Advanced Glycation End Products and Skin Autoimmune Disorders: Pathogenic Insights into Vitiligo, Bullous Pemphigoid, and Type 1 Diabetes Mellitus

Abstract

AGEs are molecules formed by nonenzymatic glycation of proteins, lipids, and nucleic acids, a process accelerated under hyperglycemic conditions such as DM1. These molecules interact with specific receptors, particularly the Receptor for AGEs (RAGE), triggering intracellular signaling cascades that promote oxidative stress through the generation of Reactive Oxygen Species (ROS) and activation of inflammatory pathways. A critical pathological mechanism involves the formation of neoantigens, modified self-proteins that elicit immune responses. Structural alterations caused by AGEs expose new epitopes or modify existing ones, making them targets for autoreactive T cells and autoantibodies. This mechanism is implicated in autoimmune skin diseases such as vitiligo and bullous pemphigoid. Oxidative stress plays a central role in these diseases, exacerbated by AGEs through the generation of ROS and depletion of antioxidants, leading to melanocyte destruction in vitiligo and tissue damage in bullous pemphigoid. In addition, hypoxia enhances ROS production, mitochondria, and other cellular systems contributing to oxidative stress. Emerging evidence suggests that hypoxia can be mitigated by oxygen nanobubbles. Targeting AGE formation and oxidative stress presents a promising approach for the management of autoimmune skin disorders in DM1. Therapeutic strategies targeting AGE formation, oxidative stress, and immune dysregulation show promise for managing autoimmune skin disorders in Type 1 Diabetes Mellitus (T1DM). AGE inhibitors, such as aminoguanidine and pyridoxamine, reduce non-enzymatic protein glycation, limiting AGE accumulation and inflammatory signaling. Antioxidants, including polyphenols, vitamins C and E, N-acetylcysteine, selenium, and hydrogen-rich water, help neutralize Reactive Oxygen Species (ROS), restoring oxidative balance. Combining AGE inhibitors and antioxidants may provide synergistic benefits by reducing oxidative stress and protein immunogenicity. Additionally, immune modulation therapies, such as Treg therapy and cytokine inhibitors, aim to restore immune tolerance and prevent autoimmune activation. Anti-TNF-α and IL-6 inhibitors offer targeted inflammation suppression, while RAGE antagonists mitigate AGE-induced immune dysregulation. This study aims to explore the role of Advanced Glycation End products (AGEs) in the pathogenesis of autoimmune skin disorders associated with type 1 Diabetes Mellitus (DM1) and to evaluate potential therapeutic strategies targeting AGE formation and oxidative stress.

Keywords: Advanced glycation end products; bullous pemphigoid; immune dysregulation; therapeutic interventions.; type 1 diabetes mellitus; vitiligo.