How would glycemic dysregulation be limited to the brain?

I’m not sure anyone really knows. See: Insulin Resistance in Peripheral Tissues and the Brain: A Tale of Two Sites 2022

This has led to the investigation of brain or central nervous system (CNS) insulin resistance and the question of the relation between CNS and peripheral insulin resistance. While both may involve dysregulated insulin signaling, the two conditions are not identical and not always interlinked.
Often, the tissue selectivity ultimately leads to widespread tissue insulin resistance in the periphery. While this can sometimes extend to the CNS, it is not always the case as discussed above. It will be important to continue exploring this area to determine why peripheral insulin resistance does not always lead to CNS insulin resistance, as it can spread from tissue to tissue in the periphery. This could be related to the role of the BBB in mediating CNS insulin levels or, hypothetically, the ability of the CNS to regulate its own insulin levels

State of the Science on Brain Insulin Resistance and Cognitive Decline Due to Alzheimer’s Disease 2024

Type 2 diabetes mellitus (T2DM) is common and increasing in prevalence worldwide, with devastating public health consequences. While peripheral insulin resistance is a key feature of most forms of T2DM and has been investigated for over a century, research on brain insulin resistance (BIR) has more recently been developed, including in the context of T2DM and non-diabetes states. Recent data support the presence of BIR in the aging brain, even in non-diabetes states, and found that BIR may be a feature in Alzheimer’s disease (AD) and contributes to cognitive impairment. Further, therapies used to treat T2DM are now being investigated in the context of AD treatment and prevention, including insulin. In this review, we offer a definition of BIR, and present evidence for BIR in AD; we discuss the expression, function, and activation of the insulin receptor (INSR) in the brain; how BIR could develop; tools to study BIR; how BIR correlates with current AD hallmarks; and regional/cellular involvement of BIR. We close with a discussion on resilience to both BIR and AD, how current tools can be improved to better understand BIR, and future avenues for research. Overall, this review and position paper highlights BIR as a plausible therapeutic target for the prevention of cognitive decline and dementia due to AD.

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Lets not forget this Finish study that showed that 90% of PD patients carry a specific strain of gut bacteria : Researchers discover a potential cause of Parkinson’s disease | University of Helsinki. The hypothesis is that this (unkown) strain of Desulfovibrio generates a toxin that migrates to the brain via the Vagus Nerve.

Accordingly, a strong antibiotics course that can eradicate all Desulfovibrio strains in the gut, followed by repopulating the gut with high dose pro-biotics (to prevent recolonization with Desulfovibrio) should stop further progression of PD in its tracks (though this will not reverse any brain damage that already exists). Might want to check if your water supply has Desulfovibrio (this can happen with well water): these strains of bacteria will often cause a faint smell of rotten eggs when you run your cold water line.

Checking for leaky gut syndrome might also help : With a healthy gut lining, any toxins produced by Desulfovibrio should not make it to the Vagus Nerve in the first place and just be absorbed by blood vessels and detoxified by the liver first-pass metabolism.

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It’s a weak paper based on a worm model of Parkinson’s disease. It was published 2 years ago and has not been replicated since then as far as I know. If the authors were convinced by their own paper they would have published a new one in mice by now. So I’m fairly skeptical.

Still, there’s a case for antibiotics and some are seriously being studied.

Also, I did a microbiome test with Zoe and it came out as perfectly healthy.

But it could be worth checking for a leaky gut (although what are the interventions then?).

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I’m jealous of your ZOE results!

Grant had me do the KBMO gut barrier panel. It was fairly simple, so perhaps that would be of interest to you.

He could of course give you a much better answer, but my guess from the report is if the result wasn’t good, you would eliminate the foods that cause your inflammation. Those foods are also in the report. My report showed almost nothing, so it’s still a mystery why my ZOE results were so poor. Happy to send you my results if you’d like to see what it looks like.

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On the Role of Store-Operated Calcium Entry in Acute and Chronic Neurodegenerative Diseases

“However, the dysregulation of ER Ca2+ homeostasis is one of the mechanisms affecting the selective loss of DA neurons of the substantia nigra pars compacta(Stefani et al., 2012; Calì et al., 2014). Unlike other neurons, rhythmic activity of DA neurons depends on L-type Cav1.3 channels. Pharmacological inhibition of these currents by izradipine restores Ca2+−independent “juvenile” pacemaking activity and protects DA neurons in animal models of the disease (Chan et al., 2007). In normal conditions, the pacemaking activity of DA neurons is inhibited by the TRPC1-STIM1 complex. Accordingly, increased L-type Cav1.3 currents were observed upon Stim1 or TRPC1 silencing. Interestingly, the neurotoxin 1-methyl-4-phenylpyridinium ion (MPP+)—that mimics PD—decreases the level of TRPC1 and its interaction with STIM1, thus increasing neuronal death both in vitro and in vivo (Bollimuntha et al., 2005; Selvaraj et al., 2012). Molecularly, the decrease of TRPC1 expression leads to an abnormal increase in Cav1.3 activity, thereby causing degeneration of DA neurons (Sun et al., 2017; Figure 2). Despite the abnormal increase in L-type activity, downregulation of TRPC1 also leads to the loss of SOCE, thus triggering ER stress and initiation of the unfolded protein response (UPR) in DA neurons (Selvaraj et al., 2012). Conversely, in PC12 cell lines, Stim1 knockdown significantly attenuated 6-hydroxydopamine (6-OHDA)- and MPP±induced toxicity through inhibition of SOCE-mediated Ca2±overload (Li et al., 2013, 2014); while, pharmacological inhibition of SOCE by SKF-96365 was protective against MPP+ cytotoxicity (Chen et al., 2013). The effect on SOCE was related to Orai1 and L-type Ca2+ channels, but not to TRPC1 (Li et al., 2014). Moreover, Stim1 knockdown attenuated 6-OHDA- and MMP±induced mitochondrial Ca2+ uptake and dysfunction in PC12 cells (Li et al., 2013, 2014). This further underscores that STIM1, through SOCE, may be responsible for neuronal oxidative stress induced by ER stress and mitochondrial dysfunction in PD.

In support of the important role of SOCE for DA neurons survival, the mutant dominant-negative form of Orai1 channel leads to tyrosine hydroxylase downregulation in Drosophila thus affecting dopamine synthesis and release (Pathak et al., 2015). Furthermore, skin fibroblasts from idiopathic PD patients and patients bearing familial R747W mutation in PLA2g6 gene, that encodes for a Ca2± independent phospholipase A2, exhibit depleted stores and reduced SOCE (Zhou et al., 2016). Overall, these findings indicate that SOCE pathway in DA neurons represents an attractive target for PD drug discovery (Pchitskaya et al., 2018).”

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Failed: Inhibikase hits pause on Parkinson’s program over efficacy as it prioritizes lung drug

I mentioned this drug last week. They’ve just published their results in MSA, this is HUGE: Alterity Therapeutics Announces Positive ATH434 Phase 2 Trial Results in Multiple System Atrophy Led By Robust Clinical Efficacy

The topline data showed that ATH434 produced clinically and statistically significant improvement on the modified UMSARS Part I, a functional rating scale that assesses disability on activities of daily living affected in MSA1. On this important clinical measure, ATH434 demonstrated 48% slowing of clinical progression at the 50 mg dose (p=0.03)^ and 29% slowing of clinical progression at the 75 mg dose (p=0.2) at Week 52 when compared with placebo.

MSA is a very aggressive form of Parkinson’s disease. People die in a few years post-diagnosis. The drug works in the macaque model of PD. That’s very promising.

Markets seem positively surprised:

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Polystyrene Nanoplastics Hitch-Hike the Gut–Brain Axis to Exacerbate Parkinson’s Pathology 2025

Abstract Image

Pollution, pesticides, chemicals, and now nanoplastics, PD is really the disease of the modern world :slight_smile:

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Yes, but that further strengthens my view that while many of these might exacerbate or even perhaps trigger the initiation of the PD pathology, there are other more crucial factors that make this disease possible. In some ways I worry that focusing on pesticides, microplastics, the gut axis etc. distracts from the core underlying pathology. PD existed long before plastics, pesticides etc. were introduced. As I read more about PD, I (personally) am trying to focus more on the endogenous biological processes, such as disregulation of calcium signalling pathways. Of course, there may be downstream interaction between exogenous toxic agents, but exposure to toxins is wider than PD prevalence, so I feel the core pathology is where research should concentrate, seems to me😥.

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PD appeared during the Industrial Revolution. It’s unclear whether it existed before.

But yes, we should know the underlying dysfunctional processes. Unfortunately, there are many (dozens?) of processes that are dysfunctional and it’s hard to know which one “started”. The successful ATH434 trial in MSA suggests that iron dysregulation is very important: https://alteritytherapeutics.com/wp-content/uploads/-97 There aren’t many successful phase 2 trials in PD/MSA/DLB, even less so for potentially disease-modifying treatments. So this is really big. Unfortunately, before ATH434 becomes commercially available, I don’t think we have ways to “fix” brain iron…

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You are right, there is the issue of iron dysregulation. I have developed a mild case of RLS in the last 6-8 years or so, and PD and RLS are related. Both involve dopamine and iron. The prevalence of RLS in PD patients is much higher than the general population. These are of course distinct, but it’s interesting to see some common pathways.

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The effect of a nicotine-rich diet with/without redistribution of dietary protein on motor indices in patients with Parkinson’s disease: A randomized clinical trial - PubMed

Tiny (n=15 in the nicotine group) short (12 weeks) Iranian trial without washout period = trash.

Also, what is a “nicotine-rich diet”? :slight_smile:

A serious larger study found WORSENING of symptoms on nicotine:

The study showed no benefit of nicotine, and in fact a trend was observed toward an accelerated decline in function in the nicotine group, with UPDRS parts I–III score increased 3.5 points in the placebo arm (N = 54) versus 6.0 points in the nicotine arm (N = 47, P = 0.056) over the 60 weeks. Secondary analysis of the same measure over the full treatment period but prior to washout (ie, over 52 weeks) on a larger portion of the cohort (N=138) also showed greater worsening on nicotine compared to placebo (P = 0.010).

See:

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Tobacco leaf salad with balsamic vinaigrette?

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Your bio still says: “Are you using Rapamycin now?: Not Yet - But Interested”
Is this still true?
FWIW:
When I first started taking rapamycin, I had “age-related essential tremors”,
This mainly manifested in shaky hands.
After taking high-dose rapamycin(up to 20 mg weekly) for the first few weeks, they completely disappeared and haven’t returned.
“Age-related essential tremors (ART) and Parkinson’s disease (PD) are distinct clinical entities, but there is evidence suggesting a potential relationship between them.”

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That’s valuable feedback, thanks!

I don’t use rapamycin because:

  • It does not seem to cross the blood-brain barrier
  • Anecdotes of people with PD who tried it (such as @TomParkinson here) don’t report benefits
  • It failed in a clinical trial in MSA (a condition close to PD)
  • Research is not concluant
  • It might mess up with glycemic control and mine is already suboptimal

That’s why I looked at everolimus: Everolimus instead of Sirolimus / Rapamycin? Anyone else trying? - #177 by CronosTempi

However, the evidence in favor of everolimus is not much better. So I gave up.

Still, it might be worth giving a try to sirolimus (I was thinking about it this morning, so your message arrives at the perfect time!). Especially if, as in your case, the benefits appear quickly. Which dose did you start with? How many weeks for the tremors to disappear?

I’m testing a few other things now so I’ll wait a bit to test rapa. Also, a trial of another immunosuppressant, azathioprine, has just ended. We should have the results in April. I heard they will be “interesting”. That might strengthen the case for rapa?

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I don’t know if you’ve seen this paper (there’s so many papers & discussions).

There are a few threads on ketamine & rapamycin and videos from the lead author of the experiment which showed rapa prolonging the anti-depressant effect (they tried it because they believed it would block it).

From the paper it seems that it does cross the BBB:

Using a randomized placebo-controlled cross-over design, rapamycin was administered as a single 6 mg dose prior to ketamine infusion. In several species, preclinical studies have shown that rapamycin crosses the blood brain barrier, as measured by rapamycin levels in the cerebrospinal fluid and brain tissues, or by the inhibition of brain mTORC1 signaling [2326]. Moreover, within 2 h following peripheral rapamycin administration, one study reported decreased phosphorylation of S6 ribosomal protein in brain tissues—a pharmacodynamic readout of mTORC1 inhibition [15]. Furthermore, the immunosuppressive effect of rapamycin is an mTORC1-dependent process [27] and rapamycin was shown at therapeutic doses in humans to cross the brain blood barrier and to reduce the phosphorylation of S6 ribosomal protein in brain tissue [28, 29]. Therefore, the rapamycin dose and timing were selected based on the drug pharmacokinetics to ensure, at the time of ketamine administration, blood concentration of 5–20 ng/mL, a level that exhibits potent immunosuppression [29]. Consistent with the hypothesized mechanism of action of ketamine, we predicted that rapamycin would reduce the antidepressant effects of ketamine.

This study yielded two surprising, but potentially important, clinical observations. First, this study failed to validate the prediction from preclinical studies [10, 16], in that rapamycin pretreatment did not reduce the acute antidepressant effects of ketamine at 24 h following treatment. At 24 h, the depression scores and response rates were highly comparable between study arms. Second, rapamycin pretreatment increased the response and remission rates at 2 weeks (Fig. 1b), suggesting that this treatment approach may prolong the antidepressant effects of ketamine. This conclusion is supported by the statistically significant drug by treatment interaction effect on the primary outcome MADRS, showing overall larger reduction in depression scores following rapamycin pretreatment (Fig. 1a). Additionally, the Cohen’s d′ effect size at 2 weeks post rapamycin was 1.0, compared to 0.5 following placebo pretreatment (Fig. 1a). Moreover, the reduction in QIDS-SR scores (secondary outcome) at 2 weeks were significant following rapamycin, but not placebo pretreatment. As well as the response rate using QIDS-SR which was significantly higher at 2 weeks following rapamycin treatment. However, it is important to note the lack of significant difference at 1 week which may indicate a fluctuating course, or it may be related to the relatively small sample size. …

In humans, we are not able to administer rapamycin intracortically to fully parallel the preclinical reports. Further, we limited exposure to rapamycin to a loading immunosuppressant dose, which was selected on the basis of being the highest dose one could administer without exposing subjects to a risk of side effects associated with higher doses [32]. However, we believed that it was important to test whether systemic mTORC1 inhibition blocks the antidepressant effects of ketamine in humans because: (1) The immunosuppressant effects of rapamycin are mTORC1-dependent [27]. (2) There are preclinical and clinical reports providing evidence that peripherally administered rapamycin crosses the blood brain barrier and actively inhibit brain mTORC1 signaling [2326, 28, 29]. (3) Acute single dose of rapamycin administered peripherally was shown to inhibit mTORC1 in the brain within 2 h of administration in rodents [15]. …

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Thanks a lot you make a very good point I forgot that study!

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So sorry to hear about your diagnosis. I have learned much from you on these threads and greatly appreciate all you are doing to share knowledge on this site. I wish you all the best going fwd.

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