Pharmacotherapy for Alzheimer’s Disease, 2nd Edition

A special issue of Pharmaceuticals (ISSN 1424-8247). This special issue belongs to the section "Pharmacology".

Deadline for manuscript submissions: 25 May 2026 | Viewed by 3684

Special Issue Editor


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Guest Editor
Advanced Research and Development Center for Experimental Medicine “Prof. Ostin C. Mungiu”, “Grigore T. Popa” University of Medicine and Pharmacy of Iasi, 700115 Iasi, Romania
Interests: neuroscience; Alzheimer’s disease; in vivo studies; drug development; cannabinoid-based pharmaceuticals; repurposing current therapeutics
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Special Issue Information

Dear Colleagues,

A large body of studies highlight that Alzheimer’s disease (AD), described as a complex neurodegenerative disorder with a multilayered nature leading to a progressive decline in cognitive function and irreversible neuronal loss, continues to present a significant and escalating challenge to global health. As the frequency of cases rises and conventional pharmaceutical treatments, which primarily alleviate symptoms and come with numerous side effects, continue to exhibit a high rate of ineffectiveness, there arises a pressing demand for alternative approaches. Despite extensive knowledge on the molecular basis of AD, advancements in developing therapies that truly modify the progression of the disease have proven to be elusive. The ability of editing system tools, repurposing current therapeutics or utilizing multi-target-directed ligands, presents a promising opportunity to elucidate the fundamental mechanisms driving AD pathogenesis and discover new therapeutic pathways. This strategy has the potential to facilitate the identification of target molecules and the development of innovative preclinical disease models, thus providing hopeful prospects for therapeutic intervention.

Authors are invited to submit original research and review articles highlighting recent findings in the pharmacotherapy of Alzheimer’s disease. These include, but are not limited to, novel molecular mechanisms and potential therapeutic targets, developing or repurposing drugs with the ability to target multiple disease features or exploring the risks and benefits of cannabinoid-based drugs.

Dr. Gabriela Dumitrița Stanciu
Guest Editor

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Keywords

  • Alzheimer’s disease
  • pharmacotherapy
  • therapeutic editing tools
  • repurposing existing therapeutics
  • multi-target-directed ligands
  • preclinical studies
  • neurodegeneration
  • drug development
  • neuroprotection
  • cannabinoid-based pharmaceuticals
  • single-molecule drugs or whole-plant extracts of Cannabis sativa L.

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Related Special Issue

Published Papers (4 papers)

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Research

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15 pages, 8531 KB  
Article
Simufilam in Alzheimer’s Disease: Assessment of Efficacy of a Controversial Drug in Human Neuronal Cell Culture
by Ankita Srivastava, Heather A. Renna, Tahmina Hossain, Thomas Palaia, Aaron Pinkhasov, Irving H. Gomolin, Joshua De Leon, Thomas Wisniewski and Allison B. Reiss
Pharmaceuticals 2026, 19(2), 281; https://doi.org/10.3390/ph19020281 - 7 Feb 2026
Viewed by 1518
Abstract
Background/Objectives: Alzheimer’s disease (AD) is a progressive multifactorial neurodegenerative disorder. Current AD therapies offer minimal benefits and do not prevent or repair neuronal damage. More effective therapeutic approaches are needed to restore normal bioenergetics and metabolic function to AD neurons. Simufilam is [...] Read more.
Background/Objectives: Alzheimer’s disease (AD) is a progressive multifactorial neurodegenerative disorder. Current AD therapies offer minimal benefits and do not prevent or repair neuronal damage. More effective therapeutic approaches are needed to restore normal bioenergetics and metabolic function to AD neurons. Simufilam is a small-molecule oral drug that targets filamin A, a scaffolding protein in brain cells. Phase III clinical trials of simufilam failed to show any significant cognitive or functional improvements in AD patients. The purpose of this study is to identify and explain the molecular mechanisms that may have contributed to this drug’s lack of clinical success. Methods: Our study investigates the effects of simufilam on amyloid processing, neuronal health, and mitochondrial functioning in the SH-SY5Y human neuronal cell model. SH-SY5Y cells were differentiated into neurons using 10 µM retinoic acid. Undifferentiated and differentiated SH-SY5Y were exposed to simufilam (5 µM, 50 µM; 24 hr). Results: Simufilam did not affect the expression of genes involved in amyloid processing. Amyloid precursor protein (APP), β-secretase, and α-secretase mRNA levels in simufilam-treated SH-SY5Y cells were all unchanged compared to untreated cells. However, amyloidogenic β-secretase protein was significantly increased (fold change 1.17) at 50 µM of simufilam only in differentiated SH-SY5Y cells without affecting APP or α-secretase protein expression. Simufilam at the 50 µM concentration reduced brain-derived neurotrophic factor protein levels (fold change 0.7) only in differentiated SH-SY5Y. Further, simufilam did not improve mitochondrial genes or structure. Conclusions: Our results align with clinical outcomes and indicate that insufficient activity across multiple tests of ability to impact processes related to neuronal health can serve as a preliminary indicator of limited clinical utility. Full article
(This article belongs to the Special Issue Pharmacotherapy for Alzheimer’s Disease, 2nd Edition)
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Review

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24 pages, 3402 KB  
Review
Rhizomes as Multi-Target Pharmacological Platforms Against Tauopathy: Neuro-Metabolic Crosstalk, Drug-Likeness, and Translational Challenges
by Andreas Wilson Setiawan, Jinwon Choi, Sohyun Park, Min Choi, Raymond Rubianto Tjandrawinata, Edwin Hadinata, Moon Nyeo Park, Taruna Ikrar, Fahrul Nurkolis and Bonglee Kim
Pharmaceuticals 2026, 19(5), 792; https://doi.org/10.3390/ph19050792 (registering DOI) - 19 May 2026
Viewed by 167
Abstract
Tauopathies, including Alzheimer’s disease (AD), progressive supranuclear palsy (PSP), corticobasal degeneration (CBD), and frontotemporal lobar degeneration with tau pathology, are unified by pathogenic tau misfolding, post-translational modification, aggregation, and network-level spread. Yet decades of drug development that predominantly pursued single nodes (e.g., one [...] Read more.
Tauopathies, including Alzheimer’s disease (AD), progressive supranuclear palsy (PSP), corticobasal degeneration (CBD), and frontotemporal lobar degeneration with tau pathology, are unified by pathogenic tau misfolding, post-translational modification, aggregation, and network-level spread. Yet decades of drug development that predominantly pursued single nodes (e.g., one kinase, one aggregation inhibitor, one monoclonal antibody epitope) have repeatedly delivered late-stage disappointments, underscoring a central lesson: tauopathy behaves less like a linear pathway and more like a coupled system of proteostasis failure, neuroinflammation, synaptic-mitochondrial stress, and metabolic dysregulation. This review examines rhizomes (notably Zingiberaceae genera such as Curcuma, Zingiber, Alpinia, Kaempferia, and Boesenbergia) as chemically diverse “multi-target platforms” whose bioactives can engage several tau-relevant nodes simultaneously. We synthesise evidence across tau phosphorylation (GSK-3β/CDK5 and upstream stress signalling), tau aggregation and seeding, autophagy-lysosome and proteasome pathways, redox-mitochondrial resilience, neuroinflammatory circuits (NF-κB/NLRP3), and neuro-metabolic signalling (insulin-PI3K-AKT, AMPK-mTOR). A translational lens is applied throughout, focusing on drug-likeness and CNS multiparameter optimisation; BBB permeability and efflux; metabolism and bioavailability constraints; and formulation strategies (nanoparticles, phytosomes, engineered exosomes) that may render rhizome-derived scaffolds more clinically plausible. We conclude that rhizomes offer credible mechanistic hypotheses for tau modulation, but progress depends on rigorous standardisation, realistic exposure matching, biomarker-driven study design, and a shift from “single-compound optimism” to network pharmacology with translational discipline. Full article
(This article belongs to the Special Issue Pharmacotherapy for Alzheimer’s Disease, 2nd Edition)
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25 pages, 2525 KB  
Review
Targeting Pain and Depression in Alzheimer’s Disease: Translational Insights and Emerging Treatments
by Ivona Costachescu, Gabriela-Dumitrita Stanciu, Raluca Maria Gogu and Bogdan-Ionel Tamba
Pharmaceuticals 2026, 19(4), 626; https://doi.org/10.3390/ph19040626 - 15 Apr 2026
Viewed by 563
Abstract
Alzheimer’s disease (AD) is primarily recognized for progressive cognitive decline driven by beta-amyloid accumulation and tau pathology. However, many individuals with AD also experience chronic pain and depressive symptoms, which significantly impair daily functioning and quality of life and increase caregiver burden. These [...] Read more.
Alzheimer’s disease (AD) is primarily recognized for progressive cognitive decline driven by beta-amyloid accumulation and tau pathology. However, many individuals with AD also experience chronic pain and depressive symptoms, which significantly impair daily functioning and quality of life and increase caregiver burden. These non-cognitive features are frequently underrecognized, despite evidence suggesting they share overlapping biological pathways with neurodegeneration. Emerging data highlight the role of neuroinflammation, oxidative stress, hypothalamic–pituitary–adrenal axis dysregulation, and endocannabinoid system alterations in linking AD pathology to disturbances in pain processing and mood regulation. Persistent microglial activation, cytokine imbalance, redox disruption, and chronic stress signaling may simultaneously promote neuronal vulnerability while shaping affective and nociceptive responses. This review synthesizes current preclinical and clinical evidence on the interplay between pain, depression, and AD, emphasizing their shared pathophysiological mechanisms and clinical relevance. Recognizing these symptoms as integral components of disease progression, rather than isolated comorbidities, can inform the development of integrated, multidimensional therapeutic strategies in AD care. Full article
(This article belongs to the Special Issue Pharmacotherapy for Alzheimer’s Disease, 2nd Edition)
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17 pages, 2575 KB  
Review
Drug-Induced Amyloid-Related Imaging Abnormalities: A Neurovascular Perspective on Risk Assessment
by Marialuisa Zedde, Mattia Losa, Andrea Donniaquio, Ilaria Gandoglia, Massimo Del Sette, Luca Roccatagliata, Fabrizio Piazza, Matteo Pardini and Rosario Pascarella
Pharmaceuticals 2026, 19(4), 579; https://doi.org/10.3390/ph19040579 - 3 Apr 2026
Viewed by 1071
Abstract
Background: Anti-amyloid therapies (AAT) are reshaping the therapeutic landscape of Alzheimer’s disease (AD), yet their implementation remains constrained by the risk of amyloid-related imaging abnormalities (ARIA). Although the ARIA phenomenon is well recognized, most available evidence stems from clinical trial safety reports framed [...] Read more.
Background: Anti-amyloid therapies (AAT) are reshaping the therapeutic landscape of Alzheimer’s disease (AD), yet their implementation remains constrained by the risk of amyloid-related imaging abnormalities (ARIA). Although the ARIA phenomenon is well recognized, most available evidence stems from clinical trial safety reports framed predominantly from a dementia-oriented perspective, with relatively limited integration of vascular neurology principles. Methods: In this narrative review, we examine drug-induced ARIA through a neurovascular lens, highlighting how cerebrovascular comorbidity, particularly cerebral amyloid angiopathy (CAA), influences the risk and severity of ARIA. Results: We critically evaluated how CAA comorbidity has been assessed in randomized controlled trials, focusing on exclusion criteria, imaging thresholds, and the resulting implications for external validity. Finally, we evaluated current approaches to ARIA risk stratification and proposed a more integrative framework that combines vascular imaging markers, APOE ε4 genotype, and key clinical comorbidities. Conclusions: A more tailored patient selection and monitoring strategies may ultimately improve real-world outcomes and optimize resources in the era of AAT. Full article
(This article belongs to the Special Issue Pharmacotherapy for Alzheimer’s Disease, 2nd Edition)
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