Cited by 46Alzheimer's disease research and treatmentsCellular transport and secretionNeuroinflammation and Neurodegeneration Mechanisms

The DOI matches its Crossref record; 114 of the 114 references it cites were found in a registry or an index; 4 of the 67 sources its claims cite were checked for support.

NHE6 depletion corrects ApoE4-mediated synaptic impairments and reduces amyloid plaque load

Open access

Published version of a preprint

Abstract

Apolipoprotein E4 (ApoE4) is the most important and prevalent risk factor for late-onset Alzheimer’s disease (AD). The isoelectric point of ApoE4 matches the pH of the early endosome (EE), causing its delayed dissociation from ApoE receptors and hence impaired endolysosomal trafficking, disruption of synaptic homeostasis, and reduced amyloid clearance. We have shown that enhancing endosomal acidification by inhibiting the EE-specific sodium-hydrogen exchanger 6 (NHE6) restores vesicular trafficking and normalizes synaptic homeostasis. Remarkably and unexpectedly, loss of NHE6 (encoded by the gene Slc9a6 ) in mice effectively suppressed amyloid deposition even in the absence of ApoE4, suggesting that accelerated acidification of EEs caused by the absence of NHE6 occludes the effect of ApoE on amyloid plaque formation. NHE6 suppression or inhibition may thus be a universal, ApoE-independent approach to prevent amyloid buildup in the brain. These findings suggest a novel therapeutic approach for the prevention of AD by which partial NHE6 inhibition reverses the ApoE4-induced endolysosomal trafficking defect and reduces plaque load.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

NHE6 depletion acidifies early endosomes, restores ApoE4-impaired receptor trafficking and Reelin-enhanced synaptic plasticity, and reduces amyloid plaque load in App knockin mice even in the absence of ApoE4. These findings suggest partial NHE6 inhibition as a potential ApoE-independent approach to prevent amyloid buildup in Alzheimer’s disease.

Key findings

  • Genetic loss of NHE6 restored surface expression of Apoer2, GluN2B, GluA1, and GluA2/3 in ApoE4-treated primary neurons, and conditional NHE6 knockout abolished Reelin resistance in ApoeAPOE4 hippocampal slices, restoring Reelin-enhanced LTP to levels comparable to ApoeAPOE3; NHE6 knockout efficiency in brain regions was 65–82%.
  • NHE6 deficiency reduced plaque load by approximately 80% in 12-month-old AppNL-F mice versus littermate controls, and insoluble Aβ (GuHCl and 70% FA fractions) was reduced by approximately 71% in 1.5-year-old AppNL-F;Slc9a6- mice; the ~50% reduction in soluble Aβ (TBS fraction) was not statistically significant.
  • Conditional NHE6 ablation at 2 months in AppNL-F;ApoeAPOE4 mice reduced plaque load comparably to germline depletion and abolished or delayed the age-dependent increase in plaque load, with no significant differences in cortical thickness, hippocampal area, or CA1 thickness in the conditional model.
  • NHE inhibition or NHE6 knockdown did not alter β-CTF generation in AppSwe primary neurons, while NHE6 deficiency increased Iba1 and GFAP immunoreactivity; plaque-associated microglia/astrocyte proportions and 6E10 intensity within microglia did not differ between genotypes.

Methods

  • Generated germline Slc9a6- and tamoxifen-inducible Slc9a6fl;CAG-CreERT2 mice, crossed to ApoeAPOE3, ApoeAPOE4, AppNL-F, and AppSwe (Tg2576) lines; tamoxifen was injected at 2 months or 6–8 weeks depending on experiment.
  • Used primary cortical neurons, mouse embryonic fibroblasts, surface biotinylation, immunoblotting, Vamp3-pHluorin2 pH measurements, Aβ ELISA, histology (Thioflavin S, 4G8/6E10, GFAP/Iba1, H&E), and hippocampal field recordings with Reelin and theta burst stimulation.
  • Statistical analysis used two-tailed Student’s t-test, one-way ANOVA with Dunnett’s or Tukey’s post hoc, or two-way ANOVA with Sidak’s post hoc; significance set at p < 0.05.

Limitations

  • Stated: the discrepancy with Prasad and Rao, 2015, remains unresolved; whether plaque reduction is due to increased microglial/astrocytic phagocytosis or improved glial degradation/export of Aβ remains to be determined; AppNL-F and AppNL-F;ApoeAPOE4 mice do not show cognitive impairments in spatial learning tests like Morris water maze (Saito et al., 2014; own unpublished observations); the impact of NHE6 loss in microglia and astrocytes is still unknown.
  • Evident: NHE6 depletion causes progressive cerebellar Purkinje cell loss in both germline and conditional models, and NHE6 is ubiquitously expressed, so therapeutic safety and cell-type-specific effects are not established; the study reports mouse data only, with no human validation.

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

Integrity signals

Registry

Crossref · 10.7554/elife.72034

Cites

114 of 114 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

4 of 67 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    The ability of Reelin to protect the synapse from Aβ toxicity is impaired by ApoE4.

    “the ability of Reelin to protect the synapse from Aβ toxicity is impaired by ApoE4 (Durakoglugil et al., 2009).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Durakoglugil et al., 2009 source

      The Results report that Reelin protects neurons from Aβ-induced synaptic suppression. The Discussion notes greater sensitivity to Aβ in ApoE4 knock-in mice, but says only that ApoE isoforms might differentially modulate the relevant receptor functions; it does not establish that ApoE4 impairs Reelin’s protection. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Findingown data

    NHE6/Slc9a6 depletion in AppNL-F;ApoeAPOE4 mice showed a comparable reduction in plaque load.

    “NHE6/Slc9a6 depletion in AppNL-F;ApoeAPOE4 mice showed a comparable reduction in plaque load (Figure 7 and Figure 7—figure supplement 3).”
    Quote in the paperSubstantial claim
  • Findingown data

    The total amount of plaques labeled by 6E10 was reduced in Slc9a6- compared to control mice.

    “Whereas the total amount of plaques labeled by 6E10 was reduced in Slc9a6- as compared to control mice (Figure 9C)”
    Quote in the paperSubstantial claim
  • Findingown data

    No significant differences were found in input-output curves between the compared genotypes.

    “No significant differences were found (Figure 5I and J).”
    Quote in the paperNot a substantial claim
  • Findingown data

    In AppNL-F;ApoeAPOE4 mice, conditional Slc9a6 knockout caused a reduction in plaque load compared to Slc9a6fl control littermates.

    “In AppNL-F;ApoeAPOE4 mice conditional Slc9a6 knockout caused a reduction in plaque load compared to the Slc9a6fl control littermates.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim. 36
  • It may state two separate claims as one. 41
  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Improved ApoE lipidation by overexpression of ABCA1 decreased plaque deposition in a mouse model.

    “In a mouse model, improved ApoE lipidation by the overexpression of ATP-binding cassette transporter family member A1 (ABCA1) decreased plaque deposition (Wahrle et al., 2005; Wahrle et al., 2008; Wahrle et al., 2004).”
    Quote in the paperNot a substantial claim3 of 3 sources checked
    • cites Wahrle et al., 2005 source

      The Discussion (page unavailable) predicts that increasing ABCA1 might decrease amyloid deposition by increasing apoE lipidation, but explicitly says this hypothesis needs direct testing. This paper instead reports that deleting Abca1 increased amyloid deposition in PDAPP mice; it does not report an overexpression experiment or an observed decrease in plaques. (LLM, conf=0.90)

      Experimental — accuracy not yet measured
    • cites Wahrle et al., 2008 source
    • cites Wahrle et al., 2004 source

      The Abstract and Discussion (page unavailable) show that ABCA1 is required for normal ApoE lipidation in mice. But this study examined ABCA1-deficient mice, not ABCA1 overexpression, and did not show decreased plaque deposition. The Discussion describes an effect on amyloid pathology as a possibility, not a measured outcome. (LLM, conf=0.87)

      Experimental — accuracy not yet measured
  • It may state two separate claims as one.

    Findingown data

    Using a humanized AppNL-F knockin mouse model, NHE6/Slc9a6 deficiency in 1-year-old animals reduces plaque deposition by approximately 80%.

    “Using a humanized AppNL-F knockin mouse model, we show that NHE6/Slc9a6 deficiency in 1-year-old animals reduces plaque deposition by ∼80%.”
    Quote in the paperSubstantial claim
  • It may state two separate claims as one.

    Findingown data

    The proportion of microglial structures containing Aβ (6E10) was comparable between Slc9a6-deficient and control AppNL-F mice, as was the intensity signal for 6E10.

    “the proportion of microglial structures containing Aβ (6E10 antibody) was comparable between Slc9a6-deficient and control AppNL-F mice, as was the intensity signal for 6E10.”
    Quote in the paperSubstantial claim
  • It may state two separate claims as one.

    Findingown data

    Conditional and germline Slc9a6 deficient AppNL-F mice have a reduced number of plaques and an increase of Iba1 and GFAP labeled glia.

    “Conditional and germline Slc9a6 deficient AppNL-F mice have a reduced number of plaques in the brain and an increase of Iba1 and GFAP labeled glia.”
    Quote in the paperSubstantial claim
  • It may state two separate claims as one.

    Findingown data

    The reduction in plaque deposition by Slc9a6 deficiency persists from early (12 months) to later stages (18 months) of AD, as Slc9a6-deficient AppNL-F animals aged 18 months had a reduction in insoluble Aβ by approximately 71%.

    “the reduction in plaque deposition by Slc9a6 deficiency persists from early (12 months) to later stages (18 months) of AD, as Slc9a6-deficient AppNL-F animals aged 18 months had a reduction in insoluble Aβ by approximately 71%.”
    Quote in the paperSubstantial claim
  • It may state two separate claims as one.

    Findingown data

    Slc9a6-deficient AppNL-F mice show an increase in Iba1 and GFAP immunoreactivity but reduced Aβ immunoreactivity compared to control AppNL-F mice.

    “When compared to control AppNL-F mice, Slc9a6-deficient AppNL-F mice show an increase in Iba1 (microglia) and GFAP (astrocytes) immunoreactivity, but reduced Aβ immunoreactivity.”
    Quote in the paperSubstantial claim
  • It may state two separate claims as one.

    Findingown data

    Reelin resistance was abolished when NHE6 was genetically disrupted in ApoeAPOE4 mice: Reelin application enhanced LTP in ApoeAPOE4;Slc9a6fl;CAG-CreERT2 to a comparable extent as in ApoeAPOE3;Slc9a6fl;CAG-CreERT2 mice.

    “This resistance was abolished when NHE6 was genetically disrupted in ApoeAPOE4 mice: Reelin application enhanced LTP (Figure 5D and H) in ApoeAPOE4;Slc9a6fl;CAG-CreERT2 to a comparable extent as in the ApoeAPOE3;Slc9a6fl;CAG-CreERT2 mice (Figure 5B).”
    Quote in the paperSubstantial claim
  • It may state two separate claims as one.

    Findingown data

    Both germline deficiency and adult-onset deficiency of NHE6 cause massive Purkinje cell loss in the cerebellum.

    “Since both germline deficiency and adult-onset deficiency of NHE6 causes massive Purkinje cell loss in the cerebellum (Figure 3C–E)”
    Quote in the paperSubstantial claim
  • It may state two separate claims as one.

    Findingown data

    AppNL-F mice expressing murine ApoE developed plaques at 12 months, whereas ApoeAPOE4;AppNL-F mice showed a similar number of plaques at 15-16 months.

    “AppNL-F mice expressing murine ApoE developed plaques at 12 months (Figure 7A and B), compared to ApoeAPOE4;AppNL-F which showed a similar number of plaques at 15–16 months (Figures 7C–D–8, and Figure 7—figure supplement 3F-G).”
    Quote in the paperNot a substantial claim
  • It may state two separate claims as one.

    Findingown data

    None of brain size, cortical thickness, hippocampal area, and CA1 thickness differed significantly between Slc9a6fl;CAG-CreERT2 and controls in the AppNL-F;ApoeAPOE4 model.

    “none of the analyzed parameters differed significantly between Slc9a6fl;CAG-CreERT2 and controls (Figure 7E–I)”
    Quote in the paperSubstantial claim
  • It may state two separate claims as one.

    Findingown data

    Tamoxifen-induced Slc9a6fl;CAG-CreERT2 mice do not present with a reduction in cortical or hippocampal volume, yet have comparable immunoreactivity for markers of glial activation.

    “However, the tamoxifen-induced Slc9a6fl;CAG-CreERT2 mice do not present with a reduction in cortical or hippocampal volume (Figure 7), yet have comparable immunoreactivity for markers of glial activation.”
    Quote in the paperSubstantial claim
  • It may state two separate claims as one.

    Findingown data

    Inhibition of γ-secretase in ApoE4-treated AppSwe neurons strongly enhanced β-CTF accumulation, but additional treatment with EMD87580 did not alter the amount of β-CTF in cell lysates.

    “Inhibition of γ-secretase in ApoE4-treated AppSwe neurons strongly enhanced β-CTF accumulation, however, additional treatment with EMD87580 did not alter the amount of β-CTF in the cell lysates (Figure 6A).”
    Quote in the paperSubstantial claim
  • It may state two separate claims as one.

    Findingown data

    In the time range analyzed, plaque load increased by age in control mice, but not in Slc9a6fl;CAG-CreERT2 mice.

    “In the time range analyzed, plaque load increased by age in control, but not in Slc9a6fl;CAG-CreERT2 mice.”
    Quote in the paperSubstantial claim
  • It may state two separate claims as one.

    Findingcitation

    NHE6 ablation led to glial activation and decreased plaque load in ApoeAPOE4 and AppNL-F double knockin mice.

    “By contrast, NHE6 ablation led to glial activation and decreased plaque load in ApoeAPOE4 (Sullivan et al., 1997) and AppNL-F (Saito et al., 2014) double knockin mice.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Sullivan et al., 1997 source
    • cites Saito et al., 2014 source
  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Each ApoE4 allele reduces the age of Alzheimer's disease onset by approximately 3-5 years compared to ApoE3 homozygotes.

    “Each ApoE4 allele reduces the age of Alzheimer’s disease (AD) onset by approximately 3–5 years compared to ApoE3 homozygotes, which comprise ~80% of the human population (Roses, 1994; Sando et al., 2008).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Roses, 1994 source
    • cites Sando et al., 2008 source
  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    ApoE2 is protective against Alzheimer's disease.

    “By contrast and by comparison, ApoE2 is protective against AD (Corder et al., 1994; Panza et al., 2000; West et al., 1994).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Corder et al., 1994 source
    • cites Panza et al., 2000 source
    • cites West et al., 1994 source
  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    ApoE3 homozygotes comprise approximately 80% of the human population.

    “Each ApoE4 allele reduces the age of Alzheimer’s disease (AD) onset by approximately 3–5 years compared to ApoE3 homozygotes, which comprise ~80% of the human population (Roses, 1994; Sando et al., 2008).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Roses, 1994 source
    • cites Sando et al., 2008 source
  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Positively charged arginines raise the net charge and thus the isoelectric point of ApoE.

    “The positively charged arginines raise the net charge and thus the isoelectric point (IEP) of the protein (Eto et al., 1985; Warnick et al., 1979).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Eto et al., 1985 source
    • cites Warnick et al., 1979 source
  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    The isoelectric point of ApoE2 is 5.9, ApoE3 is 6.1, and ApoE4 is approximately 6.4.

    “The IEP of ApoE2 is the lowest (5.9), ApoE3 has an intermediate IEP of 6.1, and the IEP of ApoE4 is ~6.4 (Ordovas et al., 1987).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Ordovas et al., 1987 source
  • It may state two separate claims as one.

    Interpretationreasoning

    Accelerated acidification of early endosomes abolishes the ApoE4-induced Reelin resistance and restores normal synaptic plasticity in ApoE4-targeted replacement mice.

    “Accelerated acidification of EEs abolishes the ApoE4-induced Reelin resistance and restores normal synaptic plasticity in ApoE4-targeted replacement mice.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    In the brains of AD patients and APP-overexpressing mice, plaques are surrounded by reactive microglia and astrocytes.

    “In the brains of AD patients and APP-overexpressing mice, plaques are surrounded by reactive microglia and astrocytes (Meyer-Luehmann et al., 2008; Serrano-Pozo et al., 2013)”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Meyer-Luehmann et al., 2008 source

      Checked before — its earlier verdict is held back until a new check runs.

    • cites Serrano-Pozo et al., 2013 source
  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisenone given

    BACE1 cleaves APP to create β-CTF and sAPPβ, and β-CTF is further cleaved by γ-secretase to release Aβ peptide.

    “The β-site amyloid precursor protein cleaving enzyme 1 (BACE1) cleaves APP in its extracellular juxtamembrane domain to create a membrane-anchored C-terminal fragment (β-CTF) and a soluble extracellular APP domain (sAPPβ). β-CTF is further cleaved by the γ-secretase complex, which leads to the release of the Aβ peptide.”
    Quote in the paperNot a substantial claim
  • It may state two separate claims as one.

    Premisecitation

    Endocytic subcompartments become progressively more acidic, and their pH is regulated by vATPase proton pumps and NHE proton leakage channels.

    “Endocytic subcompartments become progressively more acidic, and the pH of these compartments is regulated by the opposing functions of vesicular ATP-dependent proton pumps (vATPase) and proton leakage channels (Na+/H+ exchangers, NHEs).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Casey et al., 2010 source
    • cites Naslavsky and Caplan, 2018 source
  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisenone given

    ApoE3 has a cysteine at amino acid position 112 and an arginine at position 158; ApoE4 has two arginines; ApoE2 has two cysteines at these positions.

    “The most common isoform, ApoE3, has a charge neutral cysteine at amino acid position 112 and an arginine at position 158. The second most common isoform, ApoE4, has two arginines, while the less frequent ApoE2 has two cysteines at these respective positions.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisenone given

    The number of positively charged arginine residues differs between the three human ApoE isoforms due to two single nucleotide polymorphisms in the ApoE gene.

    “The number of positively charged arginine residues differs between the three human isoforms due to two single nucleotide polymorphisms in the ApoE gene.”
    Quote in the paperNot a substantial claim
  • It may state two separate claims as one.

    Interpretationown data

    Both the endosomal trafficking defect induced by ApoE4 in neurons and increased plaque deposition irrespective of ApoE genotype can be corrected by inhibition or genetic deletion of NHE6/Slc9a6.

    “In conclusion, we have shown that both the endosomal trafficking defect induced by ApoE4 in neurons and increased plaque deposition irrespective of ApoE genotype can be corrected by inhibition or genetic deletion of NHE6/Slc9a6, a key regulator of early endosomal pH.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    In AppNL-F mice, plaques can be identified as early as 9 months of age.

    “In AppNL-F mice, plaques can be identified as early as 9 months of age.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Saito et al., 2014 source
  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    NHE6 is ubiquitously expressed in all cells of the body, but in the CNS it is highly expressed in neurons and to a lesser extent in glial cells.

    “NHE6 is ubiquitously expressed in all cells of the body, however, in the CNS it is highly expressed in neurons where abundant synaptic vesicles and neurotransmitter receptors recycle in synapses (Lee et al., 2020; Lee et al., 2021) and to a lesser extent in glial cells (Zhang et al., 2014).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Lee et al., 2020 source

      Checked before — its earlier verdict is held back until a new check runs.

    • cites Lee et al., 2021 source

      Checked before — its earlier verdict is held back until a new check runs.

    • cites Zhang et al., 2014 source
  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisenone given

    NHE6 deficiency in humans causes neurodevelopmental defects resulting in Christianson syndrome, characterized by cognitive dysfunction, autism, ataxia, and epilepsy.

    “NHE6 deficiency in humans causes neurodevelopmental defects, which result in Christianson syndrome, an X-linked genetic disorder characterized by cognitive dysfunction, autism, ataxia, and epilepsy.”
    Quote in the paperNot a substantial claim
  • It may state two separate claims as one.

    Interpretationown data

    NHE6 has a temporally distinct function in the adult brain: the cerebrum requires NHE6 for development but not for postnatal neuronal survival, whereas Purkinje cells in the cerebellum do.

    “Our study supports a temporally distinct function of NHE6 in the adult brain where the cerebrum requires NHE6 for development, but not for postnatal neuronal survival, whereas Purkinje cells in the cerebellum do.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim.

    Premisecitation

    BACE1 activity is preferentially active in acidic environments.

    “It has further been reported that BACE1 activity is preferentially active in acidic environments (Shimizu et al., 2008).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Shimizu et al., 2008 source
  • Probably not a substantial claim.

    Premisecitation

    APP and its secretases co-localize in endosomal compartments where cleavage can occur.

    “APP and its secretases co-localize in endosomal compartments where cleavage can occur (Wang et al., 2018).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Wang et al., 2018 source
  • It may state two separate claims as one.

    Interpretationown data

    Combined data suggest that endosomal acidification has considerable potential as a novel therapeutic approach for AD prevention and possibly also for prevention of disease progression.

    “Taken together, our combined data suggest that endosomal acidification has considerable potential as a novel therapeutic approach for AD prevention and possibly also for the prevention of disease progression.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim.

    Premisecitation

    The pH of early endosomes and recycling endosomes is approximately 6.4-6.5.

    “The pH of EEs and recycling endosomes is ∼6.4–6.5 (Casey et al., 2010).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Casey et al., 2010 source
  • It may state two separate claims as one.

    Premisecitation

    pH-dependent release of ApoE from its receptor in the early endosome is important for endosomal maturation, cargo delivery, and rapid recycling of endosomal content to the cell surface.

    “The pH-dependent release of ApoE from its receptor in the EE is important for endosomal maturation and cargo delivery (Yamamoto et al., 2008) for the ability of endosomal content to rapidly recycle to the cell surface (Heeren et al., 1999; Nixon, 2017).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Yamamoto et al., 2008 source

      Checked before — its earlier verdict is held back until a new check runs.

    • cites Heeren et al., 1999 source
    • cites Nixon, 2017 source
  • It may state two separate claims as one.

    Interpretationown data

    Purkinje cell degeneration manifests postnatally and is not developmentally determined by the absence of NHE6.

    “Therefore, Purkinje cell degeneration manifests itself postnatally and is not developmentally determined by the absence of NHE6.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductown data

    Tamoxifen-induced recombination led to broad expression of tdTomato in the hippocampus.

    “Tamoxifen-induced recombination led to a broad expression of tdTomato in the hippocampus (Figure 2G).”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisenone given

    The pathological hallmarks of Alzheimer's disease are extracellular aggregates of amyloid β peptide and intracellular tangles of hyperphosphorylated tau protein.

    “The pathological hallmarks of AD are extracellular aggregates of the amyloid β (Aβ) peptide and intracellular tangles of hyperphosphorylated tau protein.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Interpretationcitation

    The delay of plaque deposition caused by human ApoE4 as opposed to murine ApoE is consistent with earlier findings by the Holtzman group.

    “This delay of plaque deposition caused by the presence of human ApoE4 as opposed to murine ApoE is consistent with earlier findings by the Holtzman group (Liao et al., 2015).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Liao et al., 2015 source
  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Beneficial or detrimental roles of reactive microglia and astrocytes in the degradation of Aβ have been reported, depending on the activation state of these cells.

    “Beneficial or detrimental roles of reactive microglia and astrocytes in the degradation of Aβ have been reported, depending on the activation state of these cells (Meyer-Luehmann et al., 2008; Ziegler-Waldkirch and Meyer-Luehmann, 2018).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Meyer-Luehmann et al., 2008 source

      Checked before — its earlier verdict is held back until a new check runs.

    • cites Ziegler-Waldkirch and Meyer-Luehmann, 2018 source

      Checked before — its earlier verdict is held back until a new check runs.

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    ApoE is an arginine-rich protein and a major component of very-low-density lipoproteins.

    “ApoE is an arginine-rich protein and a major component of very-low-density lipoproteins (Shore and Shore, 1973).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Shore and Shore, 1973 source
  • Probably not a substantial claim. It may state two separate claims as one.

    Premisecitation

    Early endocytic vesicles are slightly acidic at pH ~6.4, facilitating ligand/receptor dissociation, while lysosomes are highly acidic at pH 4-5, required for digestion of endocytosed biomolecules.

    “Early endocytic vesicles are slightly acidic (pH, ~6.4), which facilitates ligand/receptor dissociation. Lysosomes are highly acidic (pH 4–5), which is required for the digestion of endocytosed biomolecules (Figure 1A; Casey et al., 2010; Naslavsky and Caplan, 2018).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Casey et al., 2010 source
    • cites Naslavsky and Caplan, 2018 source
  • It may state two separate claims as one.

    Interpretationown data

    Partial NHE6 inhibition reverses the ApoE4-induced endolysosomal trafficking defect and reduces plaque load, suggesting a novel therapeutic approach for prevention of Alzheimer's disease.

    “These findings suggest a novel therapeutic approach for the prevention of AD by which partial NHE6 inhibition reverses the ApoE4-induced endolysosomal trafficking defect and reduces plaque load.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Partial NHE6 inhibition can be achieved without causing Christianson syndrome-like neurodevelopmental defects or Purkinje cell loss.
  • It may state two separate claims as one.

    Interpretationown data

    Plaque deposition is modulated by the presence of NHE6 postnatally and is not affected by NHE6 activity during development.

    “We conclude that plaque deposition is modulated by the presence of NHE6 postnatally and is not affected by NHE6 activity during development.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    Plaque deposition increases by less than twofold between 9 and 12 months of age and increases tenfold between 12 and 18 months in AppNL-F mice.

    “Whereas plaque deposition only increases by less than twofold between 9 and 12 months of age, it increases tenfold between 12 and 18 months (Saito et al., 2014).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Saito et al., 2014 source
  • It may state two separate claims as one.

    Interpretationown data

    Slc9a6- and Slc9a6fl;CAG-CreERT2 mice both show progressive Purkinje cell loss in the cerebellum, indicating that NHE6 requirement is cell-autonomous and not developmentally determined.

    “Slc9a6- and Slc9a6fl;CAG-CreERT2 both show progressive Purkinje cell loss in the cerebellum, indicating that NHE6 requirement is cell-autonomous and not developmentally determined.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim. It may state two separate claims as one.

    Premisenone given

    Processing of APP at the β- and γ-sites leads to Aβ production, and Aβ forms neurotoxic oligomers and accumulates in plaques.

    “Processing of the transmembrane amyloid precursor protein (APP) at the β- and γ-sites leads to Aβ production. Aβ forms neurotoxic oligomers and accumulates in plaques.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Mouse ApoE promotes plaque deposition more potently than human ApoE4.

    “Our data are consistent with previous findings by the Holtzman group (Fagan et al., 2002) that showed that mouse ApoE promotes plaque deposition more potently than human ApoE4.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Fagan et al., 2002 source
  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    Some Slc9a6 mutant variants causing Christianson syndrome do not significantly alter NHE6 ion exchange properties, suggesting Christianson syndrome could be caused by loss of NHE6 scaffolding functions rather than loss of endosomal pH regulation.

    “However, some Slc9a6 mutant variants causing Christianson syndrome in humans do not significantly alter the ion exchange properties of NHE6 (Ilie et al., 2020; Ilie et al., 2019) suggesting that Christianson syndrome could be caused by loss of NHE6 scaffolding functions and not by loss of endosomal pH regulation.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Ilie et al., 2020 source
    • cites Ilie et al., 2019 source

      Checked before — its earlier verdict is held back until a new check runs.

  • It may state two separate claims as one.

    Study design and conductown data

    Slc9a6 knockout efficiency in the brains of tamoxifen-injected Slc9a6fl;CAG-CreERT2 mice was 65-82% and varied between brain regions.

    “Slc9a6 KO efficiency in the brains of tamoxifen-injected Slc9a6fl;CAG-CreERT2 mice was 65–82% and varied between brain regions (Figure 3B).”
    Quote in the paperSubstantial claim
  • It may state two separate claims as one.

    Premisecitation

    ApoE4, unlike ApoE3 and ApoE2, prevents Reelin-mediated glutamate receptor insertion at the synapse, a state called ApoE4-mediated Reelin resistance.

    “We previously showed that ApoE4, in contrast to ApoE3 and ApoE2, prevents Reelin-mediated glutamate receptor insertion at the synapse, a state we refer to as ApoE4-mediated Reelin resistance (Chen et al., 2010; Durakoglugil et al., 2009; Lane-Donovan and Herz, 2017; Lane-Donovan et al., 2014; Xian et al., 2018).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Chen et al., 2010 source
    • cites Durakoglugil et al., 2009 source
    • cites Xian et al., 2018 source
  • It may state two separate claims as one.

    Premisecitation

    Loss of net surface charge at the isoelectric point reduces solubility and impairs dissociation of ApoE4 from its receptors, aided by ApoE4's greater propensity to form a molten globule under acidic conditions.

    “Loss of net surface charge at the IEP is accompanied by reduced solubility in an aqueous environment, leading to impaired dissociation of ApoE4 from its receptors (Xian et al., 2018) and aided by a greater propensity of ApoE4 to form a molten globule configuration under acidic conditions (Morrow et al., 2002).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Xian et al., 2018 source
    • cites Morrow et al., 2002 source
  • Probably not a substantial claim. It may state two separate claims as one.

    Premisecitation

    ApoE4 alters APP processing and Aβ degradation.

    “ApoE4 alters APP processing and Aβ degradation (reviewed in Benilova et al., 2012; Haass et al., 2012; Huynh et al., 2017; Lane-Donovan and Herz, 2017; Pohlkamp et al., 2017; Yamazaki et al., 2019)”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Benilova et al., 2012 source
    • cites Haass et al., 2012 source
    • cites Huynh et al., 2017 source

      Checked before — its earlier verdict is held back until a new check runs.

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    In ApoE4-expressing astrocytes, overexpression of NHE6 increases LRP1 on the surface, which correlated with an increase in Aβ uptake.

    “In ApoE4-expressing astrocytes, others have shown that overexpression of NHE6 increases LRP1 on the surface, which correlated with an increase in Aβ uptake (Prasad and Rao, 2018).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Prasad and Rao, 2018 source
  • Probably not a substantial claim.

    Study design and conductnone given

    A blind observer selected the area of plaques with circles of 20, 40, or 80 μm diameter and analyzed the intensity of 6E10 and Iba1 or GFAP using the ImageJ plugin RGB_measure.

    “A blind observer selected the area of plaques with circles of 20, 40, or 80 µm diameter and analyzed the intensity of 6E10 and Iba1 or GFAP by using the ImageJ plugin RGB_measure.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Other neurobehavioral phenotypes described for Slc9a6- mice recapitulate symptoms in Christianson syndrome patients, for example, hyposensitivity to pain.

    “Other neurobehavioral phenotypes have been described for Slc9a6- mice, which also recapitulate symptoms in Christianson syndrome patients, for example, hyposensitivity to pain (Petitjean et al., 2020).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Petitjean et al., 2020 source

      Checked before — its earlier verdict is held back until a new check runs.

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Interpretationcitation

    NHE6 depletion in microglia might conversely augment toll-like receptor response.

    “suggesting that NHE6 depletion in microglia might conversely augment TLR response.”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    In phagocytic cells, deacidification of endosomes using chloroquine reduces endosomal toll-like receptor response.

    “In phagocytic cells, the deacidification of endosomes using pharmacological inhibitors like chloroquine has been shown to reduce endosomal toll-like receptor (TLR) response (de Bouteiller et al., 2005; Fox, 2019; Kuznik et al., 2011; Wozniacka et al., 2006; Yang et al., 2016)”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites de Bouteiller et al., 2005 source
    • cites Fox, 2019 source
    • cites Kuznik et al., 2011 source
  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Study design and conductnone given

    6E10-positive microglia (Iba1) were quantified by a blind observer by first identifying microglia structures/cells in the green channel (Iba1), and then analyzing the proportion of 6E10-positive structures and signal intensity (red channel).

    “6E10-positive microglia (Iba1) were quantified by a blind observer by first identifying microglia structures/cells in the green channel (Iba1), and then analyzing the proportion of 6E10-positive structures and signal intensity (red channel).”
    Quote in the paperNot a substantial claim
  • Probably not a substantial claim.

    Study design and conductnone given

    Recombination was verified with the NHE6-rec PCR, which amplifies 400 bp if recombination has occurred.

    “Recombination was verified with the NHE6-rec PCR, which amplifies 400 bp if recombination has occurred.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    Neuronal NHE6 plays a direct role in both synaptic development and plasticity, potentially through BDNF/TrkB and other pathways.

    “Neuronal NHE6 plays a direct role in both synaptic development and plasticity, potentially through BDNF/TrkB (Deane et al., 2013; Ouyang et al., 2013) and other pathways.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Deane et al., 2013 source

      Checked before — its earlier verdict is held back until a new check runs.

    • cites Ouyang et al., 2013 source

      Checked before — its earlier verdict is held back until a new check runs.

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductnone given

    The same settings were used for every image.

    “The same settings were used for every image, and images were analyzed using ImageJ software.”
    Quote in the paperNot a substantial claim
62 of 62
  • The paper relies on this without support.

    Partial NHE6 inhibition can be achieved without causing Christianson syndrome-like neurodevelopmental defects or Purkinje cell loss.

    “NHE6 suppression or inhibition may thus be a universal, ApoE-independent approach to prevent amyloid buildup in the brain.”
    “These findings suggest a novel therapeutic approach for the prevention of AD by which partial NHE6 inhibition reverses the ApoE4-induced endolysosomal trafficking defect and reduces plaque load.”
  • The paper relies on this without support.

    The reduction in brain size, cortical thickness, hippocampal area, and CA1 thickness in NHE6-deficient AppNL-F mice does not account for the reduced plaque load.

    “H&E staining did not reveal any obvious anatomical structural differences between genotypes, but brain size, cortical thickness, hippocampal area, and CA1 thickness were reduced, as described previously (Xu et al., 2017; Figure 7—figure supplement 1).”
    “We found an approximate 80% reduction of plaques in Slc9a6- mice when compared to littermate controls (Figure 7B).”
  • The paper relies on this without support.

    ApoE4 is the most important genetic risk factor for Alzheimer's disease.

    “ApoE4 is the most important genetic risk factor.”
  • The paper relies on this without support.

    Only small molecule drug therapies or immunization approaches can satisfy the requirement for globally scalable Alzheimer's disease treatment.

    “Only small molecule drug therapies or, alternatively, immunization approaches can satisfy this requirement.”
  • The paper relies on this without support.

    Biologics, including monoclonal antibodies and potential viral gene therapy approaches, are unlikely to be sufficiently scalable.

    “Biologics, including monoclonal antibodies and potential viral gene therapy approaches, are unlikely to be sufficiently scalable.”
  • The paper relies on this without support.

    AppNL-F and AppNL-F;ApoeAPOE4 mice are the most physiological currently available mouse models of Alzheimer's disease that do not rely on excessive amyloid overproduction.

    “In the current study we used AppNL-F and AppNL-F;ApoeAPOE4 mice as the most physiological currently available mouse models of AD that do not rely on excessive amyloid overproduction.”
6 of 6

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?

  • The noxious propensity of apoE4 is due to an increase in isoelectric point compared to apoE3, resulting in unfolding of the protein in the acidic milieu of endosomes.

    “This noxious propensity of apoE4 is due to an increase in the isoelectric point, as compared to apoE3, resulting in unfolding of the protein in the acidic milieu of endosomes75–79.”

    From Interaction of sortilin with apolipoprotein E3 enables neurons to use long-chain fatty acids as alternative metabolic fuel (2025) · cites this paper as [79]

    The Introduction reports that ApoE4 has a higher isoelectric point than ApoE3 (about 6.4 versus 6.1). The Discussion proposes isoelectric precipitation and structural unfolding at early-endosomal pH as a mechanism for impaired recycling. The citing sentence presents that proposed mechanism as an established cause, which the source does not establish. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

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.

  • Wild-type genotyping PCR product has two reported sizes

    Minor

    The Figure 2 legend reports a 220 bp wild-type product, while Materials and methods reports a 250 bp wild-type product for the Slc9a6fl PCR. Both give 270 bp for the floxed product.

  • Triple-asterisk significance threshold differs

    Minor

    The figure legend defines *** as p < 0.005, whereas the Statistical methods section defines the same notation as p < 0.001.

2 of 2

Citations

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Metadata

Authors
Pohlkamp, T., Xian, X., Wong, C. H., Durakoglugil, M. S., Werthmann, G. C., Saido, T. C., Evers, B. M., White, C. L., Connor, J., Hammer, R. E., & Herz, J.
Affiliations
  • The University of Texas Southwestern Medical Center (US)
  • Peking University (CN)
  • RIKEN Center for Brain Science (JP)
  • Center for Translational Neurodegeneration Research
Corresponding author
  • Pohlkamp, Theresa
  • Herz, Joachim
Venue
eLife
Published
2021-10-07
Volume
10
ISSN
2050-084X (ISSN-L)
OpenAlex
W3204755653
Cited by
46
References
114
Citations by year
2026: 11 · 2025: 12 · 2024: 14 · 2023: 4 · 2022: 4 · 2021: 1
FWCI
2.08
Type
journal article
Language
en
Open access
Locations
  • eLife (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • National Institutes of Health (HL063762, NS093382, NS108115, AG053391)
  • BrightFocus Foundation (A20135245, A2016396S)
  • National Institute on Aging (1F31AG067708-01)
  • Darrell K Royal Research Fund
  • Harrington Discovery Institute
  • Circle of Friends Pilot Synergy
  • Blue Field Project to Cure FTD
Topics
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Cellular transport and secretion
  • Life Sciences › Neuroscience › Neurology › Neuroinflammation and Neurodegeneration Mechanisms
Keywords
NHE6, SLC9A6, APOE ε4, Alzheimer's disease, endolysosomal trafficking, synaptic homeostasis, amyloid plaques, amyloid clearance, apoE receptors, therapeutic target
MeSH terms
Animals, Female, Male, Sodium-Hydrogen Exchangers, Mice, Knockout, Low Density Lipoprotein Receptor-Related Protein-1, Mice, Apolipoprotein E4, Plaque, Amyloid

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

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