Cited by 348Redox biology and oxidative stressAntioxidant Activity and Oxidative StressAdvanced Glycation End Products research

The DOI matches its Crossref record; 249 of the 251 references it cites were found in a registry or an index; 112 of the 216 sources its claims cite were checked for support.

Protein oxidation - Formation mechanisms, detection and relevance as biomarkers in human diseases

Open access

Abstract

Generation of reactive oxygen species and related oxidants is an inevitable consequence of life. Proteins are major targets for oxidation reactions, because of their rapid reaction rates with oxidants and their high abundance in cells, extracellular tissues, and body fluids. Additionally, oxidative stress is able to degrade lipids and carbohydrates to highly reactive intermediates, which eventually attack proteins at various functional sites. Consequently, a wide variety of distinct posttranslational protein modifications is formed by protein oxidation, glycoxidation, and lipoxidation. Reversible modifications are relevant in physiological processes and constitute signaling mechanisms ("redox signaling"), while non-reversible modifications may contribute to pathological situations and several diseases. A rising number of publications provide evidence for their involvement in the onset and progression of diseases as well as aging processes. Certain protein oxidation products are chemically stable and formed in large quantity, which makes them promising candidates to become biomarkers of oxidative damage. Moreover, progress in the development of detection and quantification methods facilitates analysis time and effort and contributes to their future applicability in clinical routine. The present review outlines the most important classes and selected examples of oxidative protein modifications, elucidates the chemistry beyond their formation and discusses available methods for detection and analysis. Furthermore, the relevance and potential of protein modifications as biomarkers in the context of disease and aging is summarized.

Overview

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Written from the paper’s full text.

TL;DR

This review summarizes the chemistry, detection methods, and biomarker potential of oxidative protein modifications, including sulfur/aromatic amino acid oxidation, glycoxidation, lipoxidation, carbonylation, and nitration. It concludes that protein carbonyls and 3-nitrotyrosine are promising biomarkers, while many routinely used assays remain insufficiently specific or standardized for clinical use.

Key findings

Proteins are estimated to scavenge 50%–75% of generated reactive species, making them major oxidation targets. The review describes reversible modifications such as cysteine disulfides and methionine sulfoxide as relevant to redox signaling, and irreversible products such as cysteine sulfonic acid, dityrosine, CML, pentosidine, 4-HNE/MDA adducts, protein carbonyls, and 3-nitrotyrosine as disease/aging biomarker candidates. Aminoadipic and glutamic semialdehyde are reported to account for about 60% of total protein carbonylation in liver. Clinical studies cited mostly show elevated protein carbonyls and 3-nitrotyrosine in multiple diseases, but results for MDA, AOPP, and some glycoxidation products are inconsistent; the authors conclude MDA is not a suitable marker for human aging and age-related diseases.

Methods

Narrative review of protein oxidation mechanisms, detection/quantification methods, and biomarker relevance in human disease and aging. For the clinical biomarker section, the authors searched PubMed in November 2020 using individual biomarker terms plus “human disease,” “human age-related disease,” or “human aging,” and focused on recent clinical studies from 2015–2020. The review summarizes selected studies in tables by biomarker class, specimen, study population, method, and main outcome.

Limitations

The paper states that many frequently used routine methods are “less than optimal,” that the clinical relevance of most protein modifications as biomarkers is questionable, and that further longitudinal studies with standardized methods are needed. It also states that immunoassays often lack full chemical/structural characterization and that AOPP spectrophotometric assays are highly unspecific. Evident from the text: this is a narrative review, not a systematic review or meta-analysis, and the cited clinical studies are heterogeneous in methods, specimens, and sample sizes, including several very small groups.

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Integrity signals

Registry

Crossref · 10.1016/j.redox.2021.101901

Cites

249 of 249 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Figures

Graphical abstract
Graphical abstract CC BY-NC-ND · PubMed Central
Fig. 1 Oxidation of sulfur-containing amino acids. Cysteine is oxidized in a multi-step reaction to the respective sulfenic, sulfinic, and sulfonic acid modifications or oxidatively conjugated with glutathione (GSH) or another cysteine residue (A). Methionine is reversibly oxidized to methionine sulfoxide and irreversibly oxidized to methionine sulfone (B).
Fig. 1 Oxidation of sulfur-containing amino acids. Cysteine is oxidized in a multi-step reaction to the respective sulfenic, sulfinic, and sulfonic acid modifications or oxidatively conjugated with glutathione (GSH) or another cysteine residue (A). Methionine is reversibly oxidized to methionine sulfoxide and irreversibly oxidized to methionine sulfone (B).CC BY-NC-ND · PubMed Central
Fig. 2 Oxidation of aromatic amino acids. Oxidation of tyrosine is favored by the intermediary tyrosyl radical and leads to the stable modifications dihydroxyphenylalanine and dityrosine (A). Unusual tyrosine isomers like ortho-tyrosine are generated by oxidation of phenylalanine residues (B). Oxidation of tryptophan is the initial step of the N-formyl kynurenine reaction cascade (C). The stable modification 2-oxohistidine is formed by histidine oxidation (D).
Fig. 2 Oxidation of aromatic amino acids. Oxidation of tyrosine is favored by the intermediary tyrosyl radical and leads to the stable modifications dihydroxyphenylalanine and dityrosine (A). Unusual tyrosine isomers like ortho-tyrosine are generated by oxidation of phenylalanine residues (B). Oxidation of tryptophan is the initial step of the N-formyl kynurenine reaction cascade (C). The stable modification 2-oxohistidine is formed by histidine oxidation (D).CC BY-NC-ND · PubMed Central
Fig. 3 Formation of glycoxidation products. A special subset of advanced glycation endproducts is exclusively formed under oxidative conditions including the prominent modifications carboxymethyl lysine and pentosidine. The novel modifications glyoxylyl and formyl lysine are potential biomarkers of oxidative stress based on their formation pathways.
Fig. 3 Formation of glycoxidation products. A special subset of advanced glycation endproducts is exclusively formed under oxidative conditions including the prominent modifications carboxymethyl lysine and pentosidine. The novel modifications glyoxylyl and formyl lysine are potential biomarkers of oxidative stress based on their formation pathways.CC BY-NC-ND · PubMed Central
Fig. 4 Formation of lipoxidation products. Complex reaction cascades of malondialdehyde (A) and 4-hydroxynonenal (B) are briefly summarized and important protein modifications presented.
Fig. 4 Formation of lipoxidation products. Complex reaction cascades of malondialdehyde (A) and 4-hydroxynonenal (B) are briefly summarized and important protein modifications presented.CC BY-NC-ND · PubMed Central
Fig. 5 Pathways of protein carbonylation. Lysine and proline residues are vitally important precursors of protein carbonylation by oxidative formation of aminoadipic semialdehyde (A) and glutamic semialdehyde (B), respectively. Oxidative cleavage of peptide backbone results in protein carbonylation via diamide and α-amidation pathways (C). Formation of 2-pyrrolidone by oxidation of prolyl containing peptide (D).
Fig. 5 Pathways of protein carbonylation. Lysine and proline residues are vitally important precursors of protein carbonylation by oxidative formation of aminoadipic semialdehyde (A) and glutamic semialdehyde (B), respectively. Oxidative cleavage of peptide backbone results in protein carbonylation via diamide and α-amidation pathways (C). Formation of 2-pyrrolidone by oxidation of prolyl containing peptide (D).CC BY-NC-ND · PubMed Central
Fig. 6 Generation of reactive nitrogen species (RNS). Nitric oxide synthase (NOS) catalyzes the generation of nitric oxide, which is the precursor of S-nitrosylation and nitration.
Fig. 6 Generation of reactive nitrogen species (RNS). Nitric oxide synthase (NOS) catalyzes the generation of nitric oxide, which is the precursor of S-nitrosylation and nitration.CC BY-NC-ND · PubMed Central
Fig. 7 Analysis of oxidative protein modifications. Proteins are oxidized by ROS. Subsequent molecular changes can be analyzed for individual proteins, peptides or modified amino acids. Depending on the choice of analytes, different analysis techniques are available. Among the presented methods, mass spectrometry is the most accurate technique and its application shall be further increased for biological samples to advance the knowledge regarding protein oxidation.
Fig. 7 Analysis of oxidative protein modifications. Proteins are oxidized by ROS. Subsequent molecular changes can be analyzed for individual proteins, peptides or modified amino acids. Depending on the choice of analytes, different analysis techniques are available. Among the presented methods, mass spectrometry is the most accurate technique and its application shall be further increased for biological samples to advance the knowledge regarding protein oxidation.CC BY-NC-ND · PubMed Central
Fig. 8 Quantitation of protein carbonylation. Carbonyl groups are stabilized by derivatization with 2,4-dinitrophenylhydrazine (DNPH). The resulting hydrazones are quantified using a spectrophotometer, specific antibodies, or are analyzed using LC-MS.
Fig. 8 Quantitation of protein carbonylation. Carbonyl groups are stabilized by derivatization with 2,4-dinitrophenylhydrazine (DNPH). The resulting hydrazones are quantified using a spectrophotometer, specific antibodies, or are analyzed using LC-MS.CC BY-NC-ND · PubMed Central
Fig. 9 Schematic overview of frequently used biomarkers of protein oxidation. Their strengths, limitations, and relevance as biomarkers in human diseases and aging are discussed in sections 4.1–4.6, based on the current state of research. For further details see also Table 2, Table 3, Table 4, Table 5, Table 6, Table 7 3-NT – 3-Nitrotyrosine, 4-HNE – 4-Hydroxy-2-nonenal, AD – Alzheimer's disease, AGE – Advanced glycation endproduct, ALD – Alcoholic liver disease, AOPP – Advanced oxidation protein product, AS – Amino acids, CAD – Coronary artery disease, CML – Carboxymethyl lysine, COPD – Chronic obstructive pulmonary disease, CSF – Cerebrospinal fluid, Cys-SO3H – Cysteine sulfonic acid, ELISA – Enzyme linked immunosorbent assay, HIV – Human immunodeficiency virus, HPLC – High pressure liquid chromatography, IHC – Immunohistochemistry, NAFLD – Non-alcoholic fatty liver disease, MCI – Mild cognitive impairment, MDA – Malondialdehyde, MetS – Metabolic syndrome, MetSO – Methionine sulfoxide, MS – Mass spectrometry, PBMC – Peripheral blood mononuclear cells, PD – Parkinson's disease, RA – Rheumatoid arthritis, Skin AF – Skin autofluorescence, T2D – Type 2 diabetes, TBARS – Thiobarbituric acid reactive substances, WB – Western Blot. *among others.
Fig. 9 Schematic overview of frequently used biomarkers of protein oxidation. Their strengths, limitations, and relevance as biomarkers in human diseases and aging are discussed in sections 4.1–4.6, based on the current state of research. For further details see also Table 2, Table 3, Table 4, Table 5, Table 6, Table 7 3-NT – 3-Nitrotyrosine, 4-HNE – 4-Hydroxy-2-nonenal, AD – Alzheimer's disease, AGE – Advanced glycation endproduct, ALD – Alcoholic liver disease, AOPP – Advanced oxidation protein product, AS – Amino acids, CAD – Coronary artery disease, CML – Carboxymethyl lysine, COPD – Chronic obstructive pulmonary disease, CSF – Cerebrospinal fluid, Cys-SO3H – Cysteine sulfonic acid, ELISA – Enzyme linked immunosorbent assay, HIV – Human immunodeficiency virus, HPLC – High pressure liquid chromatography, IHC – Immunohistochemistry, NAFLD – Non-alcoholic fatty liver disease, MCI – Mild cognitive impairment, MDA – Malondialdehyde, MetS – Metabolic syndrome, MetSO – Methionine sulfoxide, MS – Mass spectrometry, PBMC – Peripheral blood mononuclear cells, PD – Parkinson's disease, RA – Rheumatoid arthritis, Skin AF – Skin autofluorescence, T2D – Type 2 diabetes, TBARS – Thiobarbituric acid reactive substances, WB – Western Blot. *among others.CC BY-NC-ND · PubMed Central

Verification

Claims the paper makes

58 No full text of the sources · 49 Partly supported · 38 Supported · 35 Own interpretation · 18 No basis given · 9 Sources not found · 8 Supported so far · 4 Not checked yet · 3 Couldn’t confirm · accuracy not yet measured

Show all 146 claims

  • It may state two separate claims as one. 60
  • Probably not a substantial claim. 25
  • The quote only partly states this claim. 2
76 of 76
  • The authors state this as an assumption.

    Proteins accumulate evidence of oxidative damage in relation to disease, although some associations are only associations and oxidation is not always causal but a contributing factor.

    “It can be therefore assumed that proteins also accumulate evidence of oxidative damage in relation to disease, although some of these are only associations and oxidation is not always causal, but a contributing factor.”
  • The paper relies on this without support.

    To function as suitable biomarkers, protein oxidation products must be stable, accumulate in detectable concentrations, and correlate with disease severity.

    “To function as suitable biomarkers, it is critical that protein oxidation products are stable, accumulate in detectable concentrations, and correlate with disease severity.”
  • The paper relies on this without support.

    Sample availability is an important factor limiting the reliability of a biomarker.

    “Sample availability is another important factor limiting the reliability of a biomarker.”
  • The paper relies on this without support.

    Unmodified reference material is commonly not available in biological samples.

    “A major challenge in analyzing protein modifications in biological samples is that unmodified reference material is commonly not available.”
  • The paper relies on this without support.

    Modified peptides often occur only at low abundances, making it unlikely that untargeted approaches cover them.

    “However, modified peptides often occur only at low abundancies making it unlikely that they are covered by untargeted approaches.”
  • The paper relies on this without support.

    Standard material for oxidative modifications is often not available, especially in peptide form.

    “However, since standard material is often not available, especially not in peptide form, this approach requires synthesis efforts or cannot always be implemented.”
  • The paper relies on this without support.

    MDA-modified proteins have not been used as biomarkers in recent clinical investigations.

    “To our knowledge, MDA modified proteins have not been used as biomarkers in recent clinical investigations although antibodies are commercially available and highly selective MS methods have been established, previously [57].”
  • The paper relies on this without support.

    Only Weber et al. has determined 3-NT as a function of age in three different cohorts of the MARK-AGE study.

    “To our knowledge, only Weber et al. determined 3-NT as a function of age in three different cohorts of the MARK-AGE study [194].”
  • The paper relies on this without support.

    3-NT can be measured in plasma, serum, and tissue samples by methods including IHC, ELISA, HPLC, or LC-MS/MS.

    “The measurement of 3-NT can be performed in plasma, serum as well as tissue samples by different methods, including IHC, ELISA, HPLC or the combination of LC with MS/MS”
  • The paper relies on this without support.

    MS approaches are considered the gold standard for 3-NT measurement.

    “MS approaches have been considered as gold standard”
  • The paper relies on this without support.

    Commercially available ELISAs are preferentially used for 3-NT quantification in clinical studies due to standardization, easy sample preparation, need of conventional equipment, and high sample throughput.

    “commercially available ELISAs are preferentially used for 3-NT quantification in clinical studies due to standardization, easy sample preparation, the need of conventional equipment, and high sample throughput”
  • The paper relies on this without support.

    Reactive oxygen and nitrogen species are ubiquitous side-products of metabolism.

    “Reactive oxygen and nitrogen species are ubiquitous side-products of metabolism.”
  • The paper relies on this without support.

    Impaired balance between generation and degradation of reactive oxygen and nitrogen species in aging and disease causes oxidative and nitrosative stress.

    “Impaired balance between their generation and degradation in aging and disease causes oxidative and nitrosative stress.”
  • The paper relies on this without support.

    Many biological disciplines use immunoassays as routine methods.

    “Many biological disciplines use immunoassays as routine methods.”
  • The paper relies on this without support.

    Immunological methods are often based on monoclonal antibodies or polyclonal antisera obtained after immunization with immunogens, lacking full chemical or structural characterization.

    “Immunological methods are often based on monoclonal antibodies or polyclonal antisera obtained after immunization with immunogens, lacking full chemical or structural characterization.”
  • The paper relies on this without support.

    In many cases, the epitopes recognized by the antibodies remain unknown.

    “In many cases, the epitopes recognized by the antibodies remain unknown.”
  • The paper relies on this without support.

    Recent studies on advanced lipoxidation endproducts mainly focused on the reactive intermediates 4-HNE and MDA.

    “recent studies mainly focused on the reactive intermediates 4-HNE and MDA”
  • The paper relies on this without support.

    Elevated levels of protein carbonyls have been observed in several human diseases and are associated with the aging process.

    “elevated levels of protein carbonyls have been observed in several human diseases and are associated with the aging process”
18 of 18

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Metadata

Authors
Kehm, R., Baldensperger, T., Raupbach, J., & Höhn, A.
Affiliations
  • German Institute of Human Nutrition (DE)
  • German Center for Diabetes Research (DE)
Corresponding author
Höhn, Annika
Venue
Redox Biology
Publisher
Elsevier BV
Published
2021-06
Volume
42
Pages
101901
ISSN
2213-2317 (ISSN-L)
OpenAlex
W3129842026
Cited by
348
References
251
Citations by year
2026: 80 · 2025: 92 · 2024: 74 · 2023: 58 · 2022: 31 · 2021: 13
FWCI
11.78
Type
journal article
Language
en
Open access
Locations
  • Redox Biology (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by-nc-nd)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Informationszentrum Lebenswissenschaften (ZB MED) (submittedVersion, cc-by-nc-nd)
Funders
Bundesministerium für Bildung und Forschung
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Redox biology and oxidative stress
  • Health Sciences › Medicine › Biochemistry (medical) › Antioxidant Activity and Oxidative Stress
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Advanced Glycation End Products research
Keywords
protein oxidation, reactive oxygen species, oxidative stress, glycoxidation, lipid oxidation, post-translational modification, redox signaling, oxidative damage biomarkers, aging, disease
MeSH terms
Humans, Oxidation-Reduction, Proteins, Biomarkers, Reactive Oxygen Species, Oxidative Stress

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