Extracellular aging--accumulating molecular damage by glycation, oxidation, and crosslinking of long-lived extracellular proteins, mainly collagen and elastin--is a major cause of several important human aging pathologies. Crosslinking increases mechanical stiffness of blood vessels and urinary bladder. Crosslinking impairs the functioning of the kidney, heart, retina, and other tissues and organs. Glycation adducts trigger inflammatory signaling, provoking tissue damage and cancers. Crosslinking tightens up the extracellular matrix (ECM), hardening it against natural turnover processes. Known crosslink breakers (e.g., alagebrium, of the thiazolium halide family) are only partly effective because they break only a subset of AGE crosslink structures (sugar-derived alpha-diketone bridges). So far, no agent has been found that breaks the prevalent glucosepane and K2P crosslink structures. Enzymes that would be able to recognize and disassemble glycation products may be too big to migrate into the ECM and repair collagen or elastin in vivo. Two approaches to therapy development are presented here. ECM turnover enhancement would enhance natural processes to digest old ECM and replace it with new. It will be important to tune the collagen degradation to a rate slow enough to prevent dire side-effects, such as hemorrhage from leaky blood vessels as collagen molecules are removed and replaced. Glycation breaker discovery would use high-throughput screening and rational drug design to find molecules that are able to break glucosepane crosslinks and K2P crosslinks of extracellular proteins. Candidates would be further screened for selectivity and toxicity in order to avoid damage to other molecules.
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