One emerging therapeutic avenue involves the modulation of insulin signaling, as insulin resistance is increasingly recognized as a central contributor to AD pathophysiology. Often referred to as “type 3 diabetes” [9], AD has been linked to impaired insulin signaling, which disrupts glucose metabolism, neuronal survival, and synaptic plasticity, thereby exacerbating neurodegeneration [6,9,10,11]. Insulin signaling in the central nervous system (CNS) is mediated through the phosphoinositide 3-kinase (PI3K)/AKT pathway, which is critical for energy homeostasis, neurotransmission, and synaptic integrity [12,13]. Defects in this pathway have been observed in AD patients and are associated with neuronal energy deficits, oxidative stress, and increased vulnerability to Aβ toxicity [12,13,14]. Furthermore, insulin resistance impacts glutamatergic neurotransmission, particularly through dysregulation of N-methyl-D-aspartate receptors (NMDARs), contributing to excitotoxicity, synaptic dysfunction and cognitive impairment [15,16,17].
In this context, insulin sensitizers such as D-chiro-inositol (DCI) represent a promising intervention for restoring insulin signaling in AD.
DCI is a naturally occurring inositol isomer that can be incorporated into the body through diet and plays a crucial role in insulin-mediated glucose uptake and metabolism by acting through the PI3K/AKT pathway [18,19]. In addition to improving insulin sensitivity, DCI has been implicated in modulating neuroinflammatory responses and oxidative stress, which are key drivers of AD pathology [20,21,22]. Given its role in metabolic regulation, PI3K/AKT signaling [23], DCI may also influence glutamatergic signaling by stabilizing NMDAR function, potentially reducing excitotoxicity and synaptic deficits observed in AD. Preliminary observations indicate that DCI has beneficial effects in AD by counteracting the toxic actions of Abeta oligomers and by normalizing metabolic dysfunctions associated with amyloidosis in the humanized 5XFAD model of AD [24,2.....