AbstractBackgroundNeurons and astrocytes were differentiated separately from human induced pluripotent stem cells (HiPSC) derived from Late‐Onset Alzheimer Disease (LOAD) female patients carrying Apolipoprotein E4 (ApoE4) allele. Cells from age and sex matched healthy subject carrying Apolipoprotein E3 allele were used as control. These neuronal, astrocytic, and their co‐cultures were assessed to investigate cell‐specific AD phenotypes (Figure 1). We recently demonstrated that application of a small molecule partial mitochondrial complex I inhibitor CP2 blocked neurodegeneration and cognitive decline in multiple mouse models of AD. However, the demonstration that this novel therapeutic approach is efficacious in human brain cells has not been done. Here, we aimed to validate neuroprotective mechanisms induced by CP2 using patient‐derived neuronal cells form LOAD patient. Outcomes will further support the development of these compounds for clinical application.MethodAxonal trafficking of MitoTracker Red stained mitochondria in neuron‐astrocyte co‐cultures was captured using live confocal imaging. The Seahorse XFe96 flux analyzer was used to evaluate mitochondrial bioenergetics in co‐cultures and pure neuronal or astrocytic cultures. Cell Viability Assays were used to perform H2O2 challenge. Quantitative polymerase chain reaction (qPCR), immunohistochemistry, and western blot were carried out to assess alterations in the expression of relevant genes and protein products.ResultWe have found that LOAD cells have a significant reduction in the percentage of motile mitochondria in axons, increased accumulation of neuronal phosphorylated Tau, and altered bioenergetics in neurons and astrocytes compared to the control cells. qPCR revealed elevated expression of inflammation related genes in LOAD co‐cultures. CP2 treatment at concentrations found therapeutically relevant in vivo in APP/PS1 and 3xTgAD mice improved cellular bioenergetics, rescued mitochondrial motility, and provided neuroprotection against H2O2 induced oxidative stress.ConclusionLOAD HiPSC‐derived neuronal co‐cultures and individual brain cells recapitulate mechanisms associated with LOAD allowing validation of a novel mitochondria‐targeted therapeutics. Our results support previous observation in AD mice and the hypothesis that partial inhibition of mitochondrial complex I activates neuroprotective compensatory mechanisms improving cellular energetics in LOAD human neurons even in the presence of mitochondria with abnormal dynamics and energetics. Further efforts are focused on the determination of a cell‐specific mechanisms of neuroprotection.