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Amyloid-beta (Aβ) peptide aggregates are the hallmark pathological features of Alzheimer's disease, consisting of misfolded peptides derived from the amyloid precursor protein (APP) (PubMed: 31907461). These aggregates exist in various forms, including soluble oligomers, protofibrils, and insoluble fibrils that deposit as extracellular plaques in the brain parenchyma (PubMed: 28913148). The accumulation of these aggregates is thought to trigger a cascade of neurotoxic events, including synaptic loss, tau protein hyperphosphorylation, and chronic neuroinflammation, which collectively lead to cognitive decline (PubMed: 31907461). Therapeutic interventions targeting Aβ aggregates, such as the monoclonal antibodies aducanumab, lecanemab, and donanemab, aim to reduce the plaque burden by facilitating microglial-mediated clearance or neutralizing toxic soluble species (PubMed: 37405448). Clinical trials have demonstrated that reducing Aβ aggregate levels can modestly slow the progression of cognitive impairment in patients with early-stage Alzheimer's disease (PubMed: 36630972). Despite their therapeutic potential, these agents are associated with Amyloid-Related Imaging Abnormalities (ARIA), characterized by brain edema or microhemorrhages, necessitating rigorous safety monitoring (PubMed: 35107464).
Passive immunotherapy using monoclonal antibodies that bind to specific Aβ species (oligomers, protofibrils, or plaques) to stimulate microglial phagocytosis, promote plaque dissolution, or sequester toxic soluble aggregates (PubMed: 37405448, PubMed: 36630972).
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