Molecular Neurodegeneration

Tau pathology is a central driver of neurodegeneration, yet the molecular mechanisms linking tau accumulation to neuroinflammation, metabolic failure, and white matter degeneration remain incompletely understood. Galectin-3 (Gal3) is an inflammation-associated lectin expressed by activated microglia and has been implicated in neurodegenerative disease progression. Here, we investigated whether Gal3 modulates tau-driven pathology across cellular, molecular, and systems levels. Using the P301S tauopathy mouse model with genetic deletion of Gal3, we show that Gal3 loss robustly attenuates tau pathology across vulnerable brain regions, including cortex, hippocampus, and piriform-entorhinal cortex. Gal3 deletion reduced hyperphosphorylated and pathological tau species, normalized tau kinase signaling, and restored mitochondrial and vesicular trafficking pathways disrupted by tau accumulation. Proteomic and phosphoproteomic analyses revealed widespread normalization of tau-associated immune, metabolic, and trafficking pathways, with Tau-Gal3KO mice clustering closely with wild-type controls. In parallel, Gal3 deletion markedly reduced microglial activation and Gal3-positive inflammatory signatures, preserved white matter integrity, prevented axonal degeneration, and normalized oligodendrocyte and myelin abnormalities. Functionally, Gal3 deficiency enhanced microglial myelin phagocytosis and lysosomal degradation both in vitro and in vivo, suggesting improved clearance of myelin debris under inflammatory stress. Cell-type-specific analyses further revealed restoration of mitochondrial complex I subunit expression in both excitatory neurons and parvalbumin-positive interneurons. Importantly, translational studies in human iPSC-derived neurons demonstrated that extracellular Gal3 exacerbates tau hyperphosphorylation and aggregation following tau seeding, effects that were reversed by pharmacological Gal3 inhibition. Together, these findings identify Galectin-3 as a central upstream regulator linking tau pathology to neuroinflammation, proteomic dysregulation, mitochondrial dysfunction, and white matter degeneration. Targeting Gal3 represents a promising therapeutic strategy to mitigate tau-driven neurodegenerative processes.

MicroRNAs (miRNA), are non-coding RNA that act as post-transcriptional regulators of gene expression in various organs including the brain where they play an important role in neurodegeneration. Circular RNAs are single-stranded, covalently closed loop RNA molecules recognized as upstream regulators of miRNA. Previous studies have shown that circRNAs are dysregulated in Alzheimers and other neurodegenerative diseases. However, a systematic, age-and region-specific circRNA atlas in primary tauopathy is lacking. To this end, we performed comprehensive circRNA sequencing of hippocampal and cortical tissues from a model of human tauopathy, h-Tau mice, at 3, 6, and 12 months of age. We identified circRNA-miRNA sponging networks that target and regulate key tau disease-associated pathways, including kinases, phosphatases, histone deacetylase, glutamatergic and GABAergic synapse, and microglial efferocytosis. Our study demonstrates an age- and region-specific circRNA landscape in the brain of a model of human tauopathy and identify candidate circRNA-miRNA-mRNA regulatory axes converging on core tau pathological processes. These findings support the novel hypothesis that specific circRNAs have the potential to be used as biomarkers and therapeutic targets against tau-driven neurodegeneration.

BackgroundPhospholipase C gamma-2 (PLC{gamma}2) catalyzes the hydrolysis of the membrane phosphatidylinositol-4,5-bisphosphate (PIP2) to form diacylglycerol (DAG) and inositol trisphosphate (IP3), feeding into diverse downstream signaling pathways. PLCG2 polymorphisms have been associated with reduced and/or increased risk of Alzheimers disease (AD) and related dementias, longevity, autoinflammation, and immune disorders. In the brain, PLC{gamma}2 is expressed in microglia, and other neuroimmune and vascular interface populations, yet its role in brain homeostasis remains incompletely defined. MethodsWe analyzed the brains of three-month-old Plcg2 wild-type (WT), heterozygous (Het KO) and homozygous knockout (Homo KO) littermate mice modeling human PLCG2 loss-of-function risk alleles linked to AD risk using a multiomic approach that included lipidomics, metabolomics, proteomics, and transcriptomics, together with immunofluorescence, as well as flow-cytometric profiling of peripheral and brain-draining immune compartments. ResultsPlcg2 deficiency substantially impaired early survival and produced splenomegaly without increasing total spleen cellularity, instead shifting spleen composition toward myeloid/innate-enriched cells and away from B cells, with expansion of age-associated B-cell (ABC-like) subsets and parallel reductions in CD4 and CD8 regulatory T cells in spleen and cervical lymph nodes. Brain lipidomics revealed selective depletion of PIP2, despite very low bulk PLC{gamma}2 protein abundance relative to other PLC family members. PLC{gamma}2 loss led to significant reductions in myelin-enriched lipid classes and myelin/paranode-associated proteins, accompanied by compensatory upregulation of oligodendrocyte/myelin genes, and modest shifts in microglial, lysosomal, complement, and oxidative metabolism pathways by NanoString and DIA-MS. Targeted acylcarnitine profiling demonstrated reprogramming of brain oxidative metabolism, with increased short-, medium-, and long-chain acylcarnitines and enrichment of mitochondrial matrix fatty-acid and amino-acid catabolic enzymes in Homo KO brains. ConclusionsLoss of PLC{gamma}2 installs a coordinated program that compromises systemic immune tolerance and subtly erodes central myelin and phosphoinositide homeostasis while enhancing brain oxidative metabolism, effects that extend beyond microglial phagocytic signaling and may underlie increased vulnerability to AD pathology and aging, providing a mechanistic framework for how PLCG2 variation may link systemic immune regulation, white-matter integrity, and neurodegenerative risk. LimitationsBecause constitutive Plcg2 Homo KO mice display high early mortality and intestinal vascular abnormalities, observed phenotypes may reflect developmental compensation and may not fully recapitulate protective human PLCG2 variants.

Parkinson's disease (PD) exhibits pronounced sex differences, yet the underlying genetic and molecular mechanisms remain poorly understood. We performed the largest-to-date meta-analysis of sex-stratified genome-wide association studies of PD followed by brain proteogenomics-based causal inference analyses. We nominated 10 candidate proteins that appear important to sex-biased PD risk, of which 2 female-biased, GALC and PSMG1, and 3 male-biased, ACTR1B, WDR41, and CD151, were most robustly prioritized. Together, our findings provide evidence for genetic sex differences in PD, prioritizing sex-biased proteins implicated in lysosomal regulation, neuroinflammation, lipid biology, and other PD-relevant mechanisms, and highlighting potential sex-informed therapeutic opportunities.

Frontotemporal lobar degeneration (FTLD) and Alzheimers disease (AD) differ in their clinical features and genetic etiologies but share progressive cognitive decline. Emerging evidence implicates lipid dysregulation in neurodegeneration, but its extent across FTLD subtypes and how it compares to AD are unclear. Here, we performed integrated lipidomic and proteomic analyses of matched frontal (disease-vulnerable) and occipital (relatively spared) post-mortem cortices from individuals with genetic and sporadic FTLD-TDP, FTLD-tau (Picks disease, PiD), AD, and controls. FTLD and AD exhibited convergent lipid alterations, including reduced levels of cardiolipins and phosphatidylethanolamines, alongside increased gangliosides, diacylglycerols, cholesterol esters, acylcarnitines, and coenzyme Q, with generally greater changes in FTLD frontal cortex. FTLD displayed additional alterations, including reductions in bis(monoacylglycerol)phosphate, ceramides, phosphatidylserines, phosphatidylinositols, and sulfatides. These lipid changes were accompanied by proteomic alterations involving lysosomal proteins, phospholipases, phospholipid remodeling enzymes, and fatty acid oxidation pathways. Although lipidomic and proteomic signatures were broadly shared across FTLD subtypes, GRN associated FTLD-TDP and PiD showed the most extensive alterations. Triglycerides were selectively reduced in PiD in association with decreased DGAT1 expression, whereas cholesterol esters were elevated across all subtypes except C9orf72 associated FTLD-TDP. These findings identify shared disruptions in lipid homeostasis and lysosomal lipid metabolism across FTLD and AD, highlighting convergent metabolic pathways underlying neurodegeneration.

The neuropathology of Parkinson's disease is characterized by -synuclein (-syn) aggregation and dopaminergic (DAergic) neurodegeneration. While neuronal loss in C. elegans -syn-induced neurodegeneration models is temporally age-dependent, prior research indicates it is uncoupled from the organismal aging process. Here we examined transgenic C. elegans expressing human A53T -syn in DAergic neurons to determine the impact of localized DA metabolism on both neurodegeneration and organismal lifespan. Increasing endogenous DA levels through overexpression of tyrosine hydroxylase (CAT-2) exacerbated A53T-induced DAergic degeneration, whereas DA depletion via{Delta} cat-2 mutation rescued neuronal survival. By mutating a DA interaction motif within -syn, neurodegeneration was rendered insensitive to DA manipulation, thus confirming a structural basis for in vivo toxicity. We identified a DA--syn interaction that acts as a common upstream bridge whereby localized stress induces physiological responses in C. elegans. Genetically, this biochemical interaction acts as a pleiotropic trigger driving two compartmentalized responses: localized DAergic neurodegeneration via oxidative stress, and organism-wide, TFEB/hlh-30-dependent proteostatic remodeling that extends lifespan. Modulating autophagy, without exacerbating DA-mediated oxidative stress, represents a promising strategy to preserve adaptive systemic remodeling while limiting targeted neuronal damage.

Long non-coding RNAs (lncRNAs) are increasingly implicated in neurodegenerative disease, yet their roles in tauopathy remain poorly understood. Here, we defined the lncRNA landscape across iPSC-derived neurons, astrocytes, and microglia harboring the frontotemporal dementia-associated MAPT IVS10+16 mutation and investigated how lncRNA dysregulation interfaces with tau pathology. Transcriptomic analyses revealed extensive cell-type specific lncRNA expression changes, with neurons exhibiting the greatest degree of mutation-associated remodeling. Comparative analyses with MAPT IVS10+16 patient brain tissue identified NORAD and MIR22HG as lncRNAs significantly dysregulated across all three cell types and human brains. NORAD was also altered in Alzheimer disease and Parkinson disease brains, suggesting a broader role in neurodegenerative disease. Mechanistically, NORAD-associated protein networks converged on pathways related to RNA regulation, cytoskeletal organization, proteostasis, and tau interaction networks. Given the established role of NORAD in regulating PUM1 and PUM2 RNA-binding (pumilio) proteins, we examined the NORAD-pumilio axis and identified enrichment of pumilio-associated pathways linked to autophagy, endocytosis, proteostasis, and cytoskeletal regulation. NORAD depletion reduced tau seeding and uptake, whereas functional depletion of PUM1 or PUM2 increased both processes, supporting an antagonistic relationship between NORAD and pumilio signaling in modulation of tau aggregation. Together, these findings identify widespread lncRNA dysregulation across neural cell types in the setting of a MAPT mutation and nominate the NORAD-pumilio axis as a regulatory pathway linking RNA homeostasis and tau propagation biology.

Background: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease characterized by death of upper and lower motor neurons, usually presented with clinical heterogeneity. Fluid biomarker development remains dominated by neurofilament light chain (NEFL), a marker of neuroaxonal injury. NEFL is however unspecific to ALS and its phenotypes and there is currently a lack of biomarkers that capture ALS heterogeneity such as onset site and ALS-frontotemporal spectrum disorder (ALS-FTSD). Therefore, we investigated whether plasma proteomics could reveal pathway-level signatures that stratify and explain ALS heterogeneity. Methods: We profiled ~5,400 plasma proteins (Olink Explore HT) in 299 patients with ALS and 50 age- and sex comparable healthy controls. We used two complementary analytic frameworks: (i) differential protein abundance analysis to identify altered proteins in ALS and across clinical subgroups, and (ii) weighted gene correlation network analysis (WGCNA) to identify coordinated protein modules and relate them to ALS diagnosis and to ALS-specific clinical traits (site of onset, ALS-FTSD, ALS functional rating scale-revised (ALSFRS-R) score, and plasma NEFL). Results: Differential abundance analysis identified 56 proteins altered in ALS versus controls, of which 40 were increased. WGCNA identified 11 co-expression modules, with ALS samples having the strongest correlation to a protein module (n=51) highly enriched for muscle-related proteins. Out of the 40 proteins that had increased expression levels, 29 overlapped with the muscle-enriched protein module, indicating that muscle related proteins are the dominant circulating proteomic signature in ALS. This signal extended to clinical stratification: spinal-onset patients showed a strong positive association with the muscle-module. Further, differential abundance analysis of spinal- versus bulbar-onset ALS identified changes that mapped predominantly to the same module, supporting a molecular signature of onset phenotype. In contrast, cognitive status (ALS-FTSD) mapped to distinct modules enriched for extracellular matrix/cell-adhesion pathways, consistent with a separable biological axis of disease heterogeneity. Although multiple modules correlated with NEFL, trait-specific signatures were not fully explained by neuroaxonal injury. Notably, the muscle-enriched module increased with higher NEFL and lower ALSFRS-R, supporting its interpretation as a severity-linked, muscle-involvement proxy. Conclusions: Large-scale plasma proteomics reveals that heterogeneity in ALS reflects underlying biological structures. We identified a dominant muscle-associated protein network that distinguished ALS patients from controls and correlated with disease onset phenotype and severity, alongside distinct protein networks linked to ALS-FTSD. By integrating differential protein abundance with network-based analysis, we defined pathway-level biomarker signatures that extend beyond NEFL, enabling biologically informed patient stratification and improved therapeutic monitoring.

Progressive and chronic neuroinflammation is associated with numerous neurodegenerative diseases, including primary tauopathies such as frontotemporal dementia and progressive supranuclear palsy. Unlike Alzheimer's disease, there is no clear genetic association implicating microglial dysfunction as a primary driver of tauopathy. As such, the contributions of microglia to tauopathy pathogenesis have been less well defined. Here, we explore the cell autonomous effects of the pathogenic MAPT-S305N variant on microglial function, across two distinct iPSC-microglia protocols, followed by examination of the non-cell autonomous effects of microglial MAPT genotype on neuronal health and function. We find that different protocols produce cells of equivalent microglial identity, but result in microglia in different functional states, thereby influencing reactivity and detectable phenotypes. Regardless, across both protocols we find that MAPT-S305N induces microglial hypoactivity, evidenced by impaired phagocytosis, reduced cytokine release and diminished regulation of synaptic function. We conclude that microglial hypoactivity may be an early event in disease pathogenesis, where MAPT mutation microglia fail to adequately respond to pathogenic stimuli, thereby contributing to subsequent neuronal vulnerability and susceptibility. Further studies are required to understand how and when this initial hypoactive state may switch to a toxic pro-inflammatory state, and whether early detection and correction may be of therapeutic value.

Most plasma proteomic studies in Alzheimer's disease (AD) compare cases and controls cross-sectionally, leaving unresolved which AD-associated proteins mark diagnostic states and which are linked to disease progression. Using longitudinal SomaScan profiling from the Global Neurodegeneration Proteomics Consortium (13,449 participants, 17,269 samples, 7,362 aptamers), we separated baseline AD differences from AD-specific change over time. Linear mixed-effects models requiring concordant baseline and AD-by-time effects defined a 30-protein signature. We prioritized proteins across five evidence domains: clinical progression, AD biomarker alignment, cerebrospinal fluid concordance, independent prospective replication in UK Biobank and genetic support from Mendelian randomization and rare-variant burden. Thirteen proteins were supported in two or more domains and six in three. EDA2R, HPGDS, ITGAV and CLEC3B converged across clinical, biomarker and prospective evidence. Signature proteins aligned more strongly with tau and neuronal-injury markers than with Ab42/40. ANTXR1 showed direction-concordant plasma pQTL Mendelian randomization and nominal rare-variant burden signals, supporting its prioritization within the longitudinal AD signature. By distinguishing diagnostic-state markers from progression-linked changes, this longitudinal, multi-domain approach prioritizes proteins for validation as markers of AD progression and for mechanistic and therapeutic follow-up.

Alzheimer's disease is clinically and biologically heterogeneous. We asked whether plasma proteomics separates patients into discrete molecular subtypes or instead reflects continuous biological variation. We studied 5,895 Global Neurodegeneration Proteomics Consortium (GNPC) participants with Alzheimer's disease or mild cognitive impairment using protein coexpression networks, clustering, and continuous molecular-axis analysis. External analyses used Stanford Alzheimer's Disease Research Center (ADRC) biomarker/imaging data and UK Biobank proteomics.Four continuous axes captured 81.5% of module-level proteomic variation. Although a two-cluster solution was reproducible, separation was weak and added little clinical information beyond the continuous axes. Stanford ADRC analyses showed selected fluid biomarker associations, but imaging and PET results did not provide consistent support. In UK Biobank, projected axes were more strongly related to APOE genotype and systemic hematologic, renal, lipid, inflammatory, and hepatic traits than to clear dementia-risk replication. Plasma proteomics did not support robust Alzheimer's disease subtypes. Continuous molecular coordinates better describe plasma proteomic heterogeneity and may guide future biological stratification.

Amyotrophic lateral sclerosis (ALS) is a fatal, rapidly progressive neurodegenerative disease of motor neurons for which therapeutics are limited. Improved biomarkers are imperative to improve patient care and therapeutic development. Here, we employed 35-plex isobaric tandem mass tag labeling based on isobutyl-proline reporter group (TMTpro) to perform unbiased proteomic analysis of cerebrospinal fluid (CSF) and plasma from control (n= 28, n= 31) and sporadic ALS (sALS) (n= 39, n= 41), from the Target ALS Global Natural History Study (TALS GNHS). We identified 2,875 proteins in CSF and 1,118 proteins in plasma and identified known and novel differentially expressed proteins (DEPs) between controls and sALS, some of which were orthogonally validated using immunoassay. Comparison of TMTpro-MS and Olink proximity extension assay proteomics revealed common and non-overlapping differentially expressed proteins illustrating strengths unique to each platform. This initial cross-sectional proteomic study of biofluids from the TALS GNHS, with unrestricted availability of study results to the research community, highlights the potential of this resource as a potent platform for ALS biomarker discovery.

Why some individuals maintain good level of cognitive performances during aging, others dont or even progress toward Alzheimer disease. We profiled the hippocampal proteome of adult LOU/c/Jall rats, a strain associated with spontaneous cognitive longevity, and compared this proteomic state with a published human hippocampal Alzheimer disease dataset. Because individual protein changes did not survive proteome-wide correction, interpretation was based on convergent pathway-level, cell-type enrichment and cross-species directional analyses. The LOU hippocampus displayed a structured remodeling of mitochondrial, lysosomal, proteostatic and synaptic systems. Oligodendrocyte-associated nuclear-encoded complex I/III components were reduced, whereas neuronal mitochondrial aminoacyl-tRNA synthetases, V-ATPase, SNARE-related proteins and inhibitory-transmission markers were increased. CD200 was markedly reduced, but this occurred without accompanying complement, microglial, astrocytic or inflammatory activation signatures. Cross-species overlay indicated that several LOU-associated axes were directionally opposed to late Alzheimer disease, particularly synaptic vesicle and inhibitory-transmission programs, whereas myelin-associated changes occupied a lower-amplitude and non-inflammatory position along an axis altered in early Alzheimer disease. These findings identify a hippocampal proteomic configuration associated with the LOU resilience phenotype and suggest that successful brain aging and Alzheimer disease may involve opposing states of shared hippocampal molecular systems.

Adults with Down syndrome (DS) develop Alzheimer's disease (AD) brain pathology by age 40 due to triplication of the Amyloid Precursor Protein (APP) gene on chromosome 21. Inheritance of the apolipoprotein E-{epsilon}4 (APOE4) allele of the APOE gene on chromosome 19 remains the greatest genetic risk factor for AD in the typical population, yet its role in DS-associated AD (DS-AD) neuropathogenesis in people with DS is unclear. We generated human induced pluripotent stem cell (hiPSC)-derived neurons, astrocytes, and cerebral organoids (COs) using cells from people with DS and from euploid individuals. Aged DS COs were smaller than aged euploid COs and showed robust amyloid-{beta} neuropathology that was positively correlated with the levels of apoE expression. We then captured extracellular vesicles (EVs) from the conditioned media of COs and observed a decrease in the levels of secreted AD-related proteins, including amyloid, contained within the EVs and in the media from which the EVs were isolated. We also identified distinct neuronal and astrocytic gene expression signatures in DS COs relative to euploid COs, including a set of genes known to interact with both APOE and APP at the gene and/or protein levels. Lastly, we determined that, despite differences in the expression levels of the specific genes involved, several common pathways were upregulated in T21 hiPSC-derived neurons, astrocytes, and COs, including apoptosis, the endolysosome, and structural stabilization pathways. Taken together, our findings provide novel insights into molecular mechanisms that may contribute to DS-AD and indicate that apoE plays an important role in the disease process.

Cerebral amyloid angiopathy (CAA) is characterized by the deposition of amyloid {beta} fibrils (A{beta}) within walls of the cerebrovasculature and contributes to intracerebral hemorrhage, ischemic stroke, and cognitive dysfunction in patients with Alzheimers disease (AD) and in non-pathological aging. Previous studies have shown that mTOR drives cerebrovascular dysfunction and cognitive impairment observed in AD, vascular cognitive impairment, and normative aging. However, the mechanisms by which mTOR contributes to CAA are unknown. Here, we show that mTOR drives the accumulation of fibrillar vascular A{beta} lesions in the Tg2576 Model of AD with CAA (using equal numbers of female and male mice), which directly impair endothelium-dependent cerebrovascular reactivity. Additionally, we found that blood-brain barrier (BBB) breakdown and remodeling of tight junction proteins, dependent on mTOR, are associated with increased cerebral microhemorrhages. Finally, we show that mTOR contributes to neurovascular uncoupling in Tg2576 AD mice through nNOS dysfunction and inhibition of non-nitric oxide synthase-dependent contributions to neurovascular coupling (NVC). Contextual memory impairments were ameliorated by the mTOR inhibitor rapamycin. Improvements in memory were associated with reduced cerebrovascular A{beta} fibril accumulation, enhanced endothelium-dependent vasodilation, reduced fibrillar A{beta} load, restoration of BBB integrity, attenuation of intracerebral microhemorrhage, and restoration of NVC. These data indicate that mTOR drives vascular accumulation of fibrillar A{beta}, including those associated with brain vasculature, and mediates cerebrovascular dysfunction in a model of AD with CAA. Thus, mTOR inhibitors represent a promising treatment option for patients with CAA and AD.

Alzheimer's disease (AD) pathogenesis involves complex, multifactorial changes to the brain proteome that conventional unfractionated analyses may obscure. Proteins frequently occupy multiple subcellular compartments as spatial proteoforms, yet the contribution of aberrant protein localization to AD pathogenesis remains poorly understood. To address this, we fractionated post-mortem human hippocampi from 13 AD and 14 non-AD individuals into four subcellular fractions and quantified 6,123 proteins by TMT-LC-MS. Although 75% of proteins were detected in more than one fraction, 78% of significant AD-associated alterations were restricted to a single fraction, demonstrating that subcellular localization is a primary determinant of disease vulnerability. Discordant abundance patterns between fractions revealed retromer complex mislocalization, nuclear transport dysfunction, and insoluble protein accumulation, with the endosomal-lysosomal and protein folding pathways most consistently perturbed. To examine how these perturbations evolve with disease progression, we applied the QUAD strategy to measure protein degradation in two fractions of APPswePS1delta9 mouse cortex at 2, 5, and 12 months. Degradation rates diverged between fractions and genotypes in an age-dependent manner, and cross-dataset comparison identified six proteins altered at the earliest pre-pathological timepoint, implicating vesicle transport and proteostasis disruption as initiating features of AD. These findings establish spatial proteoforms as essential units of pathogenic analysis and reveal disease-relevant signals invisible to bulk tissue approaches.

INTRODUCTION: Parkinson's disease (PD) presents with motor and non-motor symptoms, including dementia, but the severity and rate of cognitive decline are heterogeneous and difficult to predict clinically. METHODS: We quantified baseline serum proteins with the high-throughput SomaScan(R) assay in 834 PD individuals and performed Cox regression to identify proteins associated with subsequent development of dementia. Candidate biomarker proteins were replicated in 371 individuals from an independent cohort and meta-analysed. RESULTS: Protein targets significantly associated with progression to dementia were predominantly involved in synaptic plasticity, protein degradation/lysosomal function and extracellular matrix organisation. Mendelian Randomisation further revealed that changes in the Nogo receptor RTN4R may be causally associated with the development of Lewy body dementia. DISCUSSION: We identified several proteins predicting progression to dementia in PD, indicating changes in blood proteome that precede the development of clinical symptoms by several years, providing a window of opportunity to identify at-risk individuals early on.

Aging is a major risk factor for neurological disease, yet the molecular architecture of human brain aging remains poorly defined. Here, we analyzed more than 10,000 cerebrospinal fluid (CSF) proteomes across multiple cohorts and proteomic platforms to develop a 249-protein CSF aging clock that accurately predicted chronological age and generalized across independent datasets. CSF brain-age acceleration was increased across diverse neurological diseases, associated with blood-brain barrier (BBB) dysfunction, and predictive of longitudinal cognitive decline, neuroimaging progression and dementia conversion. A simplified 30-protein panel retained similar prognostic performance. Biologically, the clock resolved two opposing programs: pro-aging activation of immune, vascular/BBB, extracellular matrix and coagulation pathways, marked by CHI3L1, CD14, VWF, LRG1 and LTBP2, and collapse of anti-aging neuronal-maintenance programs, marked by NPTX2, COL1A2, NID1, CDH8 and PENK. Brain-wide single-cell and regional mapping linked these programs to disease-vulnerable compartments. These findings establish a CSF-based molecular framework for quantifying biological brain aging and predicting neurological disease progression.

Amyotrophic lateral sclerosis/parkinsonism-dementia complex (ALS/PDC) is a fatal neurodegenerative disorder that was once hyperendemic in the island of Guam (Mariana Islands, US) and a few other Pacific locales. Despite extensive investigations into its origins, the etiology of ALS/PDC remains unclear. ALS/PDC is, at the neuropathology level, characterized by tau-dominant multiple proteinopathy in brain and spinal cord. It was recently reported that Guam ALS/PDC brain extracts exhibit tau seeding activity in fluorescence resonance energy transfer (FRET)-based biosensor cells. To build upon those findings and explore the nature of tau seeds in ALS/PDC in more detail, we used an alanine mutational scanning (Ala scan) approach to determine the seeding profile of tau in nervous tissues of Guam ALS/PDC cases. First, we confirmed the detection of tau seeding activity in ALS/PDC brain samples in tau biosensor cells. Notably, we could also detect potent tau seeding activity in spinal cord. Subsequent Ala scan assays demonstrated that ALS/PDC tau displays an aggregate incorporation pattern that resembles that of chronic traumatic encephalopathy (CTE)-type tau. This result is consistent with recent electron cryo-microscopy studies of tau, which revealed that ALS/PDC tau filaments are predominantly of the CTE-type. The structural characteristics and seeding behavior of ALS/PDC tau, as well as the regional distribution of tau pathology at post-mortem, suggest that ALS/PDC is a CTE-like tauopathy. Significance StatementNeurodegenerative tauopathies are characterized by proteinaceous deposits containing microtubule-associated tau in nervous tissue. Emerging evidence suggests that disease-associated tau proteins adopt abnormal, self-propagating conformations characteristic of prions. Here, we employed alanine mutational scanning (Ala scan) to determine the nature of prion-like tau seeds in ALS/PDC, a mysterious disorder that occurred formerly in high incidence in certain regions in the western Pacific. We show that the Ala scan incorporation profile of ALS/PDC tau is similar to that of abnormal tau proteins in chronic traumatic encephalopathy (CTE). The findings lend support to the idea that ALS/PDC can be classified structurally as a CTE-like tauopathy. This work may have important implications for our understanding of ALS/PDC as well as common neurological disorders beyond the Pacific.

LRRK2 is implicated in Parkinson's disease (PD) microbiome-gut-brain axis. We compared plasma lipopolysaccharide-binding protein (LBP) and soluble CD14 (sCD14), markers of gut permeability and endotoxin exposure, in PD patients with/without LRRK2 p.G2385R and/or p.R1628P, and controls, and examined their associations with systemic inflammation and clinical severity. Neither marker differed between groups. Across PD patients, LBP correlated with higher IL-6, TNF- and worse motor function, while sCD14 correlated with higher IL-6, CCL5 and worse constipation. These findings highlight the clinical relevance of endotoxin-related immune signaling in PD, without LRRK2 risk variant-specific associations and identify LBP as an emerging marker of inflammatory burden.