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Review
. 2023 Mar 7;12(3):663.
doi: 10.3390/antiox12030663.

The Potential of Flavonoids and Flavonoid Metabolites in the Treatment of Neurodegenerative Pathology in Disorders of Cognitive Decline

Affiliations
Review

The Potential of Flavonoids and Flavonoid Metabolites in the Treatment of Neurodegenerative Pathology in Disorders of Cognitive Decline

James Melrose. Antioxidants (Basel). .

Abstract

Flavonoids are a biodiverse family of dietary compounds that have antioxidant, anti-inflammatory, antiviral, and antibacterial cell protective profiles. They have received considerable attention as potential therapeutic agents in biomedicine and have been widely used in traditional complimentary medicine for generations. Such complimentary medical herbal formulations are extremely complex mixtures of many pharmacologically active compounds that provide a therapeutic outcome through a network pharmacological effects of considerable complexity. Methods are emerging to determine the active components used in complimentary medicine and their therapeutic targets and to decipher the complexities of how network pharmacology provides such therapeutic effects. The gut microbiome has important roles to play in the generation of bioactive flavonoid metabolites retaining or exceeding the antioxidative and anti-inflammatory properties of the intact flavonoid and, in some cases, new antitumor and antineurodegenerative bioactivities. Certain food items have been identified with high prebiotic profiles suggesting that neutraceutical supplementation may be beneficially employed to preserve a healthy population of bacterial symbiont species and minimize the establishment of harmful pathogenic organisms. Gut health is an important consideration effecting the overall health and wellbeing of linked organ systems. Bioconversion of dietary flavonoid components in the gut generates therapeutic metabolites that can also be transported by the vagus nerve and systemic circulation to brain cell populations to exert a beneficial effect. This is particularly important in a number of neurological disorders (autism, bipolar disorder, AD, PD) characterized by effects on moods, resulting in depression and anxiety, impaired motor function, and long-term cognitive decline. Native flavonoids have many beneficial properties in the alleviation of inflammation in tissues, however, concerns have been raised that therapeutic levels of flavonoids may not be achieved, thus allowing them to display optimal therapeutic effects. Dietary manipulation and vagal stimulation have both yielded beneficial responses in the treatment of autism spectrum disorders, depression, and anxiety, establishing the vagal nerve as a route of communication in the gut-brain axis with established roles in disease intervention. While a number of native flavonoids are beneficial in the treatment of neurological disorders and are known to penetrate the blood-brain barrier, microbiome-generated flavonoid metabolites (e.g., protocatechuic acid, urolithins, γ-valerolactones), which retain the antioxidant and anti-inflammatory potency of the native flavonoid in addition to bioactive properties that promote mitochondrial health and cerebrovascular microcapillary function, should also be considered as potential biotherapeutic agents. Studies are warranted to experimentally examine the efficacy of flavonoid metabolites directly, as they emerge as novel therapeutic options.

Keywords: Alzheimer’s disease; Parkinson’s disease; autism; bipolar disorder; gut-brainaxis; protocatechuic acid; therapeutic treatment of neurological disorders; urolithins; γ-valerolactones.

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Conflict of interest statement

The author has no conflict to report.

Figures

Figure 1
Figure 1
Schematic of the gut-brain axis: (a) demonstration of bidirectional communication by the parasympathetic vagus nerve, and some of the neurodegenerative conditions treated by vagal stimulation; (b) the vagal nerve transports compounds (generated from dietary flavonoids by the gut microbiome) of therapeutic value in the treatment of neurological disorders. Neurodegenerative conditions treated successfully by vagal stimulation are also shown (c).
Figure 2
Figure 2
Schematic of neural signal transduction. Depiction of a neuron and its functional components (a) and the processes that occurs when a nerve is activated and signal transduction occurs (be). Specific features of the neuron are annotated, including the neural dendrite processes (1) where signal input occurs, the nucleus (2), which regulates neural activity in the neural cell body or soma (3). The myelinated sheath (4) covering the axon (5) ensures neural signal transmission efficiency is maintained. Neural synapses (6) communicate with other neurons in the neural network. Neural transmitters, such as dopamine (7), are stored in a smart gel matrix within the synaptic vesicle supplied by a 12 span transmembrane KS-storage and transport proteoglycan, SV-2 (8). The synaptic vesicle also has a calcium sensing glycoprotein: synaptotagmin (9). When a nerve becomes activated, the cell membrane becomes depolarized in the soma and a wave of membrane depolarization travels down the axon to the synapses. An influx of Ca2+ (10) into the nerve cytosol occurs in neuronal activation; this increase in Ca2+ is detected by synaptotagmin, which mobilises the transport of synaptic vesicles to the synaptic gap by SV-2 (11), and the synaptic vesicles fuse with the de-polarised pre-synaptic membrane (12). This fusion process is regulated by synaptotagmin and SNARE complex (SNAP Receptor) proteins and the neurotransmitters are released into the synaptic gap (14) to be taken up by neurotransmitter receptors on a communicating neuron in the network and the signal is successfully transduced. This is an extremely rapid process occurring in ~50–60 milliseconds.
Figure 3
Figure 3
Neurotransmitters and flavonoid metabolites. A comparison of the structure of neurotransmitters (af) conveyed by nerves by vesicular transport, as shown in Figure 2. A few selected flavonoid metabolites generated by the gut microbiome are also shown for comparison (gk). These flavonoid metabolites display a range of activities against neurons and cerebrovascular endothelial cells, and have beneficial properties that combat neuroinflammation, are neuroprotective, and have vasodilatory properties that promote cerebral blood flow in neurological disorders. Some of these metabolites have also been shown to promote mitochondrial biogenesis, improving neural bioenergetics and neuronal function in disorders, such as AD and PD, where a cognitive decline has been observed.
Figure 4
Figure 4
The flavonoids. Classification of the flavonoids, a major sub-category of phenolic compounds (a), showing the diverse modifications (b) that occur on the A, B and C flavone ring structures (c).
Figure 5
Figure 5
The many forms of quercetin. As a representative flavonoid, quercetin occurs as a glycosylated form (rutin) in plant tissues (a), which, when ingested, is converted to the aglycone form (b), isorhamnetin-3-glucuronide (c), quercetin also undergoes sulfation (d), or glucosidation (e,f), and glucuronidation (g,h), as shown at specific locations in the flavone A, B, and C rings (i). The C-ring may undergo cleavages at the positions shown when the flavone is processed by the gut microbiome.
Figure 6
Figure 6
Examples of some of the pharmacologically active complex polyphenolic compounds that have been identified in LeZhe Chinese complimentary medicine herbal preparations (af) and Shuang-Huang-Lian herbal preparations (gi) used to treat neurodegenerative conditions and respiratory infections.
Figure 7
Figure 7
Examples of the varied ring structures of some of the flavonoids covered in this review. Structures of bioactive phenolic compounds identified in Chaihu-Shugan-San, Qingfei Paidu, and Ma Xing Shi Gan traditional Chinese complimentary medical formulations. Identification of phillyrin glycoside, quercetin, glycyrrhizic acid, luteolin, baicalin, baicalein, hesperidin, hesperitin, naringin, naringenin mangiferin, and licochalcone A (al) as bioactive components of such herbal formulations.
Figure 8
Figure 8
Generation of Urolithins: complex heterocyclic elligatannin compounds, such as chebulagic acid (a), chebulinic acid (b), and punicalagin (c) occurring in plant foods are converted to ellagic acid (d) and a number of urolithin metabolites by the gut microbiome. Urolithin A (e) and B (f) are active in neural tissues.
Figure 9
Figure 9
Multicyclic structural forms of the anthocyanins and their bioactive protocatechuic acid and phlorglucinaldehyde metabolites generated by the gut microbiota. Cyanidin-3-O-glucosied (a); Delphinidin-3-O-glucosied (b); Malvidin-3-O-glucosied (c); Pelargonidin-3-O-glucosied (d); protocatechuic acid (e); Phloroglucinaldehyde (f).
Figure 10
Figure 10
Degradative pathways used by C. perfringens and B. fragilis of the human gut microbiome to process quercetin into bioactive metabolites, as proposed by Peng et al. [325]. Quercetin-4’glucuronide (a) is initially degraded by β-glucuronidase to form quercetin aglycone (b) then dihydroxyphenyl acetic acid (e) and dihydroxybenzoic acid (i). Alternatatively C ring internal cleavage of quercetin aglycone into an intermediate form (c) can also be converted to hydroxyphenyl acetic acid (f) and phenyl acetic acid (j) or to hydroxyphenyl propionic acid (d) then dihydroxyphenyl acetic acid (g) then to methoxy phenylacetic acid (k) or protocatechuic acid (h).
Figure 11
Figure 11
Generation of tea EGCG metabolites by the gut microbiome, as proposed by Lotito et al. 2011 [227] 5(3,4,5-trihydroxyphenyl)-g-valerolactone has therapeutic pharmacological properties useful in cancer therapy, antioxidant free radical scavenging, and cerebrovascular therapeutic applications in neurodegenerative disorders. (a) Epigallocatechin gallate (EGCG); (b) (-)-Epigallocatechin-3-O-gallate-4’-O-glucuroide; (c) 4’’O-Methyl-(-)epigallocatechin-3-O-gallate; (d) (-)-Epigallocatechin; (e) 4’,4’’-Di-O-Methyl-(-)epigallocatechin-3-O-gallate; (f) 5, (3’4’5’-trihydroxyphenyl)-γ-vcalerolactone; (g) 4’’O-Methyl-(-)epigallocatechin.

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This study was funded by Melrose Personal Research Fund, Sydney, Australia.

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