GLYCOTOXINS (A.G.E.s) IN NEURODEGENERATION

Introduction to role of glycotoxins in foods.

In recent years, powerful evidence has emerged that toxins in our foods play a major role in neurodegeneration. They play a role in cognitive decline, in Alzheimer's disease, in vascular dementia and some role in Parkinson's disease. In the following sections we will look at the evidence. The AGEs in our food appear to play a major role in the recent epidemic of diabetes and Alzheimer's disease. Fortunately, when aware of the danger, these toxin can be easily avoided. In the following section will look at the effect of high levels of dietary AGEs on the normal aging brain.

AGEs and Cognitive Decline in Elderly

AGEs area heterogeneous group of chemicals. They can be produced endogenously in the body and they are present in foods, especially animal products cooked at high dry heat. Numerous studies have shown a direct relationship between dietary AGEs and serum AGEs. 

Here we look at 2 studies. The 2011 showed a direct relationship between a high serum level of a particular AGE, methylglyoxal and level of cognitive decline in the elderly; however, they did not prove that the high level of MG was due to diet. The second study done in 2014, by the same group, showed the direct relationship between dietary AGEs and the cognitive decline.


"Serum concentration of an inflammatory glycotoxin, methylglyoxal, is associated with increased cognitive decline in the elderly." Beeri W. 2011 (Helen Vlassara, W. Cai group at Mount Sinai, NYC)


They measured the relationship between serum methyglyoxal (sMG) and the rate of cognitive decline over 5 years in 267 non-demented elderly (mean age 83). 


Methylglyoxal (MG) is endogenously produced at low rate and produced at higher rate under conditions of increased oxidant stress. MG is also present in the diet from cooked animal products. MG is neurotoxic. 


In this study, the rate of cognitive decline as measured in MMSE test (standard intelligence test) was directly related to high serum MG level at start of study. 


Discussion: "It has been demonstrated that in addition to endogenous mechanisms that reduce MG concentrations, dietary restriction of caloric intake of AGE intake without altering calories, reduce serum concentrations of MG derivatives and its  terminal product CML, together with markers of oxidative stress and inflammation. The independent association of dietary AGE content with circulating AGE levels and the significant decrease of serum MG derivatives following dietary AGE restriction even in healthy older subjects suggests that Western diets, which are AGE-rich may potentially play a role in the development of AD (and cognitive decline). This may be clinically relevant since the dietary AGE load can be easily and safely reduced by using food processing methods that limit high or prolonged heat application and preserve food moisture."


Highlights: "Higher sMG levels at baseline were associated with faster rate of cognitive decline."



Dietary AGE associated with decline in memory, 2014

The open access paper, "Dietary advanced glycation end products are associated with decline in memory in young elderly", West, 2014, are by the same Mt Sinai, NYC group with Vlassara and Cai as the previous 2011 paper. One difference is participants averaged 12 years younger. The main difference was this study estimated intake of dietary AGEs as well as measuring serum MG. The 2011 study assumed serum MG were closely related to dietary AGEs based upon prior studies. This study proved there was a very high correlation between dietary AGEs and serum MG. The difference is dietary AGEs are hundreds of different AGEs; while serum MG is one specific AGE. MG is a very important AGE because it is highly reactive and toxic. 


The results state: "dAGE (dietary AGE) and sMG (serum MG) were highly correlated. "


Highlights:

AGEs are associated with cognitive decline.

High levels of dietary AGEs are associated with faster decline in memory.

High serum MG levels are associated with faster decline in attention.

Modifying AGEs in the diet may be a strategy to diminish cognitive compromise.


"Since subjects were cognitively normal at baseline, our finding suggest that elevated dAGEs may negatively impact memory before clinical symptoms of cognitive decline are expressed. A low-AGE diet may reduce circulating AGEs, potentially providing a simple intervention by which risk for cognitive compromise may be reduced. Since individuals with diabetes have higher circulating AGEs, our results suggest an explanation for the higher rates of cognitive decline and AD in diabetes."

Comment

The above studies are human clinical studies with statistically significant results. If the ability to reduce dietary AGEs was a brand name pill marketed by Big Pharma, it would have sales of 50 billion dollar a year and promoted by frequent TV commercials. However, reduction of dietary AGEs is free and easy and makes no money for anybody. Therefore, it is totally ignored.

DIETARY A.G.E.s IN ALZHEIMER'S DISEASE

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AGEs and Vascular Dementia

AGEs in Human Brain in Vascular Dementia

In prior study (Lubitz, 2016) about AGEs in Alzheimer's disease, there was following statement in Introduction:

"Higher levels of AGEs are associated with cognitive impairment in people with cerebrovascular disease, suggesting a relationship between AGEs and vascular dementia (Southern, 2007).


Since cerebrovascular disease is second leading cause of dementia after Alzheimer's disease, in this section take a closer look at that study (Ref 8).

Immunohistochemical study CML in human brain: relation to vascular dementia

CML (carboxymethly lysine) is the most common AGE in vivo and in foods and is generally used a a proxy for all AGEs. Its level in the body is directly related to the amount of AGEs in diet. 


In this study they examined the brains of 25 persons with known history of cerebrovascular disease. Those with dementia due to Alzheimer's disease were excluded from study. At time of death 10 werenon-demented and 15 were demented. Mean age was 79. 5 had diabetes of which 2 demented, 15 had hypertension of which 8 were demented and 3 had strokes of which 2 were demented.


The vessels and neurons in the cortex, white matter and basal ganglia were examined for the presence of CML.


Results of CML staining of brain

The probability of cortical neurons staining positive for CML was higher in cases with worse dementia and also related to hypertension.

Additionally vascular CML was related to cognitive impairment and diabetes. 

Neuronal staining in basal ganglia was related to hypertension and decreased survival; but not to dementia. 


Conclusion: "CML staining in cortical neurons and cerebral vessels is related to the severity of cognitive impairment in people with cerebrovascular disease." 


"These finding support the possibility that cerebral accumulation of AGEs may contribute to dementia in people with cerebral vascular disease."



Discussion

"CML expression in microvessels and cortical neurons related to clinical dementia in people in whom cerebrovascular disease was the main pathology. Our study focussed on the relationship between AGE levels and cognitive impairment by controlling concurrent Alzheimer pathology. This control greatly strengthens the support that our results give to the hypothesis that AGEs contribute to cognitive dysfunction in cerebrovascular disease,"

Effect Lowering dietary AGEs

Smoking Cessation

There is limited data on effect of lowering dietary AGEs and disease. As a surrogate indicator, I looked at effect of cessation of smoking on disease.

Tobacco smoke source toxic reactive glycation products

"Smoking  has been identified to be the single greatest preventable cause of morbidity and mortality in the United States. In 1985 alone there were approximately 400,000 deaths in the United States that could be directly attributable to cigarette smoking. The number one cause of death  is myocardial infarction." Cerami


Smoking also increases the risk of a long list of disease also attributed to dietary AGEs including peripheral vascular disease, cerebrovascular disease, stroke, dementia, Alzheimer's disease, various malignancies, rheumatoid arthritis, diabetes, optic neuritis, cataracts, osteoporosis. This overlap of diseases attributed to smoking and dietary AGEs suggests the possibility of a common mechanism.


The issue in this discussion is connecting tobacco smoke to AGEs.


The 1997 paper, "Tobacco smoke is a source of toxic reactive glycation products" (Cerami) investigates the connection. Curing of tobacco takes place under conditions that could lead to formation of glycation products. "Cigarette smoke is a complex mixture of more than 4000 chemical compounds, including high concentrations of free radicals and other reactive oxidant species." (ref 7 Isik from Cataldo)


In the Cerami study they show Glycotoxins from tobacco smoke promote the formation of AGEs on serum proteins in vivo. They measured  the level of AGEs in smokers and non-smokers and showed serum levels in smokers were significantly elevated. They noted the AGE-serum proteins in tobacco users were in the same range (AGE-serum proteins 200-400 units/ml)  seen in patients with diabetes.


Discussion: They noted that could not identify the specific chemical structure; they stated can surmise it is probably carbonyl group and probably dicarbonyls because removed by amnioguanidine (a substance that shown to remove these AGEs). They also demonstrated that AGEs in tobacco smoke produced cross-links  in connective tissue, a characteristic of AGEs. 


They concluded that glycotoxins in cigarette smoke are absorbed into blood stream where rapidly induce formation of AGEs. They concluded that the glycotoxins and resulting AGEs in cigarette smoke are responsible for the increased rate of atherosclerotic vascular disease.


Based on role of AGEs in promoting many disease due to smoking; we looked at smoking as surrogate indicator of what could be expected from lowering dietary AGEs.



Quitting smoking and risk heart attack decline

"A population-based case-control study involving 1282 cases plus controls was conducted to examine risk of myocardial infarction or coronary death after cigarette smokers quit smoking. The odds ration for smokers was  (OR=2.7 men and OR 4.7 for women)"


"For ex-smokers odds ratio declined rapidly after quitting and after about 3 years they were not significantly different" from non-smokers. They concluded within 2-3 years after quitting there was no increased risk of heart attack.


The data regarding quitting smoking is encouraging and in my opinion, creates the impression that within 2-3 years there may be substantial protection against disease caused by dietary AGEs including neurodegeneration and risk of dementia. 





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Glycotoxins and Parkinson's Disease

Dietary population study Parkinson's Disease

Paper: Dietary Lipids and Antioxidants in Parkinson's Disease: A Population-based, Case-Control Study, Logroscino, 1996.


They examined diet of Parkinson's disease patients in Washington Heights, NYC. 5 year residents of the community.


                     Cases               Controls

Men                 44%                   29%

White               44%                   20%

African-Am     12%                    33%

Hispanic          44%                    47%


110 cases, 70 patients PD,  40 patients with PD and Dementia, Alzheimer's patients were excluded.


Patients were more likely to be men and white. Patients with or without dementia were the same.


There was detailed analysis of diet

The following chart is Odds Ratio (OR) of Parkinson's disease comparing 1st and 4th quartile:

                             OR

Calories 1st            1      

4th                           6.92


Fat  1st                    1

4th                           4.03


Protein  1st              1

4th                            1.93


Carbohydrates 1st    1

4th                            1.56


There was significant   increased risk for Calories and Fat.


Animal fats           OR

1st                           1

2nd                          1.86

3rd                           3.61

4th                            5.28


Fat from Vegetable     OR

1st                                   1

2nd                                  1.03

3rd                                  0.78

4th                                   1.01


The data showed Odds ratio of for animal was 5.3 compared with lowest quartile. There was no association shown for fats from vegetables.


There was no calculation of A.G.E.s in diet. It is very well understood that animal fats is very strongly associated with high intake of AGE.


The data regarding high intake animal fat is very similar to data regarding dietary intake high AGEs and Alzheimer's disease.


This data is consistent with theory that a low AGE diet will help prevent Parkinson's disease.

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Normal Aging Brain

Rapamycin protects cognitive and non-cognitive behavior

Rapamycin by decreasing activity of mTOR can preserve normal cognitive function through the pathways related to prevention of AD and by pathways independent of AD. Those pathways related to prvention of AD include preservation of cerebral microcirculation and increasing autophagy which can prevent accumulation of amyloid-B. 


Here we look at pathways related to decreasing activity of mTOR; but independent from AD pathways. 

As usual the two leading papers are by Galvan group 2012 and the Oddo group 2012.

In this paper by Galvan group they used standard non-transgenic lab mice called C57 Black 6. The treated mice were fed oral rapamycin in the standard low dose used by Harrison in 2009 anti-aging studies.

Results showed this dose only inhibits mTORC1 in brain but not mTORC2. 

8 month old mice was fed rapamycin for 4 months and then evaluated at 12 months.  Rapamycin fed mice had better spacial learning and memory than control mice fed standard diet. 

They then test effect of rapamycin on older mice.  They tested 12 month old mice and 25 month old mice, both had been fed rapamycin for 10 months. They also tested a 25 month old mice in which rapamycin was started at 18 months of age. 


All three groups of mice fed rapamycin had better preserved cognitive function than regular chow fed mice. 

They also tested a 8 month old mice and 14 month old mice that had been treated wth rapamycin. The mice showed reduced anxiety.


They also tested 4 month old, 8 month old and 12 month old mice that had been treated with rapamycin for 2 months. All groups treated with rapamycin demonstrated reduced depressive like behavior. 

Studies showed the treated mice had increased levels of monoamines in midbrain after being fed rapamycin. The monoamines were epinephrine, norepinephrone, dopamine and 5-hydroxytrptamine.

They state: "In summary, the results of the present study demonstrate that chronic feeding with encapsulated rapamycin enhances memory in young C57BL/6 mice and delays cognitive decline associated with aging. Moreover, our results show that long-term feeding with rapamycin has concomitant anxiolytic and antidepressant like effects."


Very important note in discussion was that there was an approximate 30% reduction in TOR activity in brain. They state 30% reduction in TOR activity can improve learning and memory in old animals. mTOR levels too high or too low are bad.


"It has been suggested that there was little selective pressure to evolve effective mechanisms of neuroprotection in old age. It is therefore conceivable that brain mTOR levels that are adequate during the reproductive years may be detrimental as mammals age."


In other words, mTOR is like a rheostat, set at the proper level for the growing animals; but too high for the older animal.

Rapamycin enhancing NMDA signaling

The Oddo group 2012 paper  is entitled, "Life-long rapamycin administration ameliorates age-dependent cognitive deficits by reducing Il-1B and enhancing NMDA signaling.  

The study used the common lab mouse same as used in above study. Mice were tested for spacial learning and memory. Untreated mice did well at age 2 and 6 months; but showed decreases in learning and memory at 15 months and 18 months.


Mice were fed rapamycin in same low dose used in Harrison study. Mice fed rapamycin for 16 months, starting at age 2 months, had preserved learning and memory. Mice fed rapamycin for 3 months, starting at 15 months had no improvement. The results showed rapamycin prevents age-dependent cognitive deficits. They conclude:

"Short-term rapamycin administration to 15-month-old mice, an age at which mice already have spatial learning deficits, has no impact on learning. In contrast, life-long rapamycin administration ameliorates age-dependent spatial learning."


What was of great interest was the mechanism:

Rapamycin decreases mTOR signaling in brains of mice treated for 16 months and for 3 months. However, the cytokine IL-1B was only reduced in 2-->18 rapamycin mouse and not reduced in the 15-->18 rapamycin mouse in which rapamycin was begun at 15 months. IL-1B is a proinflammatory cytokine. The conclusion  was "high levels of IL-1B impair hippocampal-dependent learning and memory. "

NMDA is one of main signaling molecules in the brain. NMDA has receptors designated NR1and NR2 and there is subunit NR2B receptor which is important for learning and memory. Rapamycin increases phosphorylation of NR2B receptor and this facilitates NMDA signaling of this receptor.

 "The NMDA receptors play a key role in synaptic plasticity and long-term potentiation, which is believed to be the cellular mechanism underlying learning and memory."

They state: "Taken together, these data suggests that rapamycin ameliorates age-dependent cognitive deficits by decreasing hippocampal IL-1B levels and by facilitating NR2B surface expression and overall NMDA signaling."


Discussion: All these substances, like mTOR and Il-1B have a window of proper level. [They all follow the Goldilocks rule: too much, too little, and just right ]

"Overall these data ...show that a small decrease in mTOR signaling in aged mice has beneficial effects on learning and memory, suggests that there may be a window of mTOR activity that is necessary for learning and memory, wheras complete blockage of mTOR or hyperactive mTOR are detrimental to learning and memory."

Discussion of IL-1B:


"It is very well established that the production of pro-inflammatory cytokines increases in the brain as a function of age while the levels of anti-inflammatory cytokines decreases."


"IL-1B levels increase as a function of age in the hippocampus and its involvement in memory has been clearly established."


"Specifically, there is growing appreciation for a dual role of IL-1B in learning and memory; whereas IL-1B is required for memory, a chronic increase in IL-1B has a negative effects on learning and memory."

"The data presented here are consistent with these reports as we have shown that the improvement in behavior is strictly linked to reduction of central IL-1B levels. Indeed, we show that rapamycin improved learning and memory only in Rapa 2--18 mice, which have significantly lower IL-1B levels compared to the other two groups. In contrast Rapa 15-18 mice, in which IL-1B levels were not decreased, performed the same as the control mice."


Conclusion: "Data presented here suggests that rapamycin-mediated changes in IL-1B and NMDA signaling contribute to the learning and memory improvements in the Rapa 2-18 mice. 


The results were that rapamycin administered in young mice and continued until age 18 months reduced IL-1B signaling and this reduction in IL-1B brain levels enhanced NMDA signaling which then ameliorated age-related cognitive deficits.

Genetic variation in IL-1B and improved Cognitive Function

 This study looked at genetic variation in the IL-1B converting enzyme, which regulates IL-1B and is associated with lower production levels of IL-1B. They found lower levels of IL-1B were associated with better performance in cognitive function in elderly persons, suggestion that low levels of IL-1B are protective against age-associated learning and memory deficits. 

Mice, Caloric Restriction, NMDA Receptor

In this study 2 month old mice were maintined on diet of long-term intermittent fasting diet, consisting of  alternate day feeding for 6-8 months.  They found the caloric restriction mice had enhance learning. 


In the hippocampus of CR mice they found increase in expression of NMDA receptor subunit NR2B. 


This was similar to above rapamycin mouse study with enhanced function of NMDA signaling through NR2B subunit and improved memory

Caloric Restriction in the Elderly

In this study 50 healthy overweight elderly adults, mean age 60.5 years and mean BMI 28 [overweight BMI 25-30], were studied. The study group had 30% caloric restriction for 3 months. 


They found a significant increase in verbal memory scores after caloric restriction. The increase in verbal memory sores was correlated with a decrease in fasting levels of insulin. 


Note: Both caloric restriction and decrease in fasting levels of insulin are correlated with decrease activity of mTOR.

Summary: Rapamycin and Aging Brain

Rapamycin fed mice were protected against cognitive decline in older age group. 


The cognitive protection was associated with rapamycin decreasing activity of mTOR; which caused decrease in pro-inflammatory cytokine IL-1B. The preserved cognitive function was associated with NR2B receptor subunits of the NMDA receptor in hippocampus. 


Elderly persons with genetic mutation which caused decreased levels of IL-1B had improved cognitive function. 


Mice treated with intermittent long-term caloric restriction had improved memory. This was associated with mechanism dependent on NR2B subunits of NMDA receptor in hippocampus. 


60 year old overweight adults on 30% caloric restriction for 3 months had lower fasting insulin levels and improved memory performance. Caloric restriction and decreased  fasting insulin levels would cause lower activity of mTOR.


Looking at these 5 studies in total would suggest that in elderly humans @ 60 years of age, decrease of activity of mTOR with rapamycin would decrease proinflammatory cytokine levels of IL-1B land improve cognitive function through improved NMDA signaling through NR2B receptor.


Elderly humans not infrequently suffer from depression. The Galvan study  suggests rapamycin treatment and reduction activity of mTOR might increase monoamine levels in midbrain and decrease depression as noted in older mice.