A Toxic Tau-PFKFB3 Circuit Reduces F2,6BP Levels and Drives Neurodegeneration

Alzheimer's disease (AD) and related dementias are progressive neurodegenerative disorders manifested by aggregation of Tau and Amyloid beta (Aβ). Emerging evidence suggests that metabolic dysregulation contributes to AD pathogenesis, yet how metabolic alterations interface with neuronal integrity remains unclear. Here, we identify dysfunction in PFKFB3-F2,6BP (fructose-2,6-bisphosphate) metabolic axis as a key feature of AD. We show that pathological Tau aggregates aberrantly sequester PFKFB3, limiting its activity and resulting in F2,6BP depletion. F2,6BP exerts protective effects through multiple convergent mechanisms: (i) direct activation of polynucleotide kinase 3'-phosphatase (PNKP) to facilitate DNA strand break repair; (ii) transcriptional upregulation of the protein phosphatase 2A catalytic subunit (PP2CA) to limit Tau phosphorylation; (iii) stabilization of PFKFB3 to diminish its sequestration into aggregates; and (iv) direct inhibition of Tau aggregation. These findings establish F2,6BP as a central node linking metabolic regulation to both genomic stability and proteostasis in AD. Importantly, exogenous F2,6BP supplementation rescues multiple pathological features across diverse model systems, including induced neuronal cell lines (iN), primary neurons, organotypic hippocampal slice cultures, and in a Drosophila model of AD. These findings redefine F2,6BP as a metabolite that directly coordinates genome maintenance and proteostasis in neurons. Overall, this study identifies the PFKFB3-F2,6BP axis as a central driver of AD pathogenesis and a promising therapeutic target.

Tau aggregates sequester PFKFB3 depletes neuronal F2,6BPF2,6BP links metabolism to DNA repair and Tau proteostasisF2,6BP activates PNKP and upregulates PP2A to counter Tau pathologyF2,6BP supplementation rescues AD phenotypes across models.