Cholesterol enhances mitophagosome formation evoked by A while impairing mitochondrial clearance by lysosomes in SH-SY5Y cells
To study the effect of intracellular cholesterol on mitophagy, we first used the human neuroblastoma SH-SY5Y cells treated with a water-soluble cholesterol complex (CHO:MCD, cholesterol:methyl-β-cyclodextrin) and exposed to 10 M oligomeric Aβ for 24 h. The increase of cholesterol content after treatment was confirmed by staining the cells with filipin (0.25 mg/ml), a fluorescent polyene antibiotic that specifically binds cholesterol. Fluorescence microscopy images showed a higher and homogeneous intracellular staining in CHO:MCD-treated cells (Fig. 1a). We had previously shown that cholesterol loading using this water-soluble complex resulted in a 3 times increase of mitochondrial cholesterol levels associated with a nearly 60% decrease of the mitochondrial GSH content [19]. Upon autophagy induction, a key requirement for autophagosome formation is the recruitment of cytosolic LC3B to the phagophore membranes and the subsequent conjugation to phosphatidylethanolamine. Therefore, levels of lipidated LC3B (also known as LC3B-II) have been widely used as a measure of autophagosome content. As shown, A exposure induced autophagosome synthesis, with a significant increase of the LC3B-II:LC3B-I ratio in cholesterol-enriched cells when the autophagy flux was blocked with the lysosomotropic reagent chloroquine (CQ) (Fig. 1b). To analyze mitophagy in cells, we next performed double immunostaining with antibodies against LC3B and cytochrome C (CYC), used as a marker of mitochondria (Fig. 1c). As expected, confocal microscopy showed a greater presence of autophagosomes (LC3B puncta) after Aincubation. The degree of colocalization between LC3B-positive vesicles and the mitochondrial marker was higher in cholesterol-enriched cells (Fig. 1c). However, despite the enhanced formation of autophagosomes, no overt co-localization between the lysosomal marker LAMP2 (lysosomal associated membrane protein 2) and CYC was observed when the cellular cholesterol content was high (Fig. 1d), therefore, suggesting that mitophagosomes accumulation in cholesterol-enriched cells is in part due to defective autophagy resolution.
To more readily assess the mitophagy flux in living cells, we used the monomeric Keima probe targeted to the mitochondrial matrix with a mitochondria targeting signal peptide sequence (mt-mKeima) [31]. mKeima is a pH-sensitive, dual-excitation ratiometric fluorescent protein that also exhibits resistance to lysosomal proteases. At the physiological pH of the mitochondria the excitation of mt-mKeima at 440 nm predominates, however, when mitochondria are delivered to the acidic lysosomal environment, the peak of the excitation spectrum of mt-Keima shifts from 440 to 586 nm. Taking advantage of these properties, lentiviral-transduced SH-SY5Y cells stably expressing mt-mKeima were cholesterol-enriched and the formation of autolysosomes was analyzed by confocal microscopy after A exposure (Fig. 1e). In control cells exposed to the cytotoxic peptide up to 48 h, the dual-excitation ratiometric imaging of mt-mKeima showed cytoplasmic puncta structures with strong signals at an excitation wavelength of 561 nm (Fig. 1e), which were already evident after 24 h of A incubation (Supplementary Fig. 3). Interestingly, and consistent with the results obtained by immunocytochemistry, no fluorescence signal was observed at 561 nm when the cells exposed to A were previously enriched with cholesterol, indicating that mitochondrial delivery to lysosomes was disrupted (Fig. 1e and Supplementary Fig. 3). Accordingly, the mitophagy index calculated from these ratiometric images, as previously described [33], increased cumulatively over time in control cells exposed to A while remained unchanged in CHO:MCD-treated cells (Fig. 1f). Similar results were observed when mitophagy was triggered by the mitochondrial uncoupler carbonyl cyanide chlorophenylhydrazone (CCCP) (Supplementary Fig. 4), thus further proving that rise of intracellular cholesterol levels impairs mitophagy flux regardless of mitochondrial insult.
Cholesterol-mediated depletion of mitochondrial GSH promotes incomplete PINK1-mediated mitophagy in embryonic cortical/hippocampal neurons exposed to A.
Most of the studies regarding mitophagy regulation have been performed in transformed cell lines using the mitochondrial uncoupler CCCP as a trigger. Remarkably, CCCP-induced mitophagy is significantly attenuated when cells are forced to depend on mitochondrial respiration [38]. Because of the high energetic dependence of neurons on mitochondrial function [3], and the unability of neurons to dilute mitochondrial damage through cell division, it is possible that the mitophagy changes observed in cholesterol-enriched SH-SHY5Y cells may be different in primary neuronal cultures. To evaluate this possibility, embryonic cortical/hippocampal neurons from wild-type (WT) and SREBF2 mice were incubated with A at 5 M for 24 h and double immunostained with anti-LC3B and anti-CYC antibodies (Fig. 2a). Cell viability remained unaffected at the length of the incubation period and doses used (Supplementary Fig. 5). Confocal images revealed a marked accumulation of LC3B-positive structures in the soma of the cells after A treatment, which partially co-localized with the mitochondrial marker (Fig. 2a). The degree of mitochondria co-localization with LC3B puncta was significantly higher in SREBF2 cells compared to WT cells (Fig. 2a). Similarly, an enhanced presence of mitochondria in autophagosomes was observed in SREBF2 cells when we used a common autophagy inducer like the mTOR inhibitor rapamycin (Supplementary Fig. 6a) at sub-toxic concentrations (Supplementary Fig. 5), thereby confirming that changes in cholesterol homeostasis in cultured primary neurons regulate mitophagy to the same extent as in transformed cell lines. In parallel, mitophagy resolution was assessed by co-immunostaining with anti-LAMP-2 and anti-CYC antibodies. Confocal microscopy showed an increased amount of double-stained CYC- and LAMP-2-positive structures in WT cells elicited by A (Fig. 2b) and rapamycin (Supplementary Fig. 6b). In contrast, no evident co-localization was found between mitochondria and the lysosomal marker in SREBF2 cells (Fig. 2b and Supplementary Fig. 6b), hence, recapitulating the mitophagy flux defect observed in cholesterol-enriched SH-SY5Y cells. It is also noteworthy the difference in organelle distribution observed after mitophagy engagement. Whereas in WT cells, lysosomes were mainly confined in the neuronal soma and co-localized with the mitochondrial marker, in SERBF2 cells the lysosomes remained evenly distributed in the perikaryon and along neurites after A or rapamycin insult (Fig. 2b and Supplementary Fig. 6b). Furthermore, unlike WT cells, mitochondria in SERBF2 cells mostly accumulated in the soma once mitophagy was induced, displaying a more fragmented pattern in neurites (Fig. 2b and Supplementary Fig. 6b). In agreement with these findings, a similar abnormal distribution was previously reported in pyramidal neurons of AD-affected individuals [39].
Early steps of the nascent autophagosome synthesis require a transient generation of mitochondrial ROS [40]. As previously mentioned, we have recently demonstrated that an increase in intracellular cholesterol levels provides the necessary local burst of ROS to trigger autophagosomes formation by reducing the mitochondrial GSH levels and favoring mitochondrial A-induced oxidative stress [18]. Furthermore, the presence of LC3B-positive vesicles elicited by A in cholesterol-enriched neuronal cultures is abolished after treatment with GSH ethyl ester (GSHee), a cell-permeable form of GSH that recovers the pool of mitochondrial GSH and prevents Aβ-induced oxidative damage [18]. Consistent with these data, pretreatment with GSHee significantly inhibited mitophagy in SREBF2 cells (Fig. 2c). After mitochondrial GSH recovery, confocal photomicrographs of SREBF2 cells exposed to A displayed a marked decrease of CYC- and LC3B-positive vesicles. The treatment with GSHee also reduced the mitochondrial accumulation of PINK1 in these cells, with confocal photomicrographs showing a loss of co-localization between the key mitophagy player and the mitochondrial marker (Fig. 2c). Interestingly, A promoted PINK1 presence in mitochondria from SREBF2 cells without loss of mitochondrial membrane potential, assessed by tetramethyl rhodamine methyl ester (TMRM), a cell-permeant fluorescent dye that only accumulates in mitochondria with intact membrane potential (Supplementary Fig 7). Moreover, confocal microscopy analyses revealed that mitochondrial stabilization of PINK1 and the subsequent mitophagy induced by A in SREBF2 cells occurred without parkin recruitment (Fig. 2d). Translocation of the cytosolic E3 ubiquitin-protein ligase was only observed when cells were treated with the potassium ionophore valinomycin, as shown by the punctate parkin-positive staining that highly co-localizes with the mitochondrial marker (Fig. 2d). Altogether, these findings indicate that A triggers a PINK1-mediated but parkin-independent mitophagy in cultured primary neurons, which is exacerbated by cholesterol-induced depletion of mitochondrial GSH and does not require the loss of mitochondrial membrane potential.
SREBF2 overexpression in APP-PSEN1 neurons induces PINK1-mediated accumulation of mitophagosomes but prevents mitophagy completion.
To further explore the impact of cholesterol on the mitophagy pathway during AD progression, we used both primary neuronal cultures and brains from WT and APP-PSEN1 mice with and without overexpressing SREBF2, at different ages. Of note, unlike the SREBF1 isoform, a strong activator of lipogenic genes, SREBF2 mainly induces cholesterogenic genes [41]; accordingly, SREBF2-overexpressing mice display enhanced levels of cholesterol in all the tissues analyzed, while triglyceride content, although slightly elevated in the liver, remain unchanged in the plasma and peripheral tissues [25].
In neuronal cultures, consistent with the reported blockage of the last steps of autophagy by high cholesterol burden, no colocalization was found between mitochondria and the lysosomal marker LAMP2 in APP-PSEN1-SREBF2 cells despite mitophagosomes formation (Supplementary Fig 8a). Confocal analyses also revealed an increased presence of PINK1 and the autophagy receptor SQSTM1 in mitochondria of APP-PSEN1-SREBF2 cells (Supplementary Fig 8b). However, as in SREBF2 cells exposed to A, the mitochondrial accumulation of PINK1 did not stimulate the recruitment of parkin (Supplementary Fig 8c). Translocation of the ubiquitin ligase to mitochondria occurred only when cells were treated with valinomycin, which significantly reduced the mitochondrial membrane potential as expected (Supplementary Fig. 8d).
APP-PSEN1-SREBF2 brains show mitophagy failure with disrupted mitochondrial recruitment of the mitophagosome synthesis machinery despite high PINK1/parkin mitochondrial presence.
Outcomes were slightly different when we analyzed the mitophagy markers in isolated mitochondria from brains of WT and mutant mice. Western blot analysis showed full-length PINK1 only in mitochondria from APP-PSEN1 mice overexpressing SREBF2 (Fig. 3a), whereas levels of the 55 kDa processed form were similar in all the homogenates, regardless of mice genotype (Fig. 3a). Intriguingly, unlike previous observations in cell cultures, mitochondrial accumulation of PINK1 in APP-PSEN1-SREBF2 brains was accompanied by the presence of parkin (Fig. 3a). In contrast, in WT mice and the rest of the mutant mice, parkin was exclusively detected in total brain extracts (Fig. 3a). We examined the levels of lipidated LC3B in isolated mitochondria from WT and mutant mice at increasing ages (Fig. 3b). Unexpectedly, and despite the engagement of the PINK1-parkin pathway, mitochondria from APP-PSEN1-SREBF2 mice did not show recruitment of the autophagosomal marker LC3B at any of the ages analyzed. LC3B-II in mitochondria was only detectable after overexposing the immunoblots, revealing a similar age-dependent increase in both WT and APP-PS1-SREBP2 mice (Supplementary Fig. 9). Recruitment of the ULK1 protein kinase complex, a key requirement for mitophagy initiation [42], was also blunted in brains from triple transgenic mice, without any detectable presence of the Ser/Thr kinase ULK1 in the mitochondrial fraction (Fig. 3a). In line with these findings, immunoblots of autophagosomes isolated from brain of APP-PSEN1 mice showed comparable levels of the mitochondrial marker CYC regardless of SREBF2 overexpression (Fig. 3c). Moreover, no differences of CYC levels were observed in the endo-lysosomal fractions between both genotypes (Fig. 3c). Altogether, these findings suggest that the formation of mitophagosomes is disrupted in APP-PSEN1-SREBF2 mice despite PINK1-parkin recruitment. Remarkably, results were different when mitophagy was acutely elicited by an in vivo administration of rapamycin. We observed an increase of CYC in autophagosomes isolated from the brain of rapamycin-treated SREBF2 mice compared to WT mice (Fig. 3c), which was accompanied by low levels of the mitochondrial marker in the endo-lysosomal fraction (Fig. 3c), consistent with the loss of lysosomes fusogenic capacity due to cholesterol rise.
Impaired mitophagy in APP-PSEN1-SREBF2 brains results in increased mitochondrial content.
To further explore whether the cholesterol-mediated impairment of mitophagy affects mitochondrial content in APP-PSEN1-SREBF2 brains, we quantified the mitochondrial DNA (mtDNA) copy number in different brain regions (prefrontal cortex, hippocampus, and cerebellum) by dPCR (Fig. 3d and Supplementary Fig. 10). Despite its limitations, dPCR has been shown to correlate with the mitochondrial mass [43]. Results, expressed as mtDNA copies per diploid genome, revealed an age-dependent increase of mtDNA in the hippocampus of APP-PSEN mice that overexpress SREBF2 (Fig. 3d and Supplementary Fig. 10). A similar rise was observed in the prefrontal cortex while the mtDNA remained unaltered in the cerebellum, a less affected region in AD (Supplementary Fig. 10). In contrast, in the hippocampus of WT and the other transgenic mice, the mtDNA content did not change (APP/PSEN1 mice) or even decreased (WT and SREBF2 mice) at late ages (Fig. 3d).
The increase of mtDNA copies could also reflect in part stimulated mitochondrial biogenesis, triggered by injured mitochondria as a part of the mitochondrial quality control program [44]. To check this possibility, we first determined the expression levels of the co-transcriptional regulation factor PGC-1α /PPARG coactivator 1 alpha (PPARGC1A), a master modulator of mitochondrial biogenesis [45] that through activating the nuclear respiratory factor 1 and 2 (NRF1 and 2) governs the expression of multiple mitochondrial-related proteins, including the mitochondrial transcription factor A (TFAM), ultimately responsible of driving transcription and replication of mtDNA. As shown, immunoblots of brain extract from 7-month-old APP-PSEN1-SREBF2 mice showed a significant increase of PGC-1α levels compared to WT mice (Fig. 3e). Conversely, the transcriptional regulatory factor was found reduced in brain extracts of 10-month-old APP-PSEN1 mice with and without SREBF2 overexpression (Fig. 3e). In agreement with these findings, mRNA levels of Tfam significantly increased only in brains of 7-month-old APP-PSEN1-SREBF2 mice (Fig. 3f), which was associated with an increase of the TFAM protein levels (Fig. 3g). No significant changes in TFAM expression levels were observed in WT mice and the rest of mutant mice, at any of the ages analyzed (Fig. 3f and 3g). Thus, these results indicate that while the increase of the mtDNA content in the brain of APP-PSEN1-SREBF2 mice up to 7 months of age is in part due to biogenesis induction, the mtDNA rise at late ages can only be accounted for mitophagy defects.
Progressive activation of the PINK1-parkin signaling pathway in brain mitochondria from APP-PSEN1-SREBF2 mice during aging.
Having established that mitophagy flux is impaired in APP-PSEN1-SREBF2 mice and results in increased mitochondrial content, we next sought to go deeper insight into the nature of these cholesterol-mediated alterations during aging, focusing our analyses mainly on the initial steps of the PINK1-parkin cascade of events. We examined the presence of PINK1 and parkin in isolated mitochondria from brains of WT and mutant mice at increasing ages (Fig. 4a). As shown, only mitochondria from APP-PSEN1-SREBF2 mice displayed a significant age-dependent accumulation of PINK1 that was accompanied by enhanced parkin recruitment (Fig. 4a).
In healthy mitochondria, PINK1 is targeted to the inner mitochondrial membrane and cleaved by the rhomboid intra-membrane protease PARL (presenilin associated, rhomboid-like). In some cases, when PARL activity becomes rate limiting, the unprocessed PINK1 can reach again the OMM and initiate mitophagy, without loss of mitochondrial membrane potential [46]. Interestingly, recent studies have shown that mitochondrial bioenergetic stress promotes an autocatalytic cleavage of PARL, producing a C-terminal PARL (PACT) fragment less efficient in processing PINK1 [47]. We analyzed the presence of PARL and the resulting processed PACT fragments in mitochondrial extracts by western blot (Fig. 4b). The immunoblots revealed an age-dependent increase of the PACT/PARL ratio in mitochondria from brains of APP-PSEN1-SREBF2 mice, while mitochondria from WT mice displayed a similar PACT/PARL ratio, regardless of aging. It is therefore likely that the increment of this proteolytically deficient fragment of PARL in mitochondria of triple transgenic mice may favor the observed rise of PINK1 levels, although, further studies would be need to prove a mechanistic link.
Next, as a measure of PINK1 functionality, we examined its phosphorylation state in mitochondrial extracts by phosphate affinity SDS-polyacrylamide gel electrophoresis (Phos-tag SDS-PAGE), an assay based on the ability of the Phos-tag reagent to bind phosphorylated proteins and retard their electrophoretic mobility [48]. Phos-tag immunoblots showed an increased presence of slower migration bands in brain mitochondrial extracts from 7-month-old APP-PSEN1-SREBF2 mice compared to APP-PSEN1 samples (Fig. 4c) and as expected, the bands disappeared after phosphatase treatment (Fig. 4d). The shifted bands were more evident in older APP-PSEN1-SREBF2 mice, indicating a progressive accumulation of hyperphosphorylated PINK1(Fig. 4d). To further confirm that the PINK1-parkin signaling axis is active, we analyzed the levels of polyubiquitinated chains, in particular those connected via lysine residues at position 63 (K63), which act as scaffolds for autophagy receptors [49, 50]. Immunoblots displayed an increased age-dependent accumulation of high molecular weight bands in brain mitochondrial extracts from APP-PSEN1-SREBF2 mice in comparison with samples from WT and APP-PSEN1 mice (Fig. 4e and Supplementary Fig 11), which disappeared in the absence of the deubiquitinases inhibitor N-ethylmaleimide (NEM) (Supplementary Fig 11). Immunostaining analyses of hippocampal slices from APP-PSEN1-SREBF2 mice corroborated the increased levels of K63-ubiquitin in mitochondria, showing high co-localization with the translocase of outer mitochondrial membrane 20 (TOMM20) (Fig. 4f). Remarkably, the ubiquitin recruitment to mitochondria was completely abolished following an in vivo treatment with GSHee for two weeks (Fig. 4f). Thus, these findings suggest that high brain cholesterol levels in APP-PSEN1-SREBF2 mice stimulate the PINK1-parkin-mediated ubiquitin signaling by modulating oxidative stress.
Reduced mitochondrial translocation of OPTN in elderly APP-PSEN1-SREBF2 mice due to accumulation in aggresome-like structures
The next step was to evaluate the presence of autophagy receptors in mitochondria. As previously shown, SQSTM1 accumulated in APP-PSEN1-SREBF2 neurons (Supplementary Fig 8b), and also in brain mitochondria of old triple transgenic mice (Supplementary Fig. 12a). Nonetheless, according to previous studies, the role of SQSTM1 is limited to mitochondrial clustering [51] while OPTN and NDP52 would be the primary PINK1-parkin-dependent mitophagy receptors [50, 52]. Moreover, despite functional redundancy, OPTN and NDP52 are differentially distributed among tissues, being OPTN highly expressed in the brain [52]. These observations prompted us to study the impact of high cholesterol particularly on the recruitment of OPTN to mitochondria. We observed that levels of OPTN increased in total brain homogenates from APP-PSEN1-SREBF2 mice (Supplementary Fig. 12b). Conversely, the presence of the autophagy receptor was markedly lower in the mitochondrial fraction of the triple transgenic mice, in comparison with samples from WT and the other mutant mice (Supplementary Fig. 12b). OPTN content progressively decreased with age in brain mitochondria of APP-PSEN1 mice overexpressing SREBF2 (Fig. 5a). In contrast, A-treated SH-SY5Y cells acutely enriched with cholesterol displayed enhanced mitochondrial levels of OPTN, and the consequent recruitment of LC3B-II (Supplementary Fig. 12c), consistent with the observed formation of mitophagosomes (Fig. 1c). Thus, these findings indicate that chronic cholesterol accumulation in the brain of APP-PSEN1-SREBF2 mice results in an age-dependent impairment of OPTN translocation to mitochondria.
Given that phosphorylation of OPTN by TANK-binding kinase-1 (TBK1) has been described to promote its binding to ubiquitin, thereby favoring its retention to damaged mitochondria [53], we investigated whether the decreased mitochondrial levels of OPTN in APP-PSEN1-SREBF2 mice correlate with a limited phosphorylation-mediated activation of TBK1. Western blot analysis showed a significant decrease of phosphorylated TBK1 in brain extracts of old APP-PSEN1-SREBF2 mice; nonetheless, the reduction was even more pronounced in brains from WT mice (Fig. 5b), indicating that the lower presence of OPTN in mitochondria of triple transgenic mice cannot be explained simply by age-dependent changes in TBK1 activity.
Expression and distribution of OPTN in mouse brains were also monitored by fluorescence microscopy (Fig. 5c). Immunostainings with anti-OPTN yielded a higher intensity in the hippocampus of 10-month-old APP-PSEN1-SREBF2 mice compared to WT and APP-PSEN1 brains (Fig. 5c). Nonetheless, the autophagy receptor did not co-localize with the mitochondrial marker TOMM20 but accumulated in cytosolic deposits (Fig. 5c). Cellular inclusions of mutant OPTN are a hallmark of amyotrophic lateral sclerosis (ALS) and primary open-angle glaucoma (POAG) [54]. Likewise, intraneuronal aggregates of OPTN have been observed in other neurodegenerative diseases, including AD [55]. Under some pathological conditions and stimuli like oxidative stress, OPTN can form aggregates made of covalently-bonded oligomers [56]. Moreover, if the ubiquitin–proteasome system fails these aggregates are sequestered into large inclusion body-like structures called aggresomes [57], which can eventually be eliminated via autophagy [58]. To confirm that the cytosolic buildups of OPTN in hippocampal neurons of APP-PSEN1-SREBF2 mice were part of aggresome-like structures, we analyzed their interaction with the histone deacetylase 6 (HDAC6), a crucial player in the recruitment of polyubiquitinated proteins and the subsequent aggresome formation [59]. Consistent with a stimulated aggresome synthesis, photomicrographs of the hippocampus from 10-month-old triple transgenic mice showed an increased presence of HDAC6 that co-localized with OPTN (Fig. 5d). Furthermore, filipin staining of APP-PSEN1-SREBF2 brain slices showed a marked presence of cholesterol in the OPTN-containing aggresomes; in contrast, intracellular cholesterol staining was almost negligible in WT and APP-PSEN1 brain samples (Fig. 5e). In all the cases, cell membranes were not labeled by filipin since samples were permeabilized before OPTN and HDAC6 immunostaining. Interestingly, the formation of OPTN-containing aggresomes was significantly reduced when mice were subjected to an in vivo treatment with GSHee (Fig. 5f), indicating that sustained cholesterol-mediated depletion of mitochondrial GSH and the subsequent oxidative stress in aged APP-PSEN1-SREBF2 mice may play a key role in regulating OPTN expression and its recruitment to aggresomes.
Progressive presence of OPTN-containing aggresomes in the hippocampus of AD patients correlates with increased mitochondrial cholesterol levels at late stages
Recently, Fang et al [12] have provided compelling evidence of mitophagy impairment in the hippocampus of AD patients. In line with our findings, the study showed low levels of mitophagy initiation proteins, such as phosphorylated TBK1 and ULK1, in all the human AD samples analyzed. They also reported unchanged OPTN levels in total brain extracts; however, the intracellular distribution of OPTN was not specifically evaluated. We addressed this question by analyzing the presence of OPTN-containing aggresomes in post-mortem hippocampal tissues from age-matched AD and control individuals (patients’ information in Table 1). The immunohistochemical analysis showed HDAC6-positive structures in the hippocampus of individuals with AD, which increased progressively along AD stages and displayed a higher degree of co-localization with OPTN in comparison with tissue from control subjects (Fig. 6a and Supplementary Fig. 13). At higher magnification, confocal micrographs from control tissues showed an OPTN immune-positivity evenly distributed throughout the neuronal soma (Fig. 6b). In contrast, a perinuclear accumulation of the autophagy receptor was noticed in pyramidal neurons of AD tissues, which progressed towards more condensed aggresome-like structures in the late AD VI stages (Fig. 6b). Thus, these results corroborated the observations in APP-PSEN1-SREBF2 mice, which led us to question whether OPTN aggregates in human AD tissues were also linked to changes in cholesterol levels. To avoid the reported drawbacks of filipin use in immunohistochemistry of human brain tissues (photobleaching issues and high autofluorescence at the filipin excitation wavelength), we analyzed the cholesterol distribution in hippocampal slices using recombinant perfringolysin O, a cholesterol-binding bacterial toxin fused with glutathione S-transferase (GST-FPO). We first performed a protein-lipid overlay assay to confirm that the recombinant protein recognizes cholesterol. As shown, GST-PFO (1 μg/ml) binds cholesterol in a dose-dependent manner, starting from 200 pmol of the sterol (Supplementary Fig. 14a). The selectivity of the probe for cholesterol was also demonstrated in SH-SY5Y cells, showing an enhanced GST-PFO fluorescence intensity after cholesterol enrichment that mimicked the cellular pattern of filipin staining (Supplementary Fig. 14b). In the hippocampus of human control brains, GST-PFO immunofluorescence staining mainly visualized the boundaries of the pyramidal neurons, consistent with the high cholesterol content of the plasma membrane (Supplementary Fig. 15). Cholesterol labeling at the plasma membrane significantly decreased in hippocampal neurons from AD brains, turning into more intracellular staining, with GST-PFO-immunopositive aggregates at late AD VI stages (Supplementary Fig. 15). Furthermore, quantification of confocal microscopy images showed significant co-localization of GST-PFO with TOMM20 in hippocampal neurons of AD-affected brains at late stages (Fig. 6c), suggesting that cholesterol accumulates in mitochondria throughout the course of the disease.
Overall, our data illustrate systematically the impact of high cholesterol levels in A-induced mitophagy. Cholesterol exerts a dual effect; it promotes PINK1-mediated mitophagy induction by downregulating the mitochondrial antioxidant defense but impairs the lysosomal clearance of mitophagosomes. Additionally, during the disease progression, a chronic high cholesterol loading stimulates the oxidative-mediated formation of OPTN aggregates, thereby inhibiting its translocation to mitochondria and the mitophagy completion, despite enhanced PINK1/parkin activation.