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<p>Alzheimer’s disease (AD) is increasingly recognized as a disorder of dysregulated immunometabolism at the neurovascular–glia–neuron interface. Systemic metabolic stressors such as insulin resistance, dyslipidaemia, and obesity converge on brain innate immune cells to reprogram energy pathways and sustain maladaptive inflammation. In microglia, metabolic rewiring across glycolysis–oxidative phosphorylation balance, glutaminolysis, and lipid handling governs trained-immunity programs that dictate amyloid and tau clearance, synaptic maintenance, and neurotoxicity. These processes converge on druggable nodes including AMPK–mTOR signaling, HIF-1α, and tricarboxylic-acid intermediates. Neurovascular fuel delivery is likewise impaired: endothelial GLUT1 loss and mitochondrial stress at the blood–brain barrier accelerate amyloid accumulation and neuronal injury. Lipid metabolism bridges metabolism and inflammation, as APOE4-driven microglial lipid droplets link genetic risk to inflammatory phenotypes. NLRP3 integrates metabolic danger signals into chronic neuroinflammation. Translational momentum now builds around metabolic interventions particularly GLP-1 receptor agonists and SGLT2 inhibitors that modulate glial metabolism, systemic inflammation, and barrier integrity. Converging metabolomic, lipidomic, and extracellular-vesicle biomarkers enable tracking of these pathways in humans, defining an immunometabolic axis of AD and supporting precision-medicine strategies to reprogram metabolism for disease modification.</p> Graphical Abstract <p>Systemic metabolic stress primes neurovascular and glial metabolism, driving pro-inflammatory microglia that can be therapeutically rewired toward homeostatic, neuroprotective states.</p> <p></p>

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Immunometabolism Reframes Alzheimer’s Disease: From Systemic Dysmetabolism to Glial Rewiring

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年2月13日

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  • Duc-Hiep Bach,
  • Thanh Liem Nguyen

摘要

Alzheimer’s disease (AD) is increasingly recognized as a disorder of dysregulated immunometabolism at the neurovascular–glia–neuron interface. Systemic metabolic stressors such as insulin resistance, dyslipidaemia, and obesity converge on brain innate immune cells to reprogram energy pathways and sustain maladaptive inflammation. In microglia, metabolic rewiring across glycolysis–oxidative phosphorylation balance, glutaminolysis, and lipid handling governs trained-immunity programs that dictate amyloid and tau clearance, synaptic maintenance, and neurotoxicity. These processes converge on druggable nodes including AMPK–mTOR signaling, HIF-1α, and tricarboxylic-acid intermediates. Neurovascular fuel delivery is likewise impaired: endothelial GLUT1 loss and mitochondrial stress at the blood–brain barrier accelerate amyloid accumulation and neuronal injury. Lipid metabolism bridges metabolism and inflammation, as APOE4-driven microglial lipid droplets link genetic risk to inflammatory phenotypes. NLRP3 integrates metabolic danger signals into chronic neuroinflammation. Translational momentum now builds around metabolic interventions particularly GLP-1 receptor agonists and SGLT2 inhibitors that modulate glial metabolism, systemic inflammation, and barrier integrity. Converging metabolomic, lipidomic, and extracellular-vesicle biomarkers enable tracking of these pathways in humans, defining an immunometabolic axis of AD and supporting precision-medicine strategies to reprogram metabolism for disease modification.

Graphical Abstract

Systemic metabolic stress primes neurovascular and glial metabolism, driving pro-inflammatory microglia that can be therapeutically rewired toward homeostatic, neuroprotective states.