Mitochondrial Dysfunction in Alzheimer’s Disease Is Driven By Excess ER-Calcium Release in Patient-Derived Neurons

Tight regulation of mitochondrial Ca ²⁺ is essential for neuronal bioenergetics and cellular metabolism. Ca ²⁺ transfer from ER-localized ryanodine receptors (RyR) and inositol triphosphate receptors (IP ₃ R) to the mitochondria maintains a steady Ca ²⁺ source that fuels oxidative phosphorylation and ATP production. In Alzheimer’s disease (AD), RyR-evoked Ca ²⁺ release is markedly increased, contributing to synaptic deficits, protein mishandling, and memory impairment. Here, we demonstrate that dysregulated RyR-Ca ²⁺ release directly compromises mitochondrial activity and is an early contributor to AD cellular pathology. We measured an array of mitochondrial functions using fluorescent biosensors and optical imaging in RyR2-expressing HEK cells and iPSC-derived neurons from familial AD and nonAD patients. In neurons from AD patients, resting mitochondrial Ca ²⁺ levels were elevated alongside increased free radical production and higher caspase-3 activity relative to nonAD neurons. RyR-evoked Ca ²⁺ release further potentiated pathogenic mitochondrial responses in AD neurons, with increased Ca ²⁺ uptake and exaggerated membrane depolarization. Additionally, clearance of damaged mitochondria was impaired in AD neurons, demonstrating consequences from dysfunctional lysosomes. Notably, impairments to mitochondria in AD neurons were largely prevented with the RyR negative allosteric modulator, Ryanodex. These findings highlight how excess RyR-Ca ²⁺ release broadly contributes to early cellular pathology in AD which includes a cascade of ER, lysosomal, and mitochondrial deficits culminating in neuronal decline and degeneration. Additionally, pharmacological suppression of RyR-Ca ²⁺ release preserves mitochondrial, ER and lysosomal function, thus providing a novel and effective therapeutic.