S100A9-Driven AmyloidNeuroinfammatory Cascade in Traumatic Brain Injury as a Precursor State for Alzheimer’s Disease

Pro-infammatory and amyloidogenic S100A9 protein is an important contributor to Alzheimer’s disease (AD) pathology. Traumatic brain injury (TBI) is viewed as a precursor state for AD. Here we have shown that S100A9-driven amyloid-neuroinfammatory cascade was initiated in TBI and may serve as a mechanistic link between TBI and AD. By analyzing the TBI and AD human brain tissues, we demonstrated that in post-TBI tissues S100A9, produced by neurons and microglia, becomes drastically abundant compared to Aβand contributes to both precursor-plaque formation and intracellular amyloid oligomerization. Conditions implicated in TBI, such as elevated S100A9 concentration, acidifcation and fever, provide strong positive feedback for S100A9 nucleation-dependent amyloid formation and delay in its proteinase clearance. Consequently, both intracellular and extracellular S100A9 oligomerization correlated with TBI secondary neuronal loss. Common morphology of TBI and AD plaques indicated their similar initiation around multiple aggregation centers. Importantly, in AD and TBI we found S100A9 plaques without Aβ. S100A9 and Aβplaque pathology was signifcantly advanced in AD cases with TBI history at earlier age, signifying TBI as a risk factor. These new fndings highlight the detrimental consequences of prolonged post-TBI neuroinfammation, which can sustain S100A9-driven amyloid-neurodegenerative cascade as a specifc mechanism leading to AD development.