Transthyretin sequesters amyloid β protein and prevents amyloid formation

The cardinal pathological features of Alzheimer disease are depositions of aggregated amyloid β protein (Aβ) in the brain and cerebrovasculature. However, the Aβ is found in a soluble form in cerebrospinal fluid in healthy individuals and patients with Alzheimer disease. We postulate that sequestration of Aβ precludes amyloid formation. Failure to sequester Aβ in Alzheimer disease may result in amyloidosis. When we added Aβ to cerebrospinal fluid of patients and controls it was rapidly sequestered into stable complexes with transthyretin. Complexes with apolipoprotein E, which has been shown to bind Aβ in vitro, were not observed in cerebrospinal fluid. Additional in vitro studies showed that both purified transthyretin and apolipoprotein E prevent amyloid formation.