Altered central and peripheral glutathione in Alzheimer disease and mild cognitive impairment: A meta‐analysis

Abstract

AbstractBackgroundIncreasing evidence implicates oxidative stress (OS) in Alzheimer Disease (AD) and Mild Cognitive Impairment (MCI). Depletion of the brain antioxidant glutathione (GSH) may be important in OS‐mediated neurodegeneration, though post‐mortem brain GSH changes in AD have been inconclusive. Recent in vivo measurements of brain and peripheral GSH may shed light on GSH changes, with implications for its role as a biomarker and therapeutic target. Aim: To quantitatively review in vivo GSH in AD and MCI compared to healthy controls (HC) using meta‐analysis.MethodStudies published before June 2020 containing measurements of in vivo brain or peripheral GSH in MCI or AD with a HC group were identified using Medline, PsychInfo, and Embase. Standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated for outcomes using random effects models. Outcome measures included brain GSH (Meshcher‐Garwood Point Resolved Spectroscopy (MEGA‐PRESS versus non) in AD and MCI, and peripheral GSH (intracellular versus extracellular) in AD and MCI. The Q statistic and Egger’s test were used to assess heterogeneity and risk of publication bias respectively.ResultsFor brain GSH, 4 AD (AD=175, HC=272) and 4 MCI (MCI=254, HC=260) studies were included. For peripheral GSH, 26 AD (ADD=981, HCl=993) and 7 MCI (MCI=434, HC=408) studies were included. Brain GSH did not differ in AD or MC compared to HC; however, the subgroup of studies using MEGA‐PRESS reported lower brain GSH in AD (SMD [95%CI] = ‐1.47 [‐1.91, ‐1.02], p=0.02) and MCI (‐1.08 [‐1.53,‐0.64], p=0.01). Peripheral GSH was lower in AD (‐0.94 [‐1.37, ‐0.51], p<0.001). In a subgroup analysis, intracellular GSH was lower in MCI (‐0.66 [‐1.11, ‐0.21], p=0.02). Significant heterogeneity was observed in all analyses and supported the use of random effect models. Egger’s test indicated risk of publication bias in MCI brain GSH literature.Conclusion In vivo measures of GSH in AD and MCI had significant heterogeneity. Peripheral analyses suggested intracellular GSH decreases may be prominent in early disease stages with both intra‐ and extracellular decreases in later stages. Brain GSH may be decreased in AD and MCI but heterogeneity and potential bias indicate the need for measurement standardization and replication.