The present review analyzes the results of recent clinical trials of β secretase inhibition in sporadic Alzheimer's disease (SAD), considers the striking dichotomy between successes in tests of β-site Amyloid Precursor Protein-Cleaving Enzyme (BACE) inhibitors in healthy subjects and familial Alzheimer's disease (FAD) models versus persistent failures of clinical trials and interprets it as a confirmation of key predictions for a mechanism of amyloid precursor protein (APP)-independent, β secretase inhibition-resistant production of β amyloid in SAD, previously proposed by us. In light of this concept, FAD and SAD should be regarded as distinctly different diseases as far as β-amyloid generation mechanisms are concerned, and whereas β secretase inhibition would be neither applicable nor effective in the treatment of SAD, the β-site APP-Cleaving Enzyme (BACE) inhibitor(s) deemed failed in SAD trials could be perfectly suitable for the treatment of FAD. Moreover, targeting the aspects of Alzheimer's disease (AD) other than cleavages of the APP by β and α secretases should have analogous impacts in both FAD and SAD.
Keywords: Alzheimer’s disease; amyloid precursor protein; amyloid precursor protein-independent generation of β amyloid; familial Alzheimer’s disease; sporadic Alzheimer’s disease; β-site amyloid precursor protein-cleaving enzyme 1 inhibitors.