A manifesto for Alzheimer’s disease drug discovery in the era of disease-modifying therapies

Abstract After decades of disappointment, three disease-modifying therapies for Alzheimer’s disease (AD) have been approved since 2021. Burgeoning clinical data on these amyloid β-protein (Aβ) targeting drugs validate the amyloid cascade hypothesis as a molecular roadmap for the development of yet m...

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Main Authors: Heike Hering, Thierry Bussiere, Chia-Chen Liu, Kelly E. Glajch, Andreas Weihofen, Jane Grogan, Dominic M. Walsh
Format: Article
Language:English
Published: BMC 2025-08-01
Series:Molecular Neurodegeneration
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Online Access:https://doi.org/10.1186/s13024-025-00872-7
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author Heike Hering
Thierry Bussiere
Chia-Chen Liu
Kelly E. Glajch
Andreas Weihofen
Jane Grogan
Dominic M. Walsh
author_facet Heike Hering
Thierry Bussiere
Chia-Chen Liu
Kelly E. Glajch
Andreas Weihofen
Jane Grogan
Dominic M. Walsh
author_sort Heike Hering
collection DOAJ
description Abstract After decades of disappointment, three disease-modifying therapies for Alzheimer’s disease (AD) have been approved since 2021. Burgeoning clinical data on these amyloid β-protein (Aβ) targeting drugs validate the amyloid cascade hypothesis as a molecular roadmap for the development of yet more effective therapeutics and offer a template for drugging other AD-associated aggregation-prone proteins. While there remains much to be learned about the molecular pathology of AD, the current state of knowledge is sufficient to expedite the delivery of new drugs. Mindful of the urgent need of patients, we recommend prioritizing efforts in four directions: finishing the job on Aβ, accelerating and diversifying efforts on tau, and expanding discovery on apolipoprotein E and ⍺-synuclein. For each target, we explain the scientific premise, current efforts, and possible new approaches. In the short- and medium-term, we advocate focusing on the technical innovations required to better drug these already well validated targets. While the focus of this review is on expediating development of monotherapies, the subsequent approval of such agents will enable add-on or combination approaches best suited to individual patients.
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issn 1750-1326
language English
publishDate 2025-08-01
publisher BMC
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series Molecular Neurodegeneration
spelling doaj-art-bb37bdcd89384e88abdd6e8c75f347f42025-08-20T03:06:05ZengBMCMolecular Neurodegeneration1750-13262025-08-0120112910.1186/s13024-025-00872-7A manifesto for Alzheimer’s disease drug discovery in the era of disease-modifying therapiesHeike Hering0Thierry Bussiere1Chia-Chen Liu2Kelly E. Glajch3Andreas Weihofen4Jane Grogan5Dominic M. Walsh6Neurodegeneration Research UnitNeurodegeneration Research UnitNeurodegeneration Research UnitNeurodegeneration Research UnitNeurodegeneration Research UnitNeurodegeneration Research UnitNeurodegeneration Research UnitAbstract After decades of disappointment, three disease-modifying therapies for Alzheimer’s disease (AD) have been approved since 2021. Burgeoning clinical data on these amyloid β-protein (Aβ) targeting drugs validate the amyloid cascade hypothesis as a molecular roadmap for the development of yet more effective therapeutics and offer a template for drugging other AD-associated aggregation-prone proteins. While there remains much to be learned about the molecular pathology of AD, the current state of knowledge is sufficient to expedite the delivery of new drugs. Mindful of the urgent need of patients, we recommend prioritizing efforts in four directions: finishing the job on Aβ, accelerating and diversifying efforts on tau, and expanding discovery on apolipoprotein E and ⍺-synuclein. For each target, we explain the scientific premise, current efforts, and possible new approaches. In the short- and medium-term, we advocate focusing on the technical innovations required to better drug these already well validated targets. While the focus of this review is on expediating development of monotherapies, the subsequent approval of such agents will enable add-on or combination approaches best suited to individual patients.https://doi.org/10.1186/s13024-025-00872-7Aggregation inhibitors⍺-synucleinAmyloid β-proteinAntisense oligonucleotidesApolipoprotein EBrain shuttles
spellingShingle Heike Hering
Thierry Bussiere
Chia-Chen Liu
Kelly E. Glajch
Andreas Weihofen
Jane Grogan
Dominic M. Walsh
A manifesto for Alzheimer’s disease drug discovery in the era of disease-modifying therapies
Molecular Neurodegeneration
Aggregation inhibitors
⍺-synuclein
Amyloid β-protein
Antisense oligonucleotides
Apolipoprotein E
Brain shuttles
title A manifesto for Alzheimer’s disease drug discovery in the era of disease-modifying therapies
title_full A manifesto for Alzheimer’s disease drug discovery in the era of disease-modifying therapies
title_fullStr A manifesto for Alzheimer’s disease drug discovery in the era of disease-modifying therapies
title_full_unstemmed A manifesto for Alzheimer’s disease drug discovery in the era of disease-modifying therapies
title_short A manifesto for Alzheimer’s disease drug discovery in the era of disease-modifying therapies
title_sort manifesto for alzheimer s disease drug discovery in the era of disease modifying therapies
topic Aggregation inhibitors
⍺-synuclein
Amyloid β-protein
Antisense oligonucleotides
Apolipoprotein E
Brain shuttles
url https://doi.org/10.1186/s13024-025-00872-7
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