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It is becoming increasingly clear that the dominant, century-old neurocentric view of neurodegeneration is insufficient to explain why certain neurons degenerate, in particular with aging. Genetic studies in patient populations as well as mechanistic and functional studies in animal models altogether implicate nonneuronal cells, especially glia, to play more than bystander roles in neurodegeneration. Throughout the life span, neuronal function and homeostasis are modulated by glia, the functions of which become even more critical with aging. This review highlights key emerging concepts of the role of glia in neurodegeneration., (Copyright © 2024 Cold Spring Harbor Laboratory Press; all rights reserved.)

Region-specific synapse loss is an early pathological hallmark in Alzheimer's disease (AD). Emerging data in mice and humans highlight microglia, the brain-resident macrophages, as cellular mediators of synapse loss; however, the upstream modulators of microglia-synapse engulfment remain elusive. Here, we report a distinct subset of astrocytes, which are glial cells essential for maintaining synapse homeostasis, appearing in a region-specific manner with age and amyloidosis at onset of synapse loss. These astrocytes are distinguished by their peri-synaptic processes which are 'bulbous' in morphology, contain accumulated p62-immunoreactive bodies, and have reduced territorial domains, resulting in a decrease of astrocyte-synapse coverage. Using integrated in vitro and in vivo approaches, we show that astrocytes upregulate and secrete phagocytic modulator, milk fat globule-EGF factor 8 (MFG-E8), which is sufficient and necessary for promoting microglia-synapse engulfment in their local milieu. Finally, we show that knocking down Mfge8 specifically from astrocytes using a viral CRISPR-saCas9 system prevents microglia-synapse engulfment and ameliorates synapse loss in two independent amyloidosis mouse models of AD. Altogether, our findings highlight astrocyte-microglia crosstalk in determining synapse fate in amyloid models and nominate astrocytic MFGE8 as a potential target to ameliorate synapse loss during the earliest stages of AD., Competing Interests: Declaration of interests SH has acted as a paid consultant to Eisai Ltd, Novo Nordisk, and Alnylam; receives research funding from AstraZeneca and Eisai Ltd; and has a collaborative project with Ionis Ltd. During this research, OJF was employed by AstraZeneca; OJF is now employed by MSD. The following patents have been granted or applied for: PCT/2015/010288, US14/988387 and EP14822330 (SH). All the other authors declare that they have no competing interests.