Cited by 107Adipokines, Inflammation, and Metabolic DiseasesAlzheimer's disease research and treatmentsRegulation of Appetite and Obesity

The DOI matches its Crossref record; 194 of the 194 references it cites were found in a registry or an index; 42 of the 154 sources its claims cite were checked for support.

BACE1: More than just a β‐secretase

Open access
Taylor, Hannah A., Przemylska, Lena, Clavane, Eva M., Meakin, Paul J.·2022·Obesity Reviews

Abstract

Summary: β‐site amyloid precursor protein cleaving enzyme‐1 (BACE1) research has historically focused on its actions as the β‐secretase responsible for the production of β‐amyloid beta, observed in Alzheimer's disease. Although the greatest expression of BACE1 is found in the brain, BACE1 mRNA and protein is also found in many cell types including pancreatic β‐cells, adipocytes, hepatocytes, and vascular cells. Pathologically elevated BACE1 expression in these cells has been implicated in the development of metabolic diseases, including type 2 diabetes, obesity, and cardiovascular disease. In this review, we examine key questions surrounding the BACE1 literature, including how is BACE1 regulated and how dysregulation may occur in disease, and understand how BACE1 regulates metabolism via cleavage of a myriad of substrates. The phenotype of the BACE1 knockout mice models, including reduced weight gain, increased energy expenditure, and enhanced leptin signaling, proposes a physiological role of BACE1 in regulating energy metabolism and homeostasis. Taken together with the weight loss observed with BACE1 inhibitors in clinical trials, these data highlight a novel role for BACE1 in regulation of metabolic physiology. Finally, this review aims to examine the possibility that BACE1 inhibitors could provide a innovative treatment for obesity and its comorbidities.

Overview

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TL;DR

BACE1 is best known as the β-secretase producing Aβ in Alzheimer’s disease, but this review argues it also has broad non-neuronal metabolic roles via cleavage of many substrates in insulin, leptin, adipose, vascular, and immune pathways. It proposes that existing BACE1 inhibitors, despite failing in AD trials, might be repurposed for obesity and cardiometabolic disease because weight loss was observed as a side effect.

Key findings

  • BACE1 is a 501-amino-acid type 1 membrane aspartyl protease with five domains, active at optimal pH 4.5, and has nearly 70 identified substrates beyond APP; many are associated with non-neuronal functions including insulin signaling, inflammation, cardiovascular function, and glucose homeostasis.
  • BACE1 knockout/inhibition phenotypes include reduced weight gain, increased energy expenditure, enhanced leptin signaling, and no change in daily food intake, suggesting weight effects occur through energy expenditure; BACE1 knock-in mice display AD-like pathology and systemic diabetes.
  • In clinical trials, Verubecestat reduced cerebrospinal fluid Aβ levels by 63%–81% but did not improve cognition and caused adverse effects including weight loss and decreased appetite; Lanabecestat produced mean weight loss of −1.9 kg in the 50-mg group versus 0 with placebo, with more individuals losing at least 7% weight than placebo.
  • The review links BACE1 to T2D and obesity via insulin receptor cleavage, Aβ-mediated insulin resistance, leptin resistance, BAT differentiation through the Dicer1/miR-328/BACE1 axis, and vascular/immune mechanisms; T2D sufferers have a 50% increased risk of developing AD.

Methods

  • Narrative review synthesizing published literature on BACE1 structure, substrates, transcriptional/translational/post-translational regulation, metabolic physiology, disease associations, and therapeutic inhibition.
  • Includes a table of confirmed non-neuronal BACE1 substrates and their experimental evidence, plus figures on BACE1 structure, isoforms, post-translational modifications, insulin/leptin pathways, BAT commitment, and vasculature.
  • Discusses preclinical models (BACE1 knockout/knock-in, diet-induced obese mice, cell culture, zebrafish) and clinical trial data for BACE1 inhibitors including Verubecestat and Lanabecestat.

Limitations

  • The authors state that the mechanisms linking BACE1 to leptin resistance are unclear, that BACE1-mediated proteolysis of the leptin receptor is yet to be determined, and that many areas require further investigation.
  • The authors note contradictory findings, including that both Aβ and BACE1 inhibitors can inhibit angiogenesis in tumor models, and that plasma Aβ lacks consensus as an AD biomarker.
  • Evident from the text: this is a narrative review without a stated systematic search strategy, and many conclusions rely on preclinical models or associative human data; the authors also note that identified BACE1 substrates are primarily neurological, possibly reflecting experimental design rather than true biological distribution.

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Integrity signals

Registry

Crossref · 10.1111/obr.13430

Cites

194 of 194 references verified0 citation errors · 0 not checkable

Statistics

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Figures

FIGURE 1 The structure and domains of BACE1. (A) The primary structure of BACE1 with functional domains labeled. There are five domains: signal peptide (1–23), pro‐peptide (23–47), catalytic domain (47–454), transmembrane domain (454–478), and the cytosolic domain (478–501). Created with BioRender.com. (B) BACE1 crystal structure made using structure 3TPR on RSCB Protein DataBank (https://www.rcsb.org/). The unannotated structure (left) and inhibitor C3 binding (red), the two aspartyl protease active sites (blue) at D93 and D289, and the antiparallel‐hairpin flap (green) between Y128‐G138, are shown (right). The structure is missing 62 residues
FIGURE 1 The structure and domains of BACE1. (A) The primary structure of BACE1 with functional domains labeled. There are five domains: signal peptide (1–23), pro‐peptide (23–47), catalytic domain (47–454), transmembrane domain (454–478), and the cytosolic domain (478–501). Created with BioRender.com. (B) BACE1 crystal structure made using structure 3TPR on RSCB Protein DataBank (https://www.rcsb.org/). The unannotated structure (left) and inhibitor C3 binding (red), the two aspartyl protease active sites (blue) at D93 and D289, and the antiparallel‐hairpin flap (green) between Y128‐G138, are shown (right). The structure is missing 62 residuesCC BY · PubMed Central
FIGURE 2 Alternative splicing of BACE1 produces different isoforms. (A) BACE1 is alternatively spliced at four variable regions; 190–214 (green), 146–189 (blue), 21–120 (yellow), and 1–20 (purple). Alternative splicing of these regions produces at least six distinct isoforms, the most characterized being Isoforms A–F: Isoform A (501aa), Isoform B (476aa), Isoform C (457aa), Isoform D (432aa), Isoform E (401aa), Isoform F (376aa) are depicted. Isoforms E and F contain an alternative Exon 1 (pink). (B) The variable regions shown on the BACE1 crystal structure with inhibitor C3 (red) made using structure 3TPR, on RSCB Protein DataBank (https://www.rcsb.org/). Variable regions 1 (190–214) (green), 2 (146–189) (blue), and 3 (21–120) (yellow) show close proximity to the inhibitor binding site. The structure is missing 62 residues, including variable region 1–20, which therefore could not be labeled
FIGURE 2 Alternative splicing of BACE1 produces different isoforms. (A) BACE1 is alternatively spliced at four variable regions; 190–214 (green), 146–189 (blue), 21–120 (yellow), and 1–20 (purple). Alternative splicing of these regions produces at least six distinct isoforms, the most characterized being Isoforms A–F: Isoform A (501aa), Isoform B (476aa), Isoform C (457aa), Isoform D (432aa), Isoform E (401aa), Isoform F (376aa) are depicted. Isoforms E and F contain an alternative Exon 1 (pink). (B) The variable regions shown on the BACE1 crystal structure with inhibitor C3 (red) made using structure 3TPR, on RSCB Protein DataBank (https://www.rcsb.org/). Variable regions 1 (190–214) (green), 2 (146–189) (blue), and 3 (21–120) (yellow) show close proximity to the inhibitor binding site. The structure is missing 62 residues, including variable region 1–20, which therefore could not be labeledCC BY · PubMed Central
FIGURE 3 Post‐translational modifications on BACE1. (A) Diagram showing all post‐translational modifications reported in the literature, and predicted phosphorylation sites from Phosphosite (https://www.phosphosite.org/). This includes phosphorylation (green) at T47, S59, S71, S83, S243, S245, S252, S260, S308, and S498. SUMOylation (red) at K501. Ubiquitination (orange) at K285, K300 and K501. Acetylation (blue) at K126, K136, K275, K279, K285, K299, K300, and K307. Palmitoylation (yellow) at C478, C482, C485, and C474. N‐linked glycosylation (purple) at N153, N172, D223, and D354. (B) BACE1 crystal structure with inhibitor C3 (red) made using structure 3TPR on RSCB Protein DataBank (https://www.rcsb.org/). Not all modifications are shown as 62 residues are missing, including N‐ and C‐terminal regions. Phosphorylation (green), ubiquitination (orange), acetylation (blue) and N‐linked glycosylation sites (purple) are labeled on the BACE1 crystal structure
FIGURE 3 Post‐translational modifications on BACE1. (A) Diagram showing all post‐translational modifications reported in the literature, and predicted phosphorylation sites from Phosphosite (https://www.phosphosite.org/). This includes phosphorylation (green) at T47, S59, S71, S83, S243, S245, S252, S260, S308, and S498. SUMOylation (red) at K501. Ubiquitination (orange) at K285, K300 and K501. Acetylation (blue) at K126, K136, K275, K279, K285, K299, K300, and K307. Palmitoylation (yellow) at C478, C482, C485, and C474. N‐linked glycosylation (purple) at N153, N172, D223, and D354. (B) BACE1 crystal structure with inhibitor C3 (red) made using structure 3TPR on RSCB Protein DataBank (https://www.rcsb.org/). Not all modifications are shown as 62 residues are missing, including N‐ and C‐terminal regions. Phosphorylation (green), ubiquitination (orange), acetylation (blue) and N‐linked glycosylation sites (purple) are labeled on the BACE1 crystal structureCC BY · PubMed Central
FIGURE 4 The role of BACE1 in the insulin signaling pathway. (A) BACE1 can impact insulin signaling through the negative regulators of the insulin signaling pathway, PTBP1 and PTEN (left), and through cleavage of the insulin receptor (IR) (right). PTBP1 and PTEN inhibit PI3K/Akt signaling affecting glucose uptake, glycogen synthesis, protein and lipid synthesis, and vasodilation. Cleavage of the insulin receptor prevents signaling in response to insulin binding. (B) BACE1‐mediated Aβ production can also impact insulin signaling. The accumulation of Aβ causes inflammation, which in turn stimulates the JAK/STAT3 signaling cascade, increased SOCS‐1 expression and inhibition of insulin signaling. PI3K/Akt signaling can also be inhibited by ER stress and Aβ mediated interruption of phosphoinositide‐dependent kinase‐1 (PDK) activity through binding with its target protein kinase B (PKB/Akt). Additionally, Aβ competitively binds the insulin receptor (IR) preventing insulin binding. Elevated BACE1 activity and Aβ can therefore lead to dysregulated insulin signaling. Created with BioRender.com
FIGURE 4 The role of BACE1 in the insulin signaling pathway. (A) BACE1 can impact insulin signaling through the negative regulators of the insulin signaling pathway, PTBP1 and PTEN (left), and through cleavage of the insulin receptor (IR) (right). PTBP1 and PTEN inhibit PI3K/Akt signaling affecting glucose uptake, glycogen synthesis, protein and lipid synthesis, and vasodilation. Cleavage of the insulin receptor prevents signaling in response to insulin binding. (B) BACE1‐mediated Aβ production can also impact insulin signaling. The accumulation of Aβ causes inflammation, which in turn stimulates the JAK/STAT3 signaling cascade, increased SOCS‐1 expression and inhibition of insulin signaling. PI3K/Akt signaling can also be inhibited by ER stress and Aβ mediated interruption of phosphoinositide‐dependent kinase‐1 (PDK) activity through binding with its target protein kinase B (PKB/Akt). Additionally, Aβ competitively binds the insulin receptor (IR) preventing insulin binding. Elevated BACE1 activity and Aβ can therefore lead to dysregulated insulin signaling. Created with BioRender.comCC BY · PubMed Central
FIGURE 5 The role of BACE1 in the leptin pathway. BACE1 contributes to dysregulated leptin signaling directly and indirectly. Elevated BACE1 expression is associated with increased PTP1B and SOCS3, which negatively regulate JAK2/STAT3 signaling, preventing leptin‐stimulated gene regulation. When BACE1 is reduced, energy expenditure is increased likely via increases in UCP1 expression and □‐oxidation. Aβ‐mediated inflammation can cause JAK/STAT3 signaling and ER stress, which can increase PTP1B and SOCS‐3 transcription, and regulate genes important in appetite and body weight regulation and β‐oxidation. Created with BioRender.com
FIGURE 5 The role of BACE1 in the leptin pathway. BACE1 contributes to dysregulated leptin signaling directly and indirectly. Elevated BACE1 expression is associated with increased PTP1B and SOCS3, which negatively regulate JAK2/STAT3 signaling, preventing leptin‐stimulated gene regulation. When BACE1 is reduced, energy expenditure is increased likely via increases in UCP1 expression and □‐oxidation. Aβ‐mediated inflammation can cause JAK/STAT3 signaling and ER stress, which can increase PTP1B and SOCS‐3 transcription, and regulate genes important in appetite and body weight regulation and β‐oxidation. Created with BioRender.comCC BY · PubMed Central
FIGURE 6 The role of BACE1 in brown adipose fat commitment. Dicer1 cleavage of pre miRNA produces the miR‐328. miR‐328 binds BACE1 mRNA, regulating the stability of the transcript and therefore BACE1 expression. BACE1 promotes myogenesis and consequently inhibits brown adipose tissue (BAT) differentiation. Silencing of BACE1 by miR‐328 therefore increases pre‐adipocyte commitment to brown adipose tissue. Created with BioRender.com
FIGURE 6 The role of BACE1 in brown adipose fat commitment. Dicer1 cleavage of pre miRNA produces the miR‐328. miR‐328 binds BACE1 mRNA, regulating the stability of the transcript and therefore BACE1 expression. BACE1 promotes myogenesis and consequently inhibits brown adipose tissue (BAT) differentiation. Silencing of BACE1 by miR‐328 therefore increases pre‐adipocyte commitment to brown adipose tissue. Created with BioRender.comCC BY · PubMed Central

Verification

Claims the paper makes

47 Not checked yet · 31 Own interpretation · 18 No full text of the sources · 14 Partly supported · 13 Supported · 3 Not supported · 2 Supported so far · 2 Sources not found · 1 Mixed support · accuracy not yet measured

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Show all 65 claims

  • It may state two separate claims as one. 61
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66 of 66
  • The paper relies on this without support.

    Weight loss is observed with BACE1 inhibitors in clinical trials.

    “Taken together with the weight loss observed with BACE1 inhibitors in clinical trials, these data highlight a novel role for BACE1 in regulation of metabolic physiology.”
  • The paper relies on this without support.

    Obesity increases cdk5 and casein kinase 1 activity.

    “Furthermore obesity increases cdk5 and casein kinase 1 activity is enhanced.”
  • The paper relies on this without support.

    The weight loss observed with BACE1 inhibitors in clinical trials is due to BACE1 inhibition.

    “Taken together with the weight loss observed with BACE1 inhibitors in clinical trials, these data highlight a novel role for BACE1 in regulation of metabolic physiology.”
  • The paper relies on this without support.

    Findings from mouse models of BACE1 manipulation translate to human metabolic physiology and disease.

    “This presents an important metabolic role for BACE1 and highlights BACE1 as a potential therapeutic target for the treatment of obesity induced diabetes.”
4 of 4

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Metadata

Authors
Taylor, H. A., Przemylska, L., Clavane, E. M., & Meakin, P. J.
Affiliations
  • University of Leeds (GB)
  • Discovery & Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine University of Leeds Leeds UK
Corresponding author
Meakin, Paul J.
Venue
Obesity Reviews
Publisher
Wiley
Published
2022-02-04
Volume
23
Issue
7
Pages
e13430-e13430
ISSN
  • 1467-7881 (ISSN-L)
  • 1467-789X
OpenAlex
W4210406803
Cited by
107
References
194
Citations by year
2026: 20 · 2025: 25 · 2024: 32 · 2023: 22 · 2022: 7
FWCI
2.78
Type
journal article
Language
en
Open access
Locations
  • Obesity Reviews (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
Funders
  • Biotechnology and Biological Sciences Research Council (BB/V014358/1)
  • British Heart Foundation (FS/18/38/33659, FS/4yPhD/F/20/34130)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adipokines, Inflammation, and Metabolic Diseases
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Regulation of Appetite and Obesity
Keywords
BACE1, beta-secretase, BACE1 inhibitors, energy metabolism, obesity, type 2 diabetes, cardiovascular disease, leptin signaling, metabolic disorders, Alzheimer's disease, amyloid-beta
MeSH terms
Animals, Diabetes Mellitus, Type 2, Humans, Obesity, Amyloid beta-Peptides, Aspartic Acid Endopeptidases, Amyloid beta-Protein Precursor, Mice, Amyloid Precursor Protein Secretases

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