Hi @baldwidx, thanks for your interesting post. The role of microglia in alzheimers is complex and not straight forward. In summary, microglia are thought to be able to both ameliorate and contribute to the disease at different stages of its development. Here is a useful review.
https://www.sciencedirect.com/science/article/pii/S0165572824000602
In fact, in the paper you have provided a link to the authors propose an elegant hypothesis around how this happens and conclude "Digestive exophagy could thus constitute a double-edged sword: extracellular degradation would help trim portions of large aggregates, but secretion of indigestible fibrillar Aβ inside lysosomal synapses could contribute to plaque growth."
In particular, "In the absence of pro-inflammatory stimuli, microglial cells degrade fibrillar Aβ material only very slowly, over the course of several days, which we showed here too. Digestive exophagy is therefore most likely not sufficient for rapid, efficient degradation of large Aβ aggregates."
Therefore, I would maintain my thinking that 2591 could be most useful in Alzheimer's as an adjunct to other therapeutics like Leqembi that directly target amyloid beta plaques. Indeed, the authors of the paper you have cited wrap up their discussion by making the statement "It is interesting to speculate that enhanced digestive exophagy may be a mechanism by which anti-Aβ monoclonal antibodies can promote clearance of Aβ plaques in humans."
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