Drugs to block this enzyme (BACE inhibitors) in theory would prevent the buildup of beta-amyloid and (per the
Amyloid hypothesis) may help slow or stop Alzheimer's disease.
For Alzheimer's disease Several companies are in the early stages of development and testing of this potential class of treatment. In March 2008 phase I results were reported for CoMentis Inc's candidate CTS-21166. In April 2012
Merck & Co., Inc reported phase I results for its candidate
verubecestat (MK-8931). Merck began a Phase II/III trial of MK-8931 in December, 2012 estimated to be completed in July 2019. In February 2017, Merck halted its late-stage trial of verubecestat for mild to moderate Alzheimer's disease after it was reported as having "virtually no chance" of working according to an independent panel of experts. This came just three months after Eli Lilly & Co. announced its own setback with
solanezumab. In September 2014
AstraZeneca and
Eli Lilly and Company announced an agreement to codevelop
lanabecestat (AZD3293). A pivotal Phase II/III clinical trial of lanabecestat started in late 2014, but was halted in 2018 before its planned conclusion due to poor results. Another BACE1 inhibitor that has reached phase II trials is the Eli Lilly's inhibitor LY2886721. The data on phase I trial were first presented at the Alzheimer's Association International conference in 2012. Daily dosing during 2 weeks, reduced BACE1 activity by 50–75% and CSF Aβ42 by 72% (Willis et al., 2012; Bowman Rogers and Strobel, 2013). Recently, Lilly reported that the phase II trial of LY2886721 was terminated due to liver abnormalities that were found in 4 out of 45 patients (Rogers, 2013). This toxicity, however, does not have to be related to the working mechanism of the inhibitor, but can represent off-target effects as the livers of BACE1 knockout mice are normal.
Potential side effects Tests in mice have indicated that BACE proteases, specifically BACE1, are necessary for the proper function of
muscle spindles. These results raise the possibility that BACE inhibiting drugs currently being investigated for the treatment of Alzheimer's may have significant side effects related to impaired motor coordination, though BACE1
knockout mice are healthy. == Relationship to plasmepsin ==