Alzheimer's Disease: A Systemic Review of Substantial Therapeutic Targets and the Leading Multi-functional Molecules

Abstract

Alzheimer's Disease (AD) is a fatal neurodegenerative disorder, having a complex aetiology with numerous possible drug targets. There are targets that have been known for years while more new targets and theories have also emerged. Beta amyloid and cholinesterases are the most significant biological targets for finding curative treatment of AD. The major class of drugs used for AD till now has been the Cholinesterase (ChE) inhibitors. Other prevailing models of molecular pathogenesis in AD include Neurofibrillary Tangles (NFTs) and amyloid deposition, tryptophan degradation pathway, kinase and phosphatase activity imbalance and neuroinflammation. The beta amyloid aggregation initiates flow of events resulting in neurotoxicity and finally clinical pathogenesis of AD. Furthermore, ApoE is another very significant entity involved in repairing and maintaining the neurons and has important role in neurodegeneration. Neuroinflammation being the primmest symptom for AD is essential to focus on. Multiple factors and complexity in interlinking disease progression pose huge challenge to find one complete curing drug. With so many promising molecules having multiform pharmacological profile from all over the world however facing failures in clinical trials indicates the need to consider all aspects of the old as well as new therapeutic targets of AD. Until the disease mechanism is better understood, it is likely that multiple targeting, symptomatic and diseasemodifying, is the way forward. Most recent approaches to find anti-Alzheimer's agents have focused on multi-target directed agents that include targeting all glorious targets hypothesized against AD. New identification of prototype candidates that could be starting point of a new way of thinking drug design has been done and many drug candidates are under preclinical evaluation. The main focus of this review is to discuss the recent understanding of key targets and the development of potential therapeutic agents for the treatment of AD. It also documents the current therapeutic agents in clinical trials and under development based on their main mode of action.

Keywords: Alzheimer's disease; Cholinesterase; Drug targets; Neurofibrillary tangles; Neuroinflammation.