1. Introduction
Axonal damage represents an early-stage neurodegenerative disorder within the central nervous system (CNS). The retina and optic nerve, being accessible regions of the CNS, offer unique substrates for investigating the impact of retinal ganglion cell (RGC) injury on optic nerve axons. The injury to RGCs, coupled with the antero-/retro-grade loss of RGC axons, manifests as a characteristic pathological alteration. Hence, comprehending the molecular mechanisms underlying axonal degeneration holds significant scientific import. Advanced glycation end-products (AGEs) form under hyperglycemic conditions via a non-enzymatic Maillard reaction between proteins and/or amino acids and reducing sugars [
1]. The formation and subsequent accumulation of AGEs in various tissues progress during normal aging, with a notably accelerated pace in type 2 diabetes mellitus (T2DM). Considering that the incidence of Alzheimer's disease (AD) surpasses 2-5 times in patients with T2DM [
2], numerous studies have explored whether T2DM serves as a clinical risk factor for the onset and progression of AD [
3,
4]. Several investigations have delved into the mechanisms underlying AGEs-induced neurotoxicity to elucidate the pathological mechanisms of T2DM-related neurodegeneration. In diabetic retinopathy, AGEs impede normal cellular functions such as axonal transport and intracellular protein trafficking [
5,
6]. Conversely, optic neuropathy, encompassing optic nerve degeneration and RGC loss, has been documented in AD retinas [
7,
8]. Optic neuropathy in AD correlates with AGEs-dependent cell death [
9]. Nonetheless, no reports of AGEs-dependent axonal degeneration are associated with AD or DM.
In our previous work, we demonstrated that glyceraldehyde (GA), a metabolic intermediate of glucose (Glu) and fructose, elicits AD-like changes, including axonal degeneration, and elevates total tau and phosphorylated tau protein levels in an AGEs-dependent manner [
10]. We illustrated that GA-derived AGEs exhibit robust neurotoxicity [
11] and that GA-AGEs display greater neurotoxic effects compared to Glu-AGEs in neuronal cultures, thus designating them as toxic AGEs (TAGE) [
1]. TAGE has been detected in axons and intracellular neuronal cells within the hippocampus and parahippocampal gyrus of patients with AD [
12]. Recently, through proteomics analysis, we identified β-tubulin as one of the proteins targeted by TAGE [
13]. Microtubules consist of repeating units of heterodimers between α-tubulin and β-tubulin, and their assembly is a crucial event implicated in axon outgrowth in vitro models such as SH-SY5Y, a human neuroblastoma cell line. As tau phosphorylation diminishes its binding to microtubules, GA-induced tau phosphorylation leads to axonal degeneration via TAGE-mediated abnormal aggregation of β-tubulin in SH-SY5Y cells [
13]. However, the impact of TAGE-β-tubulin on axonal elongation in the adult mouse optic nerve, particularly in a model utilizing intraocular injection, remains unexplored. Hence, we utilized zymosan, known to induce axonal regeneration in adults following optic nerve injury [
14,
15], to investigate the effects of GA on zymosan-induced axonal elongation in adult mice after optic nerve injury. These findings hold promise for developing novel therapeutic strategies against AGEs-related axonal degeneration disorders within the CNS.
3. Discussion
The alterations observed in the retina of patients with AD are linked to neuronal degeneration and loss, optic nerve degeneration, accumulation of amyloid-beta (Aβ) in the optic disk, and visual functional impairment [
7,
17,
18]. Similar mechanisms of neurodegeneration observed in the brain have been demonstrated in retinal neurons, including RGCs and the optic nerve, in the eyes of patients with AD [
19]. In contrast, normal visual function relies on the proper functioning of retinal neurons; thus, the loss of neuronal function must underlie vision impairment in diabetes [
20]. Recent studies suggest that retinal degeneration in diabetes may result not only from vasculopathy but also from neuropathy, encompassing both neuronal and axonal loss [
21]. AGEs play a pivotal role in the progression of diabetic retinopathy, contributing to dysfunction and various losses of retinal neurons [
22]. Moreover, the extent of AGEs immunolabeling was higher in older donor eyes than that in younger ones [
23]. Elevated levels of AGEs in RGCs and the optic nerve head signify axonal degeneration and visual loss, even in eyes affected by glaucoma [
23].
Bikbova et al. reported that various AGEs, including Glu-AGEs and glyceraldehyde-AGEs (GA-AGEs), can induce apoptosis in retinal neurons and reduce the number of regenerating neurites in a retinal explant culture system [
24]. Accumulating evidence suggests that cell death in retinal neurons and neurite abnormalities are linked to the early development of diabetic retinopathy [
25]. However, the underlying mechanism remains elusive. This study aimed to explore the association between AD-related and AGEs-dependent axonal degeneration in the optic nerve in diabetes mellitus (DM). While most research on AD has centered on Glu-AGEs, we previously reported the critical involvement of α-hydroxyaldehydes, such as GA, a metabolic intermediate of Glu and fructose, and glycolaldehyde, including glyoxal, methylglyoxal, and 3-deoxyglucosone, in protein glycation. GA-derived AGEs exhibit higher cytotoxicity than other sugar-dependent AGEs, including Glu-AGEs [
26]. Hence, GA-AGEs are also referred to as TAGE. TAGE have been detected in the axons and cytosol of neuronal cells in the hippocampus and parahippocampal gyrus of the brain tissues of patients with AD, but not in senile plaques (SP) or glial cells [
27]. In contrast, Glu-AGEs were found in SP amyloid cores and astrocytes. Additionally, TAGE were exclusively detected intracellularly, while Glu-AGEs were found both intra- and extracellularly. Based on this evidence, TAGE may represent a promising candidate for treating neurodegeneration in patients with AD.
In our previous study, GA was found to reduce Aβ42 levels in culture media [
10]. Additionally, GA elevated the intracellular levels of total tau and phosphorylated tau in the human neuroblastoma cell line SH-SY5Y [
10]. Through proteomics analysis using matrix-assisted laser desorption ionization-time of flight mass spectrometry, we identified β-tubulin as a target protein of TAGE. Microtubules, composed of α- and β-tubulin heterodimers, play a crucial role in neurite outgrowth. In our SH-SY5Y cell model, GA facilitated the formation of TAGE-β-tubulin and abnormal β-tubulin aggregation, resulting in the inhibition of axonal elongation [
13]. Interestingly, β-tubulin can also undergo glycation by Glu in a DM experimental model [
28]. However, under our experimental conditions, Glu did not induce abnormal β-tubulin aggregation or inhibit neurite outgrowth [
13]. GA is derived from two distinct pathways: the glycolytic and fructose metabolic pathways [
29]. In hyperglycemic conditions, increased intracellular Glu stimulates the polyol pathway to generate fructose in insulin-independent nerve tissue [
30]. Fructose is further metabolized to dihydroxyacetone phosphate and GA by aldolase [
31]. Consequently, GA production is promoted. Aldolase proteins are expressed in RGCs and other retinal cell layers [
32]. However, a high-fructose diet has been shown to induce retinopathy by suppressing synaptic plasticity [
33]. Elevated levels of the fructose transporter have been detected in diabetic retinopathy [
34]. These findings suggest that both GA and TAGE are produced in the retinas of patients with diabetes.
Previous studies have demonstrated that PM, a natural form of vitamin B
6, acts as an inhibitor of AGEs [
35]. PM suppresses the formation of TAGE-β-tubulin and alleviate the GA-induced inhibition of axonal elongation. Vitamin B
6 encompasses three subtypes: PM, pyridoxal, and pyridoxine. PM can trap aldehyde groups via its amino group, thereby preventing the formation of AGEs under physiological conditions. PM can effectively suppress AGEs formation in various proteins both in vitro and in vivo, thereby preventing the development of diabetic complications such as hemoglobin glycation and lipoxidation reactions [
36,
37]. These compounds, including PM, serve as potent AGEs inhibitors, attenuating diabetes-related nephropathy, neuropathy, and retinopathy [
38]. Moreover, a deficiency in vitamin B
6 is associated with abnormal nerve growth, contributing to conditions such as schizophrenia, depression, and central neuropathy [
39]. Additionally, PM inhibits the early development of retinopathy in experimental diabetic models [
40].
In this study, intraocular injection of GA increased the TAGE levels in the GCL and NFL. Furthermore, GA induced β-tubulin aggregation and inhibited zymosan-induced axonal elongation even in vivo. Benowitz et al. reported that zymosan induces macrophage invasion and appears to release trophic factors such as oncomodulin, stromal cell-derived factor 1, and CCL5 chemokine that can promote axonal elongation [
41,
42,
43].
Tau proteins, integral components of paired helical filaments, exhibit distinct characteristics such as high aggregation propensity and hyperphosphorylation [
44,
45]. In neurodegenerative conditions such as AD, tau dissociates from microtubules within neurofibrillary tangles and aggregates in the cytosol, facilitating self-aggregation and phosphorylation [
45]. Consequently, abnormal β-tubulin aggregation may increase the detachment of tau proteins from microtubules. While the precise mechanism remains unknown, the elevation in total tau levels is believed to stem from axonal loss [
46]. Recent studies have highlighted GA ability to induce AD-like alterations in vitro [
47,
48]. Piccirillo et al. documented GA-induced phosphorylation of tau at T212 and T214, while another study illustrated the impact of GA on tau phosphorylation at S199 and S396, alongside reduced axonal outgrowth [
49,
50]. Consequently, tau proteins become hyperphosphorylated at various sites, aggregating into neurofibrillary tangles within AD patient brains. Notably, tau phosphorylation at T181, T217, and T231 in CSF is a promising biomarker for AD diagnosis [
51]. T217 and T231 are indicative of postsynaptic pathology, while T181 marks axonal abnormalities [
52]. In our recent study, TAGE-β-tubulin accelerated abnormal aggregation and hindered neurite outgrowth, accompanied by T181 phosphorylation [
10,
13]. Similar outcomes were observed in the retinal optic nerve model. Further investigations are warranted since the detailed mechanisms underlying GA-induced β-tubulin aggregation and tau phosphorylation remain elusive.
While our study provides valuable insights into the pathogenic mechanisms underlying visual dysfunction in DM and AD, several limitations warrant consideration. First, the use of animal models may not fully capture the complexity of human disease progression, potentially limiting the translational relevance of our findings. Additionally, our study focused on a single time point analysis, precluding a comprehensive assessment of the long-term effects of GA-induced β-tubulin aggregation and neurite outgrowth inhibition. Furthermore, while we elucidated the involvement of AGEs in mediating neurodegeneration, the specific molecular mechanisms remain incompletely understood. Addressing these limitations in future research endeavors could provide a more comprehensive understanding of visual dysfunction in these debilitating conditions.
Figure 1.
GA increased TAGE-β-tubulin and β-tubulin aggregation in retina in a time-dependent manner. (A) TAGE were measured using slot blot analyses with anti-TAGE antibody. Graphical representation of TAGE bands in a slot blot. **p < 0.01, *p < 0.05 vs 0 days (n=3). (B–E) The levels of β-tubulin aggregation were detected using anti-β-tubulin antibody. (B) Western blot data obtained using anti-β-tubulin antibody. U: Upper band, L: Lower band, M: Monomer band. (C) The levels of the upper bands of the GA-treated β-tubulin band. (D) The levels of the lower bands of the GA-treated β-tubulin band (E) The levels of the monomer β-tubulin bands of GA-treated. **p < 0.05 vs. 0 day (n = 3).
Figure 1.
GA increased TAGE-β-tubulin and β-tubulin aggregation in retina in a time-dependent manner. (A) TAGE were measured using slot blot analyses with anti-TAGE antibody. Graphical representation of TAGE bands in a slot blot. **p < 0.01, *p < 0.05 vs 0 days (n=3). (B–E) The levels of β-tubulin aggregation were detected using anti-β-tubulin antibody. (B) Western blot data obtained using anti-β-tubulin antibody. U: Upper band, L: Lower band, M: Monomer band. (C) The levels of the upper bands of the GA-treated β-tubulin band. (D) The levels of the lower bands of the GA-treated β-tubulin band (E) The levels of the monomer β-tubulin bands of GA-treated. **p < 0.05 vs. 0 day (n = 3).
Figure 2.
TAGE immunoreactivity was colocalized with β-tubulin in retina by GA intraocular injection. (A,D,G) Immunoreactivity of TAGE was increased in GCL and NFL at 1–3 days after intraocular injection of GA (A) 0 day, (D) 1 day, (G) 3 days. (B,E,H) Immunoreactivity of β-tubulin, (B) 0 day, (E) 1 day, (H) 3 days. (C,F,I) Merged images. Scale =100 μm.
Figure 2.
TAGE immunoreactivity was colocalized with β-tubulin in retina by GA intraocular injection. (A,D,G) Immunoreactivity of TAGE was increased in GCL and NFL at 1–3 days after intraocular injection of GA (A) 0 day, (D) 1 day, (G) 3 days. (B,E,H) Immunoreactivity of β-tubulin, (B) 0 day, (E) 1 day, (H) 3 days. (C,F,I) Merged images. Scale =100 μm.
Figure 3.
PM inhibited TAGE formation and β-tubulin aggregation by GA in retina. (A) TAGE were measured using slot blot analyses with anti-TAGE antibody. Graphical representation of TAGE bands in a slot blot. ** p < 0.01, * p < 0.05 vs. vehicle control. + p < 0.01 vs. GA alone (n=3). (B) The levels of β-tubulin were detected using anti-β-tubulin antibody. U: Upper band, L: Lower band, M: Monomer band. (C-E) The levels of upper (C), lower (D) and monomer (E) bands of the GA-treated β-tubulin. **p < 0.05 vs. vehicle control, +p < 0.01 vs. GA alone (n=3).
Figure 3.
PM inhibited TAGE formation and β-tubulin aggregation by GA in retina. (A) TAGE were measured using slot blot analyses with anti-TAGE antibody. Graphical representation of TAGE bands in a slot blot. ** p < 0.01, * p < 0.05 vs. vehicle control. + p < 0.01 vs. GA alone (n=3). (B) The levels of β-tubulin were detected using anti-β-tubulin antibody. U: Upper band, L: Lower band, M: Monomer band. (C-E) The levels of upper (C), lower (D) and monomer (E) bands of the GA-treated β-tubulin. **p < 0.05 vs. vehicle control, +p < 0.01 vs. GA alone (n=3).
Figure 4.
PM dose-dependently suppressed TAGE- formation in GCL and NFL. (A-D) PM dose-dependently suppressed TAGE formation in GCL and NFL in retina. (A) 0 day, (B) GA, (C) GA plus 250 μM PM, (D) GA plus 500 μM PM. Scale=100 μm.
Figure 4.
PM dose-dependently suppressed TAGE- formation in GCL and NFL. (A-D) PM dose-dependently suppressed TAGE formation in GCL and NFL in retina. (A) 0 day, (B) GA, (C) GA plus 250 μM PM, (D) GA plus 500 μM PM. Scale=100 μm.
Figure 5.
Axonal elongation induced by GA was dependent on TAGE. (A–D) Longitudi nal sections of the adult mouse optic nerve showing GAP-43 positive axons extending over the injury site (asterisks) after 10 days optic nerve injury. Scale =100 μm. (A) vehicle control. (B) Zymosan, (C) Zymosan plus GA, (D) Zymosan plus GA plus PM. (E) Quantification of axonal elongation at 250 μm distal point from the injury site. **p < 0.05 vs. vehicle control. +p < 0.05 vs zymosan alone. #p < 0.01 vs. zymosan plus GA (n =8, 6 mice per each group).
Figure 5.
Axonal elongation induced by GA was dependent on TAGE. (A–D) Longitudi nal sections of the adult mouse optic nerve showing GAP-43 positive axons extending over the injury site (asterisks) after 10 days optic nerve injury. Scale =100 μm. (A) vehicle control. (B) Zymosan, (C) Zymosan plus GA, (D) Zymosan plus GA plus PM. (E) Quantification of axonal elongation at 250 μm distal point from the injury site. **p < 0.05 vs. vehicle control. +p < 0.05 vs zymosan alone. #p < 0.01 vs. zymosan plus GA (n =8, 6 mice per each group).
Figure 6.
PM decreased the levels of tau-phosphorylation by GA. (A) Western blot bands. (B) Graphical representation of T-tau and (C) P-tau levels in the western blot. **p < 0.01 vs. vehicle control, +p < 0.01 vs. GA alone (n=3).
Figure 6.
PM decreased the levels of tau-phosphorylation by GA. (A) Western blot bands. (B) Graphical representation of T-tau and (C) P-tau levels in the western blot. **p < 0.01 vs. vehicle control, +p < 0.01 vs. GA alone (n=3).