The complement system in Alzheimer's disease: mechanisms, biomarkers, and therapeutic implications

Alzheimer's disease (AD) is a multifactorial neurodegenerative disorder in which synaptic loss is closely associated with cognitive decline. Although the amyloid hypothesis has long dominated AD research, the limited efficacy of amyloid-targeted therapies highlights the need to explore additional pathogenic mechanisms. Increasing evidence indicates that dysregulation of the complement system plays a critical role in AD, linking genetic risk, protein aggregation, neuroinflammation, and neurodegeneration. Under physiological conditions, complement signaling is essential for neural development and synaptic refinement; however, in AD, aberrant activation contributes to excessive synaptic pruning and sustained inflammatory responses. As a result, complement components have attracted attention as potential biomarkers and therapeutic targets, despite limitations in disease specificity. This review summarizes current advances in understanding complement system alterations in AD, discusses their roles in disease pathogenesis, and highlights emerging complement-targeted therapeutic strategies, as well as remaining challenges related to intervention timing, patient stratification, and blood-brain barrier delivery.