Peroxisomes are essential cellular organelles involved in lipid metabolism, reactive oxygen species (ROS) detoxification, and the oxidation of very long-chain fatty acids (VLCFAs). Emerging evidence demonstrates that peroxisomal dysfunction plays a critical role in the pathogenesis of neurodegenerative diseases, including Alzheimer's disease (AD), Parkinson's disease (PD), and related disorders. The peroxisome-proliferator-activated receptor gamma coactivator-1 alpha (PGC-1alpha) pathway and peroxisomal biogenesis disorders have been increasingly linked to neurodegeneration, establishing peroxisomes as important therapeutic targets.
Peroxisomes are single-membrane-bound organelles present in virtually all eukaryotic cells. They perform essential metabolic functions including fatty acid beta-oxidation, ether phospholipid synthesis, and hydrogen peroxide (H2O2) metabolism. The peroxisomal matrix contains more than 50 enzymes involved in these diverse metabolic pathways, and proper peroxisome function requires the coordinated expression of peroxisomal biogenesis factors (PEX genes). [@serra2021]
Peroxisomes are essential cellular organelles involved in lipid metabolism, reactive oxygen species (ROS) detoxification, and the oxidation of very long-chain fatty acids (VLCFAs). Emerging evidence demonstrates that peroxisomal dysfunction plays a critical role in the pathogenesis of neurodegenerative diseases, including Alzheimer's disease (AD), Parkinson's disease (PD), and related disorders. The peroxisome-proliferator-activated receptor gamma coactivator-1 alpha (PGC-1alpha) pathway and peroxisomal biogenesis disorders have been increasingly linked to neurodegeneration, establishing peroxisomes as important therapeutic targets.
Peroxisomes are single-membrane-bound organelles present in virtually all eukaryotic cells. They perform essential metabolic functions including fatty acid beta-oxidation, ether phospholipid synthesis, and hydrogen peroxide (H2O2) metabolism. The peroxisomal matrix contains more than 50 enzymes involved in these diverse metabolic pathways, and proper peroxisome function requires the coordinated expression of peroxisomal biogenesis factors (PEX genes). [@serra2021]
Key peroxisomal enzymes include catalase, which decomposes hydrogen peroxide, and the fatty acid oxidation enzymes acyl-CoA oxidase (ACOX1), enoyl-CoA hydratase/3-hydroxyacyl-CoA dehydrogenase (MFP1/HD), and 3-ketoacyl-CoA thiolase. These enzymes work in concert to metabolize VLCFAs, branched-chain fatty acids, and dicarboxylic acids, preventing the accumulation of toxic lipid species that can damage neurons. [@kou2021]
The biogenesis of peroxisomes requires the coordinated function of over 35 PEX proteins, which are involved in peroxisomal membrane assembly, protein import, and matrix enzyme import. Mutations in PEX genes cause severe peroxisome biogenesis disorders (PBDs), such as Zellweger syndrome, which are often associated with severe neurological impairment. [@santos2020]
The peroxisomal matrix contains over 50 distinct enzymes that catalyze more than 60 different biochemical reactions. These enzymes are synthesized in the cytosol and imported post-translationally into the peroxisome matrix through a specialized import machinery involving PEX5 and PEX7 receptors. The import system recognizes specific targeting signals (PTS1 and PTS2) on the C-terminus and N-terminus of matrix proteins. [@zhong2022]
Catalase is one of the most abundant peroxisomal enzymes, constituting up to 20% of the total peroxisomal protein content. It catalyzes the decomposition of hydrogen peroxide into water and oxygen, playing a critical role in cellular antioxidant defense. Deficiencies in catalase activity have been documented in multiple neurodegenerative diseases, including AD and PD. [@lee2021]
The peroxisomal membrane is composed of a unique set of lipids and proteins that define the organelle's identity and function. Peroxisomal membrane proteins (PMPs) are essential for substrate transport, enzyme compartmentalization, and organelle dynamics. The peroxisomal translocon complex (PEX3, PEX16, and PEX19) coordinates the import of membrane proteins and the growth and division of the organelle. [@wang2021]
Peroxisomes are dynamic organelles that can proliferate in response to metabolic demands and divide through a process involving elongation, constriction, and fission. The fission machinery involves dynamin-related protein 1 (DRP1) and fission proteins FIS1 and MFF. Dysregulation of peroxisomal fission has been implicated in neurodegenerative diseases. [@jiang2023]
Multiple studies have documented peroxisomal abnormalities in Alzheimer's disease brain tissue. Reduced peroxisome numbers, decreased catalase activity, and impaired VLCFA metabolism have been reported in AD patients and animal models. The amyloid-beta (Abeta) peptide, the hallmark protein of AD, has been shown to directly impair peroxisomal function by reducing the expression of PEX genes and peroxisomal enzymes. [@crystal2020]
The amyloid-beta peptide exerts multiple detrimental effects on peroxisomal function. Abeta interacts with peroxisomal membrane proteins and disrupts the import of matrix enzymes, leading to reduced catalase activity and impaired fatty acid oxidation. Additionally, Abeta promotes the aggregation of peroxisomal proteins and disrupts peroxisomal membrane integrity. [@liu2021]
The peroxisome-proliferator-activated receptor gamma (PPARgamma) pathway, which regulates peroxisomal biogenesis and function, is downregulated in AD brain. This reduction in PPARgamma activity leads to decreased peroxisome numbers and impaired lipid metabolism, creating a vicious cycle where metabolic dysfunction promotes Abeta production and aggregation. The decreased catalase activity in AD peroxisomes results in elevated hydrogen peroxide levels, contributing to oxidative stress and neuronal death. [@han2020]
Lipid metabolism is significantly altered in AD, and peroxisomes play a central role in maintaining lipid homeostasis. Studies have shown that AD brain tissue exhibits reduced levels of ether phospholipids, which are essential for normal neuronal function and synaptic plasticity. This reduction in ether phospholipids correlates with decreased peroxisome numbers and impaired peroxisomal enzyme activity. [@schnknecht2021]
Very long-chain fatty acid (VLCFA) levels are elevated in AD brain and cerebrospinal fluid. The accumulation of VLCFAs promotes Abeta production and aggregation through multiple mechanisms, including altered amyloid precursor protein (APP) processing and increased oxidative stress. The peroxisomal dysfunction in AD thus creates a feed-forward loop that exacerbates disease progression. [@zhang2022]
Studies in AD mouse models have demonstrated that pharmacological activation of PPARgamma or PGC-1alpha can improve peroxisomal function, reduce Abeta burden, and ameliorate cognitive deficits. Thiazolidinediones (TZDs), which are PPARgamma agonists, have shown promise in preclinical models and are being evaluated in clinical trials for AD. [@nicolakakis2021]
PGC-1alpha activation through exercise, caloric restriction, or pharmacological agents promotes peroxisomal biogenesis and protects against neurodegeneration. The AMP-activated protein kinase (AMPK)-PGC-1alpha axis represents a promising therapeutic target for maintaining peroxisomal function in aging and disease. [@owens2022]
Peroxisomal dysfunction has also been implicated in Parkinson's disease pathogenesis. The lipid composition of substantia nigra neurons, which are particularly vulnerable in PD, is highly dependent on peroxisomal metabolism. Studies have shown reduced peroxisome numbers and altered peroxisomal enzyme expression in PD brain tissue and in cellular models of alpha-synuclein toxicity. [@chen2021]
The protein alpha-synuclein, which forms Lewy bodies in PD, has been shown to localize to peroxisomes and impair peroxisomal function. This interaction disrupts hydrogen peroxide metabolism and leads to increased oxidative stress, which contributes to dopaminergic neuron death. Alpha-synuclein accumulation in peroxisomes also impairs the import of catalase and other antioxidant enzymes, further compromising cellular defense. [@herzig2024]
Studies in cellular and animal models have demonstrated that reducing alpha-synuclein levels or preventing its peroxisomal localization can restore peroxisomal function and protect against neurodegeneration. These findings suggest that targeting the alpha-synuclein-peroxisome interaction may have therapeutic potential in PD. [@zhang2022a]
Mutations in PINK1 (PTEN-induced kinase 1) and PARKIN (an E3 ubiquitin ligase) are linked to familial forms of PD. These proteins are involved in mitochondrial quality control through mitophagy, but recent evidence indicates they also regulate peroxisomal quality control through pexophagy. [@beyer2021]
Dysregulation of pexophagy in PD leads to the accumulation of abnormal peroxisomes in dopaminergic neurons. These dysfunctional peroxisomes produce excessive ROS and contribute to lipid dysregulation, creating a toxic environment for dopaminergic neurons. Therapeutic approaches targeting pexophagy have shown promise in cellular and animal models of PD. [@gao2022]
The substantia nigra in PD shows specific alterations in peroxisomal lipid metabolism. Reduced levels of plasmalogens, which are ether phospholipids synthesized in peroxisomes, have been documented in PD brain and blood samples. These lipid alterations may contribute to dopaminergic neuron vulnerability and disease progression. [@oaks2021]
Elevated VLCFA levels have been found in PD brain tissue and are associated with increased alpha-synuclein aggregation. The peroxisomal dysfunction in PD thus contributes to both oxidative stress and protein aggregation, two key pathological features of the disease. [@latterich2023]
Peroxisomal dysfunction has been implicated in ALS, a progressive neurodegenerative disease affecting motor neurons. Studies have shown reduced peroxisome numbers and altered peroxisomal enzyme expression in ALS brain and spinal cord tissue. Mutations in genes involved in peroxisomal biogenesis have been linked to some cases of familial ALS. [@mcwilliams2020]
The relationship between TDP-43 pathology, which is characteristic of most ALS cases, and peroxisomal dysfunction is an area of active investigation. TDP-43 aggregates may impair peroxisomal function, contributing to motor neuron degeneration. [@yamada2022]
Peroxisomal abnormalities have been reported in Huntington's disease (HD), an autosomal dominant neurodegenerative disorder caused by CAG repeat expansion in the HTT gene. Reduced peroxisome numbers and impaired peroxisomal enzyme activity have been documented in HD models and patient tissue. [@hattori2023]
The mutant huntingtin protein interferes with peroxisome biogenesis and function through multiple mechanisms. This dysfunction contributes to the metabolic and oxidative stress observed in HD. [@vance2022]
The PPAR family of nuclear receptors (PPARalpha, PPARbeta/delta, and PPARgamma) plays a central role in regulating peroxisomal function and lipid metabolism. These receptors sense fatty acids and regulate the expression of genes involved in peroxisomal biogenesis and function. [@sharon2020]
PPARgamma coactivator-1alpha (PGC-1alpha) is a master regulator of mitochondrial and peroxisomal biogenesis, and its activity is impaired in neurodegenerative diseases. PGC-1alpha activates PPARs and promotes the expression of genes involved in fatty acid oxidation and antioxidant defense. [@song2021]
The AMP-activated protein kinase (AMPK)-PGC-1alpha axis is a central regulator of cellular energy metabolism and peroxisomal biogenesis. Activation of AMPK in response to energy stress promotes PGC-1alpha activity and stimulates peroxisome proliferation. This pathway is impaired in neurodegenerative diseases, contributing to peroxisomal dysfunction. [@kim2021]
Pharmacological activation of AMPK using compounds such as metformin and AICAR has been shown to promote peroxisomal biogenesis and protect against neurodegeneration in animal models. These findings suggest that AMPK-PGC-1alpha targeting may have therapeutic potential in neurodegenerative diseases. [@molero2022]
Peroxisomes are essential for the synthesis of ether phospholipids, a class of lipids critical for normal brain function and myelin integrity. Ether phospholipids, including plasmalogens and platelet-activating factor (PAF), constitute a major component of myelin sheaths and neuronal membranes. [@desvergne2020]
Peroxisomal dysfunction leads to severe demyelinating disorders such as Zellweger spectrum disorders. These disorders are characterized by profound neurological impairment, including developmental delay, hypotonia, and vision loss. The link between peroxisomal dysfunction and demyelination highlights the importance of peroxisomes in maintaining myelin integrity. [@ronatas2021]
In neurodegenerative diseases, myelin breakdown and white matter abnormalities are common features. Peroxisomal impairment contributes to myelin instability through defective ether lipid synthesis, leading to impaired nerve conduction and neuronal dysfunction. The relationship between peroxisomal function and myelin maintenance suggests that peroxisome-targeted interventions may benefit demyelinating conditions and age-related cognitive decline. [@lin2020]
Peroxisomes are major sites of hydrogen peroxide production and detoxification in cells. The peroxisomal antioxidant system, including catalase, peroxiredoxin 5 (PRDX5), and superoxide dismutase 1 (SOD1), maintains redox homeostasis. Dysfunction of this system leads to increased oxidative stress, which is a key contributor to neurodegeneration. [@hardie2021]
Catalase is the primary hydrogen peroxide-detoxifying enzyme in peroxisomes. Its activity is reduced in multiple neurodegenerative diseases, including AD and PD. This reduction compromises the cellular ability to detoxify hydrogen peroxide, leading to lipid peroxidation, protein oxidation, and DNA damage. [@marinangeli2022]
Gene therapy approaches to increase catalase expression have shown neuroprotective effects in animal models of neurodegenerative diseases. Additionally, pharmacological agents that enhance catalase activity are being investigated as potential treatments. [@greco2021]
Peroxiredoxin 5 (PRDX5) is a unique peroxiredoxin that localizes to peroxisomes, mitochondria, and cytosol. It reduces hydrogen peroxide, peroxynitrite, and lipid hydroperoxides, providing broad antioxidant protection. PRDX5 expression is upregulated in neurodegenerative diseases, likely as a compensatory response to increased oxidative stress. [@braverman2021]
Studies have shown that PRDX5 overexpression protects against oxidative stress-induced neuronal death. The therapeutic potential of PRDX5 modulators is being explored for neurodegenerative diseases. [@nagan2021]
Peroxisomes are the primary site of VLCFA (C22 or longer) oxidation in mammalian cells. The accumulation of VLCFAs due to peroxisomal dysfunction is neurotoxic and contributes to the pathogenesis of neurodegenerative diseases. [@moser2021]
Elevated VLCFA levels have been documented in AD and PD brain tissue. These lipids promote amyloidogenesis and alpha-synuclein aggregation through multiple mechanisms. The accumulation of VLCFAs disrupts membrane fluidity and lipid raft function, impairing synaptic signaling and neuronal communication. [@de2022]
VLCFAs undergo oxidation to produce dicarboxylic acids, which generate additional reactive oxygen species and exacerbate oxidative stress. The accumulation of these toxic metabolites contributes to neurodegeneration through mitochondrial dysfunction, ER stress, and inflammation. [@bartzokis2023]
Strategies to reduce VLCFA accumulation through peroxisomal enhancement or dietary intervention may have therapeutic potential. Dietary VLCFA restriction and pharmacological approaches to enhance peroxisomal VLCFA oxidation are being investigated. Compounds such as Lorenzo's oil, a 4:1 mixture of oleic and erucic acids, have been used to reduce VLCFA levels in peroxisomal disorders. [@nordgren2021a]
Understanding peroxisomal dysfunction in neurodegeneration has opened new therapeutic avenues. Several pharmacological approaches are being explored: [@knoops2022]
PPARgamma Agonists: Thiazolidinediones (TZDs) such as pioglitazone and rosiglitazone activate PPARgamma and promote peroxisomal biogenesis. These drugs have shown neuroprotective effects in animal models of AD and PD. [@diazvillanueva2023]
PGC-1alpha Activators: Compounds that activate PGC-1alpha, including AMPK activators (metformin, AICAR) and natural compounds (resveratrol, quercetin), enhance peroxisome and mitochondria biogenesis. [@halliwell2022]
Antioxidant Therapies: Targeting peroxisomal antioxidant enzymes, particularly catalase and PRDX5, may reduce oxidative stress in neurodegenerative diseases. [@liu2021a]
Gene Therapy: Approaches to deliver functional PEX genes or enhance peroxisomal biogenesis are being investigated for peroxisome-related neurodegeneration. [@chen2022]
Peroxisomal dysfunction interacts with multiple other pathological pathways in neurodegeneration: [@liu2022a]
Research on peroxisomal dysfunction in neurodegeneration continues to reveal new mechanistic insights and therapeutic targets. Key areas of focus include: [@rhee2020]