The Janus face of the heme oxygenase/biliverdin reductase system in Alzheimer disease: It's time for reconciliation
Open accessAbstract
Alzheimer disease (AD) is the most common form of dementia among the elderly and is characterized by progressive loss of memory and cognition. These clinical features are due in part to the increase of reactive oxygen and nitrogen species that mediate neurotoxic effects. The up-regulation of the heme oxygenase-1/biliverdin reductase-A (HO-1/BVR-A) system is one of the earlier events in the adaptive response to stress. HO-1/BVR-A reduces the intracellular levels of pro-oxidant heme and generates equimolar amounts of the free radical scavengers biliverdin-IX alpha (BV)/bilirubin-IX alpha (BR) as well as the pleiotropic gaseous neuromodulator carbon monoxide (CO) and ferrous iron. Two main and opposite hypotheses for a role of the HO-1/BVR-A system in AD propose that this system mediates neurotoxic and neuroprotective effects, respectively. This apparent controversy was mainly due to the fact that for over about 20years HO-1 was the only player on which all the analyses were focused, excluding the other important and essential component of the entire system, BVR. Following studies from the Butterfield laboratory that reported alterations in BVR activity along with decreased phosphorylation and increased oxidative/nitrosative post-translational modifications in the brain of subjects with AD and amnestic mild cognitive impairment (MCI) subjects, a debate was opened on the real pathophysiological and clinical significance of BVR-A. In this paper we provide a review of the main discoveries about the HO/BVR system in AD and MCI, and propose a mechanism that reconciles these two hypotheses noted above of neurotoxic and the neuroprotective aspects of this important stress responsive system.
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Even though atorvastatin is not a direct antioxidant and cannot cross the BBB, it produces antioxidant-like effects in the brain.
“It also suggests that atorvastatin, although not a direct antioxidant and not able to cross the BBB, leads to antioxidant-like effects in brain100.”
From Oxidative stress, dysfunctional glucose metabolism and Alzheimer disease (2019) · cites this paper as [100]
In “Reconciliation of the two hypotheses” (page unavailable), the paper reports reduced brain oxidative-stress markers after atorvastatin treatment in aged beagles, supporting antioxidant-like effects in that preclinical model. It says atorvastatin can cross the BBB “only to a minute extent,” not that it cannot cross at all; the passage also does not explicitly establish that atorvastatin is not a direct antioxidant. (LLM, conf=0.87)
Experimental — accuracy not yet measuredBVR-A is both a reductase and a kinase that can phosphorylate insulin receptor substrate-1.
“BVR-A, in addition to being a reductase, is a kinase that can phosphorylate insulin receptor substrate-1100.”
From Oxidative stress, dysfunctional glucose metabolism and Alzheimer disease (2019) · cites this paper as [100]
The overview’s “HO by-products” section states that BVR-A reduces biliverdin to bilirubin and is also a serine/threonine/tyrosine kinase. It does not say that BVR-A phosphorylates insulin receptor substrate-1; instead, it describes phosphorylation of BVR-A by the insulin receptor kinase. Page numbers are unavailable in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredBoth HO-1 and BVR-A are oxidatively damaged in aMCI and AD brain.
“Both HO-1 and BVR-A are oxidatively damaged in aMCI and AD brain100.”
From Oxidative stress, dysfunctional glucose metabolism and Alzheimer disease (2019) · cites this paper as [100]
In AD and MCI brain, BVR-A is nitrosatively modified and dysfunctional, and its loss promotes insulin resistance.
“BVR-A is nitrosatively modified and dysfunctional in AD and MCI brain100, and its impairment promotes insulin resistance101.”
From Oxidative stress, dysfunctional glucose metabolism and Alzheimer disease (2019) · cites this paper as [100]
In 3xTg AD mice, intranasal insulin lowered brain nitrosative stress, tau phosphorylation, and Aβ oligomers and improved cognition; these effects required BVR-A activity.
“Recently, intranasal treatment of a 3 X Tg mice model of AD with insulin showed a significant reduction of brain nitrosative stress, tau phosphorylation, and Aβ oligomers coupled to improved cognition, and these effects were dependent on the activity of biliverdin reductase-A (BVR-A)99,100.”
From Oxidative stress, dysfunctional glucose metabolism and Alzheimer disease (2019) · cites this paper as [100]
The ‘Reconciliation of the two hypotheses’ section reports reduced nitrosative-stress markers and improved cognition after atorvastatin treatment in aged beagles, not intranasal insulin in 3xTg AD mice. Searches for intranasal insulin and the claimed mouse outcomes found no passage in our copy addressing that experiment or showing that its effects required BVR-A activity; the passages have no page numbers. (LLM, conf=0.77)
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- Authors
- Barone, E., Di Domenico, F., Mancuso, C., & Butterfield, D. A.
- Affiliations
- University of Kentucky (US)
- Università Cattolica del Sacro Cuore (IT)
- Corresponding author
- Butterfield, D. Allan
- Venue
- Neurobiology of Disease
- Publisher
- Elsevier BV
- Published
- 2014-02
- Volume
- 62
- Pages
- 144-159
- ISSN
- 0969-9961 (ISSN-L)
- PMC
- PMC3877707
- OpenAlex
- W2082990108
- Cited by
- 127
- References
- 227
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 6 · 2023: 10 · 2022: 8 · 2021: 12 · 2020: 15 · 2019: 12 · 2018: 10 · 2017: 8 · 2016: 8 · 2015: 18 · 2014: 11 · 2013: 1 · 2012: 1
- FWCI
- 1.19
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Neurobiology of Disease (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Funders
- NIH (AG-05119)
- Fondi Ateneo
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Heme Oxygenase-1 and Carbon Monoxide
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Keywords
- Alzheimer's disease, heme oxygenase-1, biliverdin reductase A, biliverdin, bilirubin, carbon monoxide, ferrous iron, oxidative stress, nitrosative stress, neuroprotection, neurotoxicity, amnestic mild cognitive impairment, post-translational modification, stress response
- MeSH terms
- Alzheimer Disease, Animals, Brain, Heme Oxygenase (Decyclizing), Humans, Models, Neurological, Oxidative Stress, Oxidoreductases Acting on CH-CH Group Donors
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