The research team built its case using a conditional knockout mouse in which TDP-43 was deleted specifically from neurons. Animals carrying floxed TDP-43 alleles crossed with Map2-CreERT2 drivers received tamoxifen at eight weeks of age, stripping the protein from cortical and spinal neurons. Within weeks, the mice developed a striking ALS-like syndrome: rotarod performance began declining by day 12 after induction and fell significantly by day 18, forelimb grip strength collapsed by day 24, and by day 28 the animals were near moribund, with profound hindlimb muscle atrophy, flaccid tails, and dramatically shortened survival compared with controls. Histochemical staining of the motor cortex and lumbar spinal cord confirmed the behavioral picture, revealing marked neuronal loss and atrophy in precisely the regions that control movement.

But the most revealing data came from metabolism. L-lactate, the end product of anaerobic glycolysis, accumulated to significantly elevated levels in the motor cortex of TDP-43 knockout mice at the terminal stage of disease, and ALDOA messenger RNA and protein were both upregulated in the same tissue. Immunofluorescence showed that the excess ALDOA colocalized with neurons, placing the metabolic shift squarely inside the cells that were dying. In parallel experiments, the researchers knocked down TDP-43 in NSC-34 motor neuron-like cells and observed the same triad: damaged mitochondria, evidenced by reduced mitochondrial membrane potential; increased glucose uptake measured with the fluorescent analog 2-NBDG; and elevated intracellular and secreted lactate, accompanied by reduced cell viability.

These results make biological sense in the context of neuronal energetics. Healthy neurons preferentially rely on mitochondrial aerobic oxidation, but when mitochondria falter or the tricarboxylic acid cycle is impaired, cells compensate by shunting glucose through anaerobic glycolysis—a less efficient pathway that demands heightened glucose uptake and produces lactate as a byproduct. The study’s authors argue that TDP-43 loss triggers precisely this compensatory shift, but in a maladaptive, runaway form. What may begin as an emergency energy measure becomes a persistent high-lactate environment that promotes acidosis, oxidative stress, and inflammatory signaling, ultimately compounding the very neuronal injury it was meant to offset.

The mechanistic linchpin connecting glycolysis to cell death is the NLRP3 inflammasome. Prior work had shown that elevated ALDOA activity in macrophages enhances glycolysis, suppresses AMPK signaling, and activates NLRP3, and that NLRP3-mediated pyroptosis exacerbates neuroinflammation and motor neuron degeneration in ALS models. The new study closes the loop. In the motor cortex of TDP-43 knockout mice, the researchers detected significant upregulation of NLRP3, cleaved caspase-1, and the pore-forming fragment of gasdermin D (N-GSDMD)—the molecular signature of pyroptosis—alongside elevated IL-1β. Immunofluorescence confirmed that NLRP3 and N-GSDMD colocalized with neuronal markers, indicating that the pyroptotic machinery was firing inside motor neurons themselves, not merely in surrounding glia.

To test whether ALDOA was a cause rather than a bystander, the team turned to aldometanib, a selective ALDOA inhibitor that blocks the enzyme’s catalysis of fructose-1,6-bisphosphate. In TDP-43 cKO mice given oral aldometanib four times per week beginning one week after TDP-43 deletion, cortical lactate levels fell sharply, the abundance of NLRP3, caspase-1, N-GSDMD, and IL-1β dropped, and Nissl staining revealed a significantly higher count of surviving neurons in the motor cortex. Most strikingly, treated mice lived a median of 33 days after induction compared with 28 days for untreated knockouts—a meaningful extension in such an aggressive model. Treated animals also retained spontaneous movement at a stage when untreated littermates were moribund, although formal rotarod and wire-hang scores did not reach statistical significance.

The cellular experiments reinforced the pharmacological findings. A 24-hour exposure to 1 nanomolar aldometanib significantly reduced glucose uptake, intracellular and extracellular lactate, and the activation of the NLRP3-caspase-1-GSDMD axis in TDP-43-deficient NSC-34 cells, while restoring cell viability and reducing propidium iodide–positive cell death. The authors emphasize that this is the first assessment of aldometanib’s neuroprotective potential; the compound had previously been studied mainly in oncology contexts. By positioning ALDOA as an upstream node in the pathogenic cascade—upstream of both the metabolic collapse and the inflammatory cell death it triggers—the work identifies an intervention point earlier than current preclinical strategies that target mitochondria or lactate downstream.

The study also speaks to the peculiar complexity of TDP-43 biology. Earlier work on mutant TDP-43 proteins such as M337V had linked the protein to ALDOA through enhanced binding, and some cell models expressing mutant TDP-43 showed time-dependent decreases in glycolytic enzymes. The new findings demonstrate that loss of TDP-43 function, by contrast, upregulates ALDOA specifically in the motor cortex, underscoring that toxic gain-of-function and loss-of-function mechanisms can push metabolic networks in opposite directions. The model itself carries technical advantages: unlike astrocyte- or microglia-specific TDP-43 deletions, which the authors note produce mild or no motor phenotypes, neuronal deletion recapitulates hallmark ALS features rapidly and without sex bias, reinforcing the idea that neuronal TDP-43 is the critical determinant of disease.

Caveats remain. Direct evidence for ALDOA dysregulation in human ALS tissue or biofluids is still lacking, and the authors call for validation in post-mortem samples and patient-derived iPSC motor neurons. Aldometanib’s pharmacokinetics, blood–brain barrier penetration, and selectivity relative to other aldolase isoforms also require characterization, and the absence of genetic ALDOA knockdown data leaves its precise causal contribution incompletely resolved. Even so, the identification of a glycolysis–inflammasome–pyroptosis axis in ALS reframes the disease as a metabolic-inflammatory disorder and raises the tantalizing possibility that taming an ancient metabolic enzyme could buy motor neurons—and patients—precious time.

Subject of Research: The role of the glycolytic enzyme ALDOA in driving NLRP3/GSDMD-mediated pyroptosis and motor neuron degeneration in TDP-43-deficient ALS.

Article Title: ALDOA Promotes Glycolysis and NLRP3/GSDMD Pyroptosis to Accelerate ALS Progression

Article References: Yan, K., Jiang, Y., Yong, Y., Zhang, T., Zhang, N., Zeng, Q., Gong, X., Meng, L., Bi, F., & Liu, Y. (2026). ALDOA Promotes Glycolysis and NLRP3 / GSDMD Pyroptosis to Accelerate ALS Progression. Annals of Clinical and Translational Neurology, 13(9), 1903-1918. https://doi.org/10.1002/acn3.70372

Image Credits: AI Generated

DOI: 10.1002/acn3.70372

Keywords: ALS, TDP-43, ALDOA, glycolysis, NLRP3 inflammasome, pyroptosis, GSDMD, aldometanib, neuroinflammation, motor neurons, lactate, mitochondrial dysfunction