Abstract
The implication that cholesterol plays an essential role in the pathogenesis of Alzheimer’s disease (AD) is based on the 1993 finding that the presence of apolipoprotein E (apoE) allele ε4 is a strong risk factor for developing AD. Since apoE is a regulator of lipid metabolism, it is reasonable to assume that lipids such as cholesterol are involved in the pathogenesis of AD. Recent epidemiological and biochemical studies have strengthened this assumption by demonstrating the association between cholesterol and AD, and by proving that the cellular cholesterol level regulates synthesis of amyloid β-protein (Aβ). Yet several studies have demonstrated that oligomeric Aβ affects the cellular cholesterol level, which in turn has a variety of effects on AD-related pathologies, including modulation of tau phosphorylation, synapse formation and maintenance of its function, and the neurodegenerative process. All these findings suggest that the involvement of cholesterol in the pathogenesis of AD is dualistic—it is involved in Aβ generation and in the amyloid cascade, leading to disruption of synaptic plasticity, promotion of tau phosphorylation, and eventual neurodegeneration. This review article describes recent findings that may lead to the development of a strategy for AD prevention by decreasing the cellular cholesterol level, and also focuses on the impact of Aβ on cholesterol metabolism in AD and mild cognitive impairment (MCI), which may result in promotion of the amyloid cascade at later stages of the AD process.
Similar content being viewed by others
References
LaDu M. J., Gilligan S. M., Lukens J. R., Cabana V. G., Reardon C. A., Van Eldik L. J., et al. (1998) Nascent astrocyte particles differ from lipoproteins in CSF. J. Neurochem. 70, 2070–2081.
Roheim P. S., Carey M., Forte T., and Vega G. L. (1979) Apolipoproteins in human cerebrospinal fluid. Proc. Natl. Acad. Sci. USA 76, 4646–4649.
Pitas R. E., Boyles J. K., Lee S. H., Foss D., and Mahley R. W. (1987) Astrocytes synthesize apolipoprotein E and metabolize apolipoprotein E- containing lipoproteins. Biochim. Biophys. Acta 917, 148–161.
Pitas R. E., Boyles J. K., Lee S. H., Hui D., and Weisgraber K. H. (1987) Lipoproteins and their receptors in the central nervous system. Characterization of the lipoproteins in cerebrospinal fluid and identification of apolipoprotein B,E (LDL) receptors in the brain. J. Biol. Chem. 262, 14,352–14,360.
Borghini I., Barja F., Pometta D., and James R. W. (1995) Characterization of subpopulations of lipoprotein particles isolated from human cerebrospinal fluid. Biochim. Biophys. Acta 1255, 192–200.
Michikawa M., Fan Q. W., Isobe I., and Yanagisawa K. (2000) Apolipoprotein E exhibits isoform-specific promotion of lipid efflux from astrocytes and neurons in culture. J. Neurochem. 74, 1008–1016.
Gong J. S., Kobayashi M., Hayashi H., Zou K., Sawamura N., Fujita S. C., Yanagisawa K., and Michikawa M. (2002) Apolipoprotein E (apoE)-isoform-dependent lipid release from astrocytes prepared from human-apoE3- and apoE4-knock-in mice. J. Biol. Chem. 277, 29,919–29,926.
Strittmatter W. J., Saunders A. M., Schmechel D., Pericak-Vance M., Enghild J., Salvesen G. S., and Roses A. D. (1993) Apolipoprotein E: high-avidity binding to β-amyloid and increased frequency of type 4 allele in late-onset familial Alzheimer disease. Proc. Natl. Acad. Sci. USA 90, 1977–1981.
Corder E. H., Saunders A. M., Strittmatter W. J., Schmechel D. E., Gaskell P. C., Small G. W., et al. (1993) Gene dose of apolipoprotein E type 4 allele and the risk of Alzheimer’s disease in late onset families. Science 261, 921–923.
Saunders A. M., Strittmatter W. J., Schmechel D., George-Hyslop P. H., Pericak-Vance M. A., Joo S. H., et al. (1993) Association of apolipoprotein E allele epsilon 4 with late-onset familial and sporadic Alzheimer’s disease. Neurology 43, 1467–1472.
Poirier J., Davignon J., Bouthillier D., Kogan S., Bertrand P., and Gauthier S. (1993) Apolipoprotein E polymorphism and Alzheimer’s disease. Lancet 342, 697–699.
Selkoe D. J. (1994) Alzheimer’s disease: a central role for amyloid. J. Neuropathol. Exp. Neurol. 53, 438–447.
Anderton B. H., Callahan L., Coleman P., Davies P., Flood D., Jicha G. A., et al. (1998) Dendritic changes in Alzheimer’s disease and factors that may underlie these changes. Prog. Neurobiol. 55, 595–609.
Terry R. D. (2000) Cell death or synaptic loss in Alzheimer disease. J. Neuropathol. Exp. Neurol. 59, 1118–1119.
Hardy J. A. and Higgins G. A. (1992) Alzheimer’s disease: the amyloid cascade hypothesis. Science 256, 184–185.
Esiri M., Hyman B., Beyreuther K., and Masters C. (1997), in Greenfield’s Neuropathology (Graham D. and Lantos P., eds.), (Edward Arnold, London), vol. 2, pp. 153–233.
Jarvik G. P., Wijsman E. M., Kukull W. A., Schellenberg G. D., Yu C., and Larson E. B. (1995) Interactions of apolipoprotein E genotype, total cholesterol level, age, and sex in prediction of Alzheimer’s disease: a case-control study. Neurology 45, 1092–1096.
Notkola I. L., Sulkava R., Pekkanen J., Erkinjuntti T., Ehnholm C., Kivinen P., et al. (1998) Serum total cholesterol, apolipoprotein E epsilon 4 allele, and Alzheimer’s disease. Neuroepidemiology 17, 14–20.
Sparks D. L. (1997) Coronary artery disease, hypertension, ApoE, and cholesterol: a link to Alzheimer’s disease? Ann. NY Acad. Sci. 826, 128–146.
Kivipelto M., Helkala E. L., Hanninen T., Laakso M. P., Hallikainen M., Alhainen K., et al. (2001) Midlife vascular risk factors and late-life mild cognitive impairment: a population-based study. Neurology 56, 1683–1989.
Wolozin B., Kellman W., Ruosseau P., Celesia G. G., and Siegel G. (2000) Decreased prevalence of Alzheimer disease associated with 3-hydroxy-3-methyglutaryl coenzyme A reductase inhibitors. Arch. Neurol. 57, 1439–1443.
Jick H., Zornberg G. L., Jick S. S., Seshadri S., and Drachman D. A. (2000) Statins and the risk of dementia. Lancet 356, 1627–1631.
Fagan A. M., Younkin L. H., Morris J. C., Fryer J. D., Cole T. G., Younkin S. G., et al. (2000) Differences in the Aβ40/Aβ42 ratio associated with cerebrospinal fluid lipoproteins as a function of apolipoprotein E genotype. Ann. Neurol. 48, 201–210.
Locatelli S., Lutjohann D., Schmidt H. H., Otto C., Beisiegel U., and von Bergmann K. (2002) Reduction of plasma 24S-hydroxycholesterol (cerebrosterol) levels using high-dosage simvastatin in patients with hypercholesterolemia: evidence that simvastatin affects cholesterol metabolism in the human brain. Arch. Neurol. 59, 213–216.
Eckert G. P., Kirsch C., and Muller W. E. (2001) Differential effects of lovastatin treatment on brain cholesterol levels in normal and ApoE-deficient mice. Neuroreport 12, 883–887.
Cucchiara B. and Kasner S. E. (2001) Use of statins in CNS disorders. J. Neurol. Sci. 187, 81–89.
Bodovitz S. and Klein W. L. (1996) Cholesterol modulates α-secretase cleavage of amyloid precursor protein. J. Biol. Chem. 271, 4436–4440.
Racchi M., Baetta R., Salvietti N., Ianna P., Franceschini G., Paoletti R., et al. (1997) Secretory processing of amyloid precursor protein is inhibited by increase in cellular cholesterol content. Biochem. J. 322, 893–898.
Simons M., Keller P., De Strooper B., Beyreuther K., Dotti C. G., et al. (1998) Cholesterol depletion inhibits the generation of β-amyloid in hippocampal neurons. Proc. Natl. Acad. Sci. USA 95, 6460–6464.
Kojro E., Gimpl G., Lammich S., Marz W., and Fahrenholz F. (2001) Low cholesterol stimulates the nonamyloidogenic pathway by its effect on the α-secretase ADAM 10. Proc. Natl. Acad. Sci. USA 98, 5815–5820.
Fassbender K., Simons M., Bergmann C., Stroick M., Lutjohann D., Keller P., et al. (2001) Simvastatin strongly reduces levels of Alzheimer’s disease β-amyloid peptides Aβ 42 and Aβ 40 in vitro and in vivo. Proc. Natl. Acad. Sci. USA 98, 5856–5861.
Bouillot C., Prochiantz A., Rougon G., and Allinquant B. (1996) Axonal amyloid precursor protein expressed by neurons in vitro is present in a membrane fraction with caveolae-like properties. J. Biol. Chem. 271, 7640–7644.
Lee S. J., Liyanage U., Bickel P. E., Xia W., Lansbury P. T., Jr., and Kosik K. S. (1998) A detergent-insoluble membrane compartment contains Aβ in vivo. Nat. Med. 4, 730–734.
Wahrle S., Das P., Nyborg A. C., McLendon C., Shoji M., Kawarabayashi T., et al. (2002) Cholesterol-dependent γ-secretase activity in buoyant cholesterol-rich membrane microdomains. Neurobiol. Dis. 9, 11–23.
Mason R. P., Shoemaker W. J., Shajenko L., Chambers T. E., and Herbette L. G. (1992) Evidence for changes in the Alzheimer’s disease brain cortical membrane structure mediated by cholesterol. Neurobiol. Aging 13, 413–419.
Svennerholm L. and Gottfries C. G. (1994) Membrane lipids, selectively diminished in Alzheimer brains, suggest synapse loss as a primary event in early-onset form (type I) and demyelination in late-onset form (type II). J. Neurochem. 62, 1039–1047.
Roth G. S., Joseph J. A., and Mason R. P. (1995) Membrane alterations as causes of impaired signal transduction in Alzheimer’s disease and aging. Trends Neurosci. 18, 203–206.
Mulder M., Ravid R., Swaab D. F., de Kloet E. R., Haasdijk E. D., Julk J., et al. (1998) Reduced levels of cholesterol, phospholipids, and fatty acids in cerebrospinal fluid of Alzheimer disease patients are not related to apolipoprotein E4. Alzheimer Dis. Assoc. Disord. 12, 198–203.
Czyzewski K., Lalowski M. M., Pfeffer A., and Barcikowska M. (2001) Lipid metabolism parameters in patients with Alzheimer’s disease and their first degree relatives. Acta Neurobiol. Exp. 61, 21–26.
Howland D. S., Trusko S. P., Savage M. J., Reaume A. G., Lang D. M., Hirsch J. D., et al. (1998) Modulation of secreted β-amyloid precursor protein and amyloid β-peptide in brain by cholesterol. J. Biol. Chem. 273, 16,576–16,582.
Chochina S. V., Avdulov N. A., Igbavboa U., Cleary J. P., O’Hare E. O., and Wood W. G. (2001) Amyloid β-peptide 1–40 increases neuronal membrane fluidity: role of cholesterol and brain region. J. Lipid Res. 42, 1292–1297.
Ji S. R., Wu Y., and Sui S. F. (2002) Cholesterol is an important factor affecting the membrane insertion of β-amyloid peptide (Aβ 1–40), which may potentially inhibit the fibril formation. J. Biol. Chem. 277, 6273–6279.
Yip C. M., Elton E. A., Darabie A. A., Morrison M. R., and McLaurin J. (2001) Cholesterol, a modulator of membrane-associated Aβ-fibrillogenesis and neurotoxicity. J. Mol. Biol. 311, 723–734.
Zhou Y. and Richardson J. S. (1996) Cholesterol protects PC12 cells from beta-amyloid induced calcium disordering and cytotoxicity. Neuroreport 7, 2487–2490.
Hartmann H., Eckert A., and Muller W. E. (1994) Apolipoprotein E and cholesterol affect neuronal calcium signalling: the possible relationship to β-amyloid neurotoxicity. Biochem. Biophys. Res. Commun. 200, 1185–1192.
Eckert G. P., Cairns N. J., Maras A., Gattaz W. F., and Muller W. E. (2000) Cholesterol modulates the membrane-disordering effects of β-amyloid peptides in the hippocampus: specific changes in Alzheimer’s disease. Dement. Geriatr. Cogn. Disord. 11, 181–186.
Poirier J., Delisle M. C., Quirion R., Aubert I., Farlow M., Lahiri D., et al. (1995) Apolipoprotein E4 allele as a predictor of cholinergic deficits and treatment outcome in Alzheimer disease. Proc. Natl. Acad. Sci. USA 92, 12,260–12,264.
Garver W. S., Krishnan K., Gallagos J. R., Michikawa M., Francis G. A., and Heidenreich R. A. (2002) Niemann-Pick C1 protein regulates cholesterol transport to the trans- Golgi network and plasma membrane caveolae. J. Lipid Res. 43, 579–589.
Mori T., Paris D., Town T., Rojiani A. M., Sparks D. L., Delledonne A., et al. (2001) Cholesterol accumulates in senile plaques of Alzheimer disease patients and in transgenic APP(SW) mice. J. Neuropathol. Exp. Neurol. 60, 778–785.
Michikawa M., Gong J. S., Fan Q. W., Sawamura N., and Yanagisawa K. (2001) A novel action of alzheimer’s amyloid β-protein (Aβ): oligomeric Aβ promotes lipid release. J. Neurosci. 21, 7226–7235.
Gong J. S., Sawamura N., Zou K., Sakai J., Yanagisawa K., and Michikawa M. (2002) Amyloid β-protein affects cholesterol metabolism in cultured neurons: Implications for pivotal role of cholesterol in the amyloid cascade. J. Neurosci. Res. 70, 438–446.
Zou K, Gong JS, Yanagisawa K, Michikawa M. (2002) A novel function of monomeric amyloid β-protein serving as an antioxidant molecule against metal-induced oxidative damage. J. Neurosci. 22, 4883–4841.
Mauch D. H., Nagler K., Schumacher S., Goritz C., Muller E. C., Otto A., and Pfrieger F. W. (2001) CNS synaptogenesis promoted by gliaderived cholesterol. Science 294, 1354–1357.
Ullian E. M., Sapperstein S. K., Christopherson K. S., and Barres B. A. (2001) Control of synapse number by glia. Science 291, 657–661.
Fan Q. W., Yu W., Gong J. S., Zou K., Sawamura N., Senda T., et al. (2002) Cholesterol-dependent modulation of dendrite outgrowth and microtubule stability in cultured neurons. J. Neurochem. 80, 178–190.
Koudinov A. R. and Koudinova N. V. (2001) Essential role for cholesterol in synaptic plasticity and neuronal degeneration. FASEB J. 15, 1858–1860.
Liu Y., Peterson D. A., and Schubert D. (1998) Amyloid β peptide alters intracellular vesicle trafficking and cholesterol homeostasis. Proc. Natl. Acad. Sci. USA 95, 13,266–13,271.
Fan Q. W., Wei Y., Senda T., Yanagisawa K., and Michikawa M. (2001) Cholesterol-dependent modulation of tau phosphorylation in cultured neurons. J. Neurochem. 76, 391–400.
Sawamura N., Gong J. S., Garver W. S., Heidenreich R. A., Ninomiya H., Ohno K., et al. (2001) Site-specific phosphorylation of tau accompanied by activation of mitogen-activated protein kinase (MAPK) in brains of Niemann-Pick type C mice. J. Biol. Chem. 276, 10,314–10,319.
Sawamura N., Gong J. S., Chang T. Y., Yanagisawa K, and Michikawa M. (2002) Promotion of tau phosphorylation by MAP kinase Erk1/2 is accompanied by reduced cholesterol level in detergent-insoluble membrane fraction in Niemann-Pick C1-deficient cells. J. Neurochem. 84, 1086–1096.
Brown D. A. and London E. (1997) Structure of detergent-resistant membrane domains: does phase separation occur in biological membranes? Biochem. Biophys. Res. Commun. 240, 1–7.
Simons K. and Ikonen E. (1997) Functional rafts in cell membranes. Nature 387, 569–572.
Kakio A., Nishimoto S. I., Yanagisawa K., Kozutsumi Y., and Matsuzaki K. (2001) Cholesterol-dependent formation of GM1 gangliosidebound amyloid β-protein, an endogenous seed for Alzheimer amyloid. J. Biol. Chem. 276, 24,985–24,990.
Mizuno T., Nakata M., Naiki H., Michikawa M., Wang R., Haass C., et al. (1999) Cholesteroldependent generation of a seeding amyloid β-protein in cell culture. J. Biol. Chem. 274, 15,110–15,114.
Matsuzaki K. and Horikiri C. (1999) Interactions of amyloid β-peptide (1–40) with ganglioside-containing membranes. Biochemistry 38, 4137–4142.
Choo-Smith L. P., Garzon-Rodriguez W., Glabe C. G., and Surewicz W. K. (1997) Acceleration of amyloid fibril formation by specific binding of Aβ(1–40) peptide to ganglioside-containing membrane vesicles. J. Biol. Chem. 272, 22,987–22,990.
McLaurin J., Franklin T., Fraser P. E., and Chakrabartty A. (1998) Structural transitions associated with the interaction of Alzheimer β-amyloid peptides with gangliosides. J. Biol. Chem. 273, 4506–4515.
Yanagisawa K., Odaka A., Suzuki N., and Ihara Y. (1995) GM1 ganglioside-bound amyloid β-protein (Aβ): a possible form of preamyloid in Alzheimer’s disease. Nat. Med. 1, 1062–1066.
Igbavboa U., Avdulov N. A., Schroeder F., and Wood W. G. (1996) Increasing age alters transbilayer fluidity and cholesterol asymmetry in synaptic plasma membranes of mice. J. Neurochem. 66, 1717–1729.
Hayashi H., Igbavboa U., Hamanaka H., Kobayashi M., Fujita S. C., Wood W. G., et al. (2002) Cholesterol is increased in the exofacial leaflet of synaptic plasma membranes of human apolipoprotein E4 knock-in mice. Neuroreport 13, 383–386.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Michikawa, M. The role of cholesterol in pathogenesis of alzheimer’s disease. Mol Neurobiol 27, 1–12 (2003). https://doi.org/10.1385/MN:27:1:1
Issue Date:
DOI: https://doi.org/10.1385/MN:27:1:1