Nonenzymatic Glycation of Collagen in Aging and Diabetes

Summary and Conclusions How can we summarize the progress that has been made in the field since this topic was previously reviewed? Should we feel optimistic that the pieces of the puzzle are falling into place, as suggested recently (118), or do we have a disquieting sense that as we work out the details in one area—all the reaction pathways, products, side reactions—the perspective shifts and the puzzle of glycation, like a fractal, regenerates complexity? Perhaps both are appropriate. Glyco-oxidative damage represents the interface between the orderly workings of genomic intelligence and the disorganizing force of stochastic events. This interface, the cusp of our mortality, is the Faustian bargain of evolution. The passage from the unconscious immortality of unicellular existence to the complexities of sentient life required the development of an oxidative metabolism, the slow fire that consumes us. Until now we have only been able to watch it and study it; whether we can change it remains to be seen.