Immunohistochemical distribution and subcellular localization of three distinct specific molecular structures of advanced glycation end products in human tissues

Using three mouse anti-human monoclonal antibodies for advanced glycation end products (AGEs), 6D12, 1F6, and 2A2, we examined the immunohistochemical distribution and localization of AGEs in various organs and tissues obtained from nondiabetic autopsy or biopsy cases (men and women, 41 to 86 years of age). 6D12 recognizes Nepsilon-(carboxymethyl)lysine (CML), a nonfluorescent and non-cross-linked AGE structure, and 1F6 recognizes fluorolink, a fluorescent and cross-linked AGE structure. The epitope of 2A2 is unknown but is different from that of CML and fluorolink or other known AGE structures such as pyrraline, pentosidine, and crosslines. Immunohistochemistry with these monoclonal antibodies revealed the intra- and extracellular accumulation of AGEs in these organs and tissues. By double immunohistochemical staining with two of the three monoclonal antibodies in different combinations, positive reaction products for all three monoclonal antibodies were demonstrated in macrophages widely distributed in various organs and tissues; endothelial cells of endocardium, arteries, veins, and blood capillaries; mesenchymal cells; epithelial or parenchymal cells; blood cells; and extracellular matrix. This result indicates that these three different AGE-specific molecules are formed intracellularly and extracellularly. In some cell types, however, one or two of these specific molecules were not always found together, suggesting that the molecular structures of AGEs and their formation are heterogeneous. Immunoelectron microscopy demonstrated the localization of AGE-labeled immunogold particles in the nuclei, nuclear envelope, mitochondria, endoplasmic reticula, Golgi complexes, endocytic vesicles, lysosomal vacuoles or granules, secretory granules, cytosol, and cell membranes, as well as in the extracellular matrix. In addition, the double histochemical staining method for ceroid/lipofuscin and immunohistochemistry for AGEs demonstrated intralysosomal formation and accumulation of AGEs in ceroid/lipofuscin pigments. These results suggest that the extracellularly produced AGEs are taken up by receptors into the cells and accumulate in secondary lysosomes and that AGEs are formed intranuclearly and/or intracellularly, probably via different metabolic pathways.     

Advanced glycosylation end products in adrenal lipofuscin

The present study examined the presence of advanced glycosylation end products (AGEs) in lipofuscin present in the brain and adrenal gland of aging rats by immunohistochemistry using antibodies raised against AGEs. Lipofuscin identified as yellow to brown granules emitting bright yellow to orange autofluorescence with ultraviolet light were detected in cortical neurons, cerebellar Purkinje cells, and adrenal cells in the inner part of the zona reticularis. However, none of the antibodies visualized lipofuscin in these areas. The outer part of the zona reticularis contained yellow granules emitting a faint orange autofluorescence. These granules were immunostained by an antibody that reacted with AGEs structures unrelated to the carboxymethyllysine moiety. Newly formed adrenal cortical cells are thought to migrate from the outer layer to the inner layer of the zona reticularis. Therefore, our results suggest that glycosylation-related processes are involved in lipofuscinogenesis, at least in its early stage, in the adrenal zona reticularis.     

Immunocytochemical detection of advanced glycated end products in rat renal tissue as a function of age and diabetes

Lifestyle practices and the health promoting environment of hospital nurses This paper examined the lifestyle practices of hospital nurses and the impact of specific interventions in the hospital environment. The perception of nurse as health promoter and as carer of AIDS patients was also examined. A self-administered questionnaire was used to collect data at two different time periods. The sample represented 729 nurses (at pre- and post-time periods), both qualified and student nurses. Qualified nurses reported the highest stress levels while student nurses reported more negative lifestyle practices such as smoking, alcohol consumption and drug use. A greater number of current smokers (29%) consumed alcohol and used drugs than non-smokers. The impact of intervention strategies around compliance with smoking policy and work-site walk routes reduced exposure to passive smoking at work for qualified nurses and increased exercise participation for both groups of nurses. Workplace was identified as the main source of stress which included relationships at work and demands of the job. Hospital nurses experiencing high work stress were more likely to use professional support and personal coping (discuss problems with friends/family, have a good cry and eat more) than others. Nurses believed in the importance of health promotion as part of their work; however, qualified nurses felt more confident and gave more health related information than student nurses. Student nurses perceived a lower risk of contacting AIDS through work and a higher concern/worry in caring for AIDS patients than qualified nurses.     

Importance of advanced glycation end products--AGE products

Recent experimental findings suggest that free oxygen radicals and AGEs may be significantly involved in the onset and development of chronic diabetic complications and Alzheimer's disease. The presented review summarizes knowledge on structure and rise of these products in vitro and in vivo and the chemical and biological properties of advanced glycation endproducts are discussed. Strategy of influencing development and prevention of diabetic complications in the near future involves a potentially promising antiglycation therapy and supplementation by antioxidants.     

Possible significance of advanced glycation end products in serum in end-stage renal disease and in late complications of diabetes

In the present study, we have characterized distribution and pharmacological properties of angiotensin II (Ang II) receptors in human adrenals frozen immediately after removal. Autoradiographic studies indicate that Ang II receptors are present throughout the gland. Co-incubations with DUP 753, a specific antagonist of the AT1 receptor, and with PD 123319, a specific antagonist of the AT2 receptor, reveal that Ang II receptors are mainly of type 2. The AT1 receptors are detected after 16 weeks of gestation at the periphery of the gland. Competition studies and Scatchard analysis reveal a homogenous population of high affinity AT2 binding sites (Kd = 0.68 +/- 0.1 nM). Binding capacities decrease from 1080 +/- 304 fmol/mg protein at 14 weeks to 275 +/- 55 fmol/mg protein at 21 weeks. These results differ from those obtained in adult glands where autoradiographic studies reveal that the AT1 receptors are found mainly in the zona glomerulosa and AT2 receptors mainly in the medulla. These data suggest that the AT2 receptors could be involved in the morphological or functional differentiation of the human fetal adrenal gland.     

Novel analytical approach to monitoring advanced glycosylation end products in human serum with on-line spectrophotometric and spectrofluorometric detection in a flow system

We proposed a simple analytical procedure for measurement of serum advanced glycosylation end products (AGEs) based on simultaneous detection of low-molecular-mass peptides and AGEs with a flow system and two detectors connected on-line: spectrophotometric for peptides (lambda = 280 nm) and spectrofluorometric for AGEs (lambda ex = 247 nm, lambda em = 440 nm). Sample pretreatment was carried out in microcentrifuge tubes: Serum (20 microL) was deproteinized with trichloroacetic acid (480 microL, 0.15 mol/L) and lipids were extracted with chloroform (100 microL). Twenty microliters of the filtered aqueous layer was injected to the flow system and the relation between fluorescence and absorption signals was measured. A peptide-derived AGE calibrator was used for calibration. Within-day and between-day CVs were 6.7% and 9.1%, respectively, at an AGE concentration corresponding approximately to that in healthy individuals. Mean results (+/-SD) in 10 healthy individuals were 10.1% +/- 1.0%, in 21 patients with diabetes without complications 18.0% +/- 6.2%, in 25 patients with complications 24.1% +/- 15.4%, and in 12 diabetic patients in end-stage renal disease 92% +/- 30%. Comparison with an ELISA procedure (x, in arbitrary units/L) yields a regression equation y = 0.713x + 1.24 (Sy [symbol: see text] x = 6777, r = 0.8477, n = 41).     

The pharmacological blockade of protein glycosylation in diabetes mellitus using sulfonylurea derivatives and biguanides

A hypothesis is advanced, according to which substances containing an amino group can compete with glucose in binding with protein groups and inhibiting in this way glycosylation. Screening in vitro experiments with nicotinic acid, nicotinamide, piracetam, panangin, ascorbic acid, bucarban, betanase, and adebit in a concentration of 10(-3) M were performed. Bucarban, betanase, and adebit were found to be capable of inhibiting glycosylation. Daily oral administration of bucarban and adebit in therapeutic doses for one month reduced the blood fructosamine level in rats with alloxan diabetes without changing the level of glycemia.     

Sequencing of two alternatively spliced mRNAs corresponding to the extracellular domain of the rat receptor for advanced glycosylation end products (RAGE)

The phosphorylation of glucose to glucose-6-phosphate, catalyzed by hexokinase, is the first committed step in glucose uptake into skeletal muscle. Two isoforms of hexokinase, HKI and HKII, are expressed in human skeletal muscle, but only HKII expression is regulated by insulin. HKII messenger RNA, protein, and activity are increased after 4 h of insulin infusion; however, glucose uptake is stimulated much more rapidly, occurring within minutes. Studies in rat muscle suggest that changes in the subcellular distribution of HKII may be an important regulatory factor for glucose uptake. The present studies were undertaken to determine if insulin causes an acute redistribution of HKII activity in human skeletal muscle in vivo. Muscle biopsies (vastus lateralis muscle) were performed before and at the end of 30 min insulin infusion, performed using the euglycemic clamp technique. Muscle biopsies were subfractionated into soluble and particulate fractions to determine if insulin acutely changes the subcellular distribution of HKII. Insulin decreased HKII activity in the soluble fraction from 2.20 +/- 0.31 to 1.40 +/- 0.18 pmoles/(min[chempt]micrograms) and increased HKII activity in the particulate fraction from 3.02 +/- 0.46 to 3.45 +/- 0.46 pmoles/(min[chempt]micrograms) (P < 0.01 for both). These changes in HKII activity were correlated with changes in HKII protein, as determined by immunoblot analysis (r = 0.53, P = 0.05). Insulin had no effect on the subcellular distribution of HKII activity, which was primarily restricted to the soluble fraction. These studies are consistent with the conclusion that, in vivo in human skeletal muscle, insulin changes the subcellular distribution of HKII within 30 min.     

Age-related increase in an advanced glycation end product in penile tissue

Nonenzymatic glycosylation (glycation) of proteins, often referred to as the Maillard reaction, has been proposed to play a role in age and diabetes-related processes by forming protein and DNA adducts and cross-links. These cross-links may contribute to erectile dysfunction by scavenging nitric oxide, which is needed for erection. As the basis for a possible role of the advanced Maillard reaction in age-related erectile dysfunction, we investigated the presence of the specific advanced glycation endproduct (AGE) pentosidine in penile corpus cavernosum tissue and penile tunica albuginea tissue as a function of age. A total of 23 penile tissue specimens were obtained at autopsy, from which 19 samples of tunica albuginea and 21 samples of corpus cavernosum were derived. In addition, 13 penile corporal and tunical specimens were procured at the time of insertion of a penile prosthesis, from which 12 tunica albugineal specimens and 10 samples of corpus cavernosum were derived. Collagen was extracted with acetic acid and pepsin digestion, and the final insoluble collagen product was acid-hydrolyzed with 6 N HCL for 24 h at 110 degrees C. Pentosidine was quantified by high-performance liquid chromatography using a reverse-phase column. The level of pentosidine (expressed in picomoles per milligram of insoluble collagen) was found to increase with age in cadaver as well as living penile corporal and tunical albugineal tissues. Best-fit analysis revealed an exponential increase in both types of cadaver penile tissue, with regression equations of y = 15.29 x 10(9.9e-3x), R2 = 0.79, being obtained in the tunica and y = 13.2 x 10(7.63e-3x), R2 = 0.56, in the corpora. These correspond to 6- and 4-fold increases in pentosidine levels from puberty to the age of 100 years (P < 0.05), respectively. Mean pentosidine levels were higher in the tunica than in the corpora. Comparison of pentosidine levels in the tunica versus the corpora revealed a weakly linear correlation (y = 24.88 + 1.08x, R2 = 0.32). Levels in the tunical and corporal specimens from the living human specimens fell with the predicted confidence intervals of the cadaveric tissue. Tunical specimens from patients who underwent repair or revision of a previously inserted penile prosthesis had very low levels of pentosidine. The exponential age-related increase in pentosidine observed in both types of penile tissue suggests an impairment of collagen turnover, which could be related to the advanced glycation reaction in aging. It is not known whether pentosidine itself is directly associated with erectile dysfunction, but its formation is usually accompanied by extensive tissue modification. Formation of advanced Maillard reaction products, which is greatly accelerated in aging, diabetes, and uremia, could contribute to erectile dysfunction in these syndromes.     

Determination of advanced glycation end products in serum by fluorescence spectroscopy and competitive ELISA

Recent studies suggest that advanced glycation endproducts play an important role in cardiovascular complications of ageing, diabetes and end-stage renal failure. Since highly elevated levels of advanced glycation endproducts are present in serum of patients on maintenance haemodialysis, an accurate and rapid assay for their determination would be useful. This would be particularly valuable for monitoring the removal of advanced glycation endproducts by novel dialysis membranes, as well as the effect of new drugs for the inhibition of their formation. Measurement of advanced glycation endproducts in serum was performed by two competitive ELISAs, using a monoclonal antibody directed against imidazolone, an advanced glycation endproduct formed by the reaction of arginine with 3-deoxyglucosone, and a polyclonal antibody directed against keyhole limpet haemocyanin-advanced glycation endproduct, as well as by quantitative fluorescence spectroscopy. Each of the assays showed significant differences between the controls and the maintenance haemodialysis patients. Advanced glycation endproduct levels determined by each of the ELISAs correlated with total and protein-bound fluorescence, but not with each other, suggesting a variable distribution of advanced glycation endproducts on serum proteins among the maintenance haemodialysis patients.     

Deposition of advanced glycation end products (AGE) and expression of the receptor for AGE in cardiovascular tissue of the diabetic rat

Advanced glycation end products (AGE) in tissues are important for the central pathological features of diabetic complication. Although AGE bind to several cell-surface sites, resulting in altered cellular functions, receptor for AGE (RAGE) appears to have a central role. We examined AGE accumulation and RAGE expression in the aorta and heart of rats with streptozotocin (STZ)-induced diabetes, 0, 4, 8, 12, 16 and 24 weeks after STZ administration. Early atherosclerotic findings in the intima and medial thinning were observed in the aorta after 16 weeks of STZ-Induced diabetes. Immunohistochemistry and microscope spectrophotometry showed that AGE deposition increased significantly in the aorta and vessels of the myocardium, depending on the period of hyperglycaemia. RAGE was expressed in the endothelial cells and vascular smooth muscle cells of all animals. The number of smooth muscle cells with RAGE immunoreactivity increased until 12 weeks after STZ injection, and then decreased in rats with diabetes between 16 and 24 weeks. On the other hand, total RAGE mRNA levels in the aorta and heart continued to increase with the duration of hyperglycaemia. Furthermore, AGE-BSA induced RAGE mRNA expression of human umbilical vein endothelial cells in vitro. Taken together, the AGE accumulation might initiate diabetic macroangiopathy through RAGE, and the increase of RAGE expression by endothelial cells could be a reason that diabetes mellitus accelerates atherosclerosis rapidly.     

Renal catabolism of advanced glycation end products: the fate of pentosidine

The CD57(+)HLA-DRbright natural suppressor (57.DR-NS) cell line derived from human decidual tissue generated the apoptosis in K562/Molt4 target cells mediated by soluble factors released into the culture supernatant. The factors in the culture fluid of the 57. DR-NS cell line were isolated by the physicochemical procedures as follows, first by a preparative octadecyl sorbent column, further by thin-layer-chromatography (TLC), finally by reverse-phase high-performance liquid chromatography (HPLC). The six major components (P1-P6) obtained by HPLC demonstrated the generation of apoptotic cell death of target cells. The physicochemical characters of six active components were strongly suggested to be nucleosides and their modified forms in nature. Then, the physicochemical structures of the six active components were finally determined by fast atom bombardment-mass spectrometry (FAB-MS) and nuclear magnetic resonance (1H NMR) spectrometry as follows: P1, 2'-deoxyuridine; P2, ribothymidine; P3, 2'-O-methyluridine; P4, thymidine; P5, 2'-O-methylinosine; P6, 2'-O-methylguanosine. Thus, we collectively named them "apoptosis inducing nucleosides (AINs)." Then, we demonstrated that the induction of apoptosis in target cells by the 57.DR-NS cell line was mediated by a series of AINs.     

Insulin enhances macrophage scavenger receptor-mediated endocytic uptake of advanced glycation end products

Hyperglycemia accelerates the formation and accumulation of advanced glycation end products (AGE) in plasma and tissue, which may cause diabetic vascular complications. We recently reported that scavenger receptors expressed by liver endothelial cells (LECs) dominantly mediate the endocytic uptake of AGE proteins from plasma, suggesting its potential role as an eliminating system for AGE proteins in vivo (Smedsrod, B., Melkko, J., Araki, N., Sano, H., and Horiuchi, S. (1997) Biochem. J. 322, 567-573). In the present study we examined the effects of insulin on macrophage scavenger receptor (MSR)-mediated endocytic uptake of AGE proteins. LECs expressing MSR showed an insulin-sensitive increase of endocytic uptake of AGE-bovine serum albumin (AGE-BSA). Next, RAW 264.7 cells expressing a high amount of MSR were overexpressed with human insulin receptor (HIR). Insulin caused a 3.7-fold increase in endocytic uptake of 125I-AGE-BSA by these cells. The effect of insulin was inhibited by wortmannin, a phosphatidylinositol-3-OH kinase (PI3 kinase) inhibitor. To examine at a molecular level the relationship between insulin signal and MSR function, Chinese hamster ovary (CHO) cells expressing a negligible level of MSR were cotransfected with both MSR and HIR. Insulin caused a 1.7-fold increase in the endocytic degradation of 125I-AGE-BSA by these cells, the effect of which was also inhibited by wortmannin and LY294002, another PI3 kinase inhibitor. Transfection of CHO cells overexpressing MSR with two HIR mutants, a kinase-deficient mutant, and another lacking the binding site for insulin receptor substrates (IRS) resulted in disappearance of the stimulatory effect of insulin on endocytic uptake of AGE proteins. The present results indicate that insulin may accelerate MSR-mediated endocytic uptake of AGE proteins through an IRS/PI3 kinase pathway.     

Specific fluorescence assay for advanced glycation end products in blood and urine of diabetic patients

Late rearrangement products that accumulate by glycation of proteins, known as advanced glycation end products (AGEs), have been implicated in the pathogenesis of complications related to diabetes. Circulating AGEs, especially in the form of a small peptide (AGE-peptide) of less than 10 kd, increase in the blood of diabetic patients with end-stage renal disease (ESRD). The aim of the study was to evaluate AGE-peptide levels by measuring AGE-specific fluorescence (excitation at 370 nm and emission at 440 nm) and to examine the relationship between AGE-peptide and diabetic nephropathy. AGE-specific fluorescence in serum and urine were examined in diabetic subjects with various levels of renal complications of varying severity: normoalbuminuria (N), microalbuminuria (Mi), macroalbuminuria (Ma), chronic renal failure (C), and hemodialysis (HD). We also assessed correlations among the AGE-peptide level and age, duration of diabetes, hemoglobin A1c (HbA1c), serum creatinine, and creatinine clearance. Serum and urine AGE-peptide levels in C and HD were significantly higher than in N, Mi, and Ma. Serum AGE-peptide levels were significantly correlated with serum creatinine (r=.866, P < .0001) and creatinine clearance (r=-.720, P < .0001) but not with duration of diabetes or age. There was a significant correlation between AGE-peptide levels measured by enzyme-linked immunosorbent assay (ELISA) and levels determined from the specific fluorescence intensity (r=.688, P < .0001). These findings suggest that renal function may play a greater role in the accumulation of AGEs than persistent hyperglycemia in diabetic patients. Measurement of AGE-specific fluorescence (ie, AGE-peptide) may serve as a simple and useful test to assess circulating AGE levels and monitor AGE excretion.     

Insulin dependent (type 1) diabetes mellitus in advanced age

In everyday praxis diabetes mellitus diagnosed over the age of fifty years, means generally type 2 diabetes. Authors present cases where diabetes, beginning in advanced age, showed typical classical diabetic symptoms, like polyuria, polydipsia, loss of bodyweight. Apart from these signs a rapid decompensation of carbohydrate metabolism characterises this diabetes form. The most significant features are the rapid decrease of serum immunoreactive insulin and C-peptide levels, what is characteristic for the diminishing insulin secretory capacity. The patients had to be switched to insulin therapy within maximum 6 weeks. These patients can be easily differentiated both from type 2 and from the slowly progressing type 1 subtype. We suppose that the pathomechanism of this type of diabetes differs from the classical insulin-dependent form, beginning in young age.     

Increased advanced glycation end products in atherosclerotic lesions of patients with end-stage renal disease

The purpose of this naturalistic, qualitative study was to describe the meaning of functional performance from the perspective of patients themselves. Twelve men and women with moderate to severe chronic obstructive pulmonary disease (COPD) participated in unstructured, tape-recorded interviews. The essential structure of the experience of finding purpose and meaning through activity was derived through an adaptation of Colaizzi's phenomenological method and the consensus dialogue approach to concept clarification. Results suggest people who are ill face an ongoing challenge of preserving their personal integrity, defined as a satisfying sense of wholeness, as they encounter a variety of physical changes that can interfere with day-to-day activity. Qualities most salient to integrity are a sense of effectiveness, or "being able," and of connectedness, or "being with." Identifying personal integrity as a motivating and explanatory factor in day-to-day activity performance may be an important consideration in designing effective intervention programs to improve capacity, strengthen performance, and enhance quality of life.     

Relationship between vascular endothelial growth factors and advanced glycation end products in the human vitreous

The relation between vascular endothelial growth factor (VEGF) and advanced glycation end product (AGE) is considered a primary factor in the development of diabetic retinopathy. Regarding the relation between VEGF in the vitreous body and pentosidine, an AGE, we compared a diabetic (DM) group (7 eyes) with a nondiabetic (nonDM) group (7 eyes), and investigated the correlation between VEGF and pentosidine by calculating the correlation coefficient. Levels of both VEGF and pentosidine were significantly higher in the DM group (p < 0.01, p < 0.05), and a positive correlation was observed between the levels of VEGF and pentosidine (r = 0.770, p < 0.001). Since it is clear that there is a relation between VEGF and pentosidine in the vitreous body, we speculated that AGE is related to the secretion of cytokine in patients with diabetic retinopathy, and that it affects the development and progression of the disease.