1. OVERVIEW OF ADVANCED GLYCATION END-PRODUCTS (AGE S ) www.diabetesincontrol.com

2. Goal of Presentation  The goal of this presentation is to gain insight into understanding the formation of advanced glycation end-products (AGEs), their overall impact on diabetic patients, and ways to reduce or negate their effect.

3. Objectives  Define advanced glycation end-products (AGEs).  Explain the formation of advanced glycation end- products (AGEs).  Explain how advanced glycation end-products (AGEs) affect diabetic patients.  Name the primary sources of advanced glycation end-products (AGEs).  Identify ways to reduce or negate the effects of advanced glycation end-products (AGEs).

4. Working definition of Advanced Glycation End-products (AGEs)

5. Working Definition  Advanced Glycation End Products (AGEs)  Diverse group of molecular products made endogenously through series of chemical reactions  Formed endogenously and exogenously Formation is natural occurrence in body due to normal metabolism and aging process Food cooked at high temperatures can create AGEs  Process accelerated by hyperglycemia observed in DM

6. Formation of Advanced Glycation End-products (AGEs)

7. Formation of AGEs  Step 1: Non-enzymatic reaction between amine and reducing sugar makes Schiff’s base  Step 2: Schiff base converts to Amadori’s product  Step 3: Series slower chemical reactions occur to form irreversible products (AGEs)

8. Formation of AGEs Glycation is the non-enzymatic condensation of the aldehyde and ketone groups in sugars with the amino groups in proteins to initially yield Schiff bases. These undergo further chemical reactions to produce AGEs.

9. Formation of AGEs Basta et al. Advanced glycation end products and vascular inflammation: implications for accelerated atherosclerosis in diabetes. Cardiovascular Research. 2004; 63: 582-592.

10. Chemical Structures of AGEs Basta et al. Advanced glycation end products and vascular inflammation: implications for accelerated atherosclerosis in diabetes. Cardiovascular Research. 2004; 63: 582-592.