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Article type: Review Article
Authors: Lynn, Jessicaa; 1 | Park, Mingia; *; 1 | Ogunwale, Christianab | Acquaah-Mensah, George K.a
Affiliations: [a] Massachusetts College of Pharmacy & Health Sciences (MCPHS University)/Takeda Pharmaceuticals Biopharmaceutical Industry Fellowship Program, Boston, MA, USA | [b] Walgreen Company, Houston, TX, USA
Correspondence: [*] Correspondence to: Mingi Park, 19 Foster Street, Worcester, MA 01608, USA. Tel.: +1 732 476 9223; E-mail: mingi-lilly.park@takeda.com.
Note: [1] These authors contributed equally to this work.
Abstract: Dementias, including the type associated with Alzheimer’s disease (AD), are on the rise worldwide. Similarly, type 2 diabetes mellitus (T2DM) is one of the most prevalent chronic diseases globally. Although mechanisms and treatments are well-established for T2DM, there remains much to be discovered. Recent research efforts have further investigated factors involved in the etiology of AD. Previously perceived to be unrelated diseases, commonalities between T2DM and AD have more recently been observed. As a result, AD has been labeled as “type 3 diabetes”. In this review, we detail the shared processes that contribute to these two diseases. Insulin resistance, the main component of the pathogenesis of T2DM, is also present in AD, causing impaired brain glucose metabolism, neurodegeneration, and cognitive impairment. Dysregulation of insulin receptors and components of the insulin signaling pathway, including protein kinase B, glycogen synthase kinase 3β, and mammalian target of rapamycin are reported in both diseases. T2DM and AD also show evidence of inflammation, oxidative stress, mitochondrial dysfunction, advanced glycation end products, and amyloid deposition. The impact that changes in neurovascular structure and genetics have on the development of these conditions is also being examined. With the discovery of factors contributing to AD, innovative treatment approaches are being explored. Investigators are evaluating the efficacy of various T2DM medications for possible use in AD, including but not limited to glucagon-like peptide-1 receptor agonists and peroxisome proliferator-activated receptor-gamma agonists. Furthermore, there are 136 active trials involving 121 therapeutic agents targeting novel AD biomarkers. With these efforts, we are one step closer to alleviating the ravaging impact of AD on our communities.
Keywords: Alzheimer’s disease, amyloid, blood-brain barrier, glucagon-like peptide 1, insulin resistance, microbiota, mitochondria, oxidative stress, therapeutics, type 2 diabetes mellitus
DOI: 10.3233/JAD-210612
Journal: Journal of Alzheimer's Disease, vol. 85, no. 2, pp. 485-501, 2022
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