Positive Feedback Regulation of Microglial Glucose Metabolism by Histone H4 Lysine 12 Lactylation in Alzheimer's Disease

The pro-inflammatory activation of microglia is a hallmark of Alzheimer’s disease (AD), and this process is known to involve a switch in energy metabolism from oxidative phosphorylation (OXPHOS) towards glycolysis. Here, we show how a positive feedback loop in microglia—comprising metabolic, histone lactylation, and transcriptional layers—drives AD pathogenesis, and we demonstrate that inhibiting this vicious cycle in microglia can ameliorate Aβ burden and cognitive deficits in AD model mice. After first detecting elevated histone lactylation in both AD model (5XFAD) mice and AD patient brains, we observed that H4K12la levels are elevated specifically in Aβ plaque-adjacent microglia. We subsequently found that this lactate-dependent histone modification is enriched at the promoters of glycolytic genes (e.g., Pkm). We confirmed that this enrichment activates transcription and thereby increases glycolysis activity, and ultimately demonstrate that a glycolysis/H4K12la/PKM2 positive feedback loop exacerbates microglial dysfunction in AD. Pharmacologic inhibition of PKM2 attenuated microglial activation, and microglia-specific ablation of Pkm2 improved spatial learning and memory in AD mice. Thus, beyond demonstrating a role for histone lactylation in a neurodegenerative disease and showing how multi-layered regulatory impacts attend altered glucose metabolism in microglia, our study illustrates that disrupting a positive feedback loop may support the development of innovative AD therapies.