Hou, Xu

Abstract Background Mitophagy constitutes a crucial cellular pathway in mitochondrial quality control, in which the enzymatic pair PINK1 and PRKN selectively decorates damaged mitochondria with phosphorylated‐ubiquitin (pS65‐Ub), facilitating their autophagic‐lysosomal removal. We previously demonstrated significant accumulation of pS65‐Ub labeled damaged mitochondria in Lewy body and Alzheimer’s disease autopsy brain. This mitophagy alteration was strongly associated with pre‐tangle tau pathology in neurons. The effects of distinct tau species on mitophagy across different cell types however remain largely unknown. We therefore expanded our analyses to primary tauopathies, exploring how specific tau forms and their aggregation influence mitophagy in selectively vulnerable brain regions and cell types. Method This study included 92 control and tauopathy cases with primary age‐related tauopathy (PART), Pick’s disease (PiD), progressive supranuclear palsy (PSP), or corticobasal degeneration (CBD). Immunohistochemistry for the mitophagy marker pS65‐Ub and phospho‐tau was performed in vulnerable brain regions (hippocampus for PART and PiD, primary motor cortex for PSP and CBD). A deep learning‐based image identification model was used to identify and quantify distinct tau inclusions. pS65‐Ub‐positive cells were manually counted and grouped based on signal intensity and morphology. Immunofluorescence co‐staining of pS65‐Ub and phospho‐tau was conducted to study their spatial relationship at single‐cell level. Result We observed marked increases in pS65‐Ub‐positive cells in the hippocampus of PART and PiD cases compared to controls. Although less prominent, significant increases were also found in the primary motor cortex of PSP, whereas only minor changes were observed in CBD. Single‐cell analyses revealed that the accumulation of pS65‐Ub was most abundant in hippocampal neurons from PART. Cells with lower signal intensity contained mostly granular pS65‐Ub deposits, while those with higher intensity harbored rather vacuolar inclusions. Across tau aggregate subtypes, pS65‐Ub levels were strongly correlated and often co‐resided with neurofibrillary tangles and Pick bodies. Such correlations were weaker for coiled bodies and tufted astrocytes, and absent for astrocytic plaques. Conclusion Our study highlights distinct mitophagy alterations in primary tauopathies that are associated with specific tau inclusions in neurons, oligodendrocytes, and astrocytes. The observed pathological heterogeneity and complex mitophagy disruption underscores the need for future studies to elucidate pathogenic mechanisms and advance targeted therapeutics for each tauopathy.

Objective Lewy body disease (LBD) is a complex neurodegenerative disorder characterized by the accumulation of misfolded α‐synuclein in the brain. Neuroinflammation has long been implicated in LBD pathogenesis, and recent genetic studies in Parkinson's disease (a clinical manifestation of LBD) have shown consistent association with the human leukocyte antigen (HLA) gene complex. Here, we assessed whether variation in HLA alleles influences neuropathological burden in a neuropathologically‐defined series of LBD cases. Methods We conducted a comprehensive analysis of HLA allelic variants in a cohort of 539 LBD cases of European descent from the Mayo Clinic brain bank. High‐resolution whole‐genome sequencing was used, and the HLA alleles of each sample were called using the HLA*LA tool and assessed for association with neuropathological outcomes. Results Our analysis identified 1 significant ( P < 3.43 × 10 −5 ) and 4 suggestive ( P < 0.001) associations between certain HLA alleles and specific neuropathological outcomes in LBD, suggesting a potential role for HLA‐mediated immune mechanisms in disease progression and subtype differentiation. Specifically, HLA‐DPB1*06:01 was significantly associated with lower Lewy body counts in the parahippocampal gyrus ( P = 3.30 × 10 −5 ), with weaker and suggestive associations observed in the middle frontal ( P = 1.80 × 10 −4 ) and inferior parietal gyrus ( P = 6.33 × 10 −4 ). Additionally, although only suggestive, HLA‐DRB1*11:01 correlated with a lower Thal amyloid phase ( P = 1.56 x 10 −4 ), and HLA‐B*15:01 correlated with an increased risk of diffuse LBD ( P = 7.58 x 10 −4 ). Interpretation This study provides a detailed evaluation of the relationship between HLA alleles and LBD pathology, highlighting the importance of immune‐related genetic factors in the etiology of LBD. ANN NEUROL 2026;99:492–501

AbstractINTRODUCTIONPhosphorylated ubiquitin (p‐S65‐Ub) is generated during PINK1‐PRKN mitophagy as a specific marker of mitochondrial damage. Despite the widespread deposition of p‐S65‐Ub in aged and diseased human brain, the genetic contribution to its accumulation remains unclear.METHODSTo identify novel mitophagy regulators, we performed a genome‐wide association study using p‐S65‐Ub level as a quantitative trait in 1012 autopsy‐confirmed Lewy body disease (LBD) samples.RESULTSWe identified a significant genome‐wide association with p‐S65‐Ub for rs429358 (apolipoprotein E ε4 [APOE4]) and a suggestive association for rs6480922 (ZMIZ1). APOE4 was associated with higher p‐S65‐Ub levels and greater neuropathological burden. Functional validation in mouse and human induced pluripotent stem cell (iPSC) models confirmed APOE4‐mediated mitophagy alterations. Intriguingly, ZMIZ1 rs6480922 was associated with lower p‐S65‐Ub levels, reduced neuropathological load, and increased brain weight, indicating a potential protective role.DISCUSSIONOur findings underscore the importance of mitochondrial quality control in LBD pathogenesis and nominate regulators that may contribute to disease risk or resilience.Highlights p‐S65‐Ub levels were used as a quantitative marker of mitochondrial damage. A GWAS identified two genetic variants that modify mitophagy in LBD autopsy brain. APOE4 was associated with increased p‐S65‐Ub accumulation and neuropathology. APOE4 altered mitophagy via pathology‐dependent and pathology‐independent mechanisms. ZMIZ1 was linked to reduced p‐S65‐Ub and neuropathology indicative of protection.

AbstractBackgroundDirected by the enzyme pair PINK1 and PRKN, mitophagy is a crucial mitochondrial quality control mechanism that selectively decorates damaged mitochondria with phosphorylated ubiquitin (pS65‐Ub), facilitating their lysosomal degradation. The dynamic pS65‐Ub signal accumulates upon enhanced activation from increased mitochondrial damage or upon reduced autophagic‐lysosomal flux. Previous studies including ours demonstrated altered mitophagy and elevated pS65‐Ub levels in Parkinson’s and Alzheimer’s disease brains that also independently associated with α‐synuclein, tau, or amyloid pathology. However, their combined impact on mitophagy and organelle function remains unclear. Notably these three pathologies often coexist in susceptible brain areas of a neurodegenerative condition named dementia with Lewy bodies (DLB). We herein investigated the interactions of α‐synuclein, tau, and amyloid pathology to uncover their combined effects on mitophagy in a large DLB cohort.MethodThis study included 371 DLB autopsy brains with neurologically normal cases as controls. Immunohistochemistry for the mitophagy marker pS65‐Ub in the hippocampus and amygdala was performed and associations of pS65‐Ub levels with neuropathological measures from the same region were evaluated. Immunofluorescence co‐staining of pS65‐Ub, phospho‐α‐synuclein, and phospho‐tau was conducted to study their interactions at single‐cell level.ResultpS65‐Ub positive cells were significantly more abundant in the hippocampus and amygdala of DLB cases compared to controls. Significant associations were observed between pS65‐Ub levels with age, brain weight, Braak stage, Thal phase as well as counts of Lewy body (LB), neurofibrillary tangle (NFT), and senile plaque (SP) in both regions. Strong synergistic effects of LB and NFT pathologies on pS65‐Ub accumulation were found in the amygdala, while only additive effects of LB and SP pathologies were observed. Single‐cell analysis in the amygdala showed that most affected cells contained either LB or NFT inclusion rather than co‐residing two pathologies within the same cell. Notably, cells harboring LB pathology exhibited mainly smaller, granular pS65‐Ub deposits (type G), possibly associated with increased mitochondrial dysfunction. Conversely, those containing NFT showed larger, vacuolar pS65‐Ub deposits (type V), likely resulting from reduced lysosomal degradation.ConclusionOur study revealed complex interactions of α‐synuclein, tau, and amyloid pathology on mitophagy alteration in DLB brains, highlighting different molecular mechanisms underlying α‐synuclein‐ and tau‐associated mitophagy alterations.

ABSTRACT Background Inclusion body myositis (IBM) is the most prevalent muscle disease in adults for which no current treatment exists. The pathogenesis of IBM remains poorly defined. In this study, we aimed to explore the interplay between inflammation and mitochondrial dysfunction in IBM. Methods The study population consisted of 38 IBM patients and 22 age‐ and sex‐matched controls without a myopathy. Mean age was 62.9 years (SD = 9) in IBM group and 59.7 (10) in controls. Bulk RNA sequencing, Meso Scale Discovery electrochemiluminescence (ECL), western blotting, histochemistry and immunohistochemistry were performed on frozen muscle samples from the study participants. Results We demonstrated activation of the NLRP3 inflammasome in IBM muscle samples, with the NLRP3 inflammasome being the most upregulated pathway on RNA sequencing, along with increased expression of NLRP3 and ASC proteins in IBM group. NLRP3 RNA levels most strongly correlated with TLR7 (correlation coefficient ρ = 0.91) and complement activation‐related genes, and inversely correlated with several mitochondria‐related genes among others. On muscle histopathology, there was increased NRLP3 immunoreactivity in both inflammatory cells and muscle fibres. Mitophagy is critical for removing damaged mitochondria and preventing the formation of a vicious cycle of mitochondrial dysfunction—NLRP3 inflammasome activation. Herein, we showed altered mitophagy, as witnessed by the elevated levels of p‐S65‐Ubiquitin, a mitophagy marker, in muscle lysates from IBM patients compared to controls (median of 114.3 vs. 81.25 ECL units, p = 0.005). The p‐S65‐Ubiquitin levels were most significantly elevated in IBM males compared to male controls (136 vs. 83.5 ECL units; p = 0.013), whereas IBM females had milder nonsignificant elevation compared to female controls (97.25 vs. 69 ECL units, p = 0.31). On muscle histopathology, p‐S65‐Ubiquitin aggregates accumulated in muscle fibres that were mostly Type 2 and devoid of cytochrome‐c‐oxidase reactivity. NLRP3 RNA levels correlated with p‐S65‐Ubiquitin levels in both sexes (males: ρ = 0.48, females: ρ = 0.54) but with loss of muscle strength, as reflected by the manual motor test score, only in males (males: ρ = 0.62, females: ρ = −0.14). Lastly, we identified sex‐specific molecular pathways in IBM. Females had upregulation of pathways related to response to stress, which could conceivably offset some of the pathomechanisms of IBM, while males had upregulation of pathways related to cell adhesion and migration. Conclusions There is activation of the NLRP3 inflammasome in IBM, along with altered mitophagy, particularly in males, which is of potential therapeutic significance. These findings suggest sex‐specific mechanisms in IBM that warrant further investigation.

AbstractBackgroundLoss of function mutations in PINK1 and PRKN are the most common causes of early‐onset Parkinson disease (PD). The encoded ubiquitin (Ub) kinase PINK1 and the E3 Ub ligase PRKN together regulate the autophagic degradation of dysfunctional mitochondria, termed mitophagy. During this cytoprotective process, PINK1 and PRKN identify and jointly decorate damaged mitochondria with phosphorylated Ub (pS65‐Ub) that serves as the mitophagy tag. Accumulating evidence suggest a pathogenic role for impaired mitophagy in PD and related neurodegenerative conditions. This is in line with our previous finding of increased levels of the mitophagy marker pS65‐Ub in the hippocampus of postmortem Lewy body disease (LBD) brain.MethodWe performed a genome‐wide association study (GWAS) of hippocampal pS65‐Ub level to identify novel regulators of the PINK1‐PRKN‐directed mitophagy in LBD. In our two‐stage GWAS, we obtained 1,012 autopsy confirmed LBD samples (754 discovery stage, 258, replication stage) from Caucasian participants of European ancestry. Using an established, mostly automated workflow, hippocampal sections were immunostained for pS65‐Ub, scanned, and quantified with unbiased algorithms.ResultOur findings identified that APOE rs429358 (β: 0.50, 95% CI: 0.41 to 0.69, p = 8.67×10−25) was very strongly associated with pS65‐Ub levels in LBD brain. The APOE4 genotype is known to exacerbate Aβ and tau deposition. We did observe strong correlations of pS65‐Ub levels with both tau tangle and senile plaque density in the entire LBD cohort. Nevertheless, the increased pS65‐Ub levels in APOE4‐carrying LBD brains were also independent of Aβ and tau deposition in a subgroup (N = 175) with medium levels of these pathologies. To further explore APOE4 effects on mitophagy outside disease context, this observation was also confirmed in APOE‐targeted replacement mice and in induced pluripotent stem cell‐derived astrocytes.ConclusionOur findings nominate a novel mitophagy regulator in LBD brain and highlight a strong association of APOE4 with mitophagy alteration. Our results suggested that APOE4 may mediate mitophagy defects through two mechanisms, by aggravating Alzheimer’s‐type pathologies and also independent of them. With APOE4 being the strongest known risk factor for Alzheimer’s disease and dementia with Lewy bodies, our findings suggest a common mechanistic link underscoring the importance of mitochondrial quality control.

Abstract Alpha‐synuclein (αsyn) aggregates are pathological features of several neurodegenerative conditions including Parkinson disease (PD), dementia with Lewy bodies, and multiple system atrophy (MSA). Accumulating evidence suggests that mitochondrial dysfunction and impairments of the autophagic‐lysosomal system can contribute to the deposition of αsyn, which in turn may interfere with health and function of these organelles in a potentially vicious cycle. Here we investigated a potential convergence of αsyn with the PINK1‐PRKN‐mediated mitochondrial autophagy pathway in cell models, αsyn transgenic mice, and human autopsy brain. PINK1 and PRKN identify and selectively label damaged mitochondria with phosphorylated ubiquitin (pS65‐Ub) to mark them for degradation (mitophagy). We found that disease‐causing multiplications of αsyn resulted in accumulation of the ubiquitin ligase PRKN in cells. This effect could be normalized by starvation‐induced autophagy activation and by CRISPR/Cas9‐mediated αsyn knockout. Upon acute mitochondrial damage, the increased levels of PRKN protein contributed to an enhanced pS65‐Ub response. We further confirmed increased pS65‐Ub‐immunopositive signals in mouse brain with αsyn overexpression and in postmortem human disease brain. Of note, increased pS65‐Ub was associated with neuronal Lewy body‐type αsyn pathology, but not glial cytoplasmic inclusions of αsyn as seen in MSA. While our results add another layer of complexity to the crosstalk between αsyn and the PINK1‐PRKN pathway, distinct mechanisms may underlie in cells and brain tissue despite similar outcomes. Notwithstanding, our finding suggests that pS65‐Ub may be useful as a biomarker to discriminate different synucleinopathies and may serve as a potential therapeutic target for Lewy body disease.