The carbohydrate moiety in hemoglobin A1C is present in the ring form

Glycation in diabetic neuropathy: characteristics, consequences, causes, and therapeutic options

Glycation is the nonenzymatic reaction of glucose, alpha-oxoaldehydes, and other saccharide derivatives with proteins, nucleotides, and lipids. Early glycation adducts (fructosamines) and advanced glycation adducts (AGEs) are formed. "Glycoxidation" is a term used for glycation processes involving oxidation. Sural, peroneal, and saphenous nerves of human diabetic subjects contained AGEs in the perineurium, endothelial cells, and pericytes of endoneurial microvessels and in myelinated and unmyelinated fibres localized to irregular aggregates in the cytoplasm and interstitial collagen and basement membranes. Pentosidine content was increased in cytoskeletal and myelin protein extracts of the sural nerve of human subjects and cytoskeletal proteins of the sciatic nerve of streptozotocin-induced diabetic rats. AGEs in the sciatic nerve of diabetic rats were decreased by islet transplantation. Improved glycemic control of diabetic patients may be expected to decrease protein glycation in the nerve. Protein glycation may decrease cytoskeletal assembly, induce protein aggregation, and provide ligands for cells surface receptors. The receptor for advanced glycation and products (RAGE) was expressed in peripheral neurons. It is probable that high intracellular glucose concentration is an important trigger for increased glycation, leading to increased formation of methylglyoxal, glyoxal, and 3-deoxyglucosone that glycate proteins to form AGEs intracellularly and extracellularly. Oxidative stress enhances these processes and is, in turn, enhanced by AGE/RAGE interactions. An established therapeutic strategy to prevent glycation is the use of alpha-oxoaldehyde scavengers. Available therapeutic options for trial are high-dose nicotinamide and thiamine therapies to prevent methylglyoxal formation. Future possible therapeutic strategies are RAGE antagonists and inducers of the enzymatic antiglycation defense. More research is required to understand the role of glycation in the development of diabetic neuropathy.

Chromatographic and electrophoretic methods for modified hemoglobins

The discovery of the clinically important glycohemoglobin adducts and their relation to diabetes mellitus have greatly stimulated the study of other minor post-translational modifications of hemoglobin. Chromatographic and electrophoretic procedures have played an important role in these studies. Today several hemoglobin adducts are known and the formation of adducts with glucose, phosphorylated carbohydrates, urea/cyanate, aspirin, vitamins, acetaldehyde, penicillin and acetyl CoA have been described. Furthermore, new adducts, such as those observed using hemoglobin as a biochemical marker monitoring environmental, occupational and lifestyle exposures to reactive toxic chemicals are constantly being reported. This review deals with chromatographic and electrophoretic separation methods available for the study of non-enzymatic post-translational modifications of hemoglobin. Suitability, perspectives and biomedical applications are discussed.

Role of protein-bound carbonyl groups in the formation of advanced glycation endproducts

Several mechanisms have been postulated for the formation of advanced glycation endproducts (AGEs) from glycated proteins; they all feature protein-bound carbonyl intermediates. Using 2,4-dinitrophenylhydrazine (DNPH), we have detected these intermediates on bovine serum albumin, lysozyme and beta-lactoglobulin after in vitro glycation by glucose or fructose. Carbonyls were formed in parallel with AGE-fluorophores, via oxidative Maillard reactions. Neither Amadori nor Heyns products contributed to the DNPH reaction. Fluorophore and carbonyl yields were much enhanced in lipid-associated proteins, but both groups could also be detected in lipid-free proteins. When pre-glycated proteins were incubated in the absence of free sugar, carbonyl groups were rapidly lost in a first-order reaction, while fluorescence continued to develop beyond the 21 days of incubation. Another unexpected finding was that not all carbonyl groups were blocked by aminoguanidine, although there was complete inhibition of reactions leading to AGE-fluorescence. It is suggested that carbonyls acting as fluorophore precursors react readily with aminoguanidine, while others are resistant to this hydrazine, possibly because they are involved in ring closure. Factors influencing the relative rates of acyclisation and hydrazone formation are discussed, together with possible implications for antiglycation therapy.

Failure of glucose-binding lectins Con A and Lentil Lectin to identify glycation of haemoglobin

We have studied the interaction of Concanavalin A and Lentil Lectin with glycohaemoglobin by a nephelometric lectin-glycogen/dextran precipitation system and monitored the inhibitory effect of glycohaemoglobin on the precipitation. Although inhibitory effects were clearly demonstrated using simple sugars and transferrin, no effect was observed by glycohaemoglobin in relevant concentrations. This is compared to affinity chromatography, binding studies using gel filtration and electrophoresis, and affinity studies using Concanavalin A immobilised on magnetisable polymer particles. Lack of interaction between glycohaemoglobin and lectins is discussed in view of steric constraints and reduced availability of the glycated residues and the stereochemical form of the glycated 1-amino-1-deoxy-fructosyl residues in glycohaemoglobin.

Properties of carboxymethylated cross-linked hemoglobin A

The selective carboxymethylation of the N-terminal amino groups of hemoglobin A with glyoxylic acid and sodium cyanoborohydride has been studied as a function of the state of ligation of hemoglobin. The N-terminal residues have been established as the primary sites of reaction by peptide mapping of the tryptic digest of each chain and subsequent amino acid analysis of the modified peptides. With oxyhemoglobin, the desired derivatives with a carboxymethyl group at the N-terminal of either or both chains amounted to 55% [Di Donato, A., Fantl, W. J., Acharya, A. S., & Manning, J. M. (1983) J. Biol. Chem. 258, 11890-11895]. In the present study it is shown that with deoxyhemoglobin the amount of the desired derivative is increased to 75%. The oxygen equilibrium curve of hemoglobin A carboxymethylated on its four N-terminal residues [0.5 mM as tetramer in 50 mM [bis(2-hydroxyethyl)amino]tris(hydroxymethyl)methane (Bis-Tris), pH 7.5, 37 degrees C] had a P50 value of 30 mmHg (Hill coefficient n = 2.8, alkaline Bohr value = 0.4) compared to a P50 of 9 mmHg for unmodified hemoglobin under the same conditions (n = 2.5, alkaline Bohr value = 0.5). In carboxymethylated oxyhemoglobin A, cross-linked with the mild agent glycolaldehyde for 3.5 h, there was 85% of Mr 64,000 species and 15% of Mr 128,000 or higher species. For the former, the extent of cross-linking between two subunits was 19%. For the latter, there was 29% of two cross-linked subunits and 13% of three cross-linked subunits. Termination of cross-linking, which may be desirable in some circumstances, can be successfully achieved with isonicotinic acid hydrazide.(ABSTRACT TRUNCATED AT 250 WORDS)

Nonenzymatically glycosylated proteins

Nonenzymatic glycosylation takes place in all proteins with a free-reacting lysine or valine in the presence of glucose. The formation of glycosylated plasma albumin, hemoglobin (Hb A1c), and skin collagen provides a diagnostic index of short- to long-term time-concentration of glucose in vivo. A wide range of assay methods are available, with affinity chromatographic, isoelectric focusing, and spectrophotometric methods providing the best accuracy and versatility. Glycosylated hemoglobin assays indicate glucose pressure over the previous 2 to 3 months and are of diagnostic value in general diabetic control, while glycosylated plasma albumin determinations are preferable in acute episodes in the life of a diabetic (e.g., pregnancy, infection, stress, trauma, surgery), since they provide an overview of changing blood glucose values of the previous 2 to 4 weeks. Glycosylated collagen estimations reflect tissue aging and are relevant in healing processes. Glycosylation alters the biologic activity of proteins, and these may relate to the manifold complications concomitant on the lifelong elevation of blood and tissue glucose in the diabetic (C6a). Assays for glycosylated hemoglobin have been routinely performed in clinical chemistry laboratories for a decade, and convenient determination for other nonenzymatically glycosylated proteins is proceeding apace.

delta-Aminolevulinic acid dehydratase activity in erythrocytes of diabetic patients

Erythrocytes delta-aminolevulinate dehydratase activity was assayed in 41 diabetic patients and 33 normal controls. It was found that in diabetic patients the erythrocyte ALA-D activity was lower than in controls, and the difference of the mean values was statistically highly significant (P less than 0.001). We found a significant negative correlation (r = - 0.846, P less than 0.001) between ALA-D activity and blood glucose levels. For this reason, using normal adult human whole blood haemolysates, it was investigated the effects in vitro of glucose and insulin on normal erythrocytic ALA-D. No significant difference in ALA-D activity was found in the presence of insulin. On the other hand, there was considerable decrease in the enzyme activity in the blood samples after glucose addition.

Influence of in vitro non-enzymatic glycosylation on the physicochemical parameters of type I collagen

In vitro non-enzymatic condensation of glucose on acid soluble collagen is shown not to affect the molecular structure and stability as evaluated both by circular dichroism and differential spectrometry. Viscometric studies demonstrate a lowering in intermolecular interactions; whereas the hydrodynamic volume remains unaffected by nonenzymatic glycosylation. alpha 2(I) collagen chains exhibit a modified electrophoretic mobility previously found in collagen of diabetic rats; this peculiar behavior is discussed in terms of lowered hydrophobicity due to addition of hydrophilic groups from glucose. The lowered formation of hydrophobic areas, evaluated from the fluorescence emission of diphenylhexatriene, indicates that non-enzymatic glycosylation is able to influence the close packing of collagen fibers.

Glycosylated haemoglobins: biochemical evaluation and clinical utility

A review is given of the biochemical background of the glycosylated haemoglobins, their methods of determination, and their clinical significance. Special attention is paid to the sample preparation. For all methods except the colorimetric TBA-method, the removal of the labile pre-HbA1c fraction is essential. Under proper conditions, high-performance liquid chromatography, agar-gel electrophoresis and affinity chromatography are suitable methods for use in the clinical laboratory for the estimation of HbA1c and HbA1. However, the colorimetric TBA-method must be considered to be the method of choice. The clinical utility of the test is stressed with special respect to the management of diabetic pregnancies, the control of home-monitoring of blood glucose, and the objective measurement of the effect of changing diabetic therapy.

Inhibition of alkaline phosphatase activity by glucose

Non-enzymatic glycosylation (NEG) of alkaline phosphatase (AP) was studied after short- and long-term incubation with glucose and other carbohydrates. Glucose and amino sugars clearly inhibited the enzyme activity; this was in contrast to reducing and non-reducing disaccharides, which had an enhancing effect. After AP had been incubated with 18 nmol/l glucose for 180 minutes (short-term incubation), a subsequent extensive dialysis revealed full recovery of the enzymatic activity. This, plus the demonstration of a [3H]sodium borohydride-reducible glucose-protein adduct, indicated that initially a labile aldimine (Schiff base) had been formed. Binding experiments with [14C]glucose and failure of dialysis to achieve a recovery of enzymatic activity after long-term incubation suggested that subsequently a stable ketoamine product had been formed. This was further confirmed by the thiobarbituric acid test, which revealed 0.65 nmol 5-hydroxymethylfurfural/mg protein for glycosylated AP compared to 0.11 for the non-glycosylated control. Preliminary results further suggest that NEG of AP also occurs in vivo. Streptozotocin diabetic rats had significantly lower serum AP activities than did non-diabetic controls (mean +/- SD: 153.7 +/- 28.4 vs. 760.5 +/- 95.7 U/l; p less than 0.001). Blood glucose levels and serum AP activity, which had been determined simultaneously during an oral glucose tolerance test, showed without exception an inverse relationship in each of 32 healthy children studied. The biological significance of these findings remains to be established.

Monosaccharides bound to hemoglobins in normal and diabetic individuals. Evidence for glucose, mannose and galactose as sugars released by methanolysis of the different hemoglobin components

Direct evidence is given for the presence of glucose, mannose and galactose as the products of hydrolysis of hemoglobins A1a1, A1a2, A1b, A1c and A0. The presence of galactose cannot be explained by the earlier hypothesis of Amadori rearrangement and suggests the existence of further complex rearrangements. Monosaccharide content of the different hemoglobin components varies from 0.2-2.0 mol/mol of alpha beta dimer with an increase of 1.5-2.0-times in diabetic components. This increase is not accompanied by net charge differences, suggesting that additionally bound sugars are not responsible for the pI modification of these hemoglobins. The pattern of glucose, mannose and galactose ratio in normal individuals divides these hemoglobins into two classes, hemoglobins A1b, A1c and A0 (ratio 0.60:0.25:0.15) on one hand and hemoglobins A1a1 and A1a2 (ratio 0.40:0.40: 0.20) on the other. These findings suggest that diverse mechanisms for sugar binding might exist between these two classes of glycosylated hemoglobins. This difference disappears in diabetic components suggesting that the non-NH2-terminal sites are glycosylated in all components by a common mechanism. Increase in glucose at the expense of mannose and galactose, as observed in diabetics, could be an indicator of recent glycosylation.

Non enzymatic glycosylation increases platelet aggregating potency of collagen from placenta of diabetic human beings

Pepsin extracted collagen and an acid soluble glycoprotein were purified from placentas of normal and diabetic human beings. Diabetic samples exhibit a significant increase in ketoamine-linked glucose whereas both amino acid and carbohydrate composition were unaffected. This excess non enzymatic condensation of glucose on free amino-groups was found to increase platelet aggregating potency of these proteins independently of any modification in fiber morphology.

Separation of glycosylated haemoglobins using immobilized phenylboronic acid. Effect of ligand concentration, column operating conditions, and comparison with ion-exchange and isoelectric-focusing

Haemoglobins from diabetic and non-diabetic individuals have been separated by affinity chromatography using immobilized phenylboronate, which interacts specifically with diol-containing compounds such as glycosylated haemoglobin. The effects of ligand concentration, flow rate, column geometry, preincubation of sample, buffer composition and temperature have been investigated. Significant correlation was found between results from affinity-chromatography and ion-exchange and isoelectric-focusing methods. Isoelectric-focusing of the haemoglobin fractions obtained from affinity chromatography indicate that, in addition to haemoglobin A1c, some haemoglobin A is also bound to immobilized phenylboronic acid. Assays of haemolysates obtained from red blood cells incubated in glucose solutions suggest that unstable pre-(haemoglobin A1c) does not interfere. The assay is not affected by the presence of haemoglobin F.

Glycosylation of human hemoglobin A. Kinetics and mechanisms studied by isoelectric focusing

The reaction between glucose and hemoglobin A (HbA) leading to hemoglobin A1c through a labile intermediate, designated anodal glycohemoglobin A, was studied in vitro using an isoelectric focusing method. Studies were performed on the kinetics of the formation and breakdown of the labile intermediate. The reactions of HbA with various aldohexoses and of hemoglobin A1c and anodal glycohemoglobin A with phenylhydrazine were studied. It is suggested that the glucose in the anodal glycohemoglobin A band is in the pyranose form of a Schiff base formed between the N-terminal amino group of the protein and D-glucose, while the fructose in hemoglobin A1c is in the pyranose form of the ketimine comprising also the N-terminal of the group. Elution peaks from ion-exchange chromatography of the hemoglobins termed HbA1a, HbA1b, HbA1c and HbA studied by isoelectric focusing revealed that: HbA1a formed two bands and HbA1b one band far toward the anode; both contained minor fractions of HbAlc and HbA; HbAlc appeared as a single band, while HbA was contaminated with some HbA1c. Hemoglobulin A1c purified by isoelectric focusing eluted as one peak when analysed by ion-exchange chromatography, while anodal glycohemoglobin A co-eluted with the first HbA1c fractions in the chromatogram. From kinetic studies it appeared that the rate constant for formation (k1) of anodal glycohemoglobin A was 0.096 . 10(-3) l/mol . s-1 at 37 degrees C. The constant for dissociation (k-1) was 0.10 . 10(-3) s-1. From these an equilibrium constant K of 0.96 l/mol was calculated. The apparent Arrhenius activation energies for the (k1) and (k-1) reactions were 42.5 and 47.5 kJ/degree, respectively. Consequently the equilibrium constant K is predicted to be nearly temperature-independent within the temperature range investigated. This was fully substantiated by experiments conducted at different temperatures. Furthermore, the values of the apparent Arrhenius activation energies allows the values of the rate constants to be calculated at any temperature within the experimental temperature range. This information is of importance for a closer understanding of the mechanisms of glycohemoglobin accumulation in red blood cells.