Beyond diabetes and obesity: <scp>GLP</scp> ‐1 receptor agonists in disrupting the vicious cycle of metabolic dysfunction and neuroinflammation
Renata Spezani, Carlos Alberto Mandarim‐de‐Lacerda
Abstract
Neurodegenerative diseases, including debilitating conditions like Alzheimer's and Parkinson's, are characterized by progressive neuronal loss, a process fundamentally driven by persistent chronic neuroinflammation and central metabolic dysfunction. In these disorders, persistent danger signals, such as the aggregation of misfolded proteins, activate resident microglial cells, leading to a functional shift toward a detrimental, pro-inflammatory phenotype. This damaging cycle is critically exacerbated by impaired Insulin/Insulin-like Growth Factor 1 signalling, which compromises neuronal mitochondrial homeostasis, decreases energy production, and severely diminishes synaptic plasticity, thereby establishing a self-perpetuating cycle of metabolic disturbance and neuroinflammation. This review examines the burgeoning therapeutic potential of Glucagon-Like Peptide-1 Receptor Agonists (GLP-1RAs), a class of drugs traditionally used to manage type 2 diabetes mellitus and obesity, as neuroprotective agents. We discuss mechanistic insights demonstrating how GLP-1RAs operate through a crucial dual action: effectively mitigating central insulin resistance and directly suppressing the multi-faceted neuroinflammatory cascade. By activating specific neuronal and glial signalling pathways, GLP-1RAs are shown to restore mitochondrial function, increase neuronal resilience, and crucially, modulate adverse glial cell responses-inhibiting the release of major pro-inflammatory cytokines and significantly reducing cellular oxidative stress within the central nervous system. Clinical trials and comprehensive preclinical data, analysed through diverse experimental models of neurodegeneration, strongly support the translational potential relevance of these compounds. The accumulating evidence suggests that GLP-1RAs offer a promising, readily available therapeutic strategy to disrupt the core inflammatory and metabolic pathways common across many neurodegenerative conditions, warranting further investigation in large-scale human trials.