Cited by 180Alzheimer's disease research and treatmentsNeuroscience and Neuropharmacology ResearchAmino Acid Enzymes and Metabolism

The DOI matches its Crossref record; 142 of the 144 references it cites were found in a registry or an index; none of the 68 sources its claims cite is checked for support yet.

Alzheimer’s disease: targeting the glutamatergic system

Open access
Conway, Myra E.·2020·Biogerontology

Abstract

Alzheimer’s disease (AD) is a debilitating neurodegenerative disease that causes a progressive decline in memory, language and problem solving. For decades mechanism-based therapies have primarily focused on amyloid β (Aβ) processing and pathways that govern neurofibrillary tangle generation. With the potential exception to Aducanumab, a monotherapy to target Aβ, clinical trials in these areas have been challenging and have failed to demonstrate efficacy. Currently, the prescribed therapies for AD are those that target the cholinesterase and glutamatergic systems that can moderately reduce cognitive decline, dependent on the individual. In the brain, over 40% of neuronal synapses are glutamatergic, where the glutamate level is tightly regulated through metabolite exchange in neuronal, astrocytic and endothelial cells. In AD brain, Aβ can interrupt effective glutamate uptake by astrocytes, which evokes a cascade of events that leads to neuronal swelling, destruction of membrane integrity and ultimately cell death. Much work has focussed on the post-synaptic response with little insight into how glutamate is regulated more broadly in the brain and the influence of anaplerotic pathways that finely tune these mechanisms. The role of blood branched chain amino acids (BCAA) in regulating neurotransmitter profiles under disease conditions also warrant discussion. Here, we review the importance of the branched chain aminotransferase proteins in regulating brain glutamate and the potential consequence of dysregulated metabolism in the context of BCAA or glutamate accumulation. We explore how the reported benefits of BCAA supplementation or restriction in improving cognitive function in other neurological diseases may have potential application in AD. Given that memantine, the glutamate receptor agonist, shows clinical relevance it is now timely to research related pathways, an understanding of which could identify novel approaches to treatment of AD.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review argues that dysregulated brain glutamate handling—especially failed astrocytic glutamate uptake and altered branched-chain amino acid (BCAA)/branched-chain aminotransferase (BCAT) metabolism—contributes to Alzheimer’s disease (AD) excitotoxicity and cognitive decline. It highlights BCAT and glutamate as candidate biomarkers/targets and suggests BCAA supplementation or restriction may merit study in AD, though current evidence is largely indirect.

Key findings

  • Over 40% of neuronal synapses are glutamatergic; synaptic cleft glutamate is about 0.6 μM at rest and rises to 10 μM during excitation. In AD, Aβ interrupts astrocytic glutamate uptake, evoking neuronal swelling, membrane damage, and cell death; in vitro, toxic glutamate left Ca²⁺ elevated for about 1 h and 84% of neurons died over 24 h.
  • ¹H MRS studies show lower glutamate/glutamine (Glx) in the posterior cingulate cortex in AD, reduced NAA in posterior cingulate and bilateral hippocampus (p < 0.005), decreased NAA/Cr and increased mI/Cr ratios, and reduced GABA/Glx/NAA in amnestic MCI correlated with CERAD word-learning performance.
  • Human BCATc is neuron-specific, strongest in parietal cortex, with hippocampal CA3 staining more intense than CA1; AD brain shows regional increases in BCATc in hippocampus CA1/CA4 and more widespread BCATm increases in frontal and temporal regions, also reported in dementia with Lewy bodies and vascular dementia. Serum BCAT was higher in AD than age-matched controls, and a combined BCAT/glutamate/MoCA model distinguished control from AD with sensitivity 1.00 and specificity 0.978.
  • Tracing studies indicate about 30% of the nitrogen in glutamate/glutamine derives from leucine alone; BCAT2 mutations cause mild cognitive impairment and brain lesions, MSUD involves toxic BCAA/BCKA accumulation, and TBI is associated with decreased plasma BCAAs with BCAA supplementation improving cognition in some cases. In SH-SY5Y cells, leucine reduced BCATc-induced autophagy and Aβ accumulation.

Methods

  • Narrative review; no systematic review protocol, meta-analysis, or primary experimental design is stated. It synthesizes published literature and the authors’ prior human, animal, and in vitro work.
  • Evidence discussed includes human post-mortem brain immunohistochemistry, serum biomarker/cognitive/MRI studies, ¹H MRS studies, rodent and in vitro models, and genetic disorder case reports.
  • Main analysis is qualitative synthesis linking BCAT/BCAA metabolism to brain glutamate regulation, excitotoxicity, and AD pathology, with proposed mechanistic models.

Limitations

  • Paper-stated: the serum BCAT/glutamate biomarker study was limited by its timeframe, and a longitudinal study is needed to define utility as biomarkers. Further studies are required to determine the impact of increased BCAT levels in AD brain.
  • Paper-stated: mechanisms underlying brain damage in patients with BCAT2 mutations are not well established; few studies report Aβ aggregates measured by PET and their association with ¹H MRS; debate exists about the actual synaptic glutamate concentration.
  • Evident: as a narrative review, it lacks systematic search/quality appraisal and new primary data; many mechanistic claims rely on cited models and the authors’ own prior studies, so the causal role of BCAT changes in AD remains proposed rather than established.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1007/s10522-020-09860-4

Cites

142 of 142 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Figures

Fig. 1 Amyloid precursor protein processing pathways.APP undergoes either α or β secretase processing generating the secretory APPα subunit or the secretory APP β subunit, respectively. Subsequent cleavage by γ-secretase generates the p3 peptide and Aβ for the amyloidogenic and non-amyloidogenic pathway, respectively. (Moraes and Gaudet 2018) with permission from Oxford University Press
Fig. 1 Amyloid precursor protein processing pathways.APP undergoes either α or β secretase processing generating the secretory APPα subunit or the secretory APP β subunit, respectively. Subsequent cleavage by γ-secretase generates the p3 peptide and Aβ for the amyloidogenic and non-amyloidogenic pathway, respectively. (Moraes and Gaudet 2018) with permission from Oxford University PressCC BY · PubMed Central
Fig. 2 BCAT metabolism in the human brain. Leucine (∆) readily crosses the blood brain barrier and undergoes BCATc transamination in neuronal cells producing glutamate. Excess glutamate generated during excitation is taken up by astrocytes, where glutamate is regenerated through the glutamate/glutamine cycle. Glutamate may also be removed by endothelial cells of the vasculature. (Image generated using BioRender)
Fig. 2 BCAT metabolism in the human brain. Leucine (∆) readily crosses the blood brain barrier and undergoes BCATc transamination in neuronal cells producing glutamate. Excess glutamate generated during excitation is taken up by astrocytes, where glutamate is regenerated through the glutamate/glutamine cycle. Glutamate may also be removed by endothelial cells of the vasculature. (Image generated using BioRender)CC BY · PubMed Central
Fig. 3 Branched chain amino acid (BCAA) oxidation. Transamination of the BCAAs, leucine, isoleucine and valine with α-keto glutarate forming the respective α-keto acids, (BCKAs: α-ketoisocaproate (KIC), α-keto-β-methylvalerate (KMV) and α-ketoisovalerate (KIV)) and glutamate, regenerating the enzyme. Subsequent oxidation by the branched chain α-keto acid dehydrogenase complex generates the branched chain acyl CoA, which enter the TCA cycle. Glutamate can be further metabolised by glutamate dehydrogenase to generate glutamine. (Adapted from Conway and Hutson 2016)
Fig. 3 Branched chain amino acid (BCAA) oxidation. Transamination of the BCAAs, leucine, isoleucine and valine with α-keto glutarate forming the respective α-keto acids, (BCKAs: α-ketoisocaproate (KIC), α-keto-β-methylvalerate (KMV) and α-ketoisovalerate (KIV)) and glutamate, regenerating the enzyme. Subsequent oxidation by the branched chain α-keto acid dehydrogenase complex generates the branched chain acyl CoA, which enter the TCA cycle. Glutamate can be further metabolised by glutamate dehydrogenase to generate glutamine. (Adapted from Conway and Hutson 2016)CC BY · PubMed Central
Fig. 4 Medulla BCATc and BCATm staining. a BCATc staining of the inferior olivary nucleus. b Antigen incubation of serial section, at 200× molar excess. c Increased magnification of the inferior olivary nucleus showing staining of small neurons (large arrow) and neuropil staining (small arrow) along with immunonegative hylum (*). d BCATm staining of the inferior olivary nucleus. e Antigen incubation of serial section, at 200× molar excess. f Vessel staining (*) within the amiculum of the inferior olivary nucleus. Scale bar: a, b, d and e 200 μm; c and f 100 μm. (Hull 2012)
Fig. 4 Medulla BCATc and BCATm staining. a BCATc staining of the inferior olivary nucleus. b Antigen incubation of serial section, at 200× molar excess. c Increased magnification of the inferior olivary nucleus showing staining of small neurons (large arrow) and neuropil staining (small arrow) along with immunonegative hylum (*). d BCATm staining of the inferior olivary nucleus. e Antigen incubation of serial section, at 200× molar excess. f Vessel staining (*) within the amiculum of the inferior olivary nucleus. Scale bar: a, b, d and e 200 μm; c and f 100 μm. (Hull 2012)CC BY · PubMed Central
Fig. 5 Increased hBCATc expression in the hippocampus of AD brains. CA4 region of the hippocampus in a control (a) and AD brain (b) showing intensely labelled neurons (large arrows) and the granule cell layer (dotted line). CA1 region of the hippocampus in a control (e) and AD (f) subject showing intensely labelled neurons (large arrows). c, d, g, h The slides were scored on a 0–3 scoring system and analyzed for significance using the Wilcoxon-Mann-Whitney test in Minitab™ as described in materials and methods. i Western blot analysis of hippocampal tissue. The density of each band was measured using ImageJTM software (Wayne Rasband, National Institute of Health, USA) and analyzed for significance using a one-way ANOVA test in Minitab™. j Interquartile range (box) sample variability (whiskers) and the median (horizontal line within the interquartile range) are shown. Magnification for a, b, e, and f, ×10. Scale bar: 200 μm. (Reprinted from Hull et al. (2015a) with permission from IOS Press)
Fig. 5 Increased hBCATc expression in the hippocampus of AD brains. CA4 region of the hippocampus in a control (a) and AD brain (b) showing intensely labelled neurons (large arrows) and the granule cell layer (dotted line). CA1 region of the hippocampus in a control (e) and AD (f) subject showing intensely labelled neurons (large arrows). c, d, g, h The slides were scored on a 0–3 scoring system and analyzed for significance using the Wilcoxon-Mann-Whitney test in Minitab™ as described in materials and methods. i Western blot analysis of hippocampal tissue. The density of each band was measured using ImageJTM software (Wayne Rasband, National Institute of Health, USA) and analyzed for significance using a one-way ANOVA test in Minitab™. j Interquartile range (box) sample variability (whiskers) and the median (horizontal line within the interquartile range) are shown. Magnification for a, b, e, and f, ×10. Scale bar: 200 μm. (Reprinted from Hull et al. (2015a) with permission from IOS Press)CC BY · PubMed Central
Fig. 6 BCAT metabolism in the human brain. Under conditions where excitotoxicity persists, astrocytes are ineffective at clearing excess glutamate. This results in the post synaptic overstimulation of NMDA receptors causing calcium overload and ROS-related cell death. Moreover, levels of BCATc are increased in glutamatergic neurons, increasing the synthesis of glutamate, exacerbating neuronal toxicity. (Image generated using BioRender)
Fig. 6 BCAT metabolism in the human brain. Under conditions where excitotoxicity persists, astrocytes are ineffective at clearing excess glutamate. This results in the post synaptic overstimulation of NMDA receptors causing calcium overload and ROS-related cell death. Moreover, levels of BCATc are increased in glutamatergic neurons, increasing the synthesis of glutamate, exacerbating neuronal toxicity. (Image generated using BioRender)CC BY · PubMed Central

Verification

Claims the paper makes

48 Not checked yet · 21 Own interpretation · 8 Own result · 1 Own method · 1 No basis given

Verify all 66 references — free account
  • It may state two separate claims as one. 38
  • Probably not a substantial claim. 10
43 of 43
  • The paper relies on this without support.

    There is little insight into how glutamate is regulated more broadly in the brain and the influence of anaplerotic pathways.

    “Much work has focussed on the post-synaptic response with little insight into how glutamate is regulated more broadly in the brain and the influence of anaplerotic pathways that finely tune these mechanisms.”
  • The paper relies on this without support.

    The number of plaques generated does not always reflect disease severity.

    “Whilst defective amyloid precursor protein (APP) processing and Aβ aggregation more than likely contribute to AD pathology the number of plaques generated do not always reflect disease severity, indicating that other factors, such as genetics and environmental cues, have a role in disease progression.”
  • The paper relies on this without support.

    Confirmation of AD can only be given at autopsy when morphological and histological examinations have been validated.

    “Confirmation of AD can only be given at autopsy when morphological and histological examinations have been validated.”
  • The paper relies on this without support.

    The aetiology of AD is not well understood.

    “The aetiology of AD is not well understood, but is often characterised as early-onset familial AD (less than 65 years of age) and late onset AD (greater than 65 years of age) (Tellechea et al. 2018; Wattmo and Wallin 2017).”
  • The paper relies on this without support.

    The redox switch is unique to these aminotransferases.

    “This redox switch is unique to these aminotransferases and has been shown to be important in regulating metabolite shuttling between the BCKD complex and GDH (Islam et al. 2007).”
  • The paper relies on this without support.

    Neuronal damage due to prolonged high brain BCAA concentrations was reported using MRS imaging.

    “Neuronal damage due to prolonged high brain BCAA concentrations was reported using MRS imaging.”
  • The paper relies on this without support.

    BCAAs and aromatic amino acids utilise the same transporters to access the brain.

    “The BCAAs and aromatic amino acids utilise the same transporters to access the brain.”
  • The paper relies on this without support.

    BCAA are important nutrient signals in regulating brain Glu.

    “As the BCAA are important nutrient signals in regulating brain Glu, a decrease would signal a reduction in brain repair and dysregulation of glutamate metabolism.”
  • The paper relies on this without support.

    Memantine does not cure AD but can improve memory, awareness, and the ability to carry out day-to-day activities.

    “Although it does not cure AD it can improve memory, awareness and the ability to carry out day-to-day activities.”
  • The paper relies on this without support.

    Memantine only targets the NMDA receptor; it reduces excitotoxicity but does not address other aspects of brain glutamate regulation.

    “However, this medication only targets the NMDA receptor, which although reduces excitotoxicity, it does not address other aspects of brain glutamate regulation.”
  • The paper relies on this without support.

    Excess or limiting dietary BCAAs cause neurological dysfunction, reducing cognitive function.

    “Excess or limiting dietary BCAAs cause neurological dysfunction, reducing cognitive function.”
11 of 11

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

4 of 4

Citations

Cites

Show all 144 references

Cited by

Sorted by citations

See all 180

Metadata

Authors
Conway, M. E.
Affiliations
University of the West of England (GB)
Corresponding author
Conway, Myra E.
Venue
Biogerontology
Published
2020-02-11
Volume
21
Issue
3
Pages
257-274
ISSN
  • 1389-5729 (ISSN-L)
  • 1573-6768
OpenAlex
W3006557860
Cited by
180
References
144
Citations by year
2026: 18 · 2025: 28 · 2024: 37 · 2023: 24 · 2022: 41 · 2021: 22 · 2020: 9
FWCI
3.09
Type
journal article
Language
en
Open access
Locations
  • Biogerontology (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neuroscience and Neuropharmacology Research
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Biochemistry › Amino Acid Enzymes and Metabolism
Keywords
Alzheimer's disease, glutamatergic system, glutamate metabolism, amyloid-beta, astrocytes, glutamate uptake, anaplerotic pathway, branched-chain amino acids, branched-chain amino acid aminotransferase, BCAA supplementation, memantine, glutamate receptor agonists, neurodegeneration, cognitive decline
MeSH terms
Alzheimer Disease, Astrocytes, Humans, Amyloid beta-Peptides, Neurodegenerative Diseases, Endothelial Cells

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

A language model drew the claims from the paper on 2026-10-10, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).

A second model labelled each claim on 2026-10-10 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review