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56 reviewsSUMMARYVirtually all individuals aged 65 or older develop at least early pathology of Alzheimer’s disease (AD), yet mostlack disease-causing mutations in APP, PSEN, or MAPT, and many do not carry the APOE4 risk allele. Thisraises questions about AD development in the general population. Although transcriptional dysregulation hasnot traditionally been a hallmark of AD, recent studies reveal significant epigenomic changes in late-onset AD(LOAD) patients. We show that altered expression of the LOAD biomarker phosphoglycerate dehydrogenase(PHGDH) modulates AD pathology in mice and human brain organoids independent of its enzymatic activity.PHGDH has an uncharacterized role in transcriptional regulation, promoting the transcription of inhibitor ofnuclear factor kappa-B kinase subunit alpha (IKKa) and high-mobility group box 1 (HMGB1) in astrocytes,which suppress autophagy and accelerate amyloid pathology. A blood-brain-barrier-permeable small-molecule inhibitor targeting PHGDH’s transcriptional function reduces amyloid pathology and improves ADrelated behavioral deficits. These findings highlight transcriptional regulation in LOAD and suggest therapeutic strategies beyond targeting familial mutations.
