PDE5 inhibitors against synaptic and cognitive impairment in Alzheimer’s disease and related dementia

Gene transcription mechanisms leading to synaptic plasticity and memory formation, including phosphorylation of the transcription factor CREB, are perturbed in Alzheimer’s disease (AD). In this regard, cyclic guanosine monophosphate (cGMP), which activates cGMP‐dependent protein kinases that, in turn, phosphorylate CREB, has been implicated in the memory and synaptic plasticity impairment occurring in the disease. Sildenafil (Viagra®), the well‐known FDA approved inhibitor of phosphodiesterase 5 (PDE5I), the enzyme that degrades cGMP, has shown efficacy in AD animal models (Zuccarello et al, Biochem Pharmacol. 2020) and was recently significantly associated with a reduced risk of AD in an unbiased study including 7.23 million individuals (Fang et al, Nat. Aging 2020).