Aging-dependent microglial heterogeneity worsens outcomes in models of traumatic brain injury

  • J Clin Invest. 2026 Apr 2;136(12):e196112. doi: 10.1172/JCI196112.
Zhichao Lu  1  2 ,  Yi Shuai  3 ,  Chenxing Wang  1  2 ,  Zongheng Liu  4 ,  Ziheng Wang  5  6 ,  Qianqian Liu  1  2 ,  Rui Jiang  1  2 ,  Jue Zhu  1  2 ,  Yongqi Zhu  1  2 ,  Weiquan Liao  1  2 ,  Xingjia Zhu  1  2 ,  Jingwei Zhao  7 ,  Kaibin Shi  8  9 ,  Wei Shi  1  2 ,  Peipei Gong  1  2
Affiliations
  • 1. Department of Neurosurgery, Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China.
  • 2. Neuro-Microscopy and Minimally Invasive Translational Medicine Innovation Center, Affiliated Hospital of Nantong University, Nantong, China.
  • 3. Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China.
  • 4. Department of Neurosurgery, Zhejiang Provincial Hospital of Chinese Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China.
  • 5. MOE Frontier Science Centre for Precision Oncology, University of Macau, Macau Special Administrative Region, China.
  • 6. School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
  • 7. Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
  • 8. Department of Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
  • 9. Chinese Institute for Immunology, Chinese Institutes for Medical Research, Beijing, China.
PMID: 41926211 DOI: 10.1172/JCI196112
Abstract

Traumatic brain injury (TBI) disproportionately affects the elderly, yet the underlying mechanisms remain unclear. Here, we demonstrate that aged TBI brains predominantly harbor proinflammatory NLRP3+ microglia, in stark contrast to the neuroprotective Lysozyme+ microglia prevalent in young TBI brains. This age-dependent microglial dichotomy correlates with elevated mortality and impaired recovery in aged TBI mice. By leveraging an integrative multiomics approach combined with metabolomics and epigenome analysis, we identified a previously unrecognized link between enhanced glycolysis and the proinflammatory chromatin landscape in NLRP3+ microglia. Further investigation identified ELF1 as a key transcription factor driving NLRP3+ microglia formation. Importantly, ablation of ELF1 reversed age-associated microglial dysfunction and improved TBI outcomes. Finally, we report that Imeglimin, a clinically approved antihyperglycemic agent capable of crossing the blood-brain barrier, inhibits ELF1 and reverses microglial phenotype, reducing acute mortality rate and leading to improved functional recovery of aged mice with TBI. Our work elucidates the mechanistic basis of age-dependent TBI outcomes, reveals the crosstalk between metabolic rewiring and epigenetic regulation in microglial aging, and identifies ELF1 as a promising therapeutic target for improving TBI outcomes.

Keywords
Drug therapy; Immunology; Inflammation; Innate immunity; Neurodegeneration; Neuroscience.
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