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Axonal energy metabolism, and the effects in aging and neurodegenerative diseases
Open accessAbstract
Abstract Human studies consistently identify bioenergetic maladaptations in brains upon aging and neurodegenerative disorders of aging (NDAs), such as Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, and Amyotrophic lateral sclerosis. Glucose is the major brain fuel and glucose hypometabolism has been observed in brain regions vulnerable to aging and NDAs. Many neurodegenerative susceptible regions are in the topological central hub of the brain connectome, linked by densely interconnected long-range axons. Axons, key components of the connectome, have high metabolic needs to support neurotransmission and other essential activities. Long-range axons are particularly vulnerable to injury, neurotoxin exposure, protein stress, lysosomal dysfunction, etc. Axonopathy is often an early sign of neurodegeneration. Recent studies ascribe axonal maintenance failures to local bioenergetic dysregulation. With this review, we aim to stimulate research in exploring metabolically oriented neuroprotection strategies to enhance or normalize bioenergetics in NDA models. Here we start by summarizing evidence from human patients and animal models to reveal the correlation between glucose hypometabolism and connectomic disintegration upon aging/NDAs. To encourage mechanistic investigations on how axonal bioenergetic dysregulation occurs during aging/NDAs, we first review the current literature on axonal bioenergetics in distinct axonal subdomains: axon initial segments, myelinated axonal segments, and axonal arbors harboring pre-synaptic boutons. In each subdomain, we focus on the organization, activity-dependent regulation of the bioenergetic system, and external glial support. Second, we review the mechanisms regulating axonal nicotinamide adenine dinucleotide (NAD + ) homeostasis, an essential molecule for energy metabolism processes, including NAD + biosynthetic, recycling, and consuming pathways. Third, we highlight the innate metabolic vulnerability of the brain connectome and discuss its perturbation during aging and NDAs. As axonal bioenergetic deficits are developing into NDAs, especially in asymptomatic phase, they are likely exaggerated further by impaired NAD + homeostasis, the high energetic cost of neural network hyperactivity, and glial pathology. Future research in interrogating the causal relationship between metabolic vulnerability, axonopathy, amyloid/tau pathology, and cognitive decline will provide fundamental knowledge for developing therapeutic interventions.
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![Fig. 2 The molecular underpinnings of NAD redox potential maintenance in axons. A. A schematic view of NAD biosynthetic pathways. B. Heat map visualization of the abundance of mRNA and proteins of NAD biosynthetic enzymes. Transcript levels are adapted from [259]; protein levels are adapted from [260]. Abbreviations: Inh. Neu, inhibitory neurons; Exc. Neu, excitatory neurons; Mic. Mac., microglia and macrophages; Oligo, oligodendrocytes; OPC, oligodendrocyte precursor cells; Fibro.-like, fibroblast-like cells; End, endothelial cells. C. The subcellular localization of NMNAT1-3 in the soma and proximal axon. D. The subcellular distribution of NMNAT2, NMNAT3, and proteins involved in NAD+/NADH homeostasis in presynaptic boutons. (D1) NMNAT2, LDH-A, and glycolytic enzymes closely attach to synaptic vesicles; NMNAT2 inhibits SARM1 activation and maintains local NAD redox potential together with LDH-A to support “onboard” glycolysis; (D2) NMNAT3 inside mitochondrial matrix maintains local NAD redox potential together with OXPHO units, SLC25A51 (NAD+ transporter), and Malate-Aspartate shuttle. E. A hypothetical model of mitochondrial independent NAD+ recycling through the glutamine carboxylation pathway. MDH1, cytosolic malate dehydrogenase 1; ACLY, ATP citrate lyase; GLS, glutaminase; Gln, glutamine; Glu, glutamate; GOT1, glutamic-oxaloacetic transaminase 1; α-KG, alpha ketoglutarate; IDH1, isocitrate dehydrogenase (NADP+) 1; OAA, oxaloacetate](/paper-figures/08c59655191e4be5b0df61de031a470a/axonal-energy-metabolism-and-the-effects-in-aging-and-neurodegenerative-diseases-figure-2.jpg)
![Fig. 3 Aging induced bioenergetic maladaptation in mouse brain. A. Transcriptional fold change of enzymes involved in NAD+ redox potential maintenance in glutamatergic (GLUT), GABAergic (GABA), dopaminergic (DOPA) and cholinergic (CHOL) neurons upon aging, adapted from [22]. Sirt7 in aged cholinergic neurons is increased 5.97-fold, labeled in dark red. B. Transcriptional fold change of glycolytic enzymes and monocarboxylic acid transporters (MCTs) in myelin-forming oligodendrocytes (MF-OLG) and mature oligodendrocytes (MT-OLG). (MT-OLG-1 and MT-OLG-2 are two independent repeats in [22]). HK2 in aged myelin-forming oligodendrocytes is increased 9.72-fold, labeled in purple-red. C. A hypothetical model of the sequential events caused by aging that leads to metabolic failure in long-range axonal projections and glucose hypometabolism in central hubs of the brain connectome](/paper-figures/c03fd91930b94641bafc7b5c8ece889e/axonal-energy-metabolism-and-the-effects-in-aging-and-neurodegenerative-diseases-figure-3.jpg)
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“A snRNA‐seq study in human AD also reported downregulation of synaptic cell adhesion–related gene expression and enrichment terms in an oligodendrocyte cluster. 65 , 66”
From Unique transcriptomic alterations in 5XFAD;PS19 mouse model identify glial lipid dysregulation and coordinated microglial–oligodendrocyte responses (2026) · cites this paper as [66]
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1 retracted
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“The majority of AD-susceptible regions identified are located in the default mode network (DMN), the topological central hub of the brain connectome [38, 39], containing densely interconnected long-range corticocortical axons [40, 41].”
BackgroundClinical and biomarker changes in dominantly inherited Alzheimer's disease
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Ageing as a risk factor for neurodegenerative disease
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White matter damage and degeneration in traumatic brain injury.
Armstrong, R. C., Sullivan, G. M., Perl, D. P., Rosarda, J. D., & Radomski, K. L. (2024) · Trends in Neurosciences · doi:10.1016/j.tins.2024.07.003 · Cited by 62
Mitochondria in Alzheimer’s Disease Pathogenesis
Reiss, A. B., Gulkarov, S., Jacob, B., Srivastava, A., Pinkhasov, A., Gomolin, I. H., Stecker, M. M., Wısnıewskı, T., & Leon, J. D. (2024) · Life · doi:10.3390/life14020196 · Cited by 71
“Upon axonal injury or mitochondrial malfunction, NMNAT2 levels are reduced, and so is the production of NAD+. NMNAT2 loss promotes SARM1 activation, and this combination results in energetic failure in axons [48,49].”
BackgroundVoicu, V. A., Toader, C., Șerban, M., Covache-Busuioc, R.-A., & Ciurea, A. V. (2025) · Biomedicines · doi:10.3390/biomedicines13082025 · Cited by 59
“Neurons with long axonal projections—such as layer V pyramidal neurons, cholinergic brainstem neurons and cerebellar Purkinje cells—are at the greatest risk of cytoskeletal degradation and tau-induced microtubule disassembly [169,170].”
Diabetes-related cognitive impairment: Mechanisms, symptoms, and treatments
Yu, X., He, H., Wen, J., Xu, X., Ruan, Z., Hu, R., Wang, F., & Ju, H. (2025) · Open Medicine · doi:10.1515/med-2024-1091 · Cited by 57
Energy Metabolism and Brain Aging: Strategies to Delay Neuronal Degeneration
Na, D., Zhang, Z., Meng, M., Li, M., Gao, J., Kong, J., Zhang, G., & Guo, Y. (2025) · Cellular and Molecular Neurobiology · doi:10.1007/s10571-025-01555-z · Cited by 44
“Age-related impairments in glucose metabolism have been documented in studies (Yang et al. 2023).”
Metadata
- Authors
- Yang, S., Park, J. H., & Lu, H.-C.
- Affiliations
- Indiana University Bloomington (US)
- Corresponding author
- Lu, Hui-Chen
- Venue
- Molecular Neurodegeneration
- Published
- 2023-07-20
- Volume
- 18
- Issue
- 1
- Pages
- 49-49
- ISSN
- 1750-1326 (ISSN-L)
- PMC
- PMC10357692
- OpenAlex
- W4384925673
- Cited by
- 94
- References
- 428
- Citations by year
- 2026: 25 · 2025: 37 · 2024: 28 · 2023: 4
- FWCI
- 2.54
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Molecular Neurodegeneration (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- NINDS (NS086794)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Mitochondrial Function and Pathology
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neuroscience and Neuropharmacology Research
- Life Sciences › Neuroscience › Neurology › Neurological Disease Mechanisms and Treatments
- Keywords
- axonal energy metabolism, axonopathy, neurodegenerative diseases, brain aging, glucose hypometabolism, brain connectome, long-range axons, axon initial segment, myelinated axons, axonal arbors, NAD+ homeostasis, NAD biosynthesis, NAD+ recycling, neuroprotection, Alzheimer's disease, Parkinson's disease, Huntington's disease, amyotrophic lateral sclerosis, cognitive decline
- MeSH terms
- Aging, Animals, Axons, Energy Metabolism, Glucose, Humans, NAD, Neurodegenerative Diseases
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