APP β-CTF triggers cell-autonomous synaptic toxicity independent of Aβ

Reviewer #1 (Public Review):

Summary of what the authors were trying to achieve:

In this manuscript, the authors investigated the role of β-CTF on synaptic function and memory. They report that β-CTF can trigger the loss of synapses in neurons that were transiently transfected in cultured hippocampal slices and that this synapse loss occurs independently of Aβ. They confirmed previous research (Kim et al, Molecular Psychiatry, 2016) that β-CTF-induced cellular toxicity occurs through a mechanism involving a hexapeptide domain (YENPTY) in β-CTF that induces endosomal dysfunction. Although the current study also explores the role of β-CTF in synaptic and memory function in the brain using mice chronically expressing β-CTF, the studies are inconclusive because potential effects of Aβ generated by γ-secretase cleavage of β-CTF were not considered. Based on their findings, the authors suggest developing therapies to treat Alzheimer's disease by targeting β-CTF, but did not address the lack of clinical improvement in trials of several different BACE1 inhibitors, which target β-CTF by preventing its formation.

Major strengths and weaknesses of the methods and results:

The conclusions of the in vitro experiments using cultured hippocampal slices were well supported by the data, but aspects of the in vivo experiments and proteomic studies need additional clarification.

(1) In contrast to the in vitro experiments in which a γ-secretase inhibitor was used to exclude possible effects of Aβ, this possibility was not examined in in-vivo experiments assessing synapse loss and function (Figure 3) and cognitive function (Figure 4). The absence of plaque formation (Figure 4B) is not sufficient to exclude the possibility that Aβ is involved. The potential involvement of Aβ is an important consideration given the 4-month duration of protein expression in the in vivo studies.

(2) The possibility that the results of the proteomic studies conducted in primary cultured hippocampal neurons depend in part on Aβ was also not taken into consideration.

Likely impact of the work on the field, and the utility of the methods and data to the community:

The authors' use of sparse expression to examine the role of β-CTF on spine loss could be a useful general tool for examining synapses in brain tissue.

Additional context that might help readers interpret or understand the significance of the work:

The discovery of BACE1 stimulated an international effort to develop BACE1 inhibitors to treat Alzheimer's disease. BACE1 inhibitors block the formation of β-CTF which, in turn, prevents the formation of Aβ and other fragments. Unfortunately, BACE1 inhibitors not only did not improve cognition in patients with Alzheimer's disease, they appeared to worsen it, suggesting that producing β-CTF actually facilitates learning and memory. Therefore, it seems unlikely that the disruptive effects of β-CTF on endosomes plays a significant role in human disease. Insights from the authors that shed further light on this issue would be welcome.

Reviewer #2 (Public Review):

Summary:

In this study, the authors investigate the potential role of other cleavage products of amyloid precursor protein (APP) in neurodegeneration. They combine in vitro and in vivo experiments, revealing that β-CTF, a product cleaved by BACE1, promotes synaptic loss independently of Aβ. Furthermore, they suggest that β-CTF may interact with Rab5, leading to endosomal dysfunction and contributing to the loss of synaptic proteins.

Weaknesses:

Most experiments were conducted in vitro using overexpressed β-CTF. Additionally, the study does not elucidate the mechanisms by which β-CTF disrupts endosomal function and induces synaptic degeneration.

Reviewer #3 (Public Review):

Summary:

Most previous studies have focused on the contributions of Abeta and amyloid plaques in the neuronal degeneration associated with Alzheimer's disease, especially in the context of impaired synaptic transmission and plasticity which underlies the impaired cognitive functions, a hallmark in AD. But processes independent of Abeta and plaques are much less explored, and to some extent, the contributions of these processes are less well understood. Luo et all addressed this important question with an array of approaches, and their findings generally support the contribution of beta-CTF-dependent but non-Abeta-dependent process to the impaired synaptic properties in the neurons. Interestingly, the above process appears to operate in a cell-autonomous manner. This cell-autonomous effect of beta-CTF as reported here may facilitate our understanding of some potentially important cellular processes related to neurodegeneration. Although these findings are valuable, it is key to understand the probability of this process occurring in a more natural condition, such as when this process occurs in many neurons at the same time. This will put the authors' findings into a context for a better understanding of their contribution to either physiological or pathological processes, such as Alzheimer's. The experiments and results using the cell system are quite solid, but the in vivo results are incomplete and hence less convincing (see below). The mechanistic analysis is interesting but primitive and does not add much more weight to the significance. Hence, further efforts from the authors are required to clarify and solidify their results, in order to provide a complete picture and support for the authors' conclusions.

Strengths:

(1) The authors have addressed an interesting and potentially important question

(2) The analysis using the cell system is solid and provides strong support for the authors' major conclusions. This analysis has used various technical approaches to support the authors' conclusions from different aspects and most of these results are consistent with each other.

Weaknesses:

(1) The relevance of the authors' major findings to the pathology, especially the Abeta-dependent processes is less clear, and hence the importance of these findings may be limited.

(2) In vivo analysis is incomplete, with certain caveats in the experimental procedures and some of the results need to be further explored to confirm the findings.

(3) The mechanistic analysis is rather primitive and does not add further significance.

Author Response:

Reviewer #1 (Public Review):

[...] The conclusions of the in vitro experiments using cultured hippocampal slices were well supported by the data, but aspects of the in vivo experiments and proteomic studies need additional clarification.

(1) In contrast to the in vitro experiments in which a γ-secretase inhibitor was used to exclude possible effects of Aβ, this possibility was not examined in in-vivo experiments assessing synapse loss and function (Figure 3) and cognitive function (Figure 4). The absence of plaque formation (Figure 4B) is not sufficient to exclude the possibility that Aβ is involved. The potential involvement of Aβ is an important consideration given the 4-month duration of protein expression in the in vivo studies.

Response: We appreciate the reviewer for raising this question. While our current data did not exclude the potential involvement of Aβ-induced toxicity in the synaptic and cognitive dysfunction observed in mice overexpressing β-CTF, addressing this directly remains challenging. Treatment with γ-secretase inhibitors could potentially shed light on this issue. However, treatments with γ-secretase inhibitors are known to lead to brain dysfunction by itself likely due to its blockade of the γ-cleavage of other essential molecules, such as Notch[1, 2]. As a result, this approach is unlikely to provide a definitive answer, which also prevents us from pursuing it further in vivo. We hope the reviewer understands this limitation and agrees to a discussion of this issue in the revised manuscript instead.

(2) The possibility that the results of the proteomic studies conducted in primary cultured hippocampal neurons depend in part on Aβ was also not taken into consideration.

Response: We thank the reviewer for raising this interesting question. In the revised manuscript, we plan to address this experimentally by using a γ-secretase inhibitor to investigate the potential contribution of Aβ in this study.

Likely impact of the work on the field, and the utility of the methods and data to the community:

The authors' use of sparse expression to examine the role of β-CTF on spine loss could be a useful general tool for examining synapses in brain tissue.

Response: We thank the reviewer for these comments. Indeed, it is a very robust assay and we would like to share this method with the scientific community as soon as possible.

Additional context that might help readers interpret or understand the significance of the work:

The discovery of BACE1 stimulated an international effort to develop BACE1 inhibitors to treat Alzheimer's disease. BACE1 inhibitors block the formation of β-CTF which, in turn, prevents the formation of Aβ and other fragments. Unfortunately, BACE1 inhibitors not only did not improve cognition in patients with Alzheimer's disease, they appeared to worsen it, suggesting that producing β-CTF actually facilitates learning and memory. Therefore, it seems unlikely that the disruptive effects of β-CTF on endosomes plays a significant role in human disease. Insights from the authors that shed further light on this issue would be welcome.

Response: We would like to express our gratitude to the reviewer for raising this interesting question. It remains puzzling why BACE1 inhibition has failed to yield benefits in AD patients, while amyloid clearance via Aβ antibodies has been shown to slow disease progression. One possible explanation is that pharmacological inhibition of BACE1 may not be as effective as genetic removal. Indeed, genetic depletion of BACE1 leads to the clearance of existing amyloid plaques[3], whereas its pharmacological inhibition slows plaque growth and prevents the formation of new plaques but does not stop the growth of the existing ones[4]. We think the negative results of BACE1 inhibitors in clinical trials may not be sufficient to rule out the potential contribution of β-CTF to AD pathogenesis. Given that cognitive function continues to deteriorate rapidly in plaque-free patients after 1.5 years of treatment with Aβ antibodies in phase three clinical studies[5], it is important to consider the possible role of other Aβ-related fragments, such as β-CTF. We will include some further discussion in the revised manuscript.

Reviewer #2 (Public Review):

Summary:

In this study, the authors investigate the potential role of other cleavage products of amyloid precursor protein (APP) in neurodegeneration. They combine in vitro and in vivo experiments, revealing that β-CTF, a product cleaved by BACE1, promotes synaptic loss independently of Aβ. Furthermore, they suggest that β-CTF may interact with Rab5, leading to endosomal dysfunction and contributing to the loss of synaptic proteins.

Response: We would like to thank the reviewer for his/her insightful suggestions. We have addressed the specific comments in following sections.

Weaknesses:

Most experiments were conducted in vitro using overexpressed β-CTF. Additionally, the study does not elucidate the mechanisms by which β-CTF disrupts endosomal function and induces synaptic degeneration.

Response: We would like to thank the reviewer for this insightful comment. While a significant portion of our experiments were conducted in vitro, the main findings were also confirmed in vivo (Figures 3 and 4). Repeating all the experiments in vivo would be challenging and may not be necessary. Regarding the use of overexpressed β-CTF, we acknowledge that this is a common issue in neurodegenerative disease studies. These diseases progress slowly over many years, sometimes even decades in patients. To model this progression in cell or mouse models within a time frame feasible for research, overexpression of certain proteins is often required. While not ideal, it is sometimes unavoidable. Since β-CTF levels are elevated in AD patients[6], its overexpression is a reasonable approach to investigate its potential effects.

We did not further investigate the mechanisms by which β-CTF disrupted endosomal function because our preliminary results align with previous findings. Kim et al. demonstrated that β-CTF recruits APPL1 (a Rab5 effector) via the YENPTY motif to Rab5 endosomes, where it stabilizes active GTP-Rab5, leading to pathologically accelerated endocytosis, endosome swelling and selectively impaired transport of Rab5 endosomes[6]. In our manuscript, we observed that co-expression of Rab5S34N with β-CTF effectively mitigated β-CTF-induced spine loss in hippocampal slice cultures (Figures 6I-J), indicating that Rab5 overactivation-induced endosomal dysfunction contributed to β-CTF-induced spine loss, which was consistent with their conclusions.

Reviewer #3 (Public Review):

Summary:

Most previous studies have focused on the contributions of Abeta and amyloid plaques in the neuronal degeneration associated with Alzheimer's disease, especially in the context of impaired synaptic transmission and plasticity which underlies the impaired cognitive functions, a hallmark in AD. But processes independent of Abeta and plaques are much less explored, and to some extent, the contributions of these processes are less well understood. Luo et all addressed this important question with an array of approaches, and their findings generally support the contribution of beta-CTF-dependent but non-Abeta-dependent process to the impaired synaptic properties in the neurons. Interestingly, the above process appears to operate in a cell-autonomous manner. This cell-autonomous effect of beta-CTF as reported here may facilitate our understanding of some potentially important cellular processes related to neurodegeneration. Although these findings are valuable, it is key to understand the probability of this process occurring in a more natural condition, such as when this process occurs in many neurons at the same time. This will put the authors' findings into a context for a better understanding of their contribution to either physiological or pathological processes, such as Alzheimer's. The experiments and results using the cell system are quite solid, but the in vivo results are incomplete and hence less convincing (see below). The mechanistic analysis is interesting but primitive and does not add much more weight to the significance. Hence, further efforts from the authors are required to clarify and solidify their results, in order to provide a complete picture and support for the authors' conclusions.

Response: We would like to thank the reviewer for the constructive suggestions. We have addressed the specific comments in following sections.

Strengths:

(1) The authors have addressed an interesting and potentially important question

(2) The analysis using the cell system is solid and provides strong support for the authors' major conclusions. This analysis has used various technical approaches to support the authors' conclusions from different aspects and most of these results are consistent with each other.

Response: We would like to thank the reviewer for these comments.

Weaknesses:

(1) The relevance of the authors' major findings to the pathology, especially the Abeta-dependent processes is less clear, and hence the importance of these findings may be limited.

Response: We would like to thank the reviewer for pointing this out. Phase 3 clinical trial data for Aβ antibodies show that cognitive function continues to decline rapidly, even in plaque-free patients, after 1.5 years of treatment[5]. This suggests that plaque-independent mechanisms may drive AD progression. Therefore, it is crucial to consider the potential contributions of other Aβ species or related fragments, such as alternative forms of Aβ and β-CTF. While it is too early to definitively predict how β-CTF contributes to AD progression, it is notable that β-CTF, rather than Aβ, induced synaptic deficits in mice, which recapitulates a key pathological feature of AD. Ultimately, the true role of β-CTF in AD pathogenesis can only be confirmed through clinical studies.

(2) In vivo analysis is incomplete, with certain caveats in the experimental procedures and some of the results need to be further explored to confirm the findings.

Response: We would like to thank the reviewer for this suggestion. We plan to correct these caveats in the revised manuscript.

(3) The mechanistic analysis is rather primitive and does not add further significance.

Response: We would like to thank the reviewer for this comment. We did not delve further into the underlying mechanisms because our analysis indicates that Rab5 dysfunction underlies β-CTF-induced endosomal dysfunction, which is consistent with another study and has been addressed in detail there[6]. We hope the reviewer could understand that our focus in this paper is on how β-CTF triggers synaptic deficits, which is why we did not investigate the mechanisms of β-CTF-induced endosomal dysfunction further.

References:

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2. DOODY R S, RAMAN R, FARLOW M, et al. A phase 3 trial of semagacestat for treatment of Alzheimer's disease [J]. The New England journal of medicine, 2013, 369(4): 341-50.
3. HU X, DAS B, HOU H, et al. BACE1 deletion in the adult mouse reverses preformed amyloid deposition and improves cognitive functions [J]. The Journal of experimental medicine, 2018, 215(3): 927-40.
4. PETERS F, SALIHOGLU H, RODRIGUES E, et al. BACE1 inhibition more effectively suppresses initiation than progression of β-amyloid pathology [J]. Acta Neuropathol, 2018, 135(5): 695-710.
5. SIMS J R, ZIMMER J A, EVANS C D, et al. Donanemab in Early Symptomatic Alzheimer Disease: The TRAILBLAZER-ALZ 2 Randomized Clinical Trial [J]. Jama, 2023, 330(6): 512-27.
6. KIM S, SATO Y, MOHAN P S, et al. Evidence that the rab5 effector APPL1 mediates APP-βCTF-induced dysfunction of endosomes in Down syndrome and Alzheimer's disease [J]. Molecular psychiatry, 2016, 21(5): 707-16.