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D'Alessandro A, Lukens JR, Zimring JC. The role of PIMT in Alzheimer's disease pathogenesis: A novel hypothesis. Alzheimers Dement 2023; 19:5296-5302. [PMID: 37157118 DOI: 10.1002/alz.13115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/11/2023] [Indexed: 05/10/2023]
Abstract
There are multiple theories of Alzheimer's disease pathogenesis. One major theory is that oxidation of amyloid beta (Aβ) promotes plaque deposition that directly contributes to pathology. A competing theory is that hypomethylation of DNA (due to altered one carbon metabolism) results in pathology through altered gene regulation. Herein, we propose a novel hypothesis involving L-isoaspartyl methyltransferase (PIMT) that unifies the Aβ and DNA hypomethylation hypotheses into a single model. Importantly, the proposed model allows bidirectional regulation of Aβ oxidation and DNA hypomethylation. The proposed hypothesis does not exclude simultaneous contributions by other mechanisms (e.g., neurofibrillary tangles). The new hypothesis is formulated to encompass oxidative stress, fibrillation, DNA hypomethylation, and metabolic perturbations in one carbon metabolism (i.e., methionine and folate cycles). In addition, deductive predictions of the hypothesis are presented both to guide empirical testing of the hypothesis and to provide candidate strategies for therapeutic intervention and/or nutritional modification. HIGHLIGHTS: PIMT repairs L-isoaspartyl groups on amyloid beta and decreases fibrillation. SAM is a common methyl donor for PIMT and DNA methyltransferases. Increased PIMT activity competes with DNA methylation and vice versa. The PIMT hypothesis bridges a gap between plaque and DNA methylation hypotheses.
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Affiliation(s)
- Angelo D'Alessandro
- University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado, USA
| | - John R Lukens
- Carter Immunology Center and Center for Brain Immunology and Glia, University of Virginia Departments of Pathology and Neuroscience, Charlottesville, Virginia, USA
| | - James C Zimring
- Carter Immunology Center and Center for Brain Immunology and Glia, University of Virginia Departments of Pathology and Neuroscience, Charlottesville, Virginia, USA
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Di Blasi R, Blyuss O, Timms JF, Conole D, Ceroni F, Whitwell HJ. Non-Histone Protein Methylation: Biological Significance and Bioengineering Potential. ACS Chem Biol 2021; 16:238-250. [PMID: 33411495 DOI: 10.1021/acschembio.0c00771] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Protein methylation is a key post-translational modification whose effects on gene expression have been intensively studied over the last two decades. Recently, renewed interest in non-histone protein methylation has gained momentum for its role in regulating important cellular processes and the activity of many proteins, including transcription factors, enzymes, and structural complexes. The extensive and dynamic role that protein methylation plays within the cell also highlights its potential for bioengineering applications. Indeed, while synthetic histone protein methylation has been extensively used to engineer gene expression, engineering of non-histone protein methylation has not been fully explored yet. Here, we report the latest findings, highlighting how non-histone protein methylation is fundamental for certain cellular functions and is implicated in disease, and review recent efforts in the engineering of protein methylation.
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Affiliation(s)
- Roberto Di Blasi
- Department of Chemical Engineering, Faculty of Engineering, Imperial College London, London, U.K
- Imperial College Centre for Synthetic Biology, Imperial College London, London, U.K
| | - Oleg Blyuss
- School of Physics, Astronomy and Mathematics, University of Hertfordshire, Hatfield, U.K
- Department of Paediatrics and Paediatric Infectious Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
- Department of Applied Mathematics, Lobachevsky State University of Nizhny Novgorod, Nizhny Novgorod, Russia
| | - John F Timms
- Department of Women's Cancer, EGA Institute for Women's Health, University College London, London, U.K
| | - Daniel Conole
- Department of Chemistry, Molecular Sciences Research Hub, Imperial College London, London, U.K
| | - Francesca Ceroni
- Department of Chemical Engineering, Faculty of Engineering, Imperial College London, London, U.K
- Imperial College Centre for Synthetic Biology, Imperial College London, London, U.K
| | - Harry J Whitwell
- Department of Applied Mathematics, Lobachevsky State University of Nizhny Novgorod, Nizhny Novgorod, Russia
- National Phenome Centre and Imperial Clinical Phenotyping Centre, Department of Metabolism, Digestion and Reproduction, IRDB Building, Imperial College London, Hammersmith Campus, London, W12 0NN, U.K
- Division of Systems Medicine, Department of Metabolism, Digestion and Reproduction, Sir Alexander Fleming Building, Imperial College London, Hammersmith Campus, London, SW7 2AZ, U.K
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Histological study on the protective role of vitamin B complex on the cerebellum of diabetic rat. Tissue Cell 2016; 48:283-96. [PMID: 27394072 DOI: 10.1016/j.tice.2016.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 06/21/2016] [Accepted: 06/21/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Disorder in cerebellar structure was reported in diabetes mellitus. B vitamins are involved in many significant metabolic processes within the brain. AIM OF THE WORK To detect the protective role of vitamin B complex on the histological structure of the cerebellum of experimentally induced diabetic rat. MATERIAL & METHODS Eighteen adult male Wistar rats were divided into two groups. Group I: normal vehicle control (n=6). Group II: streptozotocin-induced diabetic rats (n=12), which was equally divided into two subgroups; IIA (diabetic vehicle control), IIB (diabetic vitamin B complex-treated): streptozotocin-induced diabetic rats treated with vitamin B complex (1mg/kg/day) for 6 weeks. Specimens from the cerebellum were processed for light and electron microscopy. RESULTS In vitamin B complex treated group, the histological changes in Purkinje cells, astrocytes and oligodendrocytes were improved compared with the diabetic non-treated group. The white matter revealed intact myelinated axons. Inducible nitric oxide synthase (iNOS) and caspase-3 expression reduced. Glial fibrillary acidic protein (GFAP) expression revealed less activated astroglia. The number of Purkinje cells/mm(2) significantly increased. While, the number of GFAP positive astrocytes/mm(2) significantly decreased. In addition, the blood glucose level was reduced. CONCLUSION Vitamin B complex protected the cerebellum from the histological changes which occurred in STZ- induced diabetic rats.
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McCaddon A, Miller JW. Assessing the association between homocysteine and cognition: reflections on Bradford Hill, meta-analyses, and causality. Nutr Rev 2015; 73:723-35. [DOI: 10.1093/nutrit/nuv022] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Masadeh MM, Alzoubi KH, Al-azzam SI. Flouroquinolones-induced Antibacterial Activity Atteneuation by Pretreatment
with Vitamin B12. INT J PHARMACOL 2014. [DOI: 10.3923/ijp.2015.67.71] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kao TT, Chu CY, Lee GH, Hsiao TH, Cheng NW, Chang NS, Chen BH, Fu TF. Folate deficiency-induced oxidative stress contributes to neuropathy in young and aged zebrafish--implication in neural tube defects and Alzheimer's diseases. Neurobiol Dis 2014; 71:234-44. [PMID: 25131448 DOI: 10.1016/j.nbd.2014.08.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 07/08/2014] [Accepted: 08/02/2014] [Indexed: 12/26/2022] Open
Abstract
Folate is a nutrient essential for the development, function and regeneration of nervous systems. Folate deficiency has been linked to many neurological disorders including neural tube defects in fetus and Alzheimer's diseases in the elderly. However, the etiology underlying these folate deficiency-associated diseases is not completely understood. In this study, zebrafish transgenic lines with timing and duration-controllable folate deficiency were developed by ectopically overexpressing a recombinant EGFP-γ-glutamyl hydrolase (γGH). Impeded neural crest cell migration was observed in the transgenic embryos when folate deficiency was induced in early stages, leading to defective neural tube closure and hematopoiesis. Adding reduced folate or N-acetylcysteine reversed the phenotypic anomalies, supporting the causal link between the increased oxidative stress and the folate deficiency-induced abnormalities. When folate deficiency was induced in aged fish accumulation of beta-amyloid and phosphorylated Tau protein were found in the fish brain cryo-sections. Increased autophagy and accumulation of acidic autolysosome were apparent in folate deficient neuroblastoma cells, which were reversed by reduced folate or N-acetylcysteine supplementation. Decreased expression of cathepsin B, a lysosomal protease, was also observed in cells and tissue with folate deficiency. We concluded that folate deficiency-induced oxidative stress contributed to the folate deficiency-associated neuropathogenesis in both early and late stages of life.
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Affiliation(s)
- Tseng-Ting Kao
- The Institute of Basic Medical Science, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Yi Chu
- Department of Medical Laboratory Science and Biotechnology, National Cheng Kung University, Tainan, Taiwan
| | - Gang-Hui Lee
- The Institute of Basic Medical Science, National Cheng Kung University, Tainan, Taiwan
| | - Tsun-Hsien Hsiao
- The Institute of Basic Medical Science, National Cheng Kung University, Tainan, Taiwan
| | - Nai-Wei Cheng
- Department of Medical Laboratory Science and Biotechnology, National Cheng Kung University, Tainan, Taiwan
| | - Nan-Shan Chang
- The Institute of Basic Medical Science, National Cheng Kung University, Tainan, Taiwan; Institute of Molecular Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Bing-Hung Chen
- Department of Biotechnology, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tzu-Fun Fu
- The Institute of Basic Medical Science, National Cheng Kung University, Tainan, Taiwan; Department of Medical Laboratory Science and Biotechnology, National Cheng Kung University, Tainan, Taiwan.
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Expression of genes encoding enzymes involved in the one carbon cycle in rat placenta is determined by maternal micronutrients (folic acid, vitamin B12) and omega-3 fatty acids. BIOMED RESEARCH INTERNATIONAL 2014; 2014:613078. [PMID: 25003120 PMCID: PMC4070585 DOI: 10.1155/2014/613078] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/15/2014] [Accepted: 05/06/2014] [Indexed: 11/20/2022]
Abstract
We have reported that folic acid, vitamin B12, and omega-3 fatty acids are interlinked in the one carbon cycle and have implications for fetal programming. Our earlier studies demonstrate that an imbalance in maternal micronutrients influence long chain polyunsaturated fatty acid metabolism and global methylation in rat placenta. We hypothesize that these changes are mediated through micronutrient dependent regulation of enzymes in one carbon cycle. Pregnant dams were assigned to six dietary groups with varying folic acid and vitamin B12 levels. Vitamin B12 deficient groups were supplemented with omega-3 fatty acid. Placental mRNA levels of enzymes, levels of phospholipids, and glutathione were determined. Results suggest that maternal micronutrient imbalance (excess folic acid with vitamin B12 deficiency) leads to lower mRNA levels of methylene tetrahydrofolate reductase (MTHFR) and methionine synthase , but higher cystathionine b-synthase (CBS) and Phosphatidylethanolamine-N-methyltransferase (PEMT) as compared to control. Omega-3 supplementation normalized CBS and MTHFR mRNA levels. Increased placental phosphatidylethanolamine (PE), phosphatidylcholine (PC), in the same group was also observed. Our data suggests that adverse effects of a maternal micronutrient imbalanced diet may be due to differential regulation of key genes encoding enzymes in one carbon cycle and omega-3 supplementation may ameliorate most of these changes.
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Li J, Han S, Qian Z, Su X, Fan S, Fu J, Liu Y, Yin X, Gao Z, Zhang J, Yu DH, Ji Q. Genetic amplification of PPME1 in gastric and lung cancer and its potential as a novel therapeutic target. Cancer Biol Ther 2014; 15:128-34. [PMID: 24253382 PMCID: PMC3938515 DOI: 10.4161/cbt.27146] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 10/22/2013] [Accepted: 11/10/2013] [Indexed: 02/06/2023] Open
Abstract
Protein phosphatase methylesterase 1 (PPME1) is a protein phosphatase 2A (PP2A)-specific methyl esterase that negatively regulates PP2A through demethylation at its carboxy terminal leucine 309 residue. Emerging evidence shows that the upregulation of PPME1 is associated with poor prognosis in glioblastoma patients. By performing an array comparative genomic hybridization analysis to detect copy number changes, we have been the first to identify PPME1 gene amplification in 3.8% (5/131) of Chinese gastric cancer (GC) samples and 3.1% (4/124) of Chinese lung cancer (LC) samples. This PPME1 gene amplification was confirmed by fluorescence in situ hybridization analysis and is correlated with elevated protein expression, as determined by immunohistochemistry analysis. To further investigate the role of PPME1 amplification in tumor growth, short-hairpin RNA-mediated gene silencing was employed. A knockdown of PPME1 expression resulted in a significant inhibition of cell proliferation and induction of cell apoptosis in PPME1-amplified human cancer cell lines SNU668 (GC) and Oka-C1 (LC), but not in nonamplified MKN1 (GC) and HCC95 (LC) cells. The PPME1 gene knockdown also led to a consistent decrease in PP2A demethylation at leucine 309, which was correlated with the downregulation of cellular Erk and AKT phosphorylation. Our data indicate that PPME1 could be an attractive therapeutic target for a subset of GCs and LCs.
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Affiliation(s)
- Jing Li
- Innovation Center China; Asia & Emerging Market iMed; AstraZeneca Innovation Medicines and Early Development; Shanghai, PR China
| | - Sufang Han
- Innovation Center China; Asia & Emerging Market iMed; AstraZeneca Innovation Medicines and Early Development; Shanghai, PR China
| | - Ziliang Qian
- Innovation Center China; Asia & Emerging Market iMed; AstraZeneca Innovation Medicines and Early Development; Shanghai, PR China
| | - Xinying Su
- Innovation Center China; Asia & Emerging Market iMed; AstraZeneca Innovation Medicines and Early Development; Shanghai, PR China
| | - Shuqiong Fan
- Innovation Center China; Asia & Emerging Market iMed; AstraZeneca Innovation Medicines and Early Development; Shanghai, PR China
| | - Jiangang Fu
- Innovation Center China; Asia & Emerging Market iMed; AstraZeneca Innovation Medicines and Early Development; Shanghai, PR China
| | - Yuanjie Liu
- Innovation Center China; Asia & Emerging Market iMed; AstraZeneca Innovation Medicines and Early Development; Shanghai, PR China
| | - Xiaolu Yin
- Innovation Center China; Asia & Emerging Market iMed; AstraZeneca Innovation Medicines and Early Development; Shanghai, PR China
| | - Zeren Gao
- Innovation Center China; Asia & Emerging Market iMed; AstraZeneca Innovation Medicines and Early Development; Shanghai, PR China
| | - Jingchuan Zhang
- Innovation Center China; Asia & Emerging Market iMed; AstraZeneca Innovation Medicines and Early Development; Shanghai, PR China
| | - De-Hua Yu
- Innovation Center China; Asia & Emerging Market iMed; AstraZeneca Innovation Medicines and Early Development; Shanghai, PR China
| | - Qunsheng Ji
- Innovation Center China; Asia & Emerging Market iMed; AstraZeneca Innovation Medicines and Early Development; Shanghai, PR China
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Alzoubi K, Khabour O, Khader M, Mhaidat N, Al-Azzam S. Evaluation of vitamin B12 effects on DNA damage induced by paclitaxel. Drug Chem Toxicol 2013; 37:276-80. [DOI: 10.3109/01480545.2013.851686] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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10
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McCaddon A. Vitamin B12 in neurology and ageing; clinical and genetic aspects. Biochimie 2012; 95:1066-76. [PMID: 23228515 DOI: 10.1016/j.biochi.2012.11.017] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 11/27/2012] [Indexed: 01/13/2023]
Abstract
The classic neurological and psychiatric features associated with vitamin B12 deficiency have been well described and are the subject of many excellent review articles. The advent of sensitive diagnostic tests, including homocysteine and methylmalonic acid assays, has revealed a surprisingly high prevalence of a more subtle 'subclinical' form of B12 deficiency, particularly within the elderly. This is often associated with cognitive impairment and dementia, including Alzheimer's disease. Metabolic evidence of B12 deficiency is also reported in association with other neurodegenerative disorders including vascular dementia, Parkinson's disease and multiple sclerosis. These conditions are all associated with chronic neuro-inflammation and oxidative stress. It is possible that these clinical associations reflect compromised vitamin B12 metabolism due to such stress. Physicians are also increasingly aware of considerable inter-individual variation in the clinical response to B12 replacement therapy. Further research is needed to determine to what extent this is attributable to genetic determinants of vitamin B12 absorption, distribution and cellular uptake.
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Affiliation(s)
- Andrew McCaddon
- School of Medicine, Cardiff University, Gwenfro Units 6/7, Wrexham Technology Park, Wrexham LL17 7YP, Wales, United Kingdom.
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Alzoubi K, Khabour O, Hussain N, Al-Azzam S, Mhaidat N. Evaluation of vitamin B12 effects on DNA damage induced by pioglitazone. Mutat Res 2012; 748:48-51. [PMID: 22790087 DOI: 10.1016/j.mrgentox.2012.06.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 06/28/2012] [Accepted: 06/30/2012] [Indexed: 12/14/2022]
Abstract
Pioglitazone is a prototype of thiazolidinediones, used for the treatment of type 2 diabetes mellitus. Previous studies suggest that pioglitazone might cause DNA damage by generation of oxidative species. In this study, we investigated the mutagenic effects of pioglitazone using sister chromatid exchanges (SCEs), and chromosomal aberrations (CAs) assays in cultured human lymphocytes. In addition, oxidative DNA damage was evaluated in cells culture by measuring 8-hydroxy-2'-deoxyguanosine (8-OH-dG) marker. We also investigated the possible protective effects of vitamin B12, which is associated with DNA repair, on DNA damage induced by pioglitazone. Treatment of the human lymphocytes with pioglitazone (100μM) significantly increases the frequency of SCEs and CAs (p<0.01). In addition, significant elevation in 8-OH-dG release from lymphocytes was observed after treatment with pioglitazone (p<0.01). On the other hand, pretreatment of cultures with vitamin B12 (13.5μg/ml) protected lymphocytes from the genotoxic effect of pioglitazone. Therefore, we conclude that pioglitazone is genotoxic, and it induces chromosomal and oxidative DNA damage in cultured lymphocytes and this toxicity is prevented by pretreatment with vitamin B12.
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Affiliation(s)
- Karem Alzoubi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan.
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Fuso A, Nicolia V, Ricceri L, Cavallaro RA, Isopi E, Mangia F, Fiorenza MT, Scarpa S. S-adenosylmethionine reduces the progress of the Alzheimer-like features induced by B-vitamin deficiency in mice. Neurobiol Aging 2012; 33:1482.e1-16. [PMID: 22221883 DOI: 10.1016/j.neurobiolaging.2011.12.013] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 12/05/2011] [Accepted: 12/06/2011] [Indexed: 10/14/2022]
Abstract
Methylation reactions linked to homocysteine in the one-carbon metabolism are increasingly elicited in Alzheimer's disease, although the association of hyperhomocysteinemia and of low B vitamin levels with the disease is still debated. We previously demonstrated that hyperhomocysteinemia and DNA hypomethylation induced by B vitamin deficiency are associated with PSEN1 and BACE1 overexpression and amyloid production. The present study is aimed at assessing S-adenosylmethionine effects in mice kept under a condition of B vitamin deficiency. To this end, TgCRND8 mice and wild-type littermates were assigned to control or B vitamin deficient diet, with or without S-adenosylmethionine supplementation. We found that S-adenosylmethionine reduced amyloid production, increased spatial memory in TgCRND8 mice and inhibited the upregulation of B vitamin deficiency-induced PSEN1 and BACE1 expression and Tau phosphorylation in TgCRND8 and wild-type mice. Furthermore, S-adenosylmethionine treatment reduced plaque spreading independently on B vitamin deficiency. These results strengthen our previous observations on the possible role of one-carbon metabolism in Alzheimer's disease, highlighting hyperhomocysteinemia-related mechanisms in dementia onset/progression and encourage further studies aimed at evaluating the use of S-adenosylmethionine as a potential candidate drug for the treatment of the disease.
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Affiliation(s)
- Andrea Fuso
- Department of Surgery P. Valdoni, Via Antonio Scarpa, 14-00161, Sapienza University of Rome, Italy.
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Fuso A, Scarpa S. One-carbon metabolism and Alzheimer's disease: is it all a methylation matter? Neurobiol Aging 2011; 32:1192-5. [DOI: 10.1016/j.neurobiolaging.2011.01.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 01/11/2011] [Indexed: 10/18/2022]
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Abstract
There is an association between cognitive function and vitamin B12 and folate status. Both vitamins participate in recycling the potentially toxic amino acid homocysteine to methionine and, ultimately, to the methyl donor S-adenosylmethionine (SAM). Consequently, B12 and folate indirectly influence glutathione synthesis – a major intracellular antioxidant. Neuroinflammation and oxidative stress are early features of Alzheimer’s disease (AD). Such stress impairs homocysteine recycling, degrades folate and decreases its cellular retention, resulting in limited SAM availability and increased homocysteine levels. Oxidized homocysteine derivatives, such as homocysteic acid, can initiate a vicious cycle by promoting free-radical formation. Decreased SAM also fosters development of characteristic AD neuropathologies – neurofibrillary tangles and amyloid plaques. The latter generate additional free radicals in a further feed-forward cascade. Future therapies should simultaneously halt neuroinflammation, restore redox homeostasis and replace depleted intracellular B vitamins. Developing early markers for these harmful processes will allow targeting of such therapy before irreversible cellular damage ensues.
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Affiliation(s)
- Andrew McCaddon
- Cardiff University, Cardiff School of Medicine, Gardden Road Surgery, Rhosllanerchrugog, Wrexham, North Wales, LL14 2EN, UK
| | - Peter R Hudson
- Maelor Hospital, Department of Medical Biochemistry, Croesnewydd Road, Wrexham, North Wales, LL13 7TD, UK
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