DOI: 10.1002/alz.072027 ISSN: 1552-5260

Association of microglial activation with Alzheimer’s pathologies, presynaptic loss, hippocampal atrophy, and cognitive decline

Guoyu Lan, Pan Sun, Yue Cai, Anqi Li, Tengfei Guo,
  • Psychiatry and Mental health
  • Cellular and Molecular Neuroscience
  • Geriatrics and Gerontology
  • Neurology (clinical)
  • Developmental Neuroscience
  • Health Policy
  • Epidemiology



Loss of function of triggering receptor expressed on myeloid cells 2 (TREM2) and progranulin (PGRN), predominantly expressed by microglia in the brain, contribute to the development of Alzheimer’s disease (AD). Although animal studies suggest that the expressions of TREM2 and PGRN increase in activated microglia, their associations with AD‐related pathologies and subsequent outcomes are not well characterized. This study aimed to explore how cerebrospinal fluid (CSF) soluble TREM2 (sTREM2) and PGRN relate to β‐amyloid (Aβ), tau, synaptic loss, neurodegeneration, and cognitive decline.


We identified 610 ADNI participants with Aβ PET and CSF biomarkers measurements at baseline and 250 individuals with longitudinal CSF biomarkers measurements. All participants had concurrent longitudinal structure MRI and Preclinical Alzheimer’s Cognitive Composite (PACC) assessments. Using generalized linear models, we investigated the associations of CSF microglial biomarkers with Aβ PET, CSF p‐Tau181, CSF presynaptic biomarker growth‐associated protein‐43 (GAP‐43), hippocampal atrophy, and cognitive decline.


CSF p‐Tau181 levels rather than Aβ PET were positively associated with CSF microglial biomarkers, whereas higher Aβ PET SUVRs were related to attenuated effects of CSF p‐Tau181 on changes in CSF sTREM2 and CSF PGRN (Figure. 1). Mediation analyses further showed that Aβ PET and CSF p‐Tau181 had opposing effects on CSF microglial biomarkers (Figure. 2). In addition, CSF sTREM2 rather than CSF PGRN were positively associated with CSF GAP‐43 cross‐sectionally and longitudinally, independent of Aβ PET and CSF p‐Tau181 (Figure. 3). Furthermore, augmented microglial activation was associated with slower rates of hippocampal atrophy (sTREM2: standard β (βstd) = 0.11, p = 0.007; PGRN: βstd = 0.11, p = 0.003), but only CSF sTREM2 was related to reduced rates of cognitive decline (βstd = 0.11, p = 0.003).


This study provides novel insights into the opposing microglial immune response to Aβ and tau pathologies, where elevated CSF p‐Tau181 rather than Aβ plaque is associated with microglial activation. TREM2‐dependent signaling may contribute to the microglia‐related presynaptic loss beyond Aβ and tau pathologies, and microglial activation is protective against hippocampal atrophy and cognitive decline. These findings are critical for understanding the roles of neuroinflammation in AD or other neurodegenerative diseases.

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