Cytidine monophospho- N-acetylneuraminic acid hydroxylase ( Cmah) is an enzyme that is encoded by the CMAH gene. In most mammals, the enzyme Hydroxylation N-acetylneuraminic acid (Neu5Ac), producing N-glycolylneuraminic acid (Neu5Gc). Neu5Ac and Neu5Gc are mammalian glycans that compose the glycocalyx, especially in sialoglycoproteins, which are part of the sialic acid family. The CMAH equivalent in humans is a pseudogene (CMAHP); there is no detectable Neu5Gc in normal human tissue. This deficiency has a number of proposed effects on humans, including increased brain growth, improved self-recognition by the human immune system, and susceptibility to atherosclerosis. Incorporation of Neu5Gc from red meat and dairy into human tissues has been linked to chronic disease, including type-2 diabetes and chronic inflammation.
Because Neu5Gc differs from Neu5Ac by only one oxygen, it is handled like a native sialic acid by human biochemical pathways. The immune system does not work the same way, however; all humans have varying amounts of a diverse spectrum of anti-Neu5Gc antibodies. If Neu5Gc is constantly being incorporated into tissues due to a diet heavy in red meats and dairy, anti-Neu5Gc antibodies cause chronic inflammation, especially in blood vessels and the linings of hollow organs. These sites are also common places for atherosclerosis and Carcinoma, both of which are associated with red meat and dairy consumption and are aggravated by chronic inflammation. Red meat ingestion and chronic inflammation have also been associated with diseases like type-2 diabetes and age-dependent macular degeneration, so Neu5Gc may be linked to the development of these disorders as well.
Recent data suggests that the hypoxic conditions in can up-regulate the expression of the lysosomal sialic acid transporter necessary for Neu5Gc incorporation into human tissues. In addition, may activate enhanced macropinocytosis, which can increase Neu5Gc incorporation. Studies have shown that fetal tissues are also capable of taking up Neu5Gc from maternal dietary sources, which may explain elevated levels of Neu5Gc in the human fetus.
The presence of Neu5Gc in various derived from animal products may impact human health and is still being studied. Some complications could include immune hypersensitivity reactions, reduced half-life of the biotherapeutic in circulation, immune complex formation, increase of Neu5Gc antibody concentration, enhanced immunoreactivity against the biotherapeutic polypeptide, and directly loading more Neu5Gc into tissues.
The deletion that deactivated this gene occurred approximately 3.2 mya, after the divergence of humans from the African great apes, and quickly swept to fixation in the human population. The lineage of this pseudogene in humans indicates another deep split in Africa dating to 2.9 mya, with a complex subsequent history.
Sexual selection may have contributed to the fixation of nonfunctional CMAH in humans. This hypothesis has been tested in mice, with females carrying nonfunctional CMAH exhibiting reproductive incompatibility with males carrying functional CMAH due to anti-Neu5Gc Antibody migrating to the female reproductive tract and destroying Neu5Gc-positive sperm.
The functional loss of CMAH after the divergence of humans from the great apes has several implications for its role in human development, including less constrained brain growth and increased running endurance, two traits thought to be important to human evolution. In most mammals, CMAH Gene expression is down-regulated in the brain, and experimental up-regulation of CMAH is lethal in mice. Experimental CMAH loss in mice increases running endurance and decreases muscle fatigue, which could have been beneficial to ancestral Homo during the gene's fixation.
Nonfunctionialization of CMAH has made humans more susceptible to some by decreasing sialic acid diversity. Viruses that bind to Neu5Ac before entering the cell are enhanced by the high density of Neu5Ac, which would be reduced if other sialic acids were present on human . For example, the most serious form of malaria in humans, P. falciparum, binds to Neu5Ac on the membrane of red blood cells.
In contrast to these negative effects, losing CMAH should actually protect humans against any pathogen that targets Neu5Gc, such as those that cause diarrheal diseases in livestock, E. coli K99, transmissible gastroenteritis coronavirus (TGEV), and simian virus 40 (SV40).
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