RAGE (receptor for advanced glycation end-products), also called AGER, is a 35 kilodalton transmembrane receptor of the immunoglobulin super family which was first characterized in 1992 by Neeper et al. Its name comes from its ability to bind advanced glycation end-products (AGEs), which include chiefly glycoproteins, the glycans of which have been modified non-enzymatically through the Maillard reaction. In view of its inflammatory function in innate immunity and its ability to detect a class of ligands through a common structural motif, RAGE is often referred to as a pattern recognition receptor. RAGE also has at least one other agonistic ligand: high mobility group protein B1 (HMGB1). HMGB1 is an intracellular DNA-binding protein important in chromatin remodeling which can be released by necrotic cells passively, and by active secretion from macrophages, natural killer cells, and dendritic cells. The interaction between RAGE and its ligands is thought to result in pro-inflammatory gene activation. Due to an enhanced level of RAGE ligands in diabetes or other chronic disorders, this receptor is hypothesised to have a causative effect in a range of inflammatory diseases such as diabetic complications, Alzheimer's disease and even some tumors. Isoforms of the RAGE protein, which lack the transmembrane and the signaling domain (commonly referred to as soluble RAGE or sRAGE) are hypothesized to counteract the detrimental action of the full-length receptor and are hoped to provide a means to develop a cure against RAGE-associated diseases.
Gene The RAGE gene lies within the major histocompatibility complex (MHC class III region) on chromosome 6 and comprises 11 exons interlaced by 10 introns. Total length of the gene is about 1400 base pairs (bp) including the promoter region, which partly overlaps with the PBX2 gene. About 30 polymorphisms are known most of which are single-nucleotide polymorphisms.
RNA and alternative splicing The primary transcript of the human RAGE gene (pre-mRNA) is thought to be alternatively spliced. So far about 6 isoforms including the full length transmembrane receptor have been found in different tissues such as lung, kidney, brain etc. Five of these 6 isoforms lack the transmembrane domain and are thus believed to be secreted from cells. Generally these isoforms are referred to as sRAGE (soluble RAGE) or esRAGE (endogenous secretory RAGE). One of the isoforms lacks the V-domain and is thus believed not to be able to bind RAGE ligands.
Structure
RAGE exists in two primary forms in the body: a membrane-bound form known as mRAGE and a soluble form known as sRAGE. The membrane-bound form (mRAGE) consists of three key components: an extracellular region made up of three immunoglobulin-like domains (one variable V-type domain and two constant C-type domains), a transmembrane domain that anchors the receptor to the cell membrane, and an intracellular domain essential for signaling. In contrast, the soluble form (sRAGE) consists only of the extracellular domains and lacks both the transmembrane and intracellular domains. sRAGE can be produced by two different mechanisms: either through alternative splicing of the RAGE gene, leading to a truncated form that lacks the transmembrane and cytosolic regions, or through proteolytic cleavage of mRAGE by specific enzymes such as ADAM10 or matrix metalloproteinases (MMPs). Upon ligand binding, mRAGE recruits the intracellular protein DIAPH1 (Diaphanous-related formin-1), which is critical for initiating intracellular signaling. This signaling cascade can result in pathological outcomes, including oxidative stress, inflammation, cellular dysfunction, and apoptosis. (Refer to the schematics attached) These effects are particularly significant in the progression of several chronic diseases, such as diabetes, cardiovascular diseases, neurodegenerative disorders, and cancer. The full RAGE receptor plays an important role in cellular communication, interacting with a diverse set of ligands, including advanced glycation end products (AGEs), amyloid-β peptides, and S100 proteins. These interactions activate multiple downstream signaling pathways that contribute to cellular stress responses and are linked to the development of various inflammatory and metabolic conditions.
Membrane-bound (mRAGE) The membrane-bound form of RAGE, commonly known as mRAGE, is a full-length receptor comprising several important structural domains:
Extracellular Domain: The extracellular domain is composed of multiple immunoglobulin-like subdomains, including the variable (V) domain and two constant domains (C1 and C2). The V domain serves as the principal binding site for a wide range of ligands, such as advanced glycation end-products (AGEs), S100 proteins, and high mobility group box 1 (HMGB1). This ligand-binding feature is essential for triggering downstream signaling cascades that lead to inflammatory responses. Transmembrane Domain: The transmembrane domain helps anchor RAGE in the cellular membrane, ensuring that the receptor remains available to interact with extracellular ligands and transmit signals into the cell. Cytoplasmic Domain: The cytoplasmic domain, also referred to as the cytosolic domain, is integral for intracellular signal transduction. When ligands bind to the extracellular domain, this segment interacts with intracellular signaling proteins, initiating processes such as the activation of NF-κB, a key inflammatory pathway. It has been observed that the absence of the cytoplasmic domain impairs the receptor's ability to transmit signals effectively, which underlines its importance in RAGE-mediated signaling.
Soluble (sRAGE) The soluble form of RAGE (sRAGE) only includes the extracellular domain and lacks both the transmembrane and cytoplasmic domains. sRAGE can be generated through two primary mechanisms:
Alternative Splicing: In this mechanism, alternative splicing of the RAGE gene produces a variant that lacks the membrane-anchoring and cytoplasmic segments, creating a soluble form of the receptor Proteolytic Cleavage: Alternatively, sRAGE can be produced by proteolytic cleavage of the membrane-bound receptor. This involves enzymes, such as matrix metalloproteinases (MMPs) and ADAM10, cleaving the extracellular portion of mRAGE, which is then released into the circulation.
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