Date of Award

2014

Degree Type

Thesis

Degree Name

Doctor of Philosophy

School

School of Medical Sciences

Faculty

Health, Engineering and Science

First Advisor

Professor Ralph Martins

Second Advisor

Professor Markus Wenk

Third Advisor

Dr Ian MARTINS

Abstract

Alzheimer’s disease (AD), the commonest form of dementia, is a chronic, progressive neurodegenerative disease which manifests clinically as a slow global decline in cognitive function, including deterioration of memory, reasoning, abstraction, language and emotional stability, culminating in a patient with end-stage disease, totally dependent on custodial care. With an ageing population, there is predicted to be a marked increase in the number of people diagnosed with AD in the coming decades, making this a significant challenge to socio-economic policy and aged care. Currently there is no cure for AD and while current therapies may temporarily ameliorate symptoms, death usually occurs approximately 8 years after diagnosis. Attention is now being directed to the discovery of biomarkers that may not only facilitate pre-symptomatic diagnosis but provide an insight into aberrant biochemical pathways that may reveal potential therapeutic targets. AD pathogenesis develops over many years before clinical symptoms appear, providing the opportunity to develop therapy that could slow or stop disease progression well before any clinical manifestations develop.

Research and understanding of AD pathology has been driven in recent years by advances in technologies, enabling the precise investigation of the lipidome; the repertoire of lipid species present in cells and tissues that reflect the net effect of gene and protein expression, which in turn are influenced by the cellular environment. Lipidomic studies have identified abnormal lipid metabolism as a key component of the pathological processes which lead to the development of AD. Therefore, lipidomic studies are crucial for advancing the understanding of AD pathology and for identifying potential therapeutic targets; these studies may also facilitate biomarker discovery. Many studies have reported abnormal lipid profiles in both AD plasma and brain tissue.

This thesis investigated plasma lipid species using a “shotgun” lipidomics approach by electrospray ionisation tandem mass spectrometry (ESI/MS/MS). Additionally, Phospholipid Transfer Protein (PLTP); a protein involved in lipid metabolism was assayed using a commercial kit. The utility of these analytes as potential AD biomarkers was investigated by testing plasma samples from the highly characterised Australian Imaging, Biomarkers and Lifestyle (AIBL) study. The study cohort comprised over 1000 participants at inception who were classified as either healthy control (n=733), mild cognitive impairment (MCI, n=125) or AD (n=204): Samples from the baseline and 18 month follow-up time points were utilised. Plasma PLTP activity levels were measured in a subset of the baseline samples (n=259). Lipid and PLTP measurements were analysed in conjunction with supplementary neuroimaging and blood biomarker data collected as part of the AIBL study.

The thesis identified significant differences in several plasma lipids between clinical classification groups, including several ceramide, sphingomyelin (SM), phosphatidylethanolamine (PE), phosphatidylcholine (PC) and plasmalogen species. Additionally, a panel of lipids was identified which could distinguish AD participants from healthy controls with a sensitivity and specificity of 80%. Plasma PLTP activity was significantly lower in AD and MCI groups compared to healthy controls, and levels correlated with plasma Aβ in all groups and cerebral Aβ in the healthy controls.

The results of this thesis validate and extend previous findings reported in the literature. The current findings provide evidence to indicate that several lipid species and PLTP show promise as potential blood biomarkers of AD. Further investigation using a targeted lipidomics platform and prospective longitudinal follow-up is warranted.