Metabolic resistance of Abeta3pE-42, epitope of the anti-Alzheimer therapeutic antibody, donanemab.

Abstract

The amyloid {beta} peptide (A{beta}) starting with pyroglutamate (pE) at position 3 and ending at position 42 (A{beta}3pE-42) is a dominant species that accumulates in the Alzheimers disease (AD) brain. Consistently, a therapeutic antibody raised against this species, donanemab, has been shown to be effective in recent clinical trials. While the primary A{beta} species produced physiologically is A{beta}1-40/42, an explanation for how and why this physiological A{beta} is converted to the pathological form has remained elusive. The conversion of A{beta}1-42 to A{beta}3pE-42 is likely to take place after deposition of A{beta}1-42 given that A{beta}3pE-42 plaques arise significantly later than A{beta}1-42 deposition in the brains of single App knock-in and APP-transgenic mice. Here, we present experimental evidence that accounts for the aging-associated A{beta}3pE-42 deposition: [1] A{beta}3pE-42 is metabolically more stable than other A{beta}X-42 species; [2] Deficiency of neprilysin (NEP), the major A{beta}-degrading enzyme, induces a relatively selective deposition of A{beta}3pE-42 in APP-Tg mice. [3] A{beta}3pE-42 deposition always colocalizes with cored plaques in both APP-Tg and App knock-in mouse brains; [4] A{beta}3E-42, an immediate precursor of A{beta}3pE-42, as well as A{beta}2A-42 and A{beta}4F-42 are more short-lived than A{beta}1-42 in vivo, indicating that simple N-terminal truncation that can arise enzymatically or spontaneously makes A{beta}X-42 easier to catabolize. Consistently, newly generated knock-in mice, AppNL-({Delta}DA)-F and AppNL-({Delta}DA)-Q-F, showed no detectable A{beta} pathology even after aging, indicating that the A{beta}3E-42 and A{beta}3Q-42 species are extremely labile to the in vivo catabolic system and that the E/Q cyclase activity present in mouse brain is insufficient for A{beta}3pE-42 generation. In addition, a deficiency of NEP facilitated A{beta}3pE-42 deposition. Of note, we identified a trace amount of A{beta}3pE-42 and its immediate precursor, A{beta}3E-42, in the insoluble fraction of NEP-deficient APP-Tg mouse brains. A{beta}3pE-42 is thus likely to be a probabilistic by-product of A{beta}1-42 metabolism that selectively accumulates over a long-time range of brain aging. It is likely produced in the solid state or at the solid-liquid interface. Our findings suggest that anti-A{beta} therapies will probably be most effective if given before A{beta}3pE-42 deposition takes place.