Impaired glucose uptake in the brain is an early presymptomatic manifestation of Alzheimer's disease (AD), with symptom-free periods of varying duration that likely reflect individual differences in metabolic resilience. We propose a systemic "bioenergetic capacity", the individual ability to maintain energy homeostasis under pathological conditions. Using fasting serum acylcarnitine profiles from the AD Neuroimaging Initiative as a blood-based readout for this capacity, we identified subgroups with distinct clinical and biomarker presentations of AD. Our data suggests that improving beta-oxidation efficiency can decelerate bioenergetic aging and disease progression. The estimated treatment effects of targeting the bioenergetic capacity were comparable to those of recently approved anti-amyloid therapies, particularly in individuals with specific mitochondrial genotypes linked to succinylcarnitine metabolism. Taken together, our findings provide evidence that therapeutically enhancing bioenergetic health may reduce the risk of symptomatic AD. Furthermore, monitoring the bioenergetic capacity via blood acylcarnitine measurements can be achieved using existing clinical assays.
FörderungenNational Institutes of Health/the National Institute of Aging IXICO Ltd. GE Healthcare Fujirebio Genentech, Inc. F. Hoffmann-La Roche Ltd EuroImmun Eli Lilly and Company Elan Pharmaceuticals, Inc. Janssen Alzheimer Immunotherapy Research & Development, LLC. Johnson & Johnson Pharmaceutical Research & Development LLC. Pfizer Inc. Novartis Pharmaceuticals Corporation Neurotrack Technologies NeuroRx Research Meso Scale Diagnostics, LLC. Merck Co., Inc. Lundbeck Lumosity Eisai Inc. Cogstate Araclon Biotech Alzheimer's Association AbbVie National Institute of Biomedical Imaging and Bioengineering National Institute on Aging DOD ADNI (Department of Defense) Alzheimer's Disease Neuroimaging Initiative (ADNI) (National Institutes of Health Grant) ADNI State of Bavaria Alzheimer's Drug Discovery Foundation Althingi CereSpir, Inc. Hjartavernd Bristol-Myers Squibb Company NIA Intramural Research Program Biogen NIH BioClinica, Inc. Piramal Imaging Servier Takeda Pharmaceutical Company NINDS NIA CurePSP Foundation Mayo Foundation German Federal Ministry of Education and Research (BMBF) Helmholtz Zentrum Munchen - German Research Center for Environmental Health Alzheimer's Disease Metabolomics Consortium (National Institute on Aging ) Canadian Institutes of Health Research Transition Therapeutics