1. Brain-derived neurotrophic factor and Alzheimer’s disease
Alzheimer’s disease (AD) is a neurodegenerative disorder that is clinically characterized by progressive memory loss and cognitive decline and that shows an increasing incidence rate in aging individuals [
1]. Of the several pathological hallmarks of AD, extracellular accumulation of amyloid-β (Aβ) aggregates and intracellular aggregates of hyperphosphorylated tau in the form of neurofibrillary tangles are the best-known [
2]. Aβ1–42 (Aβ42), the primary component of plaques found in AD brain, is formed by alternative proteolytic cleavage of the amyloid precursor protein (APP) by the proteases β- (BACE1) and γ-secretases, forming a pathological variant of the protein that is soluble and has a tendency to oligomerize [
3,
4,
5]. While extracellular aggregates disrupt synaptic function, intracellular levels of Aβ42 increase in Down syndrome [
6] and AD [
7,
8] and have been linked to apoptotic cell death via a caspase cascade [
9,
10].
One of the ways that neurotoxic Aβ42 exerts its neurodegenerative effects is by decreasing brain-derived neurotrophic factor (BDNF) levels and disrupting one of BDNF’s major transcriptional regulators and mediators, cyclic adenosine monophosphate response element binding protein (CREB) [
11]. BDNF has a fundamental role in promoting neuronal survival, neurogenesis, maintenance and growth of dendrites, synaptic transmission, plasticity, and excitability [
11,
12,
13,
14,
15]. Thus, it plays a significant role in hippocampal memory formation. BDNF is involved in the occurrence and maintenance of both early-phase and late-phase LTP, which correspond to short-term and long-term hippocampal memory, respectively [
16].
Severity of cognitive impairments in AD is inversely correlated with the level of BDNF in the brain [
17,
18]. Significant downregulation of BDNF mRNA, resulting in a 50% reduction of available BDNF protein [
17,
19], occurs in AD. CREB, a transcriptional regulator of BDNF and a downstream mediator of its activity [
20,
21,
22,
23], is also reduced in AD. In glutamate stimulated hippocampal neurons treated with toxic oligomeric Aβ42, there is a significant decrease in activity of PKA, which phosphorylates CREB [
24]. In the absence of cell stimulation, on the other hand, Aβ42 downregulates CREB mRNA levels without affecting its basal phosphorylation levels [
25,
26]. Therefore, Aβ42 may impair cognitive function by reducing signaling through a BDNF/CREB autoregulatory loop, downregulating BDNF and CREB expression as well as reducing CREB phosphorylation.
Pathological tau also downregulates BDNF at the transcriptional level [
27,
28]. Although the precise molecular pathway by which this occurs is not well understood, hyperphosphorylated tau may reduce BDNF expression by inhibiting PKA and CREB phosphorylation [
29] or other transcription factors.
2. Physical Exercise and Brain Health
The benefits of exercise on brain structure and function have been the topic of study for decades. Improvements in synaptic plasticity, structure, and strength with physical exercise training are well-established in the literature [
30]. In addition to enhanced efficiency in neural processing [
31], prefrontal cortex and hippocampus are larger in adults with higher aerobic fitness [
32]. Many studies in animals have shown improved hippocampal-dependent cognitive tasks following a period of exercise participation [
30,
33,
34,
35].
Human clinical trials on the effects of exercise on cognition have produced variable results. In addition to increases in functional ability, a 6-month aerobic exercise protocol in older adults with AD or mild cognitive impairment (MCI) showed improved memory performance and reduced hippocampal atrophy [
36]. Similarly, a 6-month mind-body exercise protocol in the form of Baduanjin training showed significant improvements in cognitive function and increased hippocampal gray matter volume in individuals with MCI [
37]. Furthermore, 6-months of aerobic exercise yielded cognitive enhancement, increased frontoparietal network connectivity, and reduced brain atrophy in patients with Parkinson’s disease (PD) [
38]. While the studies above showed slowing of disease progression and reduced brain atrophy in AD, MCI, and PD patients with exercise, another exercise study did not observe any changes in age-related brain atrophy in healthy older adult brain, despite improvements in cognition [
39]. Furthermore, the above results are contradicted by several studies [
40,
41,
42] and meta-analyses [
43] that found no significant improvements in executive function, memory, or information processing with exercise training in older adults with subjective cognitive decline, MCI, or dementia, or only reported mild improvements in cognition [
44] or improvements in single domains such as executive function [
45]. Contradictions in clinical trial results may be explained by differences in protocols such as exercise duration, intensity (low-, moderate-, high-intensity exercise), and type (aerobic, resistance, strength exercise). Nevertheless, recent meta-analyses suggest that physical exercise, particularly aerobic exercise, improves cognition in those with MCI and dementia [
46], possibly by increasing neuroprotective factors such as BDNF [
47,
48].
Mechanisms behind exercise-induced improvements in neuronal health, synaptic function, neurogenesis, and cognitive function are currently under investigation. One compelling hypothesis is the role of exercise in regulating growth factors in both central and peripheral tissues. BDNF is a leading candidate for study in this field due to its extensive role in promoting neuronal survival, neurogenesis, synaptic plasticity, and cognitive function [
15,
49,
50,
51,
52,
53]. Voluntary wheel running in rats results in significant increases in BDNF mRNA in the hippocampus, specifically in the dentate gyrus (DG) and Ammon’s horn areas 1 and 4 (CA1, CA4) [
33], CA3, and cerebral cortex [
54,
55]. Increases in BDNF mRNA are also detected in the spinal cord and skeletal muscle following treadmill training in rats [
56].
Measuring BDNF changes in the brain of human participants is not currently feasible; therefore, investigators use BDNF levels in serum or plasma as a proxy. Serum and plasma BDNF levels rise as a consequence of acute or regular exercise [
47,
57,
58,
59,
60,
61]. Peripheral BDNF found in the bloodstream is derived mainly from vascular endothelial cells, much of which is bound by platelets, where it constitutes a major source of BDNF in serum [
62,
63]. However, whether free BDNF can cross the blood-brain barrier bidirectionally, and whether peripheral BDNF levels reflect BDNF levels in the brain, is controversial. While some studies have shown that brain-derived BDNF can cross the blood-brain barrier and enter the circulation [
64,
65], other studies demonstrate that circulating BDNF does not enter the brain [
66]. Several studies have reported a positive correlation between central and peripheral BDNF levels in animals, suggesting that serum and plasma BDNF levels may reflect brain BDNF levels. A positive correlation was found between hippocampal BDNF levels and plasma BDNF levels in pigs and between BDNF levels in hippocampus and prefrontal cortex and BDNF levels in whole blood and serum of rats [
67,
68,
69]. Interestingly, because mouse platelets do not contain BDNF, this neurotrophin has been undetectable in mouse blood [
67] until the recent advent of a highly sensitive BDNF ELISA [
70]. Consistent with the animal work, human studies of serum or plasma BDNF suggest that exercise-induced increases in peripheral BDNF levels reflect brain BDNF levels. There is evidence of increased serum BDNF levels in younger [
59,
71] and older adults [
57,
72,
73,
74,
75] following exercise training. The increased BDNF levels are correlated with higher memory scores as well as increased hippocampal volume post-exercise training, further supporting the usefulness of peripheral measures for judging central effects [
71,
73,
76,
77].
4. Exercise-induced BDNF reduces APP toxicity by altering its processing
Inactivity is a risk factor for AD [
113,
114,
115,
116,
117]. Of note are the higher levels of circulating Aβ protein in sedentary individuals compared to individuals who exercise [
116,
117,
118] and the correlation between increased circulating Aβ and increased risk of developing AD and MCI [
3]. Both in vitro and in vivo studies show that BDNF reduces amyloidogenic Aβ and decreases its neurotoxic effects [
119,
120,
121], and it may mediate this effect by altering APP processing. Therefore, scientists investigated a possible relationship between BDNF and some of the enzymes involved in APP processing: α-, β-, γ-, and δ-secretase. α-secretase is involved in non-amyloidogenic cleavage of APP, while β- and γ-secretase promote the production of toxic Aβ [
122]. δ-secretase, also known as asparagine endopeptidase (AEP), is a cysteine proteinase activated during aging that cleaves APP. δ-secretase cleavage generates an APP fragment that may be the preferred substrate for β-secretase, thereby enhancing β-secretase cleavage of APP and the production of Aβ [
123]. In the absence of BDNF signalling, δ-secretase expression is increased via C/EBPβ upregulation [
121], while increased BDNF signalling increases Akt phosphorylation of δ-secretase, which inhibits its activity [
124].
In parallel, β-site amyloid precursor protein cleaving enzyme 1 (BACE1 or β-secretase) is an important enzyme responsible for cleaving APP and releasing soluble Aβ peptide (i.e., amyloidogenic pathway). There is evidence that both chronic and acute exercise in mice lead to a reduction of BACE1 content, consequently decreasing Aβ accumulation and improving recognition memory [
125,
126]. Treatment of brain tissue with BDNF yielded a significant reduction in BACE1 activity [
125], while BDNF deprivation yielded increased BACE1 protein levels [
121]. These results suggest another possible mechanism by which BDNF reduces amyloidogenic APP processing, although more studies are needed to elucidate the mechanism of BDNF-induced BACE1 downregulation.
A third possible mechanism by which exercise-induced BDNF reduces Aβ production is by enhancing ADAM10 activity. ADAM10 is the main active component of α-secretase [
127]. As expected, treatment of RA-differentiated human SHSY5Y neural cells with ADAM10 inhibitor significantly increased the production of Aβ. BDNF treatment of SHSY5Y cells significantly reduced Aβ production. However, when cotreated with BDNF and ADAM10 inhibitor, Aβ levels were still significantly higher than controls [
128]. These results suggest that a possible mechanism through which BDNF reduces Aβ toxicity is by enhancing ADAM10 activity. Interestingly, BDNF does not alter ADAM10 protein levels [
126,
128] but enhances its activity by altering its distribution in the cell toward intracellular accumulation, where regulated α-secretase activity occurs, rather than on the cell surface [
128]. Together, these results suggest that possible mechanisms by which exercise-induced upregulation of BDNF reduces AD pathology include increasing α-secretase activity and decreasing β- and δ-secretase levels, shifting the balance of APP processing towards the nonamyloidogenic pathway and reducing Aβ toxicity in the brain.
5. Conclusions
BDNF is a critical molecule for neuronal health and survival, neurogenesis, synaptic plasticity, neuronal excitability, and learning and memory. BDNF deficiency is correlated with mild cognitive impairment, Alzheimer’s disease, Parkinson’s disease, and other neurodegenerative disorders. Physical exercise has produced promising results in improving neurodegenerative- and age-related learning and memory deficits, and its effects are at least partially mediated by upregulating BDNF levels. Here, we reviewed several molecules released in response to exercise that facilitate BDNF upregulation. Uncarboxylated osteocalcin release, induced by IL-6, increases BDNF expression. Osteocalcin-induced upregulation of BDNF is mediated through Gpr158 signalling, which activates a pathway involving IP3/CaMK/CREB. Another exercise-induced molecule is FNDC5/irisin, which is expressed in the brain and is released from muscle post-exercise. Peripheral and central irisin both contribute to learning and memory by stimulating the cAMP/PKA/CREB/BDNF pathway. Future studies should investigate the transporters and mechanisms by which irisin may cross the blood-brain barrier. Moreover, it is important to consider whether peripheral or central irisin is responsible for its effects on cognition post-exercise. Similarly, lactate is released from muscle following exercise and is also produced by astrocytes in the brain. It may be upregulating BDNF expression in the brain by activating NMDA receptors and also stimulating the FNDC5/irisin pathway. Interestingly, lactate-induced induction of the PGC1α/FNDC5/BDNF pathway appears to be dependent on SIRT1, although more investigation is required to confirm this. Exercise-induced BDNF upregulation reduces amyloidogenic Aβ levels. Mechanisms behind this reduction may be by reducing amyloidogenic andpromoting nonamyloidogenic cleavage of APP. Physical exercise is a cost-effective intervention that has demonstrated favorable outcomes in improving cognitive impairment in neurodegenerative diseases such as Alzheimer’s disease. Reviewed here are a few of the many mechanisms involved in the beneficial effects of exercise on the brain. A comprehensive understanding of these mechanisms is key to developing biomarkers and therapeutics to slow cognitive decline.