Aβ immunotherapy for Alzheimer’s disease: effects on apoE and cerebral vasculopathy

Aβ immunotherapy was associated with a threefold increase in concentric vessel wall splitting in leptomeningeal vessels.

• Redistribution of apolipoprotein E (apoE) from cortical plaques to cerebral vessel walls occurred following Aβ immunotherapy.
• The proportion of concentric vessel wall splitting increased significantly from 6.3% in unimmunized cases to 20.6% in immunized cases.
• Smooth muscle cell abnormalities did not show significant differences between immunized and unimmunized cases.
• Aβ immunotherapy may influence the transport of Aβ to cerebral vasculature without causing damage to vascular smooth muscle.
• Amyloid-related imaging abnormalities observed in some trials could represent severe forms of these vascular changes.

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