🧪
hypothesis

Excess orexin-A worsens AD cognition through wake-driven amyloid production

Hypothesis

Excess orexin-A worsens AD cognition through wake-driven amyloid production

Chronic orexin-A elevation may aggravate AD by extending wakefulness, fragmenting circadian rhythms, and increasing activity-dependent amyloid/tau release.
🧬 HCRT🩺 neurodegeneration🎯 Composite 71%💱 $0.59▼23.7%proposed
EvidenceModerate (59%)📖 8 cit🗣 1 debates 8 support 2 oppose
✓ All Quality Gates Passed
Mechanistic 0.74 (15%) Evidence 0.69 (15%) Novelty 0.55 (12%) Feasibility 0.79 (12%) Impact 0.72 (12%) Druggability 0.78 (10%) Safety 0.63 (8%) Competition 0.55 (6%) Data Avail. 0.65 (5%) Reproducible 0.62 (5%) KG Connect 0.58 (8%) 0.711 composite
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🧪 Overview

Chronic orexin-A elevation may aggravate AD by extending wakefulness, fragmenting circadian rhythms, and increasing activity-dependent amyloid/tau release. Lowering orexin tone should improve pathology only when it normalizes sleep rather than causing broad hypoarousal.

🧬 Mechanism

🧬 Curated Mechanism Pathway

Curated pathway from expert analysis

flowchart TD
A["Orexin-A (HCRT) Elevation"] -->|"extends wakefulness"| B["Chronic Wakefulness Duration"]
A -->|"fragmented"| C["Circadian Rhythm Dysregulation"]
B -->|"increases"| D["Activity-Dependent Amyloid Production"]
C -->|"enhances"| D
B -->|"increases"| E["Activity-Dependent Tau Release"]
C -->|"enhances"| E
A -->|"direct effect"| F["Wake-Active Neuronal Activity"]
F -->|"promotes"| D
F -->|"promotes"| E
D -->|"drives"| G["Amyloid Pathology Accumulation"]
E -->|"drives"| G
G -->|"worsens"| H["Cognitive Deficits in AD"]
I["Lowering Orexin Tone"] -->|"restores"| J["Normalized Sleep Duration"]
J -->|"reduces"| D
J -->|"reduces"| E
J -->|"stabilizes"| C
I -->|"indirect suppression"| A
K["Broad Hypoarousal State"] -.->|"fails to improve"| H

⚖️ Evidence

⚖️ Evidence Matrix6 supports1 contradicts
Supports
Orexins and orexin receptors: a family of hypothalamic neuropeptides and G protein-coupled receptors that regulate feeding behavior.
Cell1998PMID:9491897
Supports
Interaction between Aβ and Tau in the Pathogenesis of Alzheimer's Disease.
Int J Biol Sci2021PMID:34239348medium
Supports
Site-Specific Phospho-Tau Aggregation-Based Biomarker Discovery for AD Diagnosis and Differentiation.
ACS Chem Neurosci2022PMID:36350059medium
Supports
Quantitative Assessment of Hippocampal Tau Pathology in AD and PART.
J Mol Neurosci2020PMID:32372343medium
Supports
Roles of Microglia in AD Pathology.
Curr Alzheimer Res2023PMID:36740796medium
Supports
TDP-43 pathology is associated with increased tau burdens and seeding.
Mol Neurodegener2023PMID:37777806medium
Contradicts
Hypocretins (orexins): The ultimate translational neuropeptides.
J Intern Med2022PMID:35043499
📖 Linked Papers

No linked papers recorded for this hypothesis yet.

🏥 Translation

🧬 3D Protein Structure — HCRT

No curated PDB or AlphaFold mapping for HCRT yet. Search RCSB →

🧠 GTEx v10 Brain ExpressionJSON

Median TPM across 13 brain regions for HCRT from GTEx v10.

Hypothalamus34.9 Nucleus accumbens basal ganglia0.5 Cerebellar Hemisphere0.4 Putamen basal ganglia0.4 Cerebellum0.4 Caudate basal ganglia0.4 Substantia nigra0.3 Frontal Cortex BA90.2 Cortex0.2 Anterior cingulate cortex BA240.2 Amygdala0.2 Spinal cord cervical c-10.1 Hippocampus0.1median TPM (GTEx v10)

💉 Clinical Trials (5)Relevance: 72%

0
Active
0
Completed
0
Total Enrolled
PHASE2
Highest Phase
Orexin and Tau Pathology in Cognitively Normal ElderlyNA
COMPLETED·NCT03053908 · NYU Langone Health
Elderly Alzheimer Disease
Actigraphy Nocturnal Polysomnograpahy (NPSG)
Multicenter Study on the Role of Neurodegeneration Biomarkers in Obstructive Sleep Apnea Syndrome With Residual Excessive Daytime Sleepiness.Unknown
UNKNOWN·NCT05795270 · Istituto Auxologico Italiano
Sleep Apnea Syndromes
Treatment
Daridorexant for Alzheimer Disease PreventionPHASE2
RECRUITING·NCT07213349 · Douglas Mental Health University Institute
Alzheimer Disease (AD)
Daridorexant 50 mg Placebo
DORA and LP in Alzheimer's Disease BiomarkersPHASE2
RECRUITING·NCT06274528 · Washington University School of Medicine
Alzheimer Disease
Lemborexant 10 mg Lemborexant 20mg Placebo
Narcolepsy Protect Against Alzheimer's Disease?NA
COMPLETED·NCT03378453 · University Hospital, Montpellier
Narcolepsy Amyloid Pathology
PET-scan18F-AV-45 PET-scan18F-AV-45

No curated ClinVar variants loaded for this hypothesis.

Run scripts/backfill_clinvar_variants.py to fetch P/LP/VUS variants.

🔍 Search ClinVar for HCRT →

No DepMap CRISPR Chronos data found for HCRT.

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💾 Resource Usage

No resource usage or linked notebooks recorded for this hypothesis yet.

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