Disrupted myelin homeostasis in grey matter of Alzheimer’s disease

Abstract Alzheimer’s disease (AD) is characterized not only by amyloid-β plaques, tau neurofibrillary tangles and associated neuronal loss, but also by alterations in non-neuronal cell types essential for neuronal support. Oligodendrocytes and their myelin sheaths play a central role in maintaining axonal function, yet detailed molecular profiling of myelin dynamics in the human AD brain remains limited. Although neuroimaging studies increasingly highlight myelin degeneration in white matter as an important contributor to AD pathophysiology, the status of myelin within cortical grey matter is less well understood. Here, we performed a detailed histopathological characterization of myelin integrity and oligodendrocyte dynamics in both grey and white matter of the middle temporal gyrus (MTG), making use of post-mortem tissue from AD cases (n = 15) and age-, sex-, and APOE genotype–matched controls (n = 15). Strikingly, we identified a specific vulnerability of cortical grey matter myelin in AD, whereas white matter myelin appeared relatively preserved. This selective grey matter disruption was accompanied by a seemingly insufficient oligodendrocyte regenerative response, suggesting ongoing attempts at myelin repair, yet featured by a differentiation block. Importantly, the extent of myelin damage and OPC differentiation strongly correlated with proximity to tau pathology, linking cortical demyelination to neuronal and synaptic dysfunction within vulnerable AD regions. Together, our findings reveal cortical grey matter myelin disruption as a previously underrecognized, highly localized feature of AD pathology. By highlighting the tight intertwining of oligodendrocyte and myelin dynamics with tau-associated neurodegeneration, this work positions cortical myelin pathology as a potential new mechanistic and therapeutic avenue in AD.