Flavonoids as Promising Multitarget Agents in Alzheimer's Disease Therapy

The increase in the occurrence of the multifactorial Alzheimer's disease (AD) demands an urgent effort towards the development of effective anti-AD agents, such as the multitarget-directed ligands (MTDLs). In fact, AD is a genetic and an environmental disease, involving a diversity of etiopathogenic processes, and there is not yet a successful AD treatment. The major AD clinical indications (CIs) are extracellular amyloid plaques, intracellular neurofibrillary tangles (NFTs), abnormal inflammatory response, and neuron apoptosis and death caused by oxidative stress. The discovery of neuroprotective natural products, presenting good oral bioavailability, ability to cross the blood-brain barrier (BBB) and safety profile, is indeed a necessity, and some flavonoids are in clinical trials for AD treatment. In this review, the several flavonoids from natural sources that have shown activity on mechanisms associated with AD are presented. Although several reviews have been presented in the last few years, the main objective of this review is to recognize and discuss, for each CI, the scaffolds leading to the highest activity and so to attempt to achieve molecules targeting more than one CI, the MTDLs, which are potential leads for AD treatment. In conclusion, the most active flavonoids against several CIs of AD are flavanols and flavonols, which have a planar scaffold and structures presenting hydroxy groups at C5 and C7 on ring A and at C4 ' of ring B. Thus, molecules linking flavanols to flavonols, with hydroxy groups at C5 and C7 on ring A and at C4 ' of ring B, are also promising against CIs of AD and potential anti-AD agents.