The wake and sleep-modulating neurons of the lateral hypothalamic area demonstrate a differential pattern of degeneration in Alzheimer's disease.

Background:Sleep-wake dysfunction is an early and common event in Alzheimer's disease (AD). The lateral hypothalamic area (LHA) regulates the sleep and wake cycle through wake-promoting orexinergic and sleep-promoting melanin-concentrating hormone (MCH) neurons. These neurons share close anatomical proximity with functional reciprocity. This study investigated the pattern of neuronal loss (ORX and MCH) in the LHA in AD. Understanding the degeneration pattern of these neurons will be instrumental in designing potential therapeutics to slow down the disease progression and remediate the sleep-wake dysfunction in AD. Methods:Postmortem human brain tissue of subjects with AD (across progressive stages) and controls were examined using unbiased stereology. Neuronal counting was done using double immunohistochemistry with ORX, pTau (CP13), and MCH, pTau (CP13) labeled neurons on formalin-fixed, celloidin-embedded tissue. Results:We observed a progressive decline in orexinergic (ORX) neurons and a relative preservation of the melanin-concentrating hormone (MCH) neurons. The decline in ORX neurons was seen from BB 2 (56%, p=0.0634). By the late stage of the disease (BB 5-6), the decline in ORX neurons was 76% (p=0.0043). In contrast, the MCH neurons demonstrated an insignificant decline by BB 6 (25%, p=0.1313). Conclusions:Our data demonstrated very early substantial ORX neuronal loss in the LHA, while MCH neurons were resilient to AD pTau accumulation. Interventions capable of preventing ORX neuronal loss and inhibiting pTau accumulation in the LHA can reinstate sleep-wake dysfunction in AD and possibly prevent the progression of the disease.