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BIOMETALS IN
NEURODEGENERATIVE
DISEASES
Page left intentionally blank
BIOMETALS IN
NEURODEGENERATIVE
DISEASES
Mechanisms and Therapeutics
Edited by
Anthony R. White
Cell and Molecular Biology
QIMR Berghofer Medical Research Institute,
Herston, QLD, Australia
Michael Aschner
Department of Molecular Pharmacology
Albert Einstein College of Medicine
Bronx, NY, United States
Lucio G. Costa
Department of Environmental and Occupational
Health Sciences University of Washington
Seattle, WA, United States
Ashley I. Bush
Florey Institute of Neuroscience and Mental Health
University of Melbourne
Parkville, VIC, Australia
Academic Press is an imprint of Elsevier
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Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher (other than
as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our
understanding, changes in research methods, professional practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any
information, methods, compounds, or experiments described herein. In using such information or methods they
should be mindful of their own safety and the safety of others, including parties for whom they have a professional
responsibility.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for
any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from
any use or operation of any methods, products, instructions, or ideas contained in the material herein.
ISBN: 978-0-12-804562-6
Introduction 19 Introduction 67
The Physiology of Copper 20 Metal-Induced Neurotoxicity and Multiple
Copper Toxicity 28 Sclerosis 69
Conclusions 32 Metals and Oxidative Status in Multiple Sclerosis 72
References 32 Metals and Oxidative Status in Clinically
Isolated Syndromes 74
3. The Role of Selenium Conclusions 76
in Neurodegenerative Diseases References 76
BÁRBARA R. CARDOSO, DOMINIC J. HARE,
ASHLEY I. BUSH 6. Metals and Neuroinflammation
STEPHEN C. BONDY
Introduction 35
Selenoproteins and the Selenoproteome 36 Introduction 83
Selenium and Alzheimer’s Mechanisms by Which Metal Elements Can Incite
Disease 42 Immune Activity 84
Parkinson’s Disease 43 The Relation Between Reactive Oxygen and
Other Neurodegenerative Diseases 43 Nitrogen Species and Inflammation 89
Conclusions 44 Conclusions 90
References 44 References 90
v
vi Contents
ix
x Contributors
Hong Jiang Medical College of Qingdao Anna Pino National Institute of Health, Rome,
University; Shandong Provincial Collaborative Italy
Innovation Center for Neurodegenera- Germán Plascencia-Villa The University of
tive Disorders, Qingdao University, Qingdao, Texas at San Antonio (UTSA), San Antonio, TX,
China United States
Katja M. Kanninen A.I. Virtanen Institute for Alejandra Ramírez Muñoz The Florey Institute
Molecular Sciences, University of Eastern of Neuroscience and Mental Health, The Univer-
Finland, Kuopio, Finland sity of Melbourne, Melbourne, VIC, Australia
Henna Konttinen A.I. Virtanen Institute for Giovanni Ristori Center for Experimental Neu-
Molecular Sciences, University of Eastern rological Therapies, S. Andrea Hospital, “Sapi-
Finland, Kuopio, Finland enza” University of Rome, Rome, Italy
Katarína Lejavová A.I. Virtanen Institute for Silvia Romano Center for Experimental Neuro-
Molecular Sciences, University of Eastern logical Therapies, S. Andrea Hospital, “Sapi-
Finland, Kuopio, Finland enza” University of Rome, Rome, Italy
Frank W. Lewis Northumbria University New- Per M. Roos Karolinska Institutet, Institute of
castle, Newcastle, United Kingdom Environmental Medicine, Stockholm, Sweden
Wenjing Luo Fourth Military Medical Univer- Carlo Salustri Institute of Cognitive Sciences and
sity, Xi’an, China Technologies (CNR), Fatebenefratelli Hospital,
Tarja Malm A.I. Virtanen Institute for Molecular Rome, Italy
Sciences, University of Eastern Finland, Kuopio, Marco Salvetti Center for Experimental Neuro-
Finland logical Therapies, S. Andrea Hospital, “Sapi-
Dinamene Marques dos Santos University of enza” University of Rome, Rome, Italy
Lisbon, Lisboa, Portugal Mariacristina Siotto Don Carlo Gnocchi Foun-
Ana P. Marreilha dos Santos University of dation ONLUS, Italy
Lisbon, Lisboa, Portugal Rosanna Squitti IRCCS, Institute Center St. John
Carlo Mattei Center for Experimental Neurolog- of God Fatebenefratelli, Brescia, Italy
ical Therapies, S. Andrea Hospital, “Sapienza” Maria A. Stazi National Institute of Health,
University of Rome, Rome, Italy Rome, Italy
Rosella Mechelli Center for Experimental Peng Su Fourth Military Medical University,
Neurological Therapies, S. Andrea Xi’an, China
Hospital, “Sapienza” University of Rome, Rome,
David Tétard Northumbria University Newcas-
Italy
tle, Newcastle, United Kingdom
Alexandra I. Mot University of Melbourne, Mel-
K. Grace Tipps Vanderbilt University Medical
bourne, VIC, Australia
Center, Nashville, TN, United States
Anne M. Nixon The Pennsylvania State Univer-
Mariacarla Ventriglia Institute of Cognitive Sci-
sity College of Medicine, Hershey, PA, United
ences and Technologies (CNR), Fatebenefratelli
States
Hospital, Rome, Italy
Carlos M. Opazo The Florey Institute of Neuro-
Anthony R. White QIMR Berghofer Medical
science and Mental Health, The University of
Research Institute, Herston, QLD, Australia
Melbourne, Melbourne, VIC, Australia
Miguel José-Yacamán The University of Texas at
George Perry The University of Texas at
San Antonio (UTSA), San Antonio, TX, United
San Antonio (UTSA), San Antonio, TX, United
States
States
Preface
Biological metals (biometals) have key dementia worldwide. With an ageing world
functions in the brain but can also induce de- population, estimates for global Alzheimer’s
generative changes due to abnormalities in disease prevalence are in the order of 115
homeostatic mechanisms. The scientific liter- million patients by 2050. It is therefore fitting
ature in this field is advancing rapidly with that the opening chapter of this book cov-
approximately 300 publications per year ers biometals in Alzheimer’s disease. Mot
adding to our knowledge of how biometals and Crouch (Chapter 1, pp. 1–18) provide a
contribute to neurodegenerative diseases, comprehensive insight into the contribution
such as Alzheimer’s disease, Parkinson’s of biometals including copper, zinc, and iron
disease, motor neuron disease, and others. in several major pathological features of Al-
Despite this rapid increase in our under- zheimer’s disease including amyloid peptide
standing of biometals in brain disease, the aggregation and tau phosphorylation. The
fields of biomedicine and neuroscience have chapter finishes with an insight into where
often overlooked this information. The need therapeutic approaches to biometal modula-
to bring the research on biometals in neuro- tion in Alzheimer’s disease may progress in
degeneration to the forefront of biomedical the future. Staying with the role of biometals
research is essential if we are to understand in Alzheimer’s disease, Squitti et al. (Chap-
neurodegenerative disease processes and ter 2, pp. 19–34) provides a deeper insight
develop effective therapeutics. There are cur- into the role of copper in this disorder, de-
rently few sources of consolidated research scribing the pathways of copper metabolism
on biometals and neurodegeneration that and brain copper handling as well as inter-
are available to biomedical researchers, cli- esting aspects of copper toxicity and the role
nicians, students, and others. This book on of ceruloplasmin and nonceruloplasmin cop-
biometals in neurodegeneration provides an per in Alzheimer’s disease. This is followed
authoritative and timely resource to bring to- by a very interesting insight into a biometal
gether the major findings in the field for ease that receives less coverage than it should,
of access to those working in neuroscience selenium and its role in neurodegeneration.
or biomedicine, or with an interest in metals This biometal forms a critical inorganic com-
and their role in the brain function, disease, ponent of the amino acid selenocysteine,
and as therapeutic targets. which is involved in at least 25 different pro-
Overview of chapters included in Biomet- teins. Abnormal selenium stasis is found in
als in Neurodegenerative Diseases: Mechanisms many forms of leading neurodegenerative
and Therapeutics. diseases, and selenium-based therapeutics
Alzheimer’s disease is the leading form have the potential to make significant im-
of neurodegeneration contributing to the pacts in these disorders as discussed by Car-
majority of an estimated 36 million cases of doso et al. (Chapter 3, pp. 35–50).
xi
xii Preface
The subsequent three chapters by Nixon generative disorder, there are shared comor-
and Connor (Chapter 4, pp. 51–66), Ferral- bidities between ASD and neurodegenerative
deschi et al. (Chapter 5, pp. 67–82) and Ste- disorders including altered biometal stasis
phen Bondy (Chapter 6, pp. 83–94) cover in the brain. Grabrucker and G rabrucker
important aspects of biometals in inflamma- (Chapter 9, pp. 153–174) delve into the role
tion and how this modulates outcomes in of these biometal changes in ASDs, provid-
neurodegeneration. Nixon and Connor et al. ing an interesting account of how biometals
describe how the high iron (Fe) gene, HFE can affect neuro-synaptic functions resulting
genotype, affects macrophage phenotype in in the features that characterize ASD. Al-
disease. Mutations in HFE appear to alter though a rare disorder, motor neuron disease
macrophage (and microglial) iron distribu- (MND) has been the center of recent major
tion with potentially important outcomes international funding efforts. The disease is
for neurodegeneration. Ferraldeschi et al. rapid with most cases fatal in 2–5 years after
follow this with an expanded insight into onset, and no long-term effective treatment
the role of biometals in oxidative-mediated exists. Although the cause in most cases
neuroinflammatory processes, with a more remains unknown, Per Roos (Chapter 10,
detailed focus on biometal effects in mul- pp. 175–194) describes a key role for possible
tiple sclerosis. Bondy then provides a valu- environmental exposure to biometals includ-
able account of the various mechanisms ing lead, manganese, and mercury in disease
leading to biometal-mediated neuroinflam- etiology, and how these metals may contrib-
mation, including the formation of haptens, ute to neuropathological changes. In the last
the production of reactive oxygen and ni- of the chapters covering the general role of
trogen species, the sequestering of reducing biometals in neurodegeneration, Konttinen
capacity and the formation of inflammation- et al. (Chapter 11, pp. 195–216) cover impor-
provoking colloids. tant aspects of biometals in another group of
David Brown (Chapter 7, pp. 95–116) rare disorders, the lysosomal storage diseases
brings us a very informative and insightful (LSDs). Lysosomes are key sites of biometal
account of 20 years of metals research in pri- homeostasis, and abnormalities in lysosomal
on diseases, dispelling some common myths function as occurs in LSDs, leads to signifi-
and providing a comprehensive account of cant biometal abnormalities with potentially
where we have come to in this field. Iron, zinc, major impacts leading to neurodegeneration
copper, and manganese all have key roles in these disorders.
to play in prion protein stasis in diseases, The second half of this volume covers mo-
such as Creutzfeld–Jakob disease. Staying lecular and cellular aspects of metals in brain
with the biometal, manganese, Marques dos health, dysfunction, and neurotoxicity. Lucio
Santos et al. (Chapter 8, pp. 117–152) pro- G. Costa (Chapter 12, pp. 217–230) starts this
vide an in-depth coverage of this element in section with a review of how environmental
neurodegeneration, providing valuable in-
exposure to metals, such as lead and arsenic
formation on the role of manganese in neuro- in early life can affect outcomes in later life
biology, environmental exposure in humans, neurodegeneration including Alzheimer’s
and subsequent pathways to neurotoxicity disease. The mechanism of this predisposi-
and neurodegeneration. tion is unclear but could be related to epigen-
Although autism spectrum disorder (ASD) etic changes induced by biometals. Bichell
is not classically categorized as a neurode- et al. (Chapter 13, pp. 231–264) follow this
Preface xiii
with an account of metal biology in Hun- differentiate the roles of iron, manganese,
tington’s disease including potential iron, and copper in brain disorders. Brain protein
copper, and manganese interactions with a accumulation is a major feature of most neu-
range of homeostatic enzymes and proteins rodegenerative diseases and is often associ-
in the brain. Del Barrio et al. (Chapter 14, ated with impaired mechanisms for clear-
pp. 265–282) return us to Alzheimer’s dis- ance of aggregated or abnormally folded
ease again with a critical insight into the fun- proteins. Ramírez Muñoz et al. (Chapter 18,
damental copper coordination by amyloid pp. 363–376) describe how metals play a
peptide, the major protein form deposited fundamental role in protein clearance and
in Alzheimer’s brains. The review describes how this can be affected by abnormal metal
how copper drives aggregation and reactive homeostasis, contributing further to neu-
oxygen species generation through interac- rodegenerative disease pathology. Related
tion with the amyloid peptide. to this, Su et al. (Chapter 19, pp. 377–398)
Delving deeper into the cells of the brain, contribute a key insight to the role of met-
Plascencia-Villa et al. (Chapter 15, pp. 283– als in autophagic processes. A key cellular
312) explore the role of biometals in mito- mechanism for clearance of unwanted cell
chondrial function and how this contributes material, autophagy is a complex process in-
to a range of neurodegenerative disorders. volving many proteins and subcellular com-
Abnormalities in biometal handling in the partments. Studies have found major impair-
cell powerhouse leads to major outcomes in- ments to autophagy in neurodegenerative
cluding reactive oxygen species formation, diseases and this is now a common putative
abnormal cell signaling, and altered energy therapeutic target. Su et al., explore the role
production with important consequences for of metals in autophagy and how abnormali-
highly metabolic neurons. Another impor- ties to metal homeostasis can contribute to
tant aspect of biometal involvement in neu- pathological autophagic changes.
rodegeneration is biometal transportation. Of course, one of the major reasons for
Changes to key biometal transporters in the increasing our understanding of biometals
brain can have profound effects on the han- in neurodegeneration is to develop thera-
dling and action of copper, zinc, iron, manga- peutic approaches for these disorders. In
nese etc. And conversely, altered metal levels the penultimate chapter, Lewis and Tétard
can affect transporter expression and local- (Chapter 20, pp. 399–414) provide us with a
ization. Hong Jiang (Chapter 16, pp. 313–348) comprehensive overview of metal chelators
provides a comprehensive coverage of metal as potential new treatments for neurodegen-
transporters for the main neuro-metals and eration. The future of these therapeutics ap-
how changes to these transporters can un- pears to be in development of multifunction-
derlie neurodegenerative outcomes. al agents that target metals and additional
One of the most important techniques pathological features of neurodegeneration,
used to understand how biometals contrib- such as oxidative stress. Time will tell if this
ute to neurodegeneration is metal imaging. approach provides much needed advances
David Dorman (Chapter 17, pp. 349–362) in neurodegenerative disease therapeutics.
describes one of the central biometal imag- The final chapter by Kanninen and White
ing techniques applied to neurodegenerative (Chapter 21, pp. 415–438) then takes an
disease, magnetic resonance imaging (MRI), overarching view of biometals in neurode-
and how it can be used to understand and generation and provides a review of the role
xiv Preface
for metalloproteins in many forms of neuro- valuable reference source for many years in
degenerative disease, leading us to consider this major field of neurodegenerative disease
whether neurodegenerative diseases should research.
be categorized as metallopathies.
Whether student, clinician, or specialized Anthony R. White
biometals researcher, we hope that the reader
will be able to gain exciting new insights into Michael Aschner
biometals and neurodegeneration. We be- Lucio G. Costa
lieve that this volume will have an important Ashley I. Bush
place in the medical literature and provide a
C H A P T E R
1
Biometals and Alzheimer’s Disease
Alexandra I. Mot, Peter J. Crouch
University of Melbourne, Melbourne, VIC, Australia
O U T L I N E
INTRODUCTION
Alzheimer’s disease (AD) was first described in 1906 by Dr. Alois Alzheimer, and is now
the third leading cause of death in industrial countries.1 The disease is clinically character-
ized by the progressive loss of memory and other cognitive domains including language,
attention, orientation, and problem solving abilities.2 The biggest risk factor for AD is age,3
and given the ageing population demographic of our society the incidence of AD is likely
to increase in the future. This highlights the urgent need for the development of effective
disease-modifying therapies to halt or slow disease progression. Although the aetiology of
sporadic AD remains largely unknown, the disease is associated with distinct pathological
abnormalities which distinguish the condition from other forms of dementia.4 Macroscopi-
cally, AD is characterized by progressive cortical atrophy particularly of the frontal, parietal,
and temporal lobes.5 Microscopically, the disease is characterized by neuronal and synaptic
loss, extracellular senile plaques composed of aggregated amyloid beta (Aβ) peptides, and
intracellular neurofibrillary tangles (NFTs) composed of hyperphosphorylated forms of the
protein tau.6,7
According to the amyloid cascade hypothesis which was first suggested in 1992, the Aβ
peptide plays a central role in AD pathogenesis.8 The amyloid precursor protein (APP) is
cleaved through one of two pathways by the metalloproteinases α-secretase, γ-secretase, or
1
2 1. Biometals and Alzheimer’s Disease
Copper is a redox-active metal and exists in either oxidized (Cu2+) or reduced (Cu+) valence
states.18 Many enzymes utilize this change in copper oxidation state, in the presence of oxy-
gen, to catalyze redox chemistry for a wide range of important biochemical reactions. Some
important copper-containing enzymes are: Cu/Zn-superoxide dismutase (SOD1), which
converts the superoxide free radical into hydrogen peroxide,19 cytochrome c oxidase (COX)
which plays a key role in the mitochondrial electron transport chain,20 and ceruloplasmin
(Cp) which functions as a ferroxidase to facilitate iron export from cells.21 All of these pro-
teins require copper binding to perform their function, and low copper levels could therefore
lead to oxidative stress, mitochondrial dysfunction, and intracellular iron accumulation, all
of which are observed in AD.22–24 The same chemistry which makes copper useful in biol-
ogy also allows free copper to catalyze the formation of the hydroxyl radical via the Fenton
reaction.25 Therefore, because the free form of the metal is potentially damaging, absorption
and excretion of copper are tightly regulated in the body. Copper transport across cellular
membranes occurs predominantly via the transporters high affinity copper uptake protein
1 (Ctr1) and ATPase copper-transporting alpha and beta polypeptides (ATP7a and ATP7b).26
Neurodegeneration is a feature of both Menkes disease, which is caused by mutations in the
gene encoding ATP7a27,28 and Wilson disease, which is caused by mutations in the gene en-
coding ATP7b.29,30 This demonstrates that copper dysregulation is detrimental to brain health.
In the AD brain overall copper levels are decreased within affected regions31,32 but are
enriched within plaques and neurofibrillary tangles.33 From this a complex picture emerges
where abnormal copper distribution in AD leads to copper deficiency within affected brain
regions. In the healthy brain, postsynaptic N-methyl-D-aspartic acid (NMDA) neurites re-
lease ionic copper into the synaptic cleft, facilitated by ATP7a, at a concentration of around
The Role of Copper in AD 3
15 µM.34,35 Within the synaptic cleft copper causes S-nitrosylation of NMDA receptors, which
inhibits their activation.36 The sequestration of copper within amyloid plaques has been pro-
posed as a mechanism by which the pool of free copper within the synaptic cleft is depleted
leading to increased activation of NMDA receptors.37 In contrast with decreased brain cop-
per levels in AD, the serum and cerebrospinal fluid (CSF) levels of copper are significantly
elevated in AD patients when compared to age-matched controls.38,39 This may correlate with
increased expression of ceruloplasmin (a major copper-binding protein in serum) in AD, al-
though excess copper is not bound to this carrier protein.40 Furthermore, increased serum
copper was reported to correlate well with higher levels of serum peroxides in AD patients.41
Taken together these studies indicate that altered copper distribution in AD brain, serum, and
CSF contributes to disease pathogenesis.
Copper binds to APP in the amino-terminal ectodomain (between residues 142 and 166)42
and catalytically reduces copper (II) to copper (I).43 The structure of the APP copper bind-
ing domain consist of four ligands (His-147, His-151, Tyr-168, and Met-170),42 which show
structural homology to other copper chaperones. As a ubiquitously expressed protein, APP
may play a role in regulating metal ion homeostasis. This is supported by studies which have
shown that chronic copper overload or copper deficiency can both up- and downregulate
APP mRNA expression in mouse fibroblasts.44,45 Furthermore, another study found that a low
copper diet in healthy individuals was associated with decreased APP protein expression in
platelets.46 Conversely, both in vivo and in vitro studies in APP-knockout mice have shown
that copper levels are significantly increased in brain and liver tissues as well as in cortical
neuron and fibroblast primary cultures derived from these animals.47,48 One of these studies
also found that APP-knockout primary cortical neurons are susceptible to copper-induced
toxicity through copper (I) production which caused localized oxidative stress.47 Moreover,
the overexpression of mutant APP in various transgenic mouse lines decreased copper levels
in both in vivo and in vitro contexts.49–51 Additionally, copper promotes an increase in cell
surface APP by increasing its exocytosis and reducing its endocytosis, respectively.52 Collec-
tively these studies indicate that the interaction between copper and APP may contribute to
AD pathogenesis.
Copper binds to the Aβ peptide in a pH-dependent manner and Aβ1–16 has been shown
to be the minimal sequence required for copper binding.53 Between pH 6 and 7, Aβ binds to
copper at Asp1, His6, and His13/14; while at pH 8, the binding sites shift to His6, His13, and
His14.54 At pH 10 or higher, Asp1, Ala2, Glu3, and Phe4 can also form a complex with cop-
per.55,56 Of particular interest is the fact that Aβ purified from human brain plaques contains
fewer histidine residues, which has been explained by copper-mediated oxidation.57 Copper
modifies Aβ by promoting dityrosine crosslinking of the peptide, which may act as a seed to
accelerate Aβ aggregation and induce oligomer formation.58,59 Aβ toxicity is partially depen-
dant on copper and can be attenuated in cell culture by copper chelation.60,61 The mechanism
of copper-Aβ induced cytotoxicity might involve oxidative stress, as the complex catalyti-
cally generates hydrogen peroxide.62 Furthermore, another study found that the copper-Aβ
complex could inhibit COX function thereby impairing mitochondrial energy production.63
Copper also binds to the tau protein and certain fragments in the four-repeat microtu-
bule-binding domain of tau (residues 256–273, 287–304, and 306–336) were shown to ag-
gregate in the presence of copper in vitro.64,65 Furthermore, copper binding to tau induces
hydrogen peroxide production,66 which recapitulates what is observed in AD brains where
4 1. Biometals and Alzheimer’s Disease
copper-containing NFTs are a source of oxidative stress.67 Chronic copper exposure acceler-
ates tau hyperphosphorylation via abnormal cyclin-dependent kinase 5 (Cdk5) activation,
resulting in dissociation of tau from microtubules in an AD mouse model.68 However, copper
delivery drugs have been shown to decrease glycogen synthase kinase 3 beta (GSK-3β)-
dependent tau phosphorylation.69 These studies indicate that copper alters tau phosphoryla-
tion through diverse mechanisms.
Zinc is another transition metal which plays an important role in diverse cellular functions.
With the possible exception of pancreatic β islets, the brain contains the highest concentration
of zinc within the body.70 Within the healthy brain, the majority of zinc is compartmentalized
in membrane-bound metalloproteins (particularly metallothioneins MT-I, II, and III).71 Di-
verse classes of proteins require bound zinc for normal function, including metalloenzymes
(e.g., SOD1), transcription factors, and signaling kinases.72,73 In its free ionic form, zinc in the
brain is highly enriched in glutamatergic nerve terminals where it is released (at concentra-
tions of 1–100 µM) upon neuronal activation.74 Synaptic zinc has a functional role in signal
transmission and acts as an antagonist to NMDA receptors.75 Intracellular zinc uptake is fa-
cilitated by a number of zinc-importing proteins (ZIPs), particularly ZIPs 1–5 and 7–15.76
Zinc uptake can also be mediated by NMDA receptor-dependent voltage-gated L-type Ca2+,
Ca2+-permeable AMPA/kainate channels, and Na+/Zn+ exchangers.77–79 Approximately 50%
of zinc uptake requires the AD-linked presenilin protein, however, the mechanism by which
presenilin contributes to zinc uptake is unknown.80 Intracellular zinc sequestration or export
occurs via the zinc transport (ZnT) protein family. ZnT-2, 5, 7, and 8 are expressed at low
levels within the brain, while ZnT-3 is found in granule, pyramidal, and interneuron cells of
the hippocampus and plays a role in transporting zinc into glutamatergic vesicles.81 Indeed, a
loss of synaptic zinc in ZnT-3-knockout mice causes age-depend cognitive decline,82 demon-
strating the importance of synaptic zinc in brain function.
Bulk tissue analyses of postmortem AD brains have yielded inconsistent results. Earlier
work showed no difference in brain zinc levels between AD and controls,83,84 while latter
studies showed a decrease in zinc levels in several AD brain regions including the neocortex,
superior frontal and parietal gyri, medial temporal gyrus and thalamus, and the hippocam-
pus.85,86 Conflicting reports have, however, also shown elevated zinc levels in multiple AD
brain regions including the amygdala, hippocampus, cerebellum, olfactory areas, and supe-
rior temporal gyrus.31,87 These discrepancies could be a result of the examination of different
brain regions and/or the utilization of different sample preparations (e.g., tissue fixation af-
fects zinc measurement).88 Moreover, bulk tissue analyses are unlikely to reveal changes in
zinc compartmentalization. Indeed, studies have shown that in AD there is a redistribution
of zinc into extracellular plaques and surrounding neuropil.33,89 While the cause of zinc dys-
regulation in AD remains unknown, changes to several proteins involved in zinc homeostasis
including MT-I, MT-II, MT-III, ZnT-1, ZnT-3, ZnT4, and ZnT-6 in AD90–93 are likely to contrib-
ute to the aberrant compartmentalization of zinc within the brain. Interestingly, estrogen can
also modulate levels of ZnT-3 which is of particular significance given that sex is another
major risk factor for AD.94 The serum and CSF levels of zinc are decreased in AD patients
The Role of Iron in AD 5
when compared to age-matched controls,38,95 which could in part be explained by nutritional
deficiency associated with advanced age.17
Zinc binds to APP in a conserved region of amino acids between residues 170 and 188 and
this domain consists of two key cysteine ligands at position 186 and 187, which are crucial
for binding as well as other potential ligands (e.g., Cys174, Met170, Asp177, and Glu184).96,97
Zinc interferes with APP processing by altering the function of key secretases involved in APP
cleavage. A disintegrin and metalloproteinase domain-containing protein 10 (ADAM 10), the
α-secretase involved in the nonamyloidogenic processing of APP, is a zinc-dependent enzyme
and thus zinc increases APP proteolysis.98 Zinc also increases presenilin 1 expression which
facilities cellular zinc uptake,80 although the activity of the γ-secretase complex is inhibited by
zinc.99 Furthermore, the binding of zinc to Aβ within the APP protein sequence can mask the
proteolytic cleavage site,100 thus inhibiting degradation of Aβ by matrix metalloproteases.101
Zinc binds to Aβ between residues 6 and 28 with up to three zinc ions bound to histidines
6, 13, and 14.96,97,100 Zinc binding rapidly induces the aggregation of Aβ into insoluble precipi-
tates, which typify AD pathology.102 Zinc-induced plaque formation in AD is also supported
by the anatomical distribution of plaque and zinc in the brain. Although Aβ is ubiquitously
expressed, plaque formation only occurs in neocortical regions of AD-affected brains which
closely align with the expression of ZnT3.103 APP transgenic mice crossed with ZnT3-knockout
mice exhibited decreased Aβ burden,103 which demonstrates the contribution of endogenous
zinc to amyloid burden in AD. Furthermore, zinc sequestration into amyloid deposits induces
loss of functional zinc in the synapse.102 Synaptic zinc deficiency is further exacerbated in AD
by concomitant loss of ZnT3 expression.33 Therefore, by two mechanisms labile zinc is made
deficient in the brain neuropil in AD.
Zinc can directly bind to tau monomers with moderate affinity, altering its confirmation,
and can induce both the fibrillization and the aggregation of the protein.104,105 Zinc also modu-
lates the translation and phosphorylation of tau by affecting the activities of GSK-3β, protein
kinase B, ERK1/2, and c-Jun N-terminal kinase.106,107 Furthermore, zinc is elevated in neurons
with neurofibrillary tangle pathology.89
Iron is a transition metal which can exist in oxidation states from −2 to +8, but in bio-
logical systems only ferrous (Fe2+) and ferric (Fe3+) states exist. The cycling between Fe2+ and
Fe3+ is utilized in biology for various electron transfer (redox) reactions essential to life.108,109
Furthermore, iron is required for other essential biological processes including: the trans-
port of oxygen (where iron is bound to haemoglobin),110 regulation of protein expression,111,112
cell growth113 and cell differentiation,114 as well as brain development,115 neurotransmitter
synthesis,116 and myelin production.117 Although essential to biological processes, when in
excess, iron is toxic because it can react with oxygen through the Fenton reaction to generate
superoxide anions and hydroxyl radicals,118 which are a source of oxidative stress.119 For these
reasons iron levels are tightly regulated within the body and disruption of these homeostatic
processes can cause either iron-deficient anemia or iron overload disorders.120 Iron homeo-
stasis is maintained via the coordinated action of several proteins including the iron carrier
protein transferrin, the transferrin receptor for iron import, the ferroportin channel for iron
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contentava ogni giorno di venticinque miriadi! [478] Simili spettacoli
durarono quattordici giorni; e mentre Commodo combatteva, noi
Senatori (prosegue Dione) ci raccoglievamo colà coi cavalieri.....
Prorompevamo con altissime grida, nelle solite acclamazioni; e
talvolta esclamavamo: «Signore sei tu, primo, felicissimo; vinci, a
memoria di uomini, Amazonio!»
Molti del popolo neppure entravano nell’Anfiteatro: alcuni poi si
dipartivano dopo essersi arrestati un momento a guardare: chi
indotto dalla vergogna delle cose che ivi si facevano, e chi per
timore. Erasi infatti sparsa la voce che l’Imperatore avea stabilito di
trafiggere con saette gli spettatori: di fare, cioè, ciò che fece Ercole
cogli Stinfalidi. Il popolo, d’altra parte, avea ben donde di ritenere per
vera quella voce che circolava; giacchè non ignorava che quel
mostro una volta riunì in un luogo tutti gli storpi, gli zoppi, ecc.; ed
avendo loro circondato le ginocchia con figure di serpenti, e date ad
essi delle spugne perchè le lanciassero, quasi fossero pietre, e
considerandoli quali giganti, li percosse e li uccise.
«Questo timore [479], era a tutti comune, nè più agli altri che a noi
stessi appartenenti; perciocchè anche a noi senatori tal giuoco fece
che per quella cagione certissimo eccidio avessimo ad aspettarci.
Conciossiachè ucciso avendo egli uno struzzo (Στρουδός), e tagliato
ad esso il capo, si accostò al luogo ove sedevamo; e quel capo
stendendo a noi colla sinistra, colla destra la spada sanguinosa,
nulla disse in vero; il capo suo soltanto crollò, sogghignando colla
bocca, a fine di mostrare che la stessa cosa avrebbe a noi fatta. Per
la qual cosa movendosi molti al riso, perchè quell’atto invece di
timore il riso aveva in noi eccitato, sarebbero stati essi con quella
spada medesima trucidati, se io masticate non avessi le foglie del
lauro che nella corona aveva; e persuaso non avessi agli altri tutti di
fare lo stesso; affinchè con un movimento continuato della bocca,
celare potessimo gli indizi del riso........ Nell’ultimo giorno de’ giuochi
il di lui elmo fu altrove recato per la porta per la quale sogliono fare
uscire i defunti. E da queste cose nacque in tutti l’opinione che la di
lui morte fosse assolutamente vicina».
Sotto l’impero di Commodo, la professione di gladiatore, che prima
era infame per legge, addivenne tanto nobile, che si formò il collegio
Silvano Aureliano, il quale era composto di quattro decurie, ed aveva
a sua disposizione un tempio dedicato a Silvano [480]. Alla stessa
epoca probabilmente rimonta pur anche il collegio degli Arenarî o
Bestiarî, del quale fa menzione una lapide modenese [481].
SALV( d. n.... VC ET
TASIV
VM
(C. I. L. VI, p. 860, n. 83 Addit. 32099).
salvIS . DD nn . theodosio et
placiDO VAlentiniano augg.
aniciVS ACilius Glabrio Faustus (?)
v . c . et inl . praef . urbi restituit (?)
VENANTI
VC
COS
DECIVS MARIVS VE
NANTIVS BASILIVS
VC ET INL PRAEFECTVS
VRBI PATRICIVS CONS a 508
ORDINARIVS ARENAM
ET PODIVM QVAE ABOMI
NANDI TERRAE MOTVS
RVINA PROSTRA
VIT SVMPTV PRoPRIo RESTITviT [559]
«Nel 1810, nella prima arcata in fuori della parte Nord, a sinistra
dell’ingresso, sepolta da calcinacci» [560] si trovò una lapide
opistografa. Nella fronte si legge:
d. n. iNVICTISSIMO
m. auRELIO.
caRINO. PIO
fel. iNVICTO. AVG a. 284/85
chreSIMVS TABVL.
suMMARVM RATIONVM
cuM PROXIMIS ET ADIVtoriB
nuMINI EIVS DICA
TISSIMI