In different clinical studies, an association of type 2 diabetes and Alzheimers disease (AD) has been described. However, the underlying mechanisms are still unclear. One explanation could be that vascular complications of diabetes result in neurodegeneration. Alternatively, the mechanism might be directly related to insulin and insulin-like growth factor( IGF)-1 signaling, leading to the proposal that AD is a “brain-type diabetes”. Furthermore, postmortem analyses of brains from patients with AD revealed a markedly downregulated expression of insulin receptor (IR), IGF-1 receptor (IGF-1R), insulin receptor substrate (IRS)-1 and IRS-2, and these changes progress with severity of neurodegeneration. These findings raise the question, whether this phenomenon is cause or consequence of neurodegeneration. Recently, Cohen and coworkers have show that knocking down DAF-2 in C. elegans, the homolog of the mammalian IR/IGF-1R, reduces β-amyloid(Aβ)1-42 toxicity. Cell based experiments suggest a specific role for the IGF-1/IRS-2 signaling pathway in regulating α-/β-secretase activity. Moreover circulating IGF-1 might influence Aβ clearance from the brain by promoting Aβ transport over the blood brain barrier. Interestingly, brain specific deletion of IRS-2 increases life span, suggesting that long term neuronal IGF-1R signaling might be harmful. Taken together, the data from humans and different model organisms indicate a role of IR/IGF-1R signaling in Aβ metabolism, and clearance as well as longevity. Since more studies are needed to elucidate the impact of insulin and/or IGF-1 treatment in AD, the time to propose these hormones as a potential treatment option for AD has not come yet.
Department of Internal Medicine II, University of Cologne, Kerpener Str. 62, LFI 4/061, 50937 Cologne, Germany.