Anti-amyloid drugs: potential in the treatment of diseases associated with aging.

The requirements for amyloidogenesis, as it is currently understood, include an adequate amyloid precursor pool, a nidus for fibrillogenesis, interactions with a set of common components (most of which are involved in basement membrane structure) and amyloid turnover. These factors serve as the basis for therapeutic attack. General strategies focusing on each of these factors are presented with examples from the experimental and clinical literature. These include reducing the amyloid precursor protein pool in familial amyloid polyneuropathy by liver transplantation, inhibiting nidus formation in familial Mediterranean fever by the use of colchicine, inhibiting amyloid precursor protein/heparan sulphate interaction in experimental inflammation-associated amyloidosis by the use of novel small molecule anionic sulphates and sulphonates, and the use of new analogues of doxorubicin in light chain amyloidosis to accelerate amyloid removal. The potential significance of local and systemic amyloid deposits is discussed in the light of new information on the genetics of Alzheimer's disease, observations made in patients receiving long term dialysis for renal failure, and the potential involvement of amyloid deposits in the pathogenesis of non-insulin-dependent diabetes mellitus.