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10
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Carbohydrates and Carbohydrate-Based Therapeutics in Alzheimer’s Disease
Ana M. Matos, João Barros and Amélia P. Rauter
Universidade de Lisboa, Centro de Química Estrutural, Institute of Molecular Sciences, Faculdade de Ciências, Department of Chemistry and Biochemistry, Ed. C8, Piso 5, Campo Grande, Lisboa, 1749-016, Portugal
10.1 Introduction
Carbohydrates, the most abundant organic compounds in nature, play unique roles in health and disease. The complex glycans displayed on the cell surface facing the extracellular space are the key molecules for cell recognition and adhesion in signal­ing pathways and in cell–pathogen interactions[1, 2]. Carbohydrates also trigger immune responses[3–5], and modulate key biological processes in neurodegenera­tion, namely those related to the O-GlcNAc modification (also known as O-GlcNAcylation) of serine (Ser) and threonine (Thr) protein residues in the brain, the dysregulation of which is associated with neurodegenerative diseases [6, 7]. Alzheimer’s disease (AD) is the most common one, affecting 60% of the over 50 mil­lion people with dementia in 2020, a number expected to double every two years, reaching 82 sive disease, resulting from an irreversible degeneration of the brain that causes cognitive impairment, dementia, and ultimately results in death, as no efficient therapeutics are known to control the progression of this pathology. This protein misfolding disease is associated with the formation of soluble Aβ1–42 toxic small oligomers, derived from abnormal cleavage of β-amyloid precursor protein (APP). Their aggregation leads to the formation of fibrils, which give rise to extracellular deposits, the senile plaques[9]. Another AD neuropathological hallmark consists of intracellular neurofibrillary tangles (NFTs) formation due to altered kinase and phosphatase activities, leading to hyperphosphorylation of the Tau protein. This is followed by the aggregation of hyperphosphorylated Tau into paired helical fila­ments and, finally, into NFTs. The aggregation events and associated aggregation stress leads to cell apoptosis[9, 10] (Figure10.1).
million in 2030 and 152 million in 2050[8]. AD is a chronic and progres-
293
Carbohydrate-Based Therapeutics, First Edition. Edited by Roberto Adamo and Luigi Lay. © 2024 WILEY-VCH GmbH. Published 2024 by WILEY-VCH GmbH.
10 Carbohydrates and Carbohydrate-Based Therapeutics in Alzheimer’s Disease
294
Healthy Neuron
Figure10.1  Healthy neuron vs. neuron after degeneration. Source: Adapted from
Demetrius etal.[9].
AD Neuron
Neurofibrillary tangles
(hyperphosphorylated tau)
Amyloid aggregates
Disease progression
Moreover, the cellular prion protein (PrPC), located in the neuronal cell surface, is a high-affinity binding partner of Aβ oligomers (Aβos) and promotes the activa­tion of Fyn kinase, triggering a cell signaling pathway that culminates in Tau hyperphosphorylation[11]. Accordingly, Fyn activity increases in AD brain when
C
neurons are exposed to Aβo, via PrP
[12, 13]. Interestingly, prion protein misfold­ing also promotes prion amyloid formation. Its conformational transition from the α-helix-rich cellular form into the mainly β-sheet containing counterpart initiates an “autocatalytic” reaction that leads to the accumulation of amyloid fibrils
Sc
) in the central nervous system (CNS), leading to neurodegeneration. This
(PrP amyloidogenic process is, among other factors, O-glycosyl dependent and can be triggered or prevented by changing the sugar residue attached to Ser/Thr in the PrP core[14].
AD epidemiological data, associated with its devastating nature, unsuccessful treatment options, and high socio-economic impact are challenging for the research of new therapeutics. In 2015, a review on carbohydrates and glycomimet­ics in AD diagnosis and therapeutics was published[15], covering molecules act­ing on Aβ amyloid events, namely glycosides containing terpenes, phenolics, peptidomimetics, and metal-ion chelators, free and protected sugars, cyclitols and glycosaminoglycans (GAGs). Carbohydrate-based molecules targeting the cholin­ergic system were also reviewed[16], namely the acetylcholinesterase (AChE) and butyrrylcholinesterase (BChE) inhibitors, aiming to increase levels of the neuro­transmitter acetylcholine (ACh) in the brain of AD patients. More recently, carbohydrate­peptide conjugates were also reviewed as amyloidogenic aggregation inhibitors[17].
In this chapter, we focus on the investigation carried out to uncover the role of
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carbohydrates in AD and approaches toward carbohydrate-based therapeutics. Dysregulation of O-GlcNAcylation in intracellular proteins is associated with neu­rodegenerative diseases, including AD, for which O-GlcNAc cycling is considered a therapeutic target against the formation of amyloid plaques and NFTs . Patients with AD have O-GlcNAc levels 50% lower than normal individuals, and efforts toward the discovery of efficient carbohydrate-based therapeutics to control these levels by inhibition of the O-GlcNAc hydrolase enzyme, O-GlcNAcase (OGA), are here reviewed. Synthesis and bioactivity of the most promising classes of inhibitors are presented, namely carbohydrate-based thiazolines, 2-acetamido-2-deoxy-­glucono-1,5-lactone O-(phenylcarbamoyl)oxime (PUGNAc), and GlcNAc statins.
The role of GalNAc in neurodegeneration is also revised herein, highlighting reports that show the importance of GalNAc levels in APP to control Aβ production and the significance of GalNAc residues in chondroitin sulfate proteoglycans (PGs) that play a role in regulating the trophic microenvironment of neurons. Moreover, GalNAc containing oligosaccharides and chitosan (CTS) oligosaccharides have neu­rodegenerative effects and are also covered in this chapter.
AD is a multifactorial disease, with the cholinergic system of AD patients being severely affected and represent a therapeutic target. ACh is a major neurotransmit­ter in the brain and AD patients have low levels of ACh, emerging the inhibition of cholinesterases (ChEs), enzymes that split ACh into choline and acetate, as a prom­ising option to treat AD. The drugs rivastigmine, galantamine, and donepezil are clinically in use and act as ChE inhibitors. However, they are not efficient to control disease progression and have side effects, such as convulsions, severe nausea, stom­ach cramps, vomiting, irregular breathing, confusion, muscle cramps, and muscle weakness, among others[18, 19]. New directions in anticholinesterase drug devel­opment are encouraging and the latest findings on carbohydrate-based ChE inhibi­tors are also covered.
Finally, our latest discoveries on carbohydrate-based inhibitors of Fyn kinase, Aβ aggregation, Aβ and prion binding, and of the oxidative stress-induced neurotoxic­ity are also disclosed. This chapter ends by giving an overview about carbohydrate– protein interactions as potential targets for AD drug discovery.
29510.2 O-GlcNAc Transferase (OGT) and O-GlcNAc Hydrolase (OGA) in Neurodegeneration
10.2 O-GlcNAc Transferase (OGT) and O-GlcNAc Hydrolase (OGA) in Neurodegeneration
The modification of the hydroxy group of Ser and Thr residues to install an O-(2­acetamido-β--glucopyranosyl, O-GlcNAc) functionality (a process termed O-GlcNAcylation) is an essential mechanism that takes place in cell cycle and meta­bolic processes on nuclear, cytoplasmic, and mitochondrial proteins. It is achieved enzymatically by O-GlcNAc transferase (OGT), which transfers O-GlcNAc from uri- dine diphosphate (UDP)-GlcNAc donor to Ser and Thr residues, while the enzy­matic hydrolysis to remove the glycan and unveil the free hydroxy group is carried out by OGA (Figure10.2), a member of the glycoside hydrolase family 84(GH84)of
10 Carbohydrates and Carbohydrate-Based Therapeutics in Alzheimer’s Disease
296
Glucose
EXTRACELLULAR MEDIUM
CYTOPLASM
Hexosamine
biosynthesis pathway
HO O
GLUT
UDP
UDP-
GIcNAc
Protein Protein
(Ser/Thr)
OGT
OGA
Figure10.2  Illustration of O-GlcNAc modification of proteins via O-GlcNAc transferase (OGT) and the hydrolase O-GlcNAcase (OGA).
the CAZy classification system[20]. The O-GlcNAc modification is particularly abundant in the brain controlling a number of processes, including memory forma­tion[21], and seems to be essential for the normal function of the mammalian nerv­ous system [22–24]. Dysregulation of O-GlcNAcylation is associated with neurodegenerative diseases. As the O-GlcNAcylation of proteins is regulated by the intracellular glucose metabolism, which is reduced in the brain of AD patients, their O-GlcNAc levels are nearly 50% lower than in control brains[25, 26].
The role of O-GlcNAcylation in neurodegeneration has been extensively reviewed[6]. The expression and activities of OGT and OGA in the brain are age­dependent and more than four thousand O-GlcNAc protein targets have been iden­tified as playing critical roles in many cellular processes[6, 27]. In the mammalian brain, O-GlcNAc modification of Tau, which is naturally O-GlcNAcylated [28], decreases its phosphorylation and toxicity, suggesting a neuroprotective role of brain O-GlcNAcylation for AD treatment[6].
10.2.1 O-GlcNAc Cycling as a Therapeutic Target Against Alzheimer’s Amyloid Plaques and Neurofibrillary Tangles
Approximately 2–5% of all glucose entering the cell is channeled into the hexosa­mine biosynthetic pathway to generate UDP-GlcNAc [6] (Figure 10.2). Because
O-GlcNAcylation depends on the availability of UDP-GlcNAc, and in turn, intracel-
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lular UDP-GlcNAc level determines OGT activity, O-GlcNAcylation is considered a valuable intracellular sensor of glucose metabolism that can be directly regulated in a glucose-responsive manner[29].
Positron Emission Tomography (PET) studies [30], supported by experiments with transgenic mice[31, 32] have shown that brain glucose metabolism declines with age and is more impaired in AD patients. Glucose metabolism impairment may lead to lower UDP-GlcNAc levels and consequently lower O-GlcNAcylation, resulting in impaired GlcNAc cycling. But how does O-GlcNAcylation affect the main pathological hallmarks of AD, i.e. formation of extracellular Aβ amyloid plaques and intracellular NFT that is accompanied by synaptic loss and dementia? The APP is an O-GlcNAc-modified protein processed by three different proteases, namely the α-, the β-, and the γ-secretase. APP cleavage by α-secretase in the extra­cellular domain is non-amyloidogenic, generating a soluble fragment sAPPα and a membrane-bound C-terminal fragment (APP-CTFα) (Figure 10.3). The latter is cleaved by γ-secretase in the transmembrane region to afford the non- amyloidogenic fragment p3 and the β-amyloid precursor protein intracellular domain (AICD). APP β-secretase (BACE1) cleavage generates the soluble sAPPβ fragment and the membrane-bound fragment APP-CTFβ, which is also cleaved by γ-secretase gener­ating amyloid-β peptide monomers (Aβ1–40 and Aβ1–42), together with the AICD[6, 33]. This abnormal cleavage of APP is an important event leading to the overproduction and aggregation of Aβ species. Approximately, 90% of all Aβ frag­ments generated are Aβ1–40 and a smaller fraction corresponds to the toxic amyloi­dogenic, Aβ1–42, observed in amyloid plaques in the brain. Therefore, among the
29710.2 O-GlcNAc Transferase (OGT) and O-GlcNAc Hydrolase (OGA) in Neurodegeneration
O
γ-Secretase
p3
AICD
Non-amyloidogenic processing
sAPPα
CTFα
UDP
UDP-GIcNAc
α-Secretase
OGT
O-GlcNAcylation
O
APP
sAPPβ
BACE-1
CTFβ
Amyloidogenic processing
Aβ Monomers
γ-Secretase
EXTRACELLULAR
AICD
Figure10.3  Illustration of amyloidogenic and non-amyloidogenic cleavage of APP.
Source: Adapted from Wani etal.[6].
MEDIUM
CYTOPLASM
10 Carbohydrates and Carbohydrate-Based Therapeutics in Alzheimer’s Disease
COOH
HO
R
GIcNAcstatin
Streptozotocin
298
products generated by the amyloidogenic (initially cleaved by the BACE1) and non­amyloidogenic (initially cleaved by α-secretase) pathways, only the amyloidogenic products are thought to lead to AD pathology[34].
Interestingly, it was demonstrated that by increasing O-GlcNAcylation, either through pharmacological or genetic interventions, processing by α-secretase is also increased, resulting in enhanced neuroprotective sAPPα levels and decreased Aβ formation. In addition, hyper O-GlcNAcylation, produced in a 5XFAD Aβ mouse model treated with the OGA inhibitor 1,2-dideoxy-2′-propyl-α--glucopyranoso-
2
[2,1-d]-Δ
′-thiazoline (NButGT Figure10.4), decreased Aβ1–40 and Aβ1–42levels, reduced Aβ plaque formation, and improved cognition[26]. These findings suggest that O-GlcNAc cycling is indeed a target for the identification of therapeutics for AD.
After the discovery that human brain Tau is O-GlcNAcylated, scientists have focused on finding a link with neurodegeneration, as Tau hyperphosphorylation leads to the formation of NFT [28]. Hence, the relationship between protein O-GlcNAcylation and phosphorylation is key for the investigation of the molecular mechanism leading to brain tauopathies, including AD[35]. Liu etal.[36] found that decreased O-GlcNAc levels and increased Tau phosphorylation occur in mice brain obtained from mice sacrificed after injection into the left ventricle of the brain of 6-diazo-5-oxonorleucine (DON), an inhibitor of glutamine:fructose-6-P, the rate­limiting enzyme of hexosamine biosynthesis pathway. The analysis of human brain
HO
HO
HO
HO
OH
O
S
HO
OH
OH
N
CH
2CH2CH3
NButGT
O
N
O
N
NHAc NHAc
PUGNAc
N
NHCOCH(CH
H N
O
3)2
R
2
HO
Thiamet-G R MK 8719 R
HO
HO
Figure10.4  Structure of selected OGA inhibitors.
HO
OH
HO
Nagstatin
OH
HO
1
O
N
= OH, R2 = H
1
1
N
O
NHCON
S
2
N
OH
N H
CH
3
N
O
10.2 O-GlcNAc Transferase (OGT) and O-GlcNAc Hydrolase (OGA) in Neurodegeneration
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tissue showed that hyperphosphorylated Tau has up to four-fold lower O-GlcNAc levels. Interestingly, the reduction of protein O-GlcNAcylation in AD and other Tau-driven pathologies seems to vary in brain regions, as reported by Frenkel–Pinter etal.[37]. They found an increase in O-GlcNAcylation in the hippocampus of AD patients, suggesting that this complex disorder involves lesions in various brain regions, which should be separately investigated for a comprehensive study of AD etiology. Nonetheless, the research carried out so far supports that targeting O-GlcNAcylation represents one of the most promising therapeutic opportunities to control AD neurodegeneration by decreasing Tau hyperphosphorylation and by recovering brain dysmetabolism, leading to reduced brain damage and improved cognition[29].
10.2.2 OGA Inhibitors
The structure of some of the most studied OGA inhibitors is depicted in Figure10.4. These carbohydrate-based compounds contain either a thiazoline ring, such as NButGT, Thiamet-G, and MK8719, or an imidazole ring fused to the carbohydrate moiety as GlcNAcstatins, which structure was inspired by that of nagstatin. PUGNAc, one of the first OGA inhibitors discovered, shows a different structure as the sugar is linked to a carbamate functionality. Around 2000, PUGNAc and strep­tozotocin (STZ) were used to increase cellular O-GlcNAc levels for the study of related cellular processes, but STZ is a poor OGA inhibitor and is highly toxic to pancreatic β-cells, being used to induce type 1 diabetes in animals[38].
Human O-GlcNAcase (hOGA) is expressed in two isoforms. The larger variant OGA, localized in the nucleus and cytosol, is more active than the other isoform, expressed only during embryo formation[27]. The crucial role of OGA for main­taining or decreasing O-GlcNAc levels in the brain is, indeed, key for brain neurode­generation, encouraging the development of OGA inhibitors. In 2005, Vocadlo and coworkers were able to elucidate, for the first time, the catalytic mechanism of hOGA[39]. They described a two-step mechanism involving the nucleophilic par­ticipation of the 2-acetamido group, with the formation of an oxazole or oxazolin­ium intermediate. Later on, in 2016, Vocadlo’s group, supported by the experimental work carried out with thiazoline inhibitors (see Section10.2.2.3), proposed that the intermediate is an oxazoline rather than an oxazolinium ion (Figure10.5a)[40]. A molecule of water attacks the anomeric center of the intermediate, breaking the oxazole ring and leading to the hemiacetal with retention of configuration. In 2017, the crystal structures of hOGA and its substrates were determined[41], providing important information for further investigation of the mechanism of hOGA.
Recently, Xiong and Xu confirmed the existence of the oxazoline intermediate by studying the whole catalytic process with hOGA using a Quantum Mechanics/ Molecular Mechanics approach[42]. Based on the calculated free energy profiles, they showed that the intramolecular cyclization by the 2-acetamido group leading to an intermediate bicyclic oxazolinium ion (I1) is the rate-limiting step, and their simulations further suggest the formation of the oxazoline ring intermediate I2,
299
(a)
(b)
10 Carbohydrates and Carbohydrate-Based Therapeutics in Alzheimer’s Disease
300
Figure10.5  Mechanism for hOGA inhibition. (a) Mechanism proposed by Macauley
etal.[39] and Cekic etal.[40] (b) Energy profiles (Kcal mol (2020)[41] for the formation of the oxazoline intermediate by proton transfer of the oxazolinium intermediate to the residue D
as deduced by computational simulations.
174
−1
) adapted from Xiong and Xu
resulting from proton transfer from the 2-acetamido group to residue D174 (Figure 10.5b). A relatively small barrier was found to connect EI1 and EI2
1
(5.43 kcal mol
in SCC-DFTB/MM and 1.93 kcal mol1 in DFT calculations), which
might contribute to accelerating the overall reaction rate.
The authors also made mutagenesis simulations of D174A and D175A, which indicate that these catalytic residues mainly affect the observed reaction rate by affecting the stability of the intermediate[42]. These results seem to be in full agree­ment with the experimental results of Vocadlo’s group, who developed aminothia­zoline inhibitors (see Section 10.2.2.3). Their potency is strongly pK
-dependent,
a
leading to picomolar binding. The authors described them as genuine transition