An oral load of the early glycation compound lactuloselysine fails to accumulate in the serum of uraemic patients

Protein glycation compromises the bioavailability of milk protein-derived lysine in vivo in healthy adult males: a double-blind, randomized cross-over trial

BACKGROUND

Industrial processing and storage of milk products can strongly increase protein glycation level. Previously, we have reported that ingestion of highly glycated milk protein attenuates the postprandial rise in plasma lysine concentrations compared to the ingestion of an equivalent amount of milk protein with a low glycation level. Whether the attenuated increase in plasma lysine availability is attributed to compromised protein digestion and subsequent lysine absorption remains to be established.

OBJECTIVES

The present study combined stable-isotope methodology with the ingestion of specifically produced, intrinsically labeled protein to assess protein digestion and amino acid absorption following ingestion of milk protein with a high versus low glycation level in vivo in humans.

METHODS

Fifteen recreationally active, healthy young males participated in this double-blinded, randomized cross-over study. Subjects ingested 40 g intrinsically L-[1-13C]-lysine-labeled milk protein with either a low (3%) or high (50%) glycation level. Continuous intravenous infusion of L-[4,4,5,5-2H4]-lysine was combined with frequent blood sample collection during a 6-h postprandial period to evaluate dietary protein-derived lysine release into the circulation.

RESULTS

Postprandial plasma lysine concentrations were lower following the ingestion of milk protein with a high versus low glycation level (time × treatment effect: P = 0.002; ƞ2 = 0.214), resulting in a 23 mmol/L x 360 min (95% confidence interval [CI]: 13, 32) lower incremental area under the curve (0 ± 12 vs 23 ± 11 mmol/L x 360 min, respectively, P < 0.001). The postprandial release of milk protein-derived lysine into the circulation was attenuated following ingestion of the protein with the high versus low glycation level (time × treatment effect: P < 0.001; ƞ2 = 0.640) and was 31% (95% CI: 26, 36) lower over the full 6-h postprandial period (18 ± 4 vs 49 ± 10% of the ingested lysine, respectively, P < 0.001).

CONCLUSIONS

A high level of milk protein glycation strongly reduces postprandial plasma lysine availability in vivo in humans. Industrial processing and storage of (milk) protein products can strongly modulate protein bioavailability and, as such, lower the nutritional value of a protein source. This trial was registered at www.

CLINICALTRIALS

gov as NCT05479916.

Dietary glycation compounds - implications for human health

The term "glycation compounds" comprises a wide range of structurally diverse compounds that are formed endogenously and in food via the Maillard reaction, a chemical reaction between reducing sugars and amino acids. Glycation compounds produced endogenously are considered to contribute to a range of diseases. This has led to the hypothesis that glycation compounds present in food may also cause adverse effects and thus pose a nutritional risk to human health. In this work, the Senate Commission on Food Safety (SKLM) of the German Research Foundation (DFG) summarized data on formation, occurrence, exposure and toxicity of glycation compounds (Part A) and systematically assessed potential associations between dietary intake of defined glycation compounds and disease, including allergy, diabetes, cardiovascular and renal disease, gut/gastrotoxicity, brain/cognitive impairment and cancer (Part B). A systematic search in Pubmed (Medline), Scopus and Web of Science using a combination of keywords defining individual glycation compounds and relevant disease patterns linked to the subject area of food, nutrition and diet retrieved 253 original publications relevant to the research question. Of these, only 192 were found to comply with previously defined quality criteria and were thus considered suitable to assess potential health risks of dietary glycation compounds. For each adverse health effect considered in this assessment, however, only limited numbers of human, animal and in vitro studies were identified. While studies in humans were often limited due to small cohort size, short study duration, and confounders, experimental studies in animals that allow for controlled exposure to individual glycation compounds provided some evidence for impaired glucose tolerance, insulin resistance, cardiovascular effects and renal injury in response to oral exposure to dicarbonyl compounds, albeit at dose levels by far exceeding estimated human exposures. The overall database was generally inconsistent or inconclusive. Based on this systematic review, the SKLM concludes that there is at present no convincing evidence for a causal association between dietary intake of glycation compounds and adverse health effects.

The metabolism and transformation of casein-bound lactulosyllysine in vivo: Promoting dicarbonyl stress and the formation of advanced glycation end products accompanied by systemic inflammation

Lactulosyllysine (LL) widely exists in thermally processed dairy products, while the metabolism and transformation of LL remain poorly understood. We aimed to elucidate the metabolic pathways of LL and its impact on body health by subjecting C57BL/6 mice to a short-term ll-fortified casein diet. Our findings indicated that casein-bound LL might be metabolized and transformed into 3-deoxyglucosone through fructosamine-3-kinase (FN3K) in vivo, which promoted α-dicarbonyl stress, ultimately leading to the formation of advanced glycation end products (AGEs) in various tissues/organs, accompanied by systemic inflammation. The levels of AGEs formation in tissues/organs at various stages of casein-bound LL intake exhibited dynamic changes, correlating with alterations in the expression of FN3K and α-dicarbonyl compounds metabolic detoxification enzymes. The negative effects induced by casein-bound LL cannot be fully reversed by switching to a standard diet for equal periods. Consumption of dairy products rich in LL raises concerns as a potential risk factor for healthy individuals.

Metabolization of the Amadori Product N-ε-Fructosyllysine by Probiotic Bacteria

Glycation reactions in food lead to the formation of the Amadori rearrangement product (ARP) N-ε-fructosyllysine (fructoselysine, FL), which is taken up with the daily diet and comes into contact with the gut microbiota during digestion. In the present study, nine commercially available probiotic preparations as well as single pure strains thereof were investigated for their FL-degrading capability under anaerobic conditions. One of the commercial preparations as well as three single pure strains thereof was able to completely degrade 0.25 mM FL within 72 h. Three new deglycating lactic acid bacteria species, namely, Lactobacillus buchneri DSM 20057, Lactobacillus jensenii DSM 20557, and Pediococcus acidilactici DSM 25404, could be identified. Quantitative experiments showed that FL was completely deglycated to lysine. Using 13C6-labeled FL as the substrate, it could be proven that the sugar moiety of the Amadori product is degraded to lactic acid, showing for the first time that certain lactic acid bacteria can utilize the sugar moiety as a substrate for lactic acid fermentation.

1-Amino-1-deoxy-d-fructose ("fructosamine") and its derivatives

Fructosamine has long been considered as a key intermediate of the Maillard reaction, which to a large extent is responsible for specific aroma, taste, and color formation in thermally processed or dehydrated foods. Since the 1980s, however, as a product of the Amadori rearrangement reaction between glucose and biologically significant amines such as proteins, fructosamine has experienced a boom in biomedical research, mainly due to its relevance to pathologies in diabetes and aging. In this chapter, we assess the scope of the knowledge on and applications of fructosamine-related molecules in chemistry, food, and health sciences, as reflected mostly in publications within the past decade. Methods of fructosamine synthesis and analysis, its chemical, and biological properties, and degradation reactions, together with fructosamine-modifying and -recognizing proteins are surveyed.

Advanced Glycation End Products (AGEs) and Chronic Kidney Disease: Does the Modern Diet AGE the Kidney?

Since the 1980s, chronic kidney disease (CKD) affecting all ages has increased by almost 25%. This increase may be partially attributable to lifestyle changes and increased global consumption of a “western” diet, which is typically energy dense, low in fruits and vegetables, and high in animal protein and ultra-processed foods. These modern food trends have led to an increase in the consumption of advanced glycation end products (AGEs) in conjunction with increased metabolic dysfunction, obesity and diabetes, which facilitates production of endogenous AGEs within the body. When in excess, AGEs can be pathological via both receptor-mediated and non-receptor-mediated pathways. The kidney, as a major site for AGE clearance, is particularly vulnerable to AGE-mediated damage and increases in circulating AGEs align with risk of CKD and all-cause mortality. Furthermore, individuals with significant loss of renal function show increased AGE burden, particularly with uraemia, and there is some evidence that AGE lowering via diet or pharmacological inhibition may be beneficial for CKD. This review discusses the pathways that drive AGE formation and regulation within the body. This includes AGE receptor interactions and pathways of AGE-mediated pathology with a focus on the contribution of diet on endogenous AGE production and dietary AGE consumption to these processes. We then analyse the contribution of AGEs to kidney disease, the evidence for dietary AGEs and endogenously produced AGEs in driving pathogenesis in diabetic and non-diabetic kidney disease and the potential for AGE targeted therapies in kidney disease.

Effect of diet-derived advanced glycation end products on inflammation

Advanced glycation end products (AGEs) formed via the Maillard reaction during the thermal processing of food contributes to the flavor, color, and aroma of food. A proportion of food-derived AGEs and their precursors is intestinally absorbed and accumulates within cells and tissues. AGEs have been implicated in the pathogenesis of diabetes-related complications and several chronic diseases via interaction with the receptor for AGEs, which promotes the transcription of genes that control inflammation. The dicarbonyls, highly reactive intermediates of AGE formation, are also generated during food processing and may incite inflammatory responses through 1) the suppression of protective pathways, 2) the incretin axis, 3) the modulation of immune-mediated signaling, and 4) changes in gut microbiota profile and metabolite sensors. In animal models, restriction of dietary AGEs attenuates chronic low-grade inflammation, but current evidence from human studies is less clear. Here, the emerging relationship between excess dietary AGE consumption and inflammation is explored, the utility of dietary AGE restriction as a therapeutic strategy for the attenuation of chronic diseases is discussed, and possible avenues for future investigation are suggested.

The influence of body mass index on the accumulation of advanced glycation end products in hemodialysis patients

BACKGROUND/OBJECTIVES

The level of skin autofluorescence (AF) at a given moment is an independent predictor of mortality in hemodialysis (HD) patients. Skin AF is a measure of the accumulation of advanced glycation end products (AGEs). The aim of the study was to estimate the influence of nutrition on the 1-year increase of skin AF (ΔAF) in HD patients.

SUBJECTS/METHODS

A total of 156 HD patients were enrolled in this study. Skin AF, body mass index (BMI), superoxide dismutase, myeloperoxidase, C-reactive protein, inter-cellular adhesion molecule-1, von Willebrand factor and heart-type fatty acid-binding protein were measured four times at intervals of approximately half a year. Data from the monthly routine blood analysis were also used. Daily calorie, protein and AGE intakes were assessed from food recordings over a period of 1 week.

RESULTS

A J-shaped relation was found between baseline BMI and ΔAF (P=0.01). The lowest point of the J-shaped curve is found for BMI=24.3 kg/m(2). In the univariate analysis of the contributors to the 1-year ΔAF, we found that beside BMI=24.3 kg/m(2), AGE and calorie intakes, as well as myeloperoxidase and HD vintage, had a P <0.10. The sole independent predictor of the 1-year ΔAF was BMI=24.3 kg/m(2) (P=0.01).

CONCLUSIONS

It appears that calorie, protein and AGE intakes hardly influence the 1-year ΔAF in HD patients. BMI of HD patients of around 24 kg/m(2) resulted in a lower 1-year ΔAF.

Baking, ageing, diabetes: a short history of the Maillard reaction

The reaction of reducing carbohydrates with amino compounds described in 1912 by Louis-Camille Maillard is responsible for the aroma, taste, and appearance of thermally processed food. The discovery that non-enzymatic conversions also occur in organisms led to intensive investigation of the pathophysiological significance of the Maillard reaction in diabetes and ageing processes. Dietary Maillard products are discussed as "glycotoxins" and thus as a nutritional risk, but also increasingly with regard to positive effects in the human body. In this Review we give an overview of the most important discoveries in Maillard research since it was first described and show that the complex reaction, even after over one hundred years, has lost none of its interdisciplinary actuality.

Advanced glycation endproducts in food and their effects on health

Advanced glycation endproducts (AGEs) form by Maillard-reactions after initial binding of aldehydes with amines or amides in heated foods or in living organisms. The mechanisms of formation may include ionic as well as oxidative and radical pathways. The reactions may proceed within proteins to form high-molecular weight (HMW) AGEs or among small molecules to form low-molecular weight (LMW) AGEs. All free amino acids form AGEs, but lysine or arginine side chains dominate AGE formation within proteins. The analysis of AGEs in foods and body fluids is most often performed by ELISA or LC-MS; however, none of the methodologies cover all HMW and LMW AGEs. Most research is, therefore, carried out using 'representative' AGE compounds, most often N(ε)-carboxymethyl-lysine (CML). Only LMW AGEs, including peptide-bound forms, and carbonyls may be absorbed from the gut and contribute to the body burden of AGEs. Some AGEs interact with specific pro- or anti-inflammatory receptors. Most studies on the biological effects of AGEs have been carried out by administering heated foods. The pro-inflammatory and deteriorating biological effects of AGEs in these studies, therefore, need further confirmation. The current review points out several research needs in order to address important questions on AGEs in foods and health.

Produtos da glicação avançada dietéticos e as complicações crônicas do diabetes

A geração dos produtos de glicação avançada é um dos principais mecanismos desencadeadores das doenças associadas ao diabetes mellitus, que incluem cardiopatia, retinopatia, neuropatia e nefropatia. Esta revisão tem como objetivo analisar o papel dos produtos de glicação avançada presentes na alimentação como mediadores das complicações diabéticas e apresentar estratégias de redução de sua ingestão. Para tanto, foram realizados levantamentos em bancos de dados de publicações da área, dos últimos 15 anos, considerando-se artigos de revisão, estudos clínicos e experimentais. Os produtos de glicação avançada são um grupo heterogêneo de moléculas formadas a partir de reações não enzimáticas entre grupamentos amino e carbonilo, sendo a carboximetilisina e a pentosidina exemplos de produtos de glicação avançada identificados em alimentos e in vivo. Os produtos de glicação avançada ingeridos são absorvidos, somando-se aos endógenos no surgimento e na progressão das diversas complicações do diabetes, existindo uma correlação direta entre o consumo e a concentração sanguínea. Sua restrição na alimentação se correlaciona à supressão dos níveis séricos de marcadores de doença vascular e de mediadores inflamatórios diretamente envolvidos no desenvolvimento das degenerações diabéticas. As atuais orientações dietéticas centram-se na proporção em nutrientes e na restrição energética, sem considerar o risco da ingestão de produtos de glicação avançada formados durante o processamento dos alimentos. Recomendações simples, como a utilização de temperaturas baixas por períodos mais curtos, em presença de água, no preparo de alimentos, exercem efeitos importantes na prevenção das complicações do diabetes. O estudo dos mecanismos envolvidos na geração de produtos de glicação avançada e das propriedades anti-glicação de compostos presentes nos alimentos podem contribuir com a conduta terapêutica, concorrendo para a melhoria da qualidade de vida dos portadores dessa enfermidade.

Dietary advanced glycation end products--a risk to human health? A call for an interdisciplinary debate

Physiological consequences resulting from protein-bound Maillard compounds in foods must be discussed carefully. This was the idea behind the debate, which is put for discussion by the papers by Sebekova and Somoza, who argued for the motion that dietary advanced glycation end products (AGEs) are a health risk, and by Ames, who provided evidence against the motion. In this two excellent reviews, numerous arguments based on papers published in high-impact journals are given for each of the opinions. The fact that no final conclusion can be drawn, may reflect the need for a more comprehensive examination of this issue in the future. For a deeper understanding of biological consequences resulting from heated foods, the relationships between well-defined biological effects and well-characterized chemical structures must be studied. Prerequisite for this is profound chemistry--pure compounds, exact concentrations, and unambiguous analytical techniques. A real "risk assessment" is much too complex than to leave it up to one discipline alone. It must be a comprehensive and interdisciplinary approach, joining the resources of biology, medicine, and chemistry.

Evidence against dietary advanced glycation endproducts being a risk to human health

In vivo, advanced glycation endproducts (AGEs) are linked to various diseases, particularly those associated with diabetes. AGEs are also formed when many foods are thermally processed. The extent to which dietary AGEs are absorbed by the gastrointestinal (GI) tract and their possible role in the onset and promotion of disease are currently of considerable interest. This paper reviews information that supports the argument that dietary AGEs are not a risk to human health.