Multi-target-directed ligands: application to the Alzheimer's disease

The MTDL (multi-target-directed ligand) design strategy is used to develop single chemical entities that are able to simultaneously modulate multiple targets. The development of such compounds might disclose new avenues for the treatment of a variety of pathologies (e.g. cancer, AIDS, neurodegenerative diseases), for which an effective cure is urgently needed. This strategy has been successfully applied to Alzheimer’s disease (AD) due to its multifactorial nature, involving cholinergic dysfunction, amyloid aggregation, and oxidative stress. Despite many biological entities have been recognized as possible AD-relevant, only four achetylcholinesterase inhibitors (AChEIs) and one NMDA receptor antagonist are used in therapy. Unfortunately, such compounds are not disease-modifying agents behaving only as cognition enhancers. Therefore, MTDL strategy is emerging as a powerful drug design paradigm: pharmacophores of different drugs are combined in the same structure to afford hybrid molecules. In principle, each pharmacophore of these new drugs should retain the ability to interact with its specific site(s) on the target and, consequently, to produce specific pharmacological responses that, taken together, should slow or block the neurodegenerative process. To this end, the design and synthesis of several examples of MTDLs for combating neurodegenerative diseases have been published. This seems to be the more appropriate approach for addressing the complexity of AD and may provide new drugs for tackling the multifactorial nature of AD, and hopefully stopping its progression. According to this emerging strategy, in this work thesis different classes of new molecular structures, based on the MTDL approach, have been developed. Moreover, curcumin and its constrained analogs have currently received remarkable interest as they have a unique conjugated structure which shows a pleiotropic profile that we considered a suitable framework in developing MTDLs. In fact, beside the well-known direct antioxidant activity, curcumin displays a wide range of biological properties including anti-inflammatory and anti-amyloidogenic activities and an indirect antioxidant action through activation of the cytoprotective enzyme heme oxygenase (HO-1). Thus, since many lines of evidence suggest that oxidative stess and mitochondria impairment have a cental role in age-related neurodegenerative diseases such as AD, we designed mitochondria-targeted antioxidants by connecting curcumin analogs to different polyamine chains that, with the aid of electrostatic force, might drive the selected antioxidant moiety into mitochondria.

Sindrome di Down e fattori di rischio nel declino neurocognitivo

Down syndrome (DS) or Trisomy 21, occurring in 1/700 and 1/1000 livebirths, is the most common genetic disorder, characterized by a third copy of the human chromosome 21 (Hsa21). DS is associated with various defects, including congenital heart diseases, craniofacial abnormalities, immune system dysfunction, mental retardation (MR), learning and memory deficiency. The phenotypic features in DS are a direct consequence of overexpression of genes located within the triplicated region on Hsa21. In addition to developmental brain abnormalities and disabilities, people with DS by the age of 30-40 have a greatly increased risk of early-onset of Alzheimer’s disease (AD) and an apparent tendency toward premature aging. Many of the immunological anomalies in DS can be enclosed in the spectrum of multiple signs of early senescence. People with DS have an increased vulnerability to oxidative damage and many factors, including amyloid beta protein (Abeta), genotype ApoE4, oxidative stress, mutations in mitochondrial DNA (mtDNA), impairment of antioxidant enzymes, accelerated neuronal cell apoptosis, are related to neuronal degeneration and early aging in DS. SUBJECTS and METHODS: Since 2007 a population of 50 adolescents and adults with DS, 26 males and 24 females (sex-ratio: M/F = 1.08), has been evaluated for the presence of neurological features, biomarkers and genetic factors correlated with neuronal degeneration and premature aging. The control group was determined by the mother and the siblings of the patients. A neuropsychiatric evaluation was obtained from all patients. The levels of thyroid antibodies (antiTg and antiTPO) and of some biochemical markers of oxidative stress, including homocysteine (tHcy), uric acid, cobalamin, folate were measured. All patients, the mother and the siblings were genotyped for ApoE gene. RESULTS: 40% of patients, with a mild prevalence of females aged between 19 and 30 years, showed increased levels of antiTg and antiTPO. The levels of tHcy were normal in 52% patients and mildly increased in 40%; hyperomocysteinemia was associated with normal levels of thyroid antibodies in 75% of patients (p<0.005). The levels of uric acid were elevated in 26%. Our study showed a prevalence of severe MR in patients aged between 1-18 years and over 30 years. Only 3 patients, 2 females and one male, over 30 years of age, showed dementia. According to the literature, the rate of Down left-handers was high (25%) compared to the rest of population and the laterality was associated with increased levels of thyroid antibodies (70%). 21.5% of patients were ApoE4 positive (ApoE4+) with a mean/severe MR. CONCLUSIONS: Until now no biochemical evidence of oxidative damage and no deficiency or alteration of antioxidant function in our patients with DS were found. mtDNA sequencing could show some mutations age-related and associated with oxidative damage and neurocognitive decline in the early aging of DS. The final aim is found predictive markers of early-onset dementia and a target strategy for the prevention and the treatment of diseases caused by oxidative stress. REFERENCES: 1) Rachidi M, Lopes C: “Mental retardation and associated neurological dysfunctions in Down syndrome: a consequence of dysregulation in critical chromosome 21 genes and associated molecular pathways.” - Eur J Paediatr Neurol. May;12(3):168-82 (2008). 2) Lott IT, Head E: “Down syndrome and Alzheimer's disease: a link between development and aging.” - Ment Retard Dev Disabil Res Rev, 7(3):172-8 (2001). 3) Lee HC, Wei YH: “Oxidative Stress, Mitochondrial DNA Mutation, and Apoptosis in Aging.” - Exp Biol Med (Maywood), May;232(5):592-606 (2007).

Genetic and environmental factors associated with the risk of cognitive decline and dementia

AD is the most common age related neurodegenerative disease in the industrialized world. Clinically AD is defined as a progressing decline of cognitive functions. Neuropathologically, AD is characterized by the aggregation of b-amyloid (Ab) peptide in the form of extracellular senile plaques, and hyperphosphorlylated tau protein in the form of intracellular neurofibrillary tangles. These neuropathological hallmarks are often accompanied by abundant microvascular damage and pronounced inflammation of the affected brain regions. In this thesis we investigated several aspects of AD focusing on the genetic aspect. We confirmed that Alpha 1 antichymotrypsin (ACT), an acute phase protein, was associated to AD subjects, being plasma levels higher in AD cases than controls. In addition, in a GWA study we demonstrated that two different gene, Clusterin and CR1 were strongly associated to AD. A single gene association not explain such a complex disease like AD. The goal should be to created a network of genetic, phenotypic and clinical data associated to AD. We used a new algorithm, the ANNs, aimed to map variables and search for connectivity among variables. We found specific variables associated to AD like cholesterol levels, the presence of variation in HMGCR enzyme and the age. Other factors such as the BMI, the amount of HDL and blood folate levels were also associated with AD. Pathogen infections, above all viral infections, have been previously associated to AD. The hypothesis suggests that virus and in particular herpes virus could enter the brain when an individual becomes older, perhaps because of a decline in the immune system. Our new hypothesis is that the presence of SNPs in our GWA gene study results in a genetic signature that might affect individual brain susceptibility to infection by herpes virus family during aging.

Risk factors for postoperative delirium in the elderly

Background: Delirium is defined as an acute disorder of attention and cognition. Delirium is common in hospitalized elderly patient and is associated with increased morbidity, length of stay and patient care costs. Although Delirium can develop at any time during hospitalization, it typically presents early in the post-operative period (Post-Operative Delirium, POD) in the surgery context. The molecular mechanism and possible genetics basis of POD onset are not known, as well as all the risk factors are not completely defined. Our hypothesis is that genetic risk factor involving the inflammatory response could have possible effects on the immunoneuroendocrine system. Moreover, our previous data (inflamm-aging) suggest that aging is associated with an increase of inflammatory status, favouring age-related diseases such as neurodegenerative diseases, frailty, depression among other. Some pro-inflammatory or anti-inflammatory cytokines, seem to play a crucial role in increasing the inflammatory status and in the communication and regulation of immunoneuroendocrine system. Objective: this study evaluated the incidence of POD in elderly patients undergoing general surgery, clinical/physical and psychological risk factors of POD insurgency and investigated inflammatory and genetic risk factors. Moreover, this study evaluated the consequence of POD in terms of institutionalization, development of permanent cognitive dysfunction or dementia and mortality Methods: patients aged over 65 admitted for surgery at the Urgency Unit of S.Orsola-Malpighi Hospital were eligible for this case–control study. Risk factors significantly associated with POD in univariate analysis were entered into multivariate analysis to establish those independently associated with POD. Preoperative plasma level of 9 inflammatory markers were measured in 42 control subjects and 43 subjects who developed POD. Functional polymorphisms of IL-1 α , IL-2, IL-6, IL-8, IL-10 and TNF-alpha cytokine genes were determined in 176 control subjects and 27 POD subjects. Results: A total of 351 patients were enrolled in the study. The incidence of POD was 13•2 %. Independent variables associated with POD were: age, co-morbidity, preoperative cognitive impairment, glucose abnormalities. Median length of hospital stay was 21 days for patients with POD versus 8 days for control patients (P < 0•001). The hospital mortality rate was 19 and 8•4 % respectively (P = 0•021) and mortality rate after 1 year was also higher in POD (P= 0.0001). The baseline of IL-6 concentration was higher in POD patients than patients without POD, whereas IL-2 was lower in POD patients compared to patients without POD. In a multivariate analysis only IL-6 remained associated with POD. Moreover IL-6, IL-8 and IL-2 are associated with co-morbidity, intra-hospital mortality, compromised functional status and emergency admission. No significant differences in genotype distribution were found between POD subjects and controls for any SNP analyzed in this study. Conclusion: In this study we found older age, comorbidity, cognitive impairment, glucose abnormalities and baseline of IL-6 as independent risk factors for the development of POD. IL-6 could be proposed as marker of a trait that is associated with an increased risk of delirium; i.e. raised premorbid IL-6 level predict for the development of delirium.

Die Beteiligung von wildtypischer SOD1 an der Pathogenese der SOD1-vermittelten amyotrophen Lateralsklerose (ALS1)

Bei der amyotrophen Lateralsklerose 1 (ALS1) handelt es sich um eine altersabhängige Motoneuronenerkrankung, die durch Mutationen im Gen der Cu/Zn-Superoxid Dismutase (hSOD1mut) ausgelöst wird. Die toxischen Eigen¬schaften von hSOD1mut (z. B. Aggregations- oder oxidative Stress-Hypothese) und der Einfluss wildtypischer hSOD1 (hSOD1WT) auf den Krankheitsverlauf sind weithin ungeklärt. Das Ziel dieser Arbeit war es, die Auswirkungen von hSOD1mut-hSOD1WT-Heterodimeren im Vergleich zu mutanten Homodimeren auf die Pathogenese der ALS1 zu untersuchen. Nachdem gezeigt werden konnte, dass es in humanen Zellen in der Tat zu einer Bil¬dung hetero- und homodimerer mutanter hSOD1-Spezies kommt, wurden Dimerfusionsproteine aus zwei hSOD1-Monomeren generiert, die durch einen flexiblen Peptidlinker verbunden und C-terminal mit eGFP markiert waren. Neben hSOD1WT-WT wurden hSOD1mut-mut- und hSOD1mut-WT-Dimere mit vier verschiedenen hSOD1-Mu¬tanten untersucht. Die biochemische Charakterisierung zeigte, dass alle Dimere, die wildtyp-ähnliche hSOD1mut enthielten, eine Dismutaseaktivität aufwiesen. Im Gegensatz dazu war das Homodimer aus zwei metalldefizienten hSOD1G85R inaktiv, wobei interessanterweise hSOD1G85R mit hSOD1WT ein Dismutase-aktives Dimer bilden konnte. Sowohl in Zellkultursystemen als auch in einem C. elegans-Modell bildeten alle mutanten Homodimere vermehrt Aggregate im Vergleich zu den dazugehörigen Heterodimeren. Dieses Aggregationsverhalten korrelierte aber nicht mit der Toxizität der Dimerproteine in Überlebensassays und einer C. elegans Bewe¬gungs¬analyse. In diesen funktionellen Studien assoziierte die Toxizität der dimeren Fusionsproteine mit der enzy¬matischen Aktivität. In Übereinstimmung mit diesen Ergebnissen konnte gezeigt werden, dass hSOD1WT nicht in hSOD1mut-abhängigen Aggregaten vorkommt. Die Ergebnisse dieser Studie sprechen gegen die Aggregation als primäre toxische Eigen¬schaft der hSOD1mut und unterstützen die oxidative Stress-Hypothese. Dis¬mutase-inaktive hSOD1mut können eine untypische Enzymaktivität durch die Heterodimerisierung mit hSODWT erlangen, die auf diese Weise maßgeblich an der Pathogenese der ALS1 beteiligt sein könnte.

Der Einfluss der Zellalterung auf die pathobiochemischen Prozesse von Morbus Alzheimer und weiteren neurodegenerativen Erkrankungen

Die am häufigsten auftretende altersassoziierte neurodegenerative Krankheit ist die Alzheimer Demenz. Ein mit entscheidender Schritt bei der Entstehung der Alzheimer Erkrankung ist wahrscheinlich die Produktion des Aβ-Peptids durch proteolytische Spaltung das Amyloid-Vorläuferproteins APP. In der vorliegenden Arbeit wurde die altersabhängige Prozessierung des Amyloid-Vorläuferproteins (APP) in Fibroblasten von Hautbiopsien von Familiärer Alzheimer-, Trisomie21 und Niemann-Pick Typ C-Krankheit untersucht. Die in dieser Arbeit verwendeten Fibroblasten wurden bis zum Erreichen des zellulären Wachstumsstopps (replikative Seneszenz) seriell passagiert und die Untersuchungen erfolgten an Zellen aufsteigender PDL. Dabei zeigte sich, dass, unabhängig von dem durch die Krankheit vorliegenden genetischen biochemischen Hintergrund, die APP-Prozessierung im Laufe der Zellalterung progressiv verringert wird. Die altersabhängig ansteigenden Cholesterinspiegel führten zu einer Reduktion der APP-Reifung und infolge dessen nahmen sowohl die intrazellulären APP-Spaltfragmente (C99, C83 und AICD) als auch die extrazellulären APP-Fragmente (sAPPα, sAPP) ab. Ebenso konnte gezeigt werden, dass die γ-Sekretase-Aktivität abnimmt. Dies war verbunden mit einem Rückgang der Proteinspiegel von Nicastrin und Presenilin, beides Komponenten des γ-Sekretase-Komplexes. Obwohl die Proteinexpression der α-Sekretase ADAM10 altersassoziiert konstant blieb, nahm die α-Sekretase-Aktivität mit steigendem Lebensalter ab. Erste Untersuchungen zeigten, dass die NAD+-abhängige Histon-Deacetylase SIRT1 eine wichtige Rolle im Bezug auf die α-Sekretase-Aktivität spielen könnte. Im Gegensatz zu den Abnahmen der α- und γ-Sekretase-Aktivitäten konnte eine erhöhte Aktivität der β-Sekretase in seneszenten Zellen beobachtet werden. Die mRNA-Menge und Proteinspiegel der ß-Sekretase BACE1 blieben dabei unverändert. Des Weiteren zeigte sich eine Zunahme der β-Sekretase-Aktivität bei Behandlung von jungen Zellen mit konditioniertem Medium seneszenter Zellen. Da sensezente Zellen einem Proliferationsstopp in der G1-Phase unterliegen, wurde der Einfluss des Zellzyklus-Inhibitors Aphidicolin auf die β-Sekretase untersucht. Hier wurde sowohl in IMR90 Fibroblasten als auch in Neuroblastoma-Zellen N2a eine Zunahme der β-Sekretase-Aktivität nach Zugabe der Inhibitoren beobachtet. Auch kommt es im Zuge der Alterung zu einer verstärkten Expression inflammatorischer Zytokine, die mit der Entstehung von Aβ-Peptiden in Verbindung gebracht werden. Deshalb wurde der Einfluss von Zytokinen auf die β-Sekretase-Aktivität untersucht. Die Zugabe von Interferon-γ und Interleukin 6 führte bei jungen IMR90-Zellen zu einem Anstieg der β-Sekretase-Aktivität, während bei alten Zellen keine Änderung zu verzeichnen war.

Human herpes virus and Alzheimer’s disease

Alzheimer’s disease (AD) is a chronic and progressive neurodegenerative disorder and according to the WHO it is estimated that 36 millions of people worldwide currently suffer from AD. Genetic and environmental factors interact in a complex interplay that might affect pathogenic mechanisms leading to age-related neurodegeneration. The hypothesis is that the presence of allelic polymorphisms in selected genes affecting individual brain susceptibility to infection by the herpes virus family during aging, may contribute to neuronal loss, inflammation and amyloid deposition. Herpes virus family show features relevant to AD, since they infect a large proportion of human population, develop a latent form persisting for several years, are difficult to eliminate by immune responses especially when latency has been established and are able to infect neurons. The association between AD and herpes viruses infection has been investigated. In particular the investigation focused on CMV, EBV and HHV-6 in DNA samples from peripheral blood of a large cohort of patients with clinical diagnosis of AD and age matched CTR, from a longitudinal population study, and DNA samples from brain tissue of patients with neuropathological diagnosis of definitive AD. An association between the presence of EBV and HHV-6 DNA from PBL positivity with the cognitive deterioration and progression to AD has been focused. Moreover, IgG plasma levels in CTR and AD to these viruses were tested. CMV and EBV IgG plasma levels were higher in elderly subjects that developed clinical AD at the end of the five year follow up. Our findings support the notion that persistent cycles of latency and reactivation of herpes viruses may contribute to impair systemic immune response and induce altered inflammatory process that in turn affect cognitive decline during aging.

Biomolecular studies in Alzheimer’s Disease models: investigations in vitro and in vivo

The Alzheimer’s disease (AD), the most prevalent form of age-related dementia, is a multifactorial and heterogeneous neurodegenerative disease. The molecular mechanisms underlying the pathogenesis of AD are yet largely unknown. However, the etiopathogenesis of AD likely resides in the interaction between genetic and environmental risk factors. Among the different factors that contribute to the pathogenesis of AD, amyloid-beta peptides and the genetic risk factor apoE4 are prominent on the basis of genetic evidence and experimental data. ApoE4 transgenic mice have deficits in spatial learning and memory associated with inflammation and brain atrophy. Evidences suggest that apoE4 is implicated in amyloid-beta accumulation, imbalance of cellular antioxidant system and in apoptotic phenomena. The mechanisms by which apoE4 interacts with other AD risk factors leading to an increased susceptibility to the dementia are still unknown. The aim of this research was to provide new insights into molecular mechanisms of AD neurodegeneration, investigating the effect of amyloid-beta peptides and apoE4 genotype on the modulation of genes and proteins differently involved in cellular processes related to aging and oxidative balance such as PIN1, SIRT1, PSEN1, BDNF, TRX1 and GRX1. In particular, we used human neuroblastoma cells exposed to amyloid-beta or apoE3 and apoE4 proteins at different time-points, and selected brain regions of human apoE3 and apoE4 targeted replacement mice, as in vitro and in vivo models, respectively. All genes and proteins studied in the present investigation are modulated by amyloid-beta and apoE4 in different ways, suggesting their involvement in the neurodegenerative mechanisms underlying the AD. Finally, these proteins might represent novel potential diagnostic and therapeutic targets in AD.

Relevanz der Methioninoxidation aus evolutionärer Sicht und im akuten oxidativen Stressmodell der Alzheimerschen Krankheit

Im Laufe der Evolution müssen Sauerstoff-metabolisierende Organismen eine Reihe von Anpassungen entwickelt haben, um in der zytotoxischen oxidativen Umgebung der sauerstoff-haltigen Erdatmosphäre überleben zu können. Die im Rahmen dieser Arbeit durchgeführten vergleichenden Analysen mitochondrial kodierter und kern-kodierter Proteome mehrerer hundert Spezies haben ergeben, dass die Evolution eines alternativen genetischen Codes in Mitochondrien eine moderne Adaptation in diesem Sinne war. Viele aerobe Tiere und Pilze dekodieren in Abweichung vom genetischen Standard-Code das Codon AUA als Methionin. In der vorliegenden Arbeit wird gezeigt, dass diese Spezies dadurch eine massive Akkumulation der sehr leicht oxidierbaren Aminosäure Methionin in ihren Atmungskettenkomplexen erreichen, die generell ein bevorzugtes Ziel reaktiver Sauerstoffspezies sind. Der gewonnene Befund lässt sich widerspruchsfrei nur unter Annahme einer antioxidativen Wirkung dieser Aminosäure erklären, wie sie erstmals 1996 von R. Levine anhand von Oxidationsmessungen in Modellproteinen postuliert worden war. In der vorliegenden Arbeit wird diese Hypothese nun direkt mittels neuartiger Modellsubstanzen in lebenden Zellen bestätigt. Die durchgeführten bioinformatischen Analysen und zellbiologischen Experimente belegen, dass kollektive Proteinveränderungen die Triebkraft für die Evolution abweichender genetischer Codes sein können.rnDie Bedeutung von oxidativem Stress wurde darüber hinaus auch im Referenzrahmen einer akuten oxidativen Schädigung im Einzelorganismus untersucht. Da oxidativer Stress in der Pathogenese altersassoziierter neurodegenerativer Erkrankungen wie der Alzheimerschen Krankheit prominent involviert zu sein scheint, wurden die Auswirkungungen von Umwelt-induziertem oxidativem Stress auf den histopathologischen Verlauf in einem transgenen Modell der Alzheimerschen Krankheit in vivo untersucht. Dabei wurden transgene Mäuse des Modells APP23 im Rahmen von Fütterungsversuchen einer lebenslangen Defizienz der Antioxidantien Selen oder Vitamin E ausgesetzt. Während die Selenoproteinexpression durch die selendefiziente Diät gewebespezifisch reduziert wurde, ergaben sich keine Anzeichen eines beschleunigten Auftretens pathologischer Marker wie amyloider Plaques oder Neurodegeneration. Es war vielmehr ein unerwarteter Trend hinsichtlich einer geringeren Plaquebelastung in Vitamin E-defizienten Alzheimermäusen zu erkennen. Auch wenn diese Daten aufgrund einer geringen Versuchstiergruppengröße nur mit Vorsicht interpretiert werden dürfen, so scheint doch ein Mangel an essentiellen antioxidativen Nährstoffen die Progression in einem anerkannten Alzheimermodell nicht negativ zu beeinflussen.rn

Control of protein degradation pathways by BAG proteins and changes during aging

Many age-related neurodegenerative disorders such as Alzheimer’s disease, Parkinson’s disease, amyotrophic lateral sclerosis and polyglutamine disorders, including Huntington’s disease, are associated with the aberrant formation of protein aggregates. These protein aggregates and/or their precursors are believed to be causally linked to the pathogenesis of such protein conformation disorders, also referred to as proteinopathies. The accumulation of protein aggregates, frequently under conditions of an age-related increase in oxidative stress, implies the failure of protein quality control and the resulting proteome instability as an upstream event of proteinopathies. As aging is a main risk factor of many proteinopathies, potential alterations of protein quality control pathways that accompany the biological aging process could be a crucial factor for the onset of these disorders.rnrnThe focus of this dissertation lies on age-related alterations of protein quality control mechanisms that are regulated by the co-chaperones of the BAG (Bcl-2-associated athanogene) family. BAG proteins are thought to promote nucleotide exchange on Hsc/Hsp70 and to couple the release of chaperone-bound substrates to distinct down-stream cellular processes. The present study demonstrates that BAG1 and BAG3 are reciprocally regulated during aging leading to an increased BAG3 to BAG1 ratio in cellular models of replicative senescence as well as in neurons of the aging rodent brain. Furthermore, BAG1 and BAG3 were identified as key regulators of protein degradation pathways. BAG1 was found to be essential for effective degradation of polyubiquitinated proteins by the ubiquitin/proteasome system, possibly by promoting Hsc/Hsp70 substrate transfer to the 26S proteasome. In contrast, BAG3 was identified to stimulate the turnover of polyubiquitinated proteins by macroautophagy, a catabolic process mediated by lysosomal hydrolases. BAG3-regulated protein degradation was found to depend on the function of the ubiquitin-receptor protein SQSTM1 which is known to sequester polyubiquitinated proteins for macroautophagic degradation. It could be further demonstrated that SQSTM1 expression is tightly coupled to BAG3 expression and that BAG3 can physically interact with SQSTM1. Moreover, immunofluorescence-based microscopic analyses revealed that BAG3 co-localizes with SQSTM1 in protein sequestration structures suggesting a direct role of BAG3 in substrate delivery to SQSTM1 for macroautophagic degradation. Consistent with these findings, the age-related switch from BAG1 to BAG3 was found to determine that aged cells use the macroautophagic system more intensely for the turnover of polyubiquitinated proteins, in particular of insoluble, aggregated quality control substrates. Finally, in vivo expression analysis of macroautophagy markers in young and old mice as well as analysis of the lysosomal enzymatic activity strongly indicated that the macroautophagy pathway is also recruited in the nervous system during the organismal aging process.rnrnTogether these findings suggest that protein turnover by macroautophagy is gaining importance during the aging process as insoluble quality control substrates are increasingly produced that cannot be degraded by the proteasomal system. For this reason, a switch from the proteasome regulator BAG1 to the macroautophagy stimulator BAG3 occurs during cell aging. Hence, it can be concluded that the BAG3-mediated recruitment of the macroauto-phagy pathway is an important adaptation of the protein quality control system to maintain protein homeostasis in the presence of an enhanced pro-oxidant and aggregation-prone milieu characteristic of aging. Future studies will explore whether an impairment of this adaptation process may contribute to age-related proteinopathies.

Aging in human liver and skeletal muscle: studies on proteasomes

Aging is a complex phenomenon that affects organs and tissues at a different rate. With advancing age, the skeletal muscle undergoes a progressive loss of mass and strength, a process known as sarcopenia that leads to a decreased mobility and increased risk of falls and invalidity. On the other side, another organ such as the liver that is endowed with a peculiar regenerative capacity seems to be only marginally affected by aging. Accordingly, clinical data indicate that liver transplantation from aged subjects has, in specific conditions, function and duration comparable to those achievable with grafts of liver from young donors. The molecular mechanisms involved in these peculiar aging patterns are still largely unknown, but it is conceivable that protein degradation machineries might play an important role, as they are responsible for the maintenance of cellular homeostasis. Indeed, it has been suggested that alteration of proteostasis may contribute to the onset and progression of several age-related pathological conditions, including skeletal muscle wasting and sarcopenia, as well as to the aging phenotypes. The ubiquitin-proteasome system (UPS) is one of the most important cellular pathways for intracellular degradation of short-lived as well as damaged proteins. To date, studies on the age-related modifications of proteasomes in liver and skeletal muscle were performed prevalently in rodents, with controversial results, while only preliminary observations have been obtained in human liver and skeletal muscle. In this scenario, we want to investigate and characterize in humans the age-related modifications of proteasomes of these two different organs.

Metagenomic trajectory of gut microbiome in the human lifespan

Co-evolving with the human host, gut microbiota establishes configurations, which vary under the pressure of inflammation, disease, ageing, diet and lifestyle. In order to describe the multi-stability of the microbiome-host relationship, we studied specific tracts of the bacterial trajectory during the human lifespan and we characterized peculiar deviations from the hypothetical development, caused by disease, using molecular techniques, such as phylogenetic microarray and next-generation sequencing. Firstly, we characterized the enterocyte-associated microbiota in breast-fed infants and adults, describing remarkable differences between the two groups of subjects. Successively, we investigated the impact of atopy on the development of the microbiome in Italian childrens, highlithing conspicuous deviations from the child-type microbiota of the Italian controls. To explore variation in the gut microbiota depending on geographical origins, which reflect different lifestyles, we compared the phylogenetic diversity of the intestinal microbiota of the Hadza hunter-gatherers of Tanzania and Italian adults. Additionally, we characterized the aged-type microbiome, describing the changes occurred in the metabolic potential of the gut microbiota of centenarians with respect to younger individuals, as a part of the pathophysiolology of the ageing process. Finally, we evaluated the impact of a probiotics intervention on the intestinal microbiota of elderly people, showing the repair of some age-related dysbioses. These studies contribute to elucidate several aspects of the intestinal microbiome development during the human lifespan, depicting the microbiota as an extremely plastic entity, capable of being reconfigured in response to different environmental factors and/or stressors of endogenous origin.

The role of oxidative stress in C. elegans aging

The free radical theory of aging postulates that aging is caused by damage induced by oxidative stress. Such stress is present when the production of reactive oxygen species (ROS) exceeds the cellular antioxidant capacity. Hydrogen peroxide (H2O2) is one of the most abundant ROS. It is produced as a by-product by several enzymes and acts as second messenger controlling the activity of numerous cellular pathways. To maintain H2O2 levels that are sufficiently high to allow signaling to occur, but low enough to prevent damage of cellular macromolecules, the production and removal of H2O2 must be tightly regulated.rnWhen we investigated the effects of peroxide stress in the nematode C. elegans, we found that exogenous as well as endogenous peroxide stress causes age-related symptoms. We identified 40 target proteins of hydrogen peroxide that contain cysteines that get oxidized upon peroxide stress. Oxidation of redox-sensitive cysteines has been shown to regulate numerous cellular functions and likely contributes to the peroxide-mediated decrease in motility, fertility, growth rate and ATP levels. By monitoring the oxidation status of proteins over the lifespan of C. elegans, we discovered that many of the identified peroxide-sensitive proteins are heavily oxidized at distinct stages in life. As the free radical theory of aging predicts, we found oxidation to be significantly elevated in senescent worms. However, we were also able to identify numerous proteins that were significantly oxidized during the development of C. elegans. To investigate whether a correlation exists between developmental oxidative stress and lifespan, we monitored protein oxidation in long- and short-lived strains. We found that protein oxidation in short-lived C. elegans larvae was significantly increased. Additionally short-lived worms were incapable of recovering from the oxidative stress experienced during development which resulted in the inability to establish reducing conditions for the following reproductive phase. Long-lived C. elegans, on the other hand, did only experience a mild increase in protein oxidation in the developmental phase and were able to recover faster from oxidative stress than wild type worms. rnBecause many proteins that are sensitive to oxidation by H2O2 became oxidized in aging C. elegans, we monitored endogenous hydrogen peroxide concentrations over C. elegans lifespan and discovered that peroxide levels are significantly elevated in development. This suggests that the observed developmental protein oxidation is peroxide-mediated. The early onset of oxidative stress might be a result of increased metabolic activity in C. elegans development but could also represent the requirement of ROS dependent signaling events. Our results indicate that longevity is dependent on the worm’s ability to cope with this early boost of oxidants.rn

Metabolismus von Psychopharmaka durch das Cytochrom P450-Enzymsystem im Alter

Altern geht mit einer Reihe physiologischer Veränderungen einher. Da in höherem Lebensalter überdurchschnittlich viele Arzneistoffe eingenommen werden und häufig mehrere Erkrankungen gleichzeitig vorliegen, können Auffälligkeiten in den Arzneimittelkonzentrationen im Blut nicht nur altersbedingt, sondern auch krankheitsbedingt oder durch Arzneimittelwechselwirkungen verursacht sein.rnrnDie vorliegende Arbeit untersucht die Fragestellung, ob der Arzneimittelmetabolismus bei Alterspatenten generell, oder nur bei Patienten mit Multimorbidität und –medikation verändert ist, und in welchem Lebensalter diese Veränderungen einsetzen. Im Mittelpunkt stand dabei die Frage, ob die Aktivitäten distinkter Arzneimittel-abbauender Enzyme der Cytochrom P450-Enzym-Familie (CYP) verändert sind. Da viele Psychopharmaka nur bei Patienten im Alter zwischen 18 und 65 Jahren zugelassen sind, wurde die Hypothese geprüft, dass sich Patienten im Alter über und unter 65 Jahren in ihren Medikamentenspiegeln unterscheiden.rnrnFür die Untersuchungen wurde eine Datenbank aus Blutspiegelmessungen erstellt, die im Rahmen des pharmakotherapiebegleitenden TDM erhoben worden waren. Die Blutspiegel stammten von insgesamt 4197 Patienten, die mit Amisulprid, Aripiprazol, Citalopram, Clozapin, Donepezil, Escitalopram, Mirtazapin, Quetiapin, Risperidon, Sertralin, Venlafaxin oder Ziprasidon behandelt wurden. Die Messungen wurden ergänzt mit Angaben aus den TDM-Anforderungsscheinen bezüglich Tagesdosis, Begleitmedikamenten, Schweregrad der Erkrankung, Therapieerfolg und Verträglichkeit der Medikation. Zusätzlich wurden klinische Befunde der Leber- und Nierenfunktion einbezogen, sowie Angaben zur Berechnung des BMI. Die in vivo-CYP-Enzymaktivitäten wurden anhand von metabolischen Ratios (Serumkonzentrationen Metabolit/ Serumkonzentration Muttersubstanz) beurteilt.rnrnIm Mittel stieg der Schweregrad der Erkrankung mit dem Alter und der Therapieerfolg verschlechterte sich. Dies betraf im Einzelnen nur Patienten, die mit Amisulprid oder Clozapin behandelt worden waren. Ältere Patienten litten häufiger an Nebenwirkungen als jüngere.rnUnter Aripiprazol, Quetiapin, Sertralin und Venlafaxin erreichten Alterspatienten mit niedrigeren Tagesdosen gleiche Therapieerfolge wie jüngere Patienten.rnPatienten, die mit Clozapin oder Amisulprid behandelt wurden, zeigten im Alter schlechtere Behandlungserfolge bei gleicher (Clozapin) bzw. niedrigerer (Amisulprid) Tagesdosis.rnTherapieerfolg und mittlere Tagesdosis änderten sich bei Patienten, die Ziprasidon, Donepezil, Citalopram, Escitalopram und Mirtazapin einnahmen, nicht altersabhängig.rnrnAltersabhängige Unterschiede der Serumspiegel zeigten sich für Amisulprid, Aripiprazol, Donepezil, Mirtazapin, Desmethylmirtazapin, Quetiapin und DesmethylsertralinrnAllerdings lagen die Altersgrenzen außer bei Donepezil deutlich niedriger als die gängig angenommene, nämlich bei 35 Jahren (Aripiprazol), 70 Jahren (Donepezil), 55 Jahren (D-Sertralin), 41 Jahren (Amisulprid), 49 Jahren (Quetiapin) und 58 Jahren (Mirtazapin).rnEs bestand kein Zusammenhang zwischen dem Auftreten veränderter Serumspiegel im Alter und dem Verteilungsvolumen, der Plasmaproteinbindung oder der Eliminationshalbwertszeit der untersuchten Wirkstoffe.rnrnBei Patienten ohne Comedikation fand sich in keinem Fall eine altersabhängige Veränderung der Ratio. Es ergab sich daher kein Hinweis auf eine Veränderung der CYP-Aktivität im Alter. Die Einnahme von Comedikation nahm mit dem Alter zu, hierfür ließ sich eine Altersgrenze von 49 Jahren definieren. Unter Polytherapie wurden Veränderungen der CYP-Aktivität beobachtet.rnrnDer Einfluss veränderter Leber- oder Nierenfunktion auf die Biotransformation von Pharmaka wurde anhand von Serumspiegeln von Patienten, die mit Donepezil, Venlafaxin, Citalopram oder Escitalopram behandelt wurden, untersucht. rnBei keinem Wirkstoff wurden unter auffälligen Leber- oder Nierenparametern signifikant veränderte Serumspiegel gemessen.rnEine Abhängigkeit der Serumspiegel vom Körpergewicht wurde nur für Desmethylsertralin gefunden. Die Spiegel waren bei Patienten mit einem Body Mass Index unter 20 signifikant höher als bei Patienten mit einem Index über 20. Aufgrund der kleinen Fallgruppe und der Tatsache, dass der Serumspiegel der Muttersubstanz nicht stieg, konnte nicht zwingend von einem Alterseinfluss aufgrund der veränderten Körperzusammensetzung ausgegangen werden.rnInsgesamt ergaben sich aus den Untersuchungen Hinweise auf moderate altersabhängige Veränderungen der Pharmakokinetik. Es ließen sich allerdings keine allgemeinen Dosierempfehlungen für Alterspatienten ableiten. Es zeigte sich jedoch, dass mit altersabhängigen Veränderungen der Pharmakokinetik bereits nach dem 50. Lebensjahr zu rechnen ist. Weitere Untersuchungen sollten auch den Alterseffekt auf gastrointestinale Transporter einbeziehen, die die aktive Aufnahme von Arzneistoffen ins Blut bewerkstelligen. Unklar ist auch die Rolle des Alterns auf die Aktivität des P-Glykoproteins. rn

Mitochondrial DNA rearrangements during human aging: a study on liver, muscle and adipose tissue

Aging is characterized by a chronic, low-grade inflammatory state called “inflammaging”. Mitochondria are the main source of reactive oxygen species (ROS), which trigger the production of pro-inflammatory molecules. We are interested in studying the age-related modifications of the mitochondrial DNA (mtDNA), which can be affected by the lifelong exposure to ROS and are responsible of mitochondrial dysfunction. Moreover, increasing evidences show that telomere shortening, naturally occurring with aging, is involved in mtDNA damage processes and thus in the pathogenesis of age-related disorders. Thus the primary aim of this thesis was the analysis of mtDNA copy number, deletion level and integrity in different-age human biopsies from liver, vastus lateralis skeletal muscle of healthy subjects and patients with limited mobility of lower limbs (LMLL), as well as adipose tissue. The telomere length and the expression of nuclear genes related to mitobiogenesis, fusion and fission, mitophagy, mitochondrial protein quality control system, hypoxia, production and protection from ROS were also evaluated. In liver the decrease in mtDNA integrity with age is accompanied with an increase in mtDNA copy number, suggesting the existence of a “compensatory mechanism” able to maintain the functionality of this organ. Different is the case of vastus lateralis muscle, where any “compensatory pathway” is activated and mtDNA integrity and copy number decrease with age, both in healthy subjects and in patients. Interestingly, mtDNA rearrangements do not incur in adipose tissue with advancing age. Finally, in all tissues a marked gender difference appears, suggesting that aging and also gender diversely affect mtDNA rearrangements and telomere length in the three human tissues considered, likely depending on their different metabolic needs and inflammatory status.