Cited by 179Alzheimer's disease research and treatmentsDementia and Cognitive Impairment ResearchAntioxidant Activity and Oxidative Stress

The DOI matches its Crossref record; 170 of the 175 references it cites were found in a registry or an index; none of the 208 sources its claims cite is checked for support yet.

Role of Oxidative Damage in Alzheimer’s Disease and Neurodegeneration: From Pathogenic Mechanisms to Biomarker Discovery

Open access

Abstract

Alzheimer’s disease (AD) is a neurodegenerative disorder accounting for over 50% of all dementia patients and representing a leading cause of death worldwide for the global ageing population. The lack of effective treatments for overt AD urges the discovery of biomarkers for early diagnosis, i.e., in subjects with mild cognitive impairment (MCI) or prodromal AD. The brain is exposed to oxidative stress as levels of reactive oxygen species (ROS) are increased, whereas cellular antioxidant defenses are decreased. Increased ROS levels can damage cellular structures or molecules, leading to protein, lipid, DNA, or RNA oxidation. Oxidative damage is involved in the molecular mechanisms which link the accumulation of amyloid-β and neurofibrillary tangles, containing hyperphosphorylated tau, to microglia response. In this scenario, microglia are thought to play a crucial role not only in the early events of AD pathogenesis but also in the progression of the disease. This review will focus on oxidative damage products as possible peripheral biomarkers in AD and in the preclinical phases of the disease. Particular attention will be paid to biological fluids such as blood, CSF, urine, and saliva, and potential future use of molecules contained in such body fluids for early differential diagnosis and monitoring the disease course. We will also review the role of oxidative damage and microglia in the pathogenesis of AD and, more broadly, in neurodegeneration.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review synthesizes evidence that oxidative damage from reactive oxygen/nitrogen species, mitochondrial dysfunction, and microglial/astrocytic activation is an early and progressive contributor to Alzheimer’s disease pathogenesis. It evaluates oxidative-damage products in blood, CSF, urine, and saliva as candidate early biomarkers and discusses antioxidant/oxidative-stress-targeted therapies, concluding that no reliable peripheral marker has yet been established.

Key findings

  • AD accounts for over 50% of dementia patients and affects over 50 million people worldwide; about 2–3% of cases are due to autosomal dominant mutations, while the rest are sporadic and prevalent in aging populations.
  • Oxidative damage products—including 3-nitrotyrosine, protein carbonyls, 4-hydroxy-2-trans-nonenal (HNE), F2-/F3-/F4-isoprostanes, advanced glycation end products (AGEs), 8-OHdG, 8-oxoGua, and 8-oxoGuo—are described in AD and MCI brain and in body fluids such as blood, CSF, urine, and saliva.
  • Mitochondria are both sources and targets of oxidative damage in AD; mtDNA is preferentially affected, and mitochondrial abnormalities marked by 8-OHdG and nitrotyrosine are found in neurons lacking neurofibrillary tangles, suggesting early pathological change.
  • Microglia and astrocytes contribute to ROS production via mechanisms including NOX2, NOX4, NLRP3 inflammasome, and TREM2-related pathways; TREM2 mutation is associated with a three-fold higher risk of developing AD.
  • In the 2021 AD drug pipeline, of 18 phase 3 agents classified as disease-modifying treatments, three had oxidative stress as mechanism of action, two had metabolism/bioenergetic mechanisms, and two had antioxidant properties; Azeliragon was among three agents acting on synaptic plasticity/neuroprotection and also meant to ameliorate oxidative stress.

Methods

  • Design: narrative review of oxidative damage in AD and neurodegeneration, covering pathogenic mechanisms, biomarker discovery, experimental models, and therapeutic approaches.
  • Data/sample: no primary cohort or systematic dataset; the review draws on cited human studies, animal models, in vitro models, metabolomic/proteomic studies, and clinical trial reports, with attention to blood, CSF, urine, and saliva.
  • Main analysis: qualitative synthesis of literature on ROS/RNS, oxidative damage products, mitochondrial dysfunction, microglial/astrocytic responses, and antioxidant or oxidative-stress-targeted interventions; tables referenced include oxidative stress markers and phase 3 trials.

Limitations

  • The paper states that studies on oxidative damage products in AD have failed “till now” to reveal one or more reliable markers, and that it is unlikely to find a peripheral specific marker because oxidative-damage pathways occur in other neurodegenerative conditions as well.
  • The paper notes that antioxidant supplementation cannot be considered curative, though it may help limit pathogenic events in a multifactorial disease.
  • Evident from the text: as a narrative review, no systematic search strategy, inclusion criteria, or risk-of-bias assessment is described; evidence is heterogeneous across human fluids, animal models, and in vitro systems.

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

Integrity signals

Registry

Crossref · 10.3390/antiox10091353

Cites

170 of 170 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 208 cited sources checked · 0 supported · 0 flagged

  • Probably not a substantial claim. 13
  • It may state two separate claims as one. 77
  • The quote only partly states this claim. 1
83 of 83
  • The paper relies on this without support.

    Effective treatments for overt Alzheimer’s disease are lacking.

    “The lack of effective treatments for overt AD urges the discovery of biomarkers for early diagnosis, i.e., in subjects with mild cognitive impairment (MCI) or prodromal AD.”
  • The paper relies on this without support.

    Alzheimer’s disease pathogenesis starts decades before symptoms appear.

    “Independently of genetic aspects, it is well known that AD pathogenesis starts decades before the symptoms appear.”
  • The paper relies on this without support.

    Mitochondrial health is essential for maintaining energy homeostasis and preventing neuronal dysfunction in AD.

    “AD pathogenesis has been linked to mitochondria as their health is essential in maintaining energy homeostasis and in preventing neuronal dysfunction.”
  • The paper relies on this without support.

    Circulating levels of phospholipid synthesis-promoting nutrients are lower in AD compared with healthy controls.

    “This background plus the notion that circulating levels of these nutrients are lower in AD compared with healthy controls led to one of the first multicenter clinical trial to test the hypothesis that a diet supplement containing antioxidants and a combination of phospholipid synthesis-promoting nutrients could improve the synaptic function and the cognitive symptoms [160].”
  • The paper relies on this without support.

    Energy metabolism dysregulation is linked to OS in AD.

    “Energy metabolism is also implicated in AD pathogenesis, and its dysregulation can be linked to OS, as discussed previously.”
  • The paper relies on this without support.

    Animal models used in cited studies (3xTg-AD, APP/PS1, 5XFAD) adequately model human AD pathology.

    “utilizing a knockout of Mth1 and Ogg1 genes in a 3xTg-AD background”
  • The paper relies on this without support.

    Oxidative damage markers measured in peripheral fluids reflect oxidative damage in the brain.

    “Although the brain is the most affected in AD the search for markers of OS on peripheral fluids has been always active (Table 1).”
  • The paper relies on this without support.

    RAGE binds AGEs, products of the glycosylation of proteins.

    “RAGE binds AGEs, products of the glycosylation of proteins.”
  • The paper relies on this without support.

    Hyperglycemic conditions as in diabetes can cause nonenzymatic glycation of proteins and formation of AGEs.

    “Hyperglicemic conditions as the ones observed in diabetes can also cause the nonenzymatic glycation of proteins and the formation of AGEs.”
9 of 9

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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.

  • Pao study is dated 2021 in the text but 2020 in the reference

    Minor

    The text calls the cited report a 2021 study, while reference 126 lists its publication year as 2020.

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Metadata

Authors
Buccellato, F. R., D’Anca, M., Fenoglio, C., Scarpini, E., & Galimberti, D.
Affiliations
  • University of Milan (IT)
  • Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT)
Corresponding author
Buccellato, Francesca Romana
Venue
Antioxidants
Publisher
MDPI AG
Published
2021-08-26
Volume
10
Issue
9
Pages
1353
ISSN
2076-3921 (ISSN-L)
OpenAlex
W3195006074
Cited by
179
References
175
Citations by year
2026: 37 · 2025: 51 · 2024: 30 · 2023: 26 · 2022: 30 · 2021: 4
FWCI
3.00
Type
journal article
Language
en
Open access
Locations
  • Antioxidants (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Ministero della Salute (2018-, RF-2018-12365333, RF-2018, 12365333)
Topics
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Biochemistry (medical) › Antioxidant Activity and Oxidative Stress
Keywords
Alzheimer's disease, oxidative stress, reactive oxygen species, oxidative damage, biomarkers, early diagnosis, mild cognitive impairment, prodromal Alzheimer's disease, amyloid-beta, tau hyperphosphorylation, neurofibrillary tangles, microglia, neurodegeneration, peripheral biomarkers, blood biomarkers, cerebrospinal fluid, saliva, urine, disease surveillance

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