Abstract
A common feature in the Alzheimer’s disease (AD) brain is the presence of acetylcholinesterase (AChE) which is commonly associated with β-amyloid plaques and neurofibrillary tangles (NFT). Although our understanding of the relationship between AChE and the pathological features of AD is incomplete, increasing evidence suggests that both β-amyloid protein (Aβ) and abnormally hyperphosphorylated tau (P-tau) can influence AChE expression. We also review recent findings which suggest the possible role of AChE in the development of a vicious cycle of Aβ and P-tau dysregulation and discuss the limited and temporary effect of therapeutic intervention with AChE inhibitors.
Introduction
Alzheimer’s disease is the most common cause of dementia among the elderly and is characterized by loss of memory and other cognitive functions. The major pathological hallmarks include extensive synaptic and neuronal loss, astrogliosis, and accumulation of proteinaceous deposits. The AD brain is characterized by the presence of β-amyloid plaques and neurofibrillary tangles (NFT), which are the hallmark pathological features (for a review see Blennow et al., ). β-amyloid plaques are extracellular deposits of which the major component is the β-amyloid protein (Aβ), a small polypeptide generated by processing of a much larger transmembrane β-amyloid precursor protein (APP; Masters et al., ; Kang et al., ) through the successive action of proteolytic enzymes known as secretases (for a recent review see Zhang et al., 2011). The intracellular NFT are composed of paired helical filaments of the microtubule-associated protein tau, which is abnormally hyperphosphorylated (P-tau; Grundke-Iqbal et al., ). Today, the focus on research has moved away from the proteinaceous deposits toward studies on the role of the triggering effectors, soluble oligomeric Aβ, and P-tau. Accordingly, much research is devoted to understanding how Aβ and P-tau lead to the toxic events associated with AD, how they cause changes in the expression of other key brain proteins and ultimately how they cause neurodegeneration. However, it is also crucial to decipher how both Aβ and P-tau interact in order to reach a better understanding of the mechanism of neurotoxicity and to achieve an effective therapy.
As extensively reviewed in this special issue, acetylcholinesterase (AChE) is a key enzyme in the cholinergic nervous system. During the progression of AD, many different types of neurons deteriorate, although there is a profound loss of forebrain cholinergic neurons, which is accompanied by a progressive decline in acetylcholine (Davies and Maloney, ; Perry et al., ). Both the acetylcholine-synthesizing enzyme choline acetyltransferase (ChAT), as well in the acetylcholine-hydrolyzing enzyme, AChE are affected. Therapies designed to reverse the cholinergic deficit are in large measure based on the importance of cholinergic function in cognition. In spite the overall decrease in the activity of AChE in the AD brain, current AD therapy is mostly based on inhibitors of AChE (AChE-I), which enhance cholinergic transmission, but which have modest and transient therapeutic effects (Giacobini, ; Kaduszkiewicz et al., ). As a consequence of its role as a target for AD therapy, AChE is one of the most studied proteins in the Alzheimer’s field, with about 1500 manuscripts indexed into the PubMed; the vast majority of reports in the field relate with treatment strategies associated with the use of AChE-I.
It has been well known for almost 50 years that the distribution of AChE molecular forms is particularly affected in the AD brain, but the physiopathological significance and subsequent implications of these intriguing changes in AChE species remain unknown. An increase in AChE levels around amyloid plaques and NFT is a common feature of AD neuropathology, and although the significance of this increase remains to be determined. In another way, up-regulation of AChE activity following long-term AChE-I therapy has been reported in a number of studies during the last decade. All these abnormalities in AChE expression patterns, as well AChE up-regulation in reaction to chronic inhibition, may are related with the limited efficiency and persistence of AChE-I. In summary, after decades of study and hundreds of reports, AChE remains of considerable interest into the AD field. The description of changes in AChE levels and forms in the AD brain has merit extensive revision (see for example Younkin et al., 1986; Mesulam and Geula, ; Massoulié et al., ; Layer, ; Small et al., ; Kása et al., ; Grisaru et al., ; Talesa, ; Rees and Brimijoin, ; Ballard et al., ; Silman and Sussman, ; Greenfield et al., ; Inestrosa et al., ; and many others). The purpose of this article is to review changes in AChE expression in the AD brain, but with a particular emphasis on the role of these changes in the pathophysiology of AD. In addition, we summarize our recent findings about the cross-talk between AChE and Aβ, and also between AChE and P-tau. The possibility that Aβ and P-tau interact through AChE is considered.
Altered AChE Molecular Form Pattern in AD
Acetylcholinesterase can exist in several different molecular forms, which have specific patterns of expression in different cell types (for a review see Massoulié, ). Moreover, the specific subcellular distribution of each species of AChE probably reflects different physiological functions for each form. Indeed, a large number of studies suggest that AChE could have novel functions unrelated to cholinergic neurotransmission (for review see Massoulié et al., ; Layer, ; Small et al., ; Soreq and Seidman, ). In this regard, it is important to note that AChE is present in both cholinergic and non-cholinergic brain areas, where the functional significance of non-cholinergic AChE remains unknown. We particularly refer to the work of Mesulam () for a detailed view of the distribution of AChE in the non-pathological and AD brain. Even in cholinergic areas, it has been suggested that the reduction of AChE activity in the AD brain is not due to cholinergic depletion alone, as the density of AChE-rich (cholinergic) fibers decreased in cortical areas of the AD patients but was not correlated with the number of AChE-rich neurons (Heckers et al., ). Therefore, it is important to note that an alteration in AChE levels may not reflect a change in cholinergic neurotransmission.
Not all molecular forms of AChE are equally affected in the AD brain. Studies using sucrose gradient centrifugation have revealed two major forms of AChE in the mammal brain, tetrameric and monomeric species (Figure 1; reviewed in Massoulié et al., ). The major forms in the non-AD adult brain are tetramers (G4) that are anchored in the cell membrane of neurons. These tetramers probably constitute the true cholinergic species. Other minor species are monomers (G1) and dimers (G2) that cannot be completely separated from each other by sucrose gradient centrifugation. Regional variations in the AChE molecular form ratio G4/G1 usually been studied in relation to neurochemical and neuroanatomical, particularly cholinergic, features of the brain (Atack et al., ). However in the AD brain, there is a selective loss in the G4 form, while the lighter species are preserved (Atack et al., ; Fishman et al., ) or even increased in severely affected cases of AD (Figure 1; see also Arendt et al., ; Sáez-Valero et al., ). Similarly, changes in AChE molecular forms in cerebrospinal fluid (CSF) reflect changes in the brain (Sáez-Valero et al., , ). Light AChE species, which represent the major forms in plasma, are also increased in the AD plasma (García-Ayllón et al., ). In agreement with human studies, AChE monomeric species are also increased in brain of the APPC100 and Tg2576 transgenic mice which overproduce human Aβ (Figure 2; see also Sberna et al., ; Fodero et al., ; Silveyra et al., ) and in rats given intracerebral Aβ (Sáez-Valero et al., ). Different reports have corroborated the possibility that Aβ might influence AChE (Sberna et al., ; Hu et al., ; Melo et al., ). So far, the significance of this particular increase in monomeric AChE around plaques and in Aβ models is unclear.
Figure 1
Figure 2

Monomeric AChE molecular forms are increased in the brain of a transgenic mouse model of Aβ over-expression. AChE is expressed as several different species with various molecular weights which can be identified by sucrose density gradient centrifugation (see Figure 1). Cerebral cortices from an APPC100 transgenic mice which express human Aβ (Tg APPC100; open circles) display higher levels of monomeric G1 AChE forms compared to control samples of similar age (closed circles; 3 months old), while levels of tetrameric G4 AChE species were not different (no change; n.ch.). See also Sberna et al. (
Significance of Increased Monomeric AChE in AD
Light forms of AChE in the brain have been generally considered as biosynthetic precursors of the G4 forms due to the fact that oligomeric forms of AChE are assembled from monomeric precursors (Brockman et al.,
Figure 3

Monomeric AChE molecular forms are the predominant species during embryonic brain development. AChE activity was extracted from rat (Sprague-Dawley) cerebral cortex at embryonic day 12 (E14), 14 (E14), 16 (E16), and 18 (E18) and at 3 months of age (Adult), and AChE forms were separated by sucrose density gradient (see Figure 1). At early embryonic stage only light monomeric G1 AChE is present and levels are maintained (no change; n.ch.) until E15–16, an increase in G1 AChE parallels emergence of G4 AChE tetramers, the brain cholinergic species. The G4 species increase in activity during brain maturation becoming the major molecular forms during post-natal periods (N.B. difference of scales between embryonic and adult stage).
Therefore, we can speculate that G1 AChE has a non-cholinergic role during brain development, and that this role may be unrelated to the enzyme’s catalytic properties. In this context, it is assumed that all AChE forms possessed similar catalytic properties, which is probably true when oligomeric and monomeric precursors are compared. Nevertheless, it has been demonstrated subtle differences in sensitivity to inhibitors and in kinetic properties exist between tetrameric and monomeric AChE species (Ogane et al.,
Therefore, if we accept the possibility that embryonic AChE may possess a function independent of its catalytic capacities, the large pool of catalytically inactive AChE protein should be considered. The basis for the presence of an embryonic AChE species different from that of the adult, is unknown, but several questions arises regarding the use of AChE-I in AD therapy.
The existence of an unexpectedly large pool of inactive AChE has been demonstrated in brain (Chatel et al.,
This complex scenario of multiple molecular forms is brought about, at least in part, by the existence of alternative splicing of the single ACHE gene, generating different AChE variants, with potential different gene regulation (Grisaru et al.,
Figure 4

Diagram of the human AChE gene structure, its alternative splicing and generation of variants and molecular forms of AChE in brain. Gene structure showing the splicing pattern of the six major exons. The catalytic core of human AChE is encoded by three exons and additional exons encode the variant-specific carboxy-terminal sequences. In the normal human brain, much more AChE-T than AChE-R mRNA is produced. However, under stress AChE-R expression is increased. To date, no expression of AChE-H has been described in the brain (see Grisaru et al.,
The central question is whether the changes in the distribution of AChE molecular forms in the AD brain have any physiopathological consequences. As stated previously, gross sedimentation analysis cannot distinguish between monomeric isoforms that are synthesized to be assembled in oligomers, or arise as degradation products, and those specific monomeric species which may have specific functions. Therefore, in previous studies we have further characterized the increase in monomeric AChE associated to Alzheimer’s and to Aβ by characterizing its glycosylation pattern by lectin binding analysis, based on the assumption that different functional pools of AChE may have different glycosylation patterns. Correct glycosylation determines the adequate intracellular trafficking, folding, assembly, and final localization of glycoproteins. Thus different forms (glycosylated variants or glycoforms) of the same protein should differ in glycosylation in order to achieve a different oligomerization state, subcellular localization, protein–protein interaction affinity, or a different physiological function. Indeed, for a particular glycoprotein, the abundance of single glycoforms should closely correlate to each other and be regulated within narrow limits. By exploiting the ability of lectins to bind diverse carbohydrate moieties with high specificity (Sharon and Lis,
Alterations in the glycosylation state of other glycoproteins have been reported in AD tissue (Guevara et al.,
P-tau Increases AChE, Differences from Aβ
It has been noted that abnormal AChE expression in the AD brain occurs in association with the two hallmark features of the AD pathology, the amyloid plaques and the NFT (Mesulam and Morán,
Figure 5

All molecular forms of AChE are increased in the brain of a transgenic mice model of P-tau over-expression. In a transgenic mice (Tg VLW; open circles) expressing human tau mutations causing frontotemporal dementia and parkinsonism linked to chromosome 17 (FTDP-17), both the major cholinergic tetramers G4 AChE and light monomeric forms G1 AChE activities were higher compared to age-matched control-littermate mice (closed circles; 5 months old).
Downstream Consequences of Changes in AChE Levels in AD Brain
Notwithstanding the overall loss of total AChE activity in the AD brain, AChE is consistently increased in regions around amyloid plaques and NFT at all stages of the disease, including some of the earliest stages (Perry et al.,
Our own recent work also indicate that AChE can modulate APP processing and Aβ production. Aβ is produced through the successive action of two proteolytic enzymes, β-secretase and Γ-secretase on APP (Zhang et al., 2011). The active proteolytic component of the Γ-secretase complex is presenilin 1 (PS1; Suh and Checler,
Figure 6

Schematic representation of the multiple relationships between AChE and the Alzheimer’s effectors Aβ and P-tau. AChE is proposed to interact with both Aβ and P-tau. P-tau can lead to an increase in the activity of AChE (1) (Silveyra et al.,
It appears likely, therefore, that several vicious cycles trigger by Aβ and P-tau involve the potential participation of AChE. The significance of these theoretical considerations to the clinical and neuropathological course of AD remains to be demonstrated.
Effects of AChE-I
Therapies designed to reverse the cholinergic deficit are in large measure based on the importance of cholinergic function in cognition. Indeed, AChE-Is have proven to be modestly efficacious in treating the cognitive and functional symptoms of AD. In addition disease-modifying effects of AChE inhibition has been also considered (Giacobini,
The therapeutic effect of current AChE-Is is both modest and transient. Current AChE-I treatment results are disappointing both because of their poor efficacy and tolerability. Interestingly, these drugs have a limited duration of cognitive benefit. The effects of these drugs on APP processing also fail to be maintained over the long-term in Alzheimer’s patients (Basun et al.,
The transience of the response to AChE-I could be associated with AChE up-regulation in reaction to chronic inhibition (Chiappa et al.,
Summary and Conclusion
In summary, AChE species differ in their responses to disease and their interactions with β-amyloid and P-tau. The important question about the nature of the alternative functions of AChE, their association with different AChE species and variants, and their role in AD pathogenesis and therapy needs to be examined further. Recent evidence also suggests the potential participation of AChE in vicious cycles involving Aβ and P-tau. Elucidation of the mechanisms involved in these changes will be useful for understanding the physiological and pathological relevance of altered AChE expression in the AD brain and AChE-I pharmacological intervention. The chronic increases in AChE activity during AChE-I treatment may cause the therapeutic value of AChE-I to be limited and temporary and needs to be addressed in order to improve therapy.
Statements
Acknowledgments
We would especially like to thank Dr. M.-X. Silveyra for her contribution, and M.-T. García-Hedo and C. Serra-Basante for technical assistance. This work was supported by grants from Foundatión CIEN-Reina Sofía, FIS (Grant PS09/00684), and CIBERNED, ISC-III from Spain to Javier Sáez-Valero.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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Summary
Keywords
acetylcholinesterase, β-amyloid, presenilin 1, P-tau, Alzheimer’s disease
Citation
García-Ayllón M-S, Small DH, Avila J and Sáez-Valero J (2011) Revisiting the Role of Acetylcholinesterase in Alzheimer’s Disease: Cross-Talk with P-tau and β-Amyloid. Front. Mol. Neurosci. 4:22. doi: 10.3389/fnmol.2011.00022
Received
21 June 2011
Accepted
24 August 2011
Published
13 September 2011
Volume
4 - 2011
Edited by
Karl Tsim, The Hong Kong University of Science and Technology, China
Reviewed by
Nibaldo C. Inestrosa, Pontifical Catholic University of Chile, Chile; Yifan Han, Hong Kong Polytechnic University, China
Copyright
© 2011 García-Ayllón, Small, Avila and Sáez-Valero.
This is an open-access article subject to a non-exclusive license between the authors and Frontiers Media SA, which permits use, distribution and reproduction in other forums, provided the original authors and source are credited and other Frontiers conditions are complied with.
*Correspondence: Javier Sáez-Valero, Instituto de Neurociencias, Universidad Miguel Hernández-CSIC, E-03550 Sant Joan d’Alacant, Alacant, Spain. e-mail: j.saez@umh.es
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