Abstract
Nowadays, Alzheimer’s disease (AD) is a severe sociological and clinical problem. Since it was first described, there has been a constant increase in its incidence and, for now, there are no effective treatments since current approved medications have only shown short-term symptomatic benefits. Therefore, it is imperative to increase efforts in the search for molecules and non-pharmacological strategies that are capable of slowing or stopping the progress of the disease and, ideally, to reverse it. The amyloid cascade hypothesis based on the fundamental role of amyloid has been the central hypothesis in the last 30 years. However, since amyloid-directed treatments have shown no relevant beneficial results other theories have been postulated to explain the origin of the pathology. The brain is a highly metabolically active energy-consuming tissue in the human body. It has an almost complete dependence on the metabolism of glucose and uses most of its energy for synaptic transmission. Thus, alterations on the utilization or availability of glucose may be cause for the appearance of neurodegenerative pathologies like AD. In this review article, the hypothesis known as Type 3 Diabetes (T3D) will be evaluated by summarizing some of the data that has been reported in recent years. According to published research, the adherence over time to low saturated fatty acids diets in the context of the Mediterranean diet would reduce the inflammatory levels in brain, with a decrease in the pro-inflammatory glial activation and mitochondrial oxidative stress. In this situation, the insulin receptor pathway would be able to fine tune the mitochondrial biogenesis in neuronal cells, regulation the adenosine triphosphate/adenosine diphosphate intracellular balance, and becoming a key factor involved in the preservation of the synaptic connexions and neuronal plasticity. In addition, new targets and strategies for the treatment of AD will be considered in this review for their potential as new pharmacological or non-pharmacological approaches.
Highlights
Several theories have been in the headlines of the Alzheimer’s disease (AD) research scene in the last 10 years (Folch et al, 2013; Alzheimer’s Association, 2016; Dobson, 2017; HurtadoPuerto et al, 2018) and, in many of them, it was postulated how an alteration in a metabolic mechanism runs in parallel, or is the cause, for the development of the classical features of AD (Frölich et al, 2015)
Grillo et al (2015) reported that the administration of viral vectors expressing an antisense sequence of the rat brain insulin receptors (IRs) caused cognitive impairments. They generated a specific rat model of altered brain insulin signaling associated to cognitive loss. These results are of great relevance since demonstrated that selective insulin resistance at the hippocampal level contributes directly to the development of cognitive deficits observed in patients with metabolic disorders such as type 2 Diabetes Mellitus (T2DM) and obesity (Fadel and Reagan, 2016)
The authors reported that triglycerides cross the bloodbrain barrier (BBB) leading to brain leptin and insulin receptors resistance, which has a negative effect on cognition (Banks et al, 2018). These results confirm that modulation of peripheral metabolism, for example lowering elevated levels of triglycerides in the blood, could be a strategy to treat obesity and cognitive impairment associated with central nervous system (CNS) resistance to leptin and insulin
Summary
Alzheimer’s disease (AD) is a severe sociological and clinical problem. Since it was first described, there has been a constant increase in its incidence and, for there are no effective treatments since current approved medications have only shown short-term symptomatic benefits. The adherence over time to low saturated fatty acids diets in the context of the Mediterranean diet would reduce the inflammatory levels in brain, with a decrease in the pro-inflammatory glial activation and mitochondrial oxidative stress In this situation, the insulin receptor pathway would be able to fine tune the mitochondrial biogenesis in neuronal cells, regulation the adenosine triphosphate/adenosine diphosphate intracellular.
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