks of Alzheimer's disease is amyloid‑β accumulation in the parenchymal brain tissue. Amyloid‑β is also found in the vessel wall of patients with cerebral amyloid angiopathy (CAA). These pathological accumulations of the amyloid‑β peptide are referred to as amyloidosis. Both patients with AD and CAA also commonly show cerebrovascular dysfunction. The aim of this thesis was to improve our understanding of the relation between cerebrovascular dysfunction and amyloidosis. To that end, cerebrovascular function measurements were designed and carried out in mouse models of cerebral amyloidosis. Chapter 2 and 3 show improvements of the current techniques to measure cerebrovascular function in mice. Surprisingly however, no difference was found in cerebrovascular function in two different models of amyloidosis, as shown in chapter 4 and 5. Possible explanations of the negative findings are further discussed in chapter 6. Despite the negative connotation of the outcome this thesis, this work is another small step towards a better understanding of the exact relationship between cerebrovascular dysfunction and amyloid‑β deposition in AD and CAA patients. Ultimately, this will help in the design of highly needed novel therapies for AD and CAA. Show less
This thesis aimed to gain more insight into the role of iron in neurodegenerative diseases using high-field MRI. I investigated the pathological correlates of susceptibility-based contrasts on MRI,... Show moreThis thesis aimed to gain more insight into the role of iron in neurodegenerative diseases using high-field MRI. I investigated the pathological correlates of susceptibility-based contrasts on MRI, and how iron accumulation is associated with disease progression both ex vivo and in vivo. Show less
Dementie is een verwoestende ziekte waar wereldwijd miljoenen mensen aan leiden. De meest voorkomende oorzaak van dementie is de ziekte van Alzheimer. Voor het ontwikkelen van effectieve... Show moreDementie is een verwoestende ziekte waar wereldwijd miljoenen mensen aan leiden. De meest voorkomende oorzaak van dementie is de ziekte van Alzheimer. Voor het ontwikkelen van effectieve behandelingen is het belangrijk om dementie in een vroeg stadium te detecteren. Traditioneel alzheimeronderzoek is voornamelijk gericht op groepsverschillen tussen patiënten en controles. Recent onderzoek is deels verschoven naar individuele classificatie met machine learning. In dit proefschrift onderzoeken we het gebruik van magnetic resonance imaging (MRI) voor automatische detectie van de ziekte van Alzheimer, en vroege detectie van cognitieve achteruitgang. In dit proefschrift laten we zien dat het combineren van MRI modaliteiten de classificatie kan verbeteren. Ook laten we zien dat diffusie MRI een goede maat is om alzheimer te diagnosticeren. Bij toepassing van dezelfde methoden op een groep presymptomatische gendragers die amyloïdangiopathie zullen ontwikkelen vonden we geen verschillen tussen de gendragers en controles. Tevens waren we niet in staat om cognitieve achteruitgang na 4 jaar te voorspellen in een groep ouderen met verhoogd risico op achteruitgang. Met MRI kunnen betrouwbare individuele uitspraken gedaan kan worden over patiënten, maar het is met de huidige methoden niet gevoelig voor vroege detectie van cognitieve achteruitgang. Show less
The striatum plays a central role in the limbic system and the cholinergic system, which are both affected in AD. Therefore the striatum can be considered a key candidate structure to be affected... Show moreThe striatum plays a central role in the limbic system and the cholinergic system, which are both affected in AD. Therefore the striatum can be considered a key candidate structure to be affected early in the disease. Part one of this thesis bundled the results of several volumetric and morphometric structural MRI studies of the striatum in older people and especially in patients with AD. Identifying pathological (focal) brain atrophy is, however, complex and a simple estimation of brain structure volumes of an individual patient does not lead to a diagnosis but needs to be assessed relative to group volumes and premorbid brain size. Therefore, in part two of this thesis two large population studies were included that focused on improving our understanding of the physiologic variability of brain structure and degeneration. Show less
This thesis adresses a variety of early markers of Alzheimer's disease, using MRI, histology and MRS. MRS is found to be promising for early diagnosis of AD. However this study is done on mice... Show moreThis thesis adresses a variety of early markers of Alzheimer's disease, using MRI, histology and MRS. MRS is found to be promising for early diagnosis of AD. However this study is done on mice and should be replicated on AD patients over time. Besides the early markers the thesis descibes a potential difference between male and female in the development of AD in the brain. Show less
Alzheimer__s disease (AD) is the predominant form of dementia in the aging population and its increasing incidence represents an important socio-economic and public health concern. The hallmarks of... Show moreAlzheimer__s disease (AD) is the predominant form of dementia in the aging population and its increasing incidence represents an important socio-economic and public health concern. The hallmarks of this disease, amyloid plaques and neurofibrillary tangles, are thought to develop early in the disease pathogenesis, up to decades before first clinical symptoms occur. However, these pathological hallmarks are still difficult to detect in vivo, and therefore a definitive diagnosis can only be made post-mortem. A clinical imaging technique or biomarker capable of visualizing and quantifying amyloid plaques and associated early changes thus may enable an earlier diagnosis, better understanding of the pathophysiology and eventually aid therapy development. The work presented in this thesis aimed to develop innovative diagnostic imaging techniques to detect the histological signatures of AD using emerging ultra-high field MRI technologies (Part I) and molecular imaging strategies (Part II). Show less
The general objective of this thesis was to investigate new (quantitative) MR techniques and MR markers in the light of both AD and cerebral aging. The quantitative MR techniques that we used were... Show moreThe general objective of this thesis was to investigate new (quantitative) MR techniques and MR markers in the light of both AD and cerebral aging. The quantitative MR techniques that we used were MTI, tCBF and WSS measurements. The new markers we studied were cerebral microbleeds and iron accumulation in the basal ganglia. In chapter 2 we investigated whether MTI changes could be detected in the GM, WM or both in patients suffering from MCI or AD. Using MTI we found evidence for structural brain changes in both GM and WM of patients with MCI and AD. Furthermore, these MTI changes were related to cognitive impairment as expressed by the mini mental state examination (MMSE) score. These findings imply that cerebral changes can be detected in both GM and WM even before patients are clinically demented. The finding of MTI changes in the GM might relate to classical AD type pathology, whereas WM MTI changes could indicate concomitant vascular pathology. The findings in chapter 2 raised the question of how the MTI changes found in this study are distributed over the GM and WM. This was investigated in chapter 3. In this study we showed that brain damage, as detected by MTI, is widespread over the lobes in both AD and MCI patients whereas GM damage is more focally present in the temporal and frontal lobe of MCI patients. These findings are compatible with the knowledge that GM damage originates from the temporal lobe in AD. This interpretation is further supported by the observed independent association between temporal GM peak height and cognitive decline. MTI changes were found in all four lobes of the MCI patients investigated in this study and show the involvement of a diffuse process affecting the WM even before patients are clinically demented, a finding potentially explained by the presence of diffuse vascular pathology. Chapter 4 shows that the tCBF is strongly associated with parenchymal volume rather than age and, although much weaker, with the severity of WMHs. Although the association between tCBF and parenchyma volume seems straightforward, this finding has important implications for future studies. Volume flow measurements should be corrected for parenchymal volume ratherthan age in all future studies in which flow measurements are being used as a diagnostic tool. In addition, studies including elderly patients or patients with a pathological increase of WMHs, such as diabetic type II subjects, should also correct their tCBF measurements for WMH volumes. Chapter 5 shows that hemodynamic conditions of the carotid and basilar arteries, as expressed in lower WSS parameters, are worse in both MCI and AD compared to controls. In addition, the WSS parameters were found to correlate strongly with cognition. Again, this study is additional evidence for an important role of vascular pathology in the development of AD. In chapter 6, we found a high prevalence of microbleeds in a population of patients suffering from vascular disease or at high risk of developing this condition. Age, hypertension and WMH were the most important risk factors for microbleeds, especially when located in the cortico-subcortical junction and basal ganglia. Regarding the associations between the presence and location of microbleeds on the one hand and parameters of cognitive functioning on the other, chapter 7 shows that microbleeds located infratentorially are associated with impaired cognitive functioning in the aging population with increased vascular risk factors. This suggests that in elderly individuals microbleeds in the posterior fossa should be considered a sign of small vessel disease with potential functional consequences. The semi-quantative scale for scoring basal ganglia hypo-intensity on T2*- weighted imaging presented in chapter 8 was associated with markers of neurodegeneration. This study showed that low signal intensity of the caudate nucleus T2*-weighted MR is a frequent finding which is associated with more cerebral atrophy, a higher load of WMH and a higher load of invisible changes in both cortical GM and NAWM non-demented elderly. Furthermore, hypo- intensity limited to the globus pallidus and putamen was not associated with any of these parameters of neurodegeneration. In chapter 9 we present a method for automated detection and classification of hypo-intense regions on T2-weighted MR images of the basal ganglia. In this chapter we not only show an association between basal ganglia hypo-intensity and cardiovascular risk factors but also with measures of cognitive functioning. From this we conclude that hypo-intensity of the basal ganglia on T2-weighted MR is not only a radiological finding accompanying cerebral aging but also an independent marker of neurodegeneration. Show less
While aging remains one of the most significant risk factors for development of Alzheimer disease (AD), increasing evidence strongly points to the potential roles of cerebrovascular and white... Show moreWhile aging remains one of the most significant risk factors for development of Alzheimer disease (AD), increasing evidence strongly points to the potential roles of cerebrovascular and white matter abnormalities in the disease development. A better understanding of the manner in which these abnormalities contribute to disease progression can be achieved by in vivo characterization of AD related pathologies. To this end, MR based techniques serve as effective non-invasive tools to longitudinally monitor changes in AD brain. In this thesis, a variety of MR based techniques were optimized and employed to longitudinally monitor the AD progression in transgenic mouse models of the disease at 9.4T and 17.6T. In Chapter 2, age-dependent blood flow alterations were examined in a Tg2576 mouse model of Alzheimer's disease using MR angiography at 17.6T. AD is linked to abnormalities in the vascular system. In Chapter 3, in vivo T2 changes were longitudinally monitored in the corpus callosum, of the Tg2576 mice. In Chapter 4, age-dependent regional brain T1 and T2 changes in healty mice were established at 17.6T. In vivo imaging of these mouse models at ultra-high magnetic field strengths can permit a better understanding of the underlying cellular mechanism of AD. Show less
Proteins are essential for organisms and participate in virtually every process within cells. Knowledge about the structure of proteins provides crucial information about their function in... Show moreProteins are essential for organisms and participate in virtually every process within cells. Knowledge about the structure of proteins provides crucial information about their function in biological mechanisms. In determining the structure of proteins with biophysical approaches, electron paramagnetic resonance (EPR) is rapidly gaining ground. The aim of this thesis is to provide insight in how broad the application of EPR can be to study proteins, in particular those which are difficult if not impossible to study with other approaches. The focus of this thesis is to investigate the aggregation and misfolding of intrinsically disordered proteins and to determine the structure of disordered parts of proteins with EPR. Specifically, the amyloid β (Aβ) peptide, the α-synuclein (αS) protein, and the light-harvesting protein CP29 are studied. Show less
In this research heavy chain antibody fragments (VHHs) are developed as potential tools for non-invasive in vivo imaging of Alzheimer__s disease (AD) and Cerebral Amyloid Angiopathy (CAA). First... Show moreIn this research heavy chain antibody fragments (VHHs) are developed as potential tools for non-invasive in vivo imaging of Alzheimer__s disease (AD) and Cerebral Amyloid Angiopathy (CAA). First the generation of antibody fragments, directed against A_ is described. VHHs that were selected from different libraries showed differential affinity for different A_ epitopes when used for immunohistochemistry. These observations indicate that the VHHs are the first immunologic probes with the capacity to differentiate between parenchymal and vascular beta amyloid aggregates. Next, in chapter three the VHH are assessed on their ability to cross the blood-brain barrier using an established in vitro blood brain barrier co-culture system. VHH ni3A showed the highest transmigration efficiency of all tested VHHs. This transport is, in part, facilitated by a 3 amino acid substitution in its N-terminal domain. Additional studies indicated that the mechanism of transcellular passage of ni3A is by active transport. The data described in chapter four provides preliminary proof that these VHHs have the capacity to target A_ depositions in vivo. Consequently, the VHHs are promising tools for further development as imaging agents for the differential diagnosis of A_-related neurodegenerative diseases like CAA and AD. Show less
The objective of this thesis was to validate serial position effects (SPE__S) scoring in the Rey Auditory Verbal Learning Test (RAVLT). The RAVLT is a much used clinical method for assessing memory... Show moreThe objective of this thesis was to validate serial position effects (SPE__S) scoring in the Rey Auditory Verbal Learning Test (RAVLT). The RAVLT is a much used clinical method for assessing memory performance, but the method of scoring obfuscates that two memory processes underlie free recall. This is suggested by SPE__S of single-trial free recall , although the extent of the effects are not defined. The internal and external validity of SPE__S of the RAVLT is studied. The internal validity of SPE__S is studied by means of confirmatory factor analysis. It is shown that the recency effect comprises two to three items, while the primacy effect and middle (prerecency) comprise the remaining items in a list, implying that they arise from two memory functions. Studies testing their external validity show that they play a variant role in memory impairment of Alzheimer__s disease and Major Depression patients and are found to be differentially related to stress hormone activity in these patients, and in healty human subjects. Scoring of accurately determined SPE__S in the RAVLT is a valid improvement of clinical memory assessment. As serial position effects are further found in the recall of a variety of types of information, and also found in the animal, it is argued that they are general to temporal information processing. Show less
