Cited by 761Neuroinflammation and Neurodegeneration MechanismsPhagocytosis and Immune RegulationCholesterol and Lipid Metabolism

The DOI matches its Crossref record; 92 of the 92 references it cites were found in a registry or an index; 33 of the 43 sources its claims cite were checked for support.

TREM2 Regulates Microglial Cholesterol Metabolism upon Chronic Phagocytic Challenge

Open access

Abstract

Loss-of-function (LOF) variants of TREM2, an immune receptor expressed in microglia, increase Alzheimer's disease risk. TREM2 senses lipids and mediates myelin phagocytosis, but its role in microglial lipid metabolism is unknown. Combining chronic demyelination paradigms and cell sorting with RNA sequencing and lipidomics, we find that wild-type microglia acquire a disease-associated transcriptional state, while TREM2-deficient microglia remain largely homeostatic, leading to neuronal damage. TREM2-deficient microglia phagocytose myelin debris but fail to clear myelin cholesterol, resulting in cholesteryl ester (CE) accumulation. CE increase is also observed in APOE-deficient glial cells, reflecting impaired brain cholesterol transport. This finding replicates in myelin-treated TREM2-deficient murine macrophages and human iPSC-derived microglia, where it is rescued by an ACAT1 inhibitor and LXR agonist. Our studies identify TREM2 as a key transcriptional regulator of cholesterol transport and metabolism under conditions of chronic myelin phagocytic activity, as TREM2 LOF causes pathogenic lipid accumulation in microglia.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

Using chronic cuprizone-induced demyelination combined with cell sorting, RNA sequencing, and lipidomics, this study shows that TREM2 is required for microglia to acquire a damage-associated transcriptional program and to handle the cholesterol released by myelin phagocytosis. TREM2-deficient microglia still engulf myelin but accumulate cholesteryl ester (CE), a phenotype rescued in vitro by an ACAT1 inhibitor or an LXR agonist.

Key findings

  • Upon 5- or 12-week cuprizone (CPZ) diet, Trem2+/+ and Trem2+/– microglia upregulated lysosomal, phagosomal, and cholesterol metabolism genes (e.g., Apoe, Apoc1, Ch25h, Lipa, Nceh1, Npc2, Soat1) and DAM gene sets, whereas Trem2–/– microglia largely failed to respond and clustered with untreated controls (absolute log2 FC > 0.5, FDR < 0.2; interaction p < 0.05 for cathepsins).
  • After 12 weeks of CPZ, CE and oxidized CE (oxCE) species were significantly elevated in Trem2–/– forebrain (FDR < 0.05; interaction p < 0.01); CE22:6 rose upward of 38-fold versus Trem2–/– control brain and 2.5-fold versus Trem2+/+ 12-week CPZ brain, while brain free cholesterol was unchanged.
  • FACS-isolated Trem2–/– microglia showed 8- to 20-fold elevations of CE20:4 and CE22:6 after 12-week CPZ (interaction p < 0.001), with no genotype effects in astrocytes or CSF; Apoe–/– mice also accumulated CE in forebrain, microglia, astrocytes, and CSF (e.g., 3.2-, 6.9-, and 2.5-fold increases in CE18:1, CE20:4, CE22:6 in Apoe–/– microglia on control diet).
  • Sulfatide bound and signaled through TREM2 (pSYK readout); the R47H variant had reduced affinity (KD 20 μM vs 6.8 μM for sulfatide; 14 μM vs 5.6 μM for PS). In vitro, Trem2–/– BMDMs showed ~3-fold more Nile red neutral lipid staining with myelin, and TREM2–/– iPSC-derived microglia had ~20% less pHrodo-myelin uptake yet increased CE20:4, CE22:6, and cholesterol; CE accumulation was abolished by ACAT1 inhibitor K604 and by LXR agonist GW3965.
  • Trem2–/– mice showed more APP-positive dystrophic neurites and higher plasma neurofilament-light chain after CPZ (12-week interaction p < 0.001) and with aging (interaction p < 0.05).

Methods

  • Mice: Trem2+/+, Trem2+/–, Trem2–/– littermates (9–11 months old) on normal or 0.2% cuprizone diet for 5 or 12 weeks; separate Apoe–/– and wild-type cohorts (3 months, 12-week CPZ); young (2-month) and aged (15–17-month) female Trem2+/+ and Trem2–/– mice.
  • FACS isolation of CD11b+ microglia and ACSA2+ astrocytes, plus CSF collection, followed by bulk QuantSeq RNA-seq, 10x scRNA-seq (3,023 cells resolved into eight clusters), and LCMS lipidomics; histology for APP puncta and Simoa for plasma Nf-L.
  • In vitro: TREM2/DAP12 HEK293 cells and human macrophages for pSYK AlphaLISA, surface plasmon resonance for lipid binding, Trem2+/+ and Trem2–/– BMDMs, and CRISPR TREM2-knockout human iPSC-derived microglia treated with purified myelin ± K604 or GW3965.

Limitations

  • Stated by the paper: whether LOAD-associated partial loss-of-function variants such as R47H phenocopy complete TREM2 loss "remains to be established"; whether oxCE species are neurotoxic or pro-inflammatory "remains to be determined"; and extracellular/interstitial fluid lipid accumulation "cannot be ruled out" since CSF lipidomics showed no changes.
  • Evident from the text: aged Trem2–/– microglia showed only mild cholesterol-metabolism gene changes and no genotype-specific CE alteration, so the lipid phenotype is demonstrated mainly under the severe CPZ challenge; the in vitro rescue data come from small samples (n = 3 biological replicates for BMDM lipidomics, n = 2 for LXR agonist ABCA1/ABCG1 expression, n = 4 technical replicates for iMG uptake).
  • Evident from the text: all authors are paid employees and shareholders of Denali Therapeutics, which has filed patent applications on the subject matter, and several reagents are subject to material-transfer restrictions.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.neuron.2019.12.007

Cites

92 of 92 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

33 of 43 cited sources checked · 10 supported · 1 flagged · accuracy not yet measured

Show all 139 claims

  • Probably not a substantial claim. 24
  • It may state two separate claims as one. 44
63 of 63
  • The paper relies on this without support.

    The CPZ demyelination model provides a chronic and extensive cholesterol challenge that is selective to the brain and independent of peripheral lipid metabolism.

    “allowing the assessment of microglial response to a chronic and extensive cholesterol challenge that is selective to the brain and independent of peripheral lipid metabolism.”
  • The paper relies on this without support.

    TREM2 is selectively expressed in microglia within the CNS.

    “a single-pass transmembrane immune receptor selectively expressed in microglia within the CNS.”
  • The paper relies on this without support.

    The role of TREM2 in microglial lipid metabolism is unknown.

    “but its role in microglial lipid metabolism is unknown.”
  • The paper relies on this without support.

    APOE is the main cholesterol transporter in the CNS.

    “and is commonly believed to be the main cholesterol transporter in the CNS.”
    “APOE, the main cholesterol transporter in the CNS.”
  • The paper relies on this without support.

    Myelin debris contain high levels of cholesterol but low levels of CE.

    “Because myelin debris contain high levels of cholesterol but low levels of CE”
  • The paper relies on this without support.

    APOE is expressed in microglia and astrocytes.

    “However, unlike TREM2, APOE is expressed in microglia and astrocytes”
  • The paper relies on this without support.

    Myelin debris are enriched for cholesterol and signaling lipids, such as sulfatides.

    “myelin debris, which are enriched for cholesterol and signaling lipids, such as sulfatides.”
  • The paper relies on this without support.

    Most of the brain cholesterol is found in myelin.

    “Most of the brain cholesterol is found in myelin”
  • The paper relies on this without support.

    Cholesterol cannot be efficiently catabolized and is deleterious to cells at high concentrations.

    “because cholesterol cannot be efficiently catabolized and is deleterious to cells at high concentrations.”
  • The paper relies on this without support.

    Lipid ligands are recognized by the TREM2 ECD and mediate downstream signaling.

    “Lipid ligands are recognized by the TREM2 ECD and mediate downstream signaling”
  • The paper relies on this without support.

    Several other LOAD genes expressed in microglia mediate lipid metabolism (e.g., CLU, ABCA7, SORL1).

    “As several other LOAD genes expressed in microglia mediate lipid metabolism (e.g., CLU, ABCA7, SORL1)”
  • The paper relies on this without support.

    APOE, unlike TREM2, is expressed in astrocytes and controls CNS cholesterol metabolism more broadly.

    “although APOE, unlike TREM2, is expressed in astrocytes and thus controls CNS cholesterol metabolism more broadly.”
12 of 12

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • LXR agonist named inconsistently

    Minor

    The Results identify the LXR agonist used in the microglia experiment as GW3695, whereas the corresponding treatment method names it GW3965.

  • TREM2 variant named inconsistently in SPR method

    Minor

    The binding results analyze the R47H variant, but the SPR method says the mutant protein injected was R74H.

  • Myelin treatment concentration exceeds the stated preparation concentration

    Minor

    The methods say purified myelin was adjusted to 1 mg/mL, but describe adding it to iPSC-derived microglia at 25 μg/μL (25 mg/mL). The stated preparation could not produce that treatment concentration by being spiked into the wells without an unreported concentration step.

3 of 3

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Metadata

Authors
Nugent, A. A., Lin, K., van Lengerich, B., Lianoglou, S., Przybyla, L., Davis, S. S., Llapashtica, C., Wang, J., Kim, D. J., Xia, D., Lucas, A., Baskaran, S., Haddick, P. C. G., Lenser, M., Earr, T. K., Shi, J., Dugas, J. C., Andreone, B. J., Logan, T., Solanoy, H. O., Chen, H., Srivastava, A., Poda, S. B., Sanchez, P. E., Watts, R. J., Sandmann, T., Astarita, G., Lewcock, J. W., Monroe, K. M., & Di Paolo, G.
Affiliations
Denali Therapeutics (United States) (US)
Corresponding author
Monroe, Kathryn M.
Venue
Neuron
Publisher
Elsevier BV
Published
2020-03
Volume
105
Issue
5
Pages
837-854.e9
ISSN
0896-6273 (ISSN-L)
OpenAlex
W2981166078
Cited by
745
References
90
Citations by year
2026: 129 · 2025: 131 · 2024: 113 · 2023: 131 · 2022: 101 · 2021: 87 · 2020: 50
FWCI
22.67
Type
journal article
Language
en
Open access
Locations
  • Neuron (publishedVersion)
  • SSRN Electronic Journal (publishedVersion)
  • PubMed (publishedVersion)
Funders
Denali Therapeutics.
Topics
  • Life Sciences › Neuroscience › Neurology › Neuroinflammation and Neurodegeneration Mechanisms
  • Life Sciences › Immunology and Microbiology › Immunology › Phagocytosis and Immune Regulation
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Biochemistry › Cholesterol and Lipid Metabolism
Keywords
TREM2, microglia, cholesterol metabolism, myelin phagocytosis, demyelination, cholesteryl ester accumulation, apolipoprotein E, ACAT1, LXR agonists, Alzheimer's disease risk, lipidomics, neuronal injury, myelin debris clearance
MeSH terms
Liver X Receptors, Mice, Knockout, ApoE, RNA-Seq, Lipidomics, Acetyl-CoA C-Acetyltransferase, Alzheimer Disease, Animals, Brain, Cholesterol, Cholesterol Esters, Disease Models, Animal, Flow Cytometry, Humans, Macrophages, Membrane Glycoproteins, Myelin Sheath, Phagocytosis, Receptors, Immunologic, Microglia, Mice, Knockout, Lipid Metabolism, Mice, Induced Pluripotent Stem Cells

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