mTOR in Down syndrome: Role in Aß and tau neuropathology and transition to Alzheimer disease-like dementia
Open accessAbstract
The mammalian target of rapamycin (mTOR) is a serine/threonine protein kinase involved in the regulation of protein synthesis and degradation, longevity and cytoskeletal formation. The mTOR pathway represents a key growth and survival pathway involved in several diseases such as cancer, obesity, cardiovascular disease and neurodegenerative diseases. Numerous studies linked the alterations of mTOR pathway to age-dependent cognitive decline, pathogenesis of Alzheimer disease (AD) and AD-like dementia in Down syndrome (DS). DS is the most frequent chromosomal abnormality that causes intellectual disability. The neuropathology of AD in DS is complex and involves impaired mitochondrial function, defects in neurogenesis, increased oxidative stress, altered proteostasis and autophagy networks as a result of triplication of chromosome 21(chr 21). The chr21 gene products are considered a principal neuropathogenic moiety in DS. Several genes involved respectively in the formation of senile plaques and neurofibrillary tangles (NFT), two main pathological hallmarks of AD, are mapped on chr21. Further, in subjects with DS the activation of mTOR signaling contributes to Aβ generation and the formation of NFT. This review discusses recent research highlighting the complex role of mTOR associated with the presence of two hallmarks of AD pathology, senile plaques (composed mostly of fibrillar Aß peptides), and NFT (composed mostly of hyperphosphorylated tau protein). Oxidative stress, associated with chr21-related Aβ and mitochondrial alterations, may significantly contribute to this linkage of mTOR to AD-like neuropathology in DS.
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mTOR-mediated events may help explain why type 2 diabetes is a significant risk factor for Alzheimer disease.
“These mTOR-mediated events may help explain the observation that type 2 diabetes (T2DM) is a significant risk factor for development of AD7,41.”
From Oxidative stress, dysfunctional glucose metabolism and Alzheimer disease (2019) · cites this paper as [41]
The Introduction and section 2 link mTOR to insulin signaling and to amyloid pathology in Alzheimer disease, supporting a possible mechanistic connection. Our copy does not state that type 2 diabetes is a significant risk factor for developing Alzheimer disease; that point appears only in the title of another work listed in the References. No page numbers are available in our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredActivated mTORC1 regulates protein synthesis, autophagy, mitochondrial function, lipogenesis, ketogenesis, and insulin signaling, is linked to glucose metabolism, and is activated by growth factors, amino acids, and high cellular energy status.
“Activated mTORC1 is intimately involved in regulation of protein synthesis, autophagy, mitochondrial function, lipogenesis, ketogenesis, and insulin signaling, and is crucially linked to glucose metabolism, where it becomes activated by growth factors, amino acids, and high cellular energy status41,42 (Fig 2).”
From Oxidative stress, dysfunctional glucose metabolism and Alzheimer disease (2019) · cites this paper as [41]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredOxidative or nitrosative damage to multiple proteins, including synaptic proteins, very likely contributes to memory problems and other cognitive deficits, reduced neuronal ATP availability, and decreased clearance of abnormal proteins in Alzheimer disease.
“In summary, oxidative and/or nitrosative damage to multiple proteins, including synaptic proteins is very likely to contribute to the memory problems and other cognitive deficits, reduced ATP availability in neurons, and decreased clearance of abnormal proteins34, creating a “perfect storm” (or sTORm perhaps!) of detrimental cognitive effects in AD9,34,35,41,42.”
From Oxidative stress, dysfunctional glucose metabolism and Alzheimer disease (2019) · cites this paper as [41]
Section 2.1 reports oxidative damage to several protein-clearance components in Down syndrome brain, associated with reduced proteasome activity and autophagosome formation; section 3.1 links oxidative modification of lysosomal proteins to potentially reduced autophagy. The paper does not establish that damage to synaptic proteins causes memory or other cognitive deficits, or that protein oxidation reduces neuronal ATP availability in Alzheimer disease. Its reduced-ATP discussion in section 2.2 concerns neuronal progenitor cells from a Down syndrome mouse model, not that proposed causal link. (LLM, conf=0.86)
Experimental — accuracy not yet measuredInsulin resistance is a harmful consequence of mTOR activation in amnestic mild cognitive impairment and Alzheimer disease brain.
“Insulin resistance is another detrimental consequence of mTOR activation in aMCI and AD brain41 (Fig 2).”
From Oxidative stress, dysfunctional glucose metabolism and Alzheimer disease (2019) · cites this paper as [41]
The Introduction describes a mechanism by which mTOR activation can impair insulin signaling in the brain: it activates p70S6K, leading to IRS-1 degradation. Section 3.1, however, frames the resulting metabolic harm as a hypothesis about Down syndrome brain. The paper does not establish insulin resistance as a consequence of mTOR activation specifically in aMCI and AD brain. (LLM, conf=0.86)
Experimental — accuracy not yet measuredImpaired autophagy is present in early Alzheimer disease and is also found in amnestic mild cognitive impairment and preclinical Alzheimer disease brains.
“This significant mediator of neuronal death is present in the early stages of AD, and evidence of impaired autophagy is also found in aMCI brain and PCAD brains41–43.”
From Oxidative stress, dysfunctional glucose metabolism and Alzheimer disease (2019) · cites this paper as [41]
Section 2.1 (page unavailable) says autophagy is impaired in AD brains, supporting that part of the claim. It reports reduced autophagosome formation early in Down syndrome brains, not specifically in early AD, aMCI, or preclinical AD brains. The reference list names a study of mTOR signaling across preclinical AD, aMCI, and late-stage AD, but this paper does not state that impaired autophagy was found in those groups. (LLM, conf=0.85)
Experimental — accuracy not yet measured
Brain insulin resistance is common in Alzheimer disease.
“Brain insulin resistance is common in AD7,38,41.”
From Oxidative stress, dysfunctional glucose metabolism and Alzheimer disease (2019) · cites this paper as [41]
The Introduction describes how mTOR signaling can regulate the brain’s insulin response, and §3.1 hypothesizes altered insulin signaling in Down syndrome brain. Neither passage says that brain insulin resistance is common in Alzheimer disease. Searches for “brain insulin resistance,” “insulin resistance,” and its prevalence in Alzheimer disease found no such statement in our copy; page numbers were unavailable. (LLM, conf=0.72)
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- Authors
- Di Domenico, F., Tramutola, A., Foppoli, C., Head, E., Perluigi, M., & Butterfield, D. A.
- Affiliations
- Sapienza University of Rome (IT)
- University of Kentucky (US)
- Corresponding author
- Butterfield, D. Allan
- Venue
- Free Radical Biology and Medicine
- Publisher
- Elsevier BV
- Published
- 2018-01
- Volume
- 114
- Pages
- 94-101
- ISSN
- 0891-5849 (ISSN-L)
- PMC
- PMC5748251
- OpenAlex
- W2744136361
- Cited by
- 89
- References
- 127
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 6 · 2023: 7 · 2022: 1 · 2021: 18 · 2020: 17 · 2019: 17 · 2018: 9 · 2017: 1
- FWCI
- 1.48
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Free Radical Biology and Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD064993)
- Topics
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Down syndrome and intellectual disability research
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- mTOR signaling, Down syndrome, Alzheimer's disease, amyloid-beta, tau hyperphosphorylation, neurofibrillary tangles, amyloid plaques, oxidative stress, mitochondrial dysfunction, autophagy, proteostasis, neurodegeneration, cognitive decline
- MeSH terms
- Neuropathology, Alzheimer Disease, Animals, Humans, Signal Transduction, Amyloid beta-Peptides, tau Proteins, TOR Serine-Threonine Kinases
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