Overall, neuronal information is transferred to astrocytes primarily through spillover of neurotransmitters or other types of neuroligands, which diffuse into the extracellular space and next bind to various astroglial targets, such as membrane ionic channels, transporters or receptors triggering their conformational change (Figure 1). As a result, activated GPCR catalyzes dissociation of a heterotrimeric G protein complex (composed of G_α, G_β/G_γ subunits) into G_α subunit and βγ dimer by the exchange of GDP for GTP. Based on the sequence homology and functionality of α-subunits, G proteins are divided into four main families: G_αs, G_αi/G_αo, G_αq/G_α11, and G_α12/G_α13 that regulate distinct downstream signaling events (Jastrzebska, 2013). The activation of the G_q subunit stimulates phospholipase C (PLC) that leads to hydrolysis of phosphoinositol diphosphate (PIP2) into diacylglycerol (DAG), known as a membrane-bound regulator of cAMP concentration, and inositol 1,4,5-triphosphate (IP3), known as a soluble messenger triggering the release of Ca²⁺ ions from the endoplasmic reticulum (ER) (Hua et al., 2004) or secretory vesicles (Hur et al., 2010). In astrocytes, G_q-coupled receptors, mainly α1-adrenoreceptor (α₁-AR; Ding et al., 2013), D1 dopamine receptor (D1R; Corkrum et al., 2020), histamine receptor (H₁; Kárpáti et al., 2018), metabotropic glutamate receptor (mGluR; Sun et al., 2013), serotonin 5-HT₂ receptor (Peng and Huang, 2012), and P2Y purinoreceptor (Ding et al., 2009), and also G_i-coupled receptors, such as GABA_B receptor (Durkee et al., 2019), generate a wide range of inositol 1,4,5-trisphosphate receptor (IP3R)-dependent Ca²⁺ oscillations to differently regulate gliotransmission and neuronal modulation (Table 1). For example, synaptically released acetylcholine (ACh) or noradrenaline (NE) can induce an astrocytic Ca²⁺ increase thereby enhancing synaptic plasticity the in the cortex (Takata et al., 2011; Chen et al., 2012) and hippocampus (Navarrete et al., 2012; Papouin et al., 2017). The IP3R-dependent Ca²⁺ release may also occur spontaneously (King et al., 2020). The canonical function of G_i-GPCR is to suppress adenylate cyclase-dependent signaling cascade and thus, inhibit cAMP activity, which has been also observed in astrocytes (Gould et al., 2014). The G_βγ released from different G_i subunits targets ion channels such as inwardly rectifying potassium channels and voltage-gated Ca²⁺ channels (Jeremic et al., 2021). Interestingly, the GPCR-G_i/o protein signaling in neurons is commonly known to inhibit intracellular Ca²⁺ events and electrical excitability, whereas a recent study has demonstrated that astrocyte G_i/o GPCR activation may stimulate Ca²⁺ elevation involved in the release of inhibitory neurotransmitters into the synapse (Huang and Thathiah, 2015; Durkee et al., 2019). Therefore, such functional diversity of GPCRs enables integrated astrocyte-neuron communication.

Several interesting results regarding global Ca²⁺ elevations in astrocytes have been derived from IP3R type 2 knockout mice (Guerra-Gomes et al., 2021). It has been demonstrated that loss of this receptor may contribute to various types of cognitive dysfunctions (Perez-Alvarez et al., 2014; Padmashri et al., 2015) as well as depressive-like behaviors (Cao et al., 2013), but it seems unlikely that its role in shaping astrocytic Ca²⁺ is predominant (Petravicz et al., 2008, 2014). Although astrocytic IP3R2 expression is required for certain mechanisms of LTD formation, the genetic defects in IP3R2 are not sufficient to fully prevent LTP generation what probably reflects astrocyte diversity in different brain regions (Oberheim et al., 2012). Recently, it has been suggested that IP3R1 and IP3R3 subtypes co-exist in astroglia and retain their functionality by generating local Ca²⁺ events (Sherwood et al., 2017, 2021). The second key type of Ca²⁺-permeable receptor channel in the ER is the ryanodine receptor (RyR) but the mechanism of its activation and inhibition by Ca²⁺ remains largely unexplored and controversial (Rodríguez-Prados et al., 2020; Skowrońska et al., 2020). The latest report has suggested that RyR-mediated Ca²⁺-induced Ca²⁺ release (CICR) in astrocytes may be negatively modulated by neuron-derived factors which may alter the Ca²⁺ response triggered by ionotropic receptors (Skowrońska et al., 2020). Other types of stores controlling intracellular Ca²⁺ concentration are mitochondria that buffer cytosolic Ca²⁺ via the mitochondrial NCX, mitochondrial H⁺/Ca²⁺ exchanger (mHCX), mitochondrial Ca²⁺ uniporter (mCU), and mitochondrial permeability transition pore (mPTP; Agarwal et al., 2017). Interestingly, the expression of some mitochondrial transporters may be controlled by cyclic AMP response element-binding protein (CREB; Shanmughapriya et al., 2015). Primarily, a rise in mitochondrial Ca²⁺ concentration drives energy production needed to modulate glutamate release and prevents excitotoxic neuronal death. On the other hand, Ca²⁺ overload may lead to astrocytic apoptosis (Stephen et al., 2014). It is worth mentioning that Ca²⁺ signaling dynamics diffuse between mitochondria and ER (Okubo et al., 2019), and ER stress triggers mitochondrial dysfunction (Britti et al., 2018).

The resting cytosolic Ca²⁺ concentration independent from IP3-activity is also controlled by transmembrane Ca²⁺ influx through the transient receptor potential A1 (TRPA1) channel. Activation of this receptor can induce constitutive D-serine release from astrocytes for NMDA receptor-dependent LTP maintenance (Shigetomi et al., 2013). Blocking of TRPA1 decreases spontaneous Ca²⁺ events leading to lower extracellular GABA uptake by the astrocyte-specific transporter (GAT3; Shigetomi et al., 2011). In view of that, astrocytic TRPA channels are considered as integral players coordinating Ca²⁺ dynamics involved in the inhibitory efficacy of the hippocampal synapses. Likewise, intracellular Ca²⁺ is also tightly regulated by ionotropic receptors, including α-amino-3-hydroxy-5-methyl-4-isoxazolepropionate (AMPA) and N-methyl-D-aspartate (NMDA) receptors, both gated by glutamate, and ATP-gated purinergic P2X receptors (Palygin et al., 2010, 2011; Ceprian and Fulton, 2019). The plasma membrane Na⁺/Ca²⁺ exchanger (NCX) and plasma membrane Ca²⁺ ATPase (PMCA) are the main regulators of Ca²⁺ extrusion to the extracellular space while the control of Ca²⁺ concentration in the ER is ensured by the sarco/endoplasmic reticulum calcium ATPase (SERCA) (Brini and Carafoli, 2011). Compared to NCX, PMCA has a lower capacity for ionic transport but its basal affinity for Ca²⁺ is higher. This property allows PMCA to respond to even subtle changes in Ca²⁺ concentration within a range of its resting cytosolic level. By contrast, NCX can eliminate significant rises in intracellular Ca²⁺, although, in the case of increased intracellular Na⁺ concentration, due to e.g., glutamate or GABA uptake, the NCX may operate in reverse mode increasing Ca²⁺ influx (Brini and Carafoli, 2011; Rose et al., 2020).

Unlike Ca²⁺ activity, which can be regulated by multiple distinct pathways, the predominant mechanism of cAMP modulation is mediated by GPCRs coupled to either G_s or G_i leading to activation or inhibition of transmembrane adenylate cyclases (tmACs), respectively. In astrocytes, cAMP is regulated mainly by the activation of adenosine receptors (A₁ and A_2A), adrenergic receptors (α₂ and β₁₋₃), dopamine receptor (D1/5), glutamatergic receptor (mGlu3), histamine receptor (H₂), PACAP/VIP receptors, serotonin receptors (5-HT₄ and 5-HT_5A) and also opioid receptors, all summarized in Table 1. ACs are believed to be pivotal points of integration between Ca²⁺ and cAMP signaling. It is assumed that all of the nine tmAC isoforms, which have also been identified in mice astrocytes (Lee et al., 2018), can be modulated (activated or inhibited) by Ca²⁺, either directly or indirectly via Ca²⁺ binding proteins such as calmodulin (CaM), CaM kinase (CaMK), calcineurin (CaN), protein kinase C (PKC), or G_q-coupled receptor activation. For instance, AC8 activated in a Ca²⁺/CaM-dependent manner binds the Orai1 channel, which is a major functional component responsible for store-operated calcium entry (SOCE; Willoughby et al., 2012a,b). Accordingly, the AC8 seems to be highly sensitive to modest local Ca²⁺ changes. In primary astrocytic cultures, AC inhibitor 2',5'-dideoxyadenosine prevented cAMP synthesis and significantly decreased SOCE-triggered glycogenolysis. Based on this evidence, the authors proposed a new model for astrocytic coupling of Ca²⁺ homeostasis, AC8-dependent cAMP production and glycogen metabolism which could also impact on learning and memory processes (Müller et al., 2014). However, the physiological interplay between the molecular players of cAMP signaling and depletion of ER Ca²⁺ stores still remains to be determined in this subtype of glial cells.

Recent in vitro and in vivo studies provided considerable insight into the differences between Ca²⁺ and cAMP dynamics in astrocytes in terms of precise spatiotemporal regulation of complex cellular processes (Horvat et al., 2016; Oe et al., 2020). While stimulation of α₁AR generated rapid and transient Ca²⁺ increase enhancing synaptic plasticity, stimulation of βAR triggered slower and long-lasting cAMP elevations and promoted consolidation of cortical memory. It is supposed that threshold levels for activation of respective second messenger are different due to diverse affinities of NE for AR subtypes. According to this, moderate NE release may be sufficient to activate the α₁AR coupled to the G_q while activation of βAR coupled to the G_s needs relatively high extracellular NE to elevate cAMP within the cell (Ramos and Arnsten, 2007; Oe et al., 2020). Another type of AC, called soluble AC (sAC), is directly activated by HCO3- entry via the electrogenic NaHCO₃ cotransporter in response to extracellular K⁺ rises or aglycemia (Choi et al., 2012; Schmid et al., 2014). sAC is also highly expressed in astrocytes to stimulate the production of intracellular cAMP. Elevated cAMP can provide energy supply and metabolic support for the proper functioning of neurons contributing to glycolysis and delivery of lactate from astrocytes (Choi et al., 2012; MacVicar and Choi, 2017). It is worth noting that sAC is found in distinct subcellular microdomains with local cAMP signals (Tresguerres et al., 2011) and even slight changes in the intracellular Ca²⁺ dynamics may impact the activation of this AC isoform (Gancedo, 2013; Schmid et al., 2014). The fatty acids (Lee et al., 2018), lactate, aspirin (Modi et al., 2013), or some antidepressants (e.g., ketamine or fluoxetin) have been reported to cause the astrocytic cAMP-elevation but their mechanism of action toward second messengers still remains unclear (Kinoshita et al., 2018; Lasič et al., 2019; Stenovec et al., 2020; Stenovec, 2021).

It is commonly known that Ca²⁺ has multiple downstream targets (Scemes and Giaume, 2006; Bagur and Hajnóczky, 2017). cAMP can transmit Ca²⁺ signals through isoforms of exchange protein activated by cAMP (Epac), Epac1 and Epac2, or PKA or cAMP-gated ion channels called hyperpolarization-activated cyclic nucleotide-gated (HCN) channels (Halls and Cooper, 2011). cAMP itself or cAMP-dependent proteins may evoke both Ca²⁺ influx via cation channels (Catterall, 2011) and Ca²⁺ extrusion by ATP-dependent pumps (Vandecaetsbeek et al., 2011). Phosphorylation of IP3R subtypes seems to be stimulated by PKA or EPAC as well as directly activated by cAMP. This activation requires much higher concentrations of second messengers and is quickly attenuated after removing the AC stimulus (Taylor, 2017). Analysis of acute hippocampal slices has shown that astrocytic cAMP/PKA signaling may modulate oscillatory activity of intracellular Ca²⁺ (Ujita et al., 2017). In cortical astrocytes, cAMP/PKA-dependent Ca²⁺ changes may be mediated by voltage-gated Ca²⁺ channels (VGCCs) to maintain the exocytotic secretion of gliotransmitters (Burgos et al., 2007). The cytosolic Ca²⁺ elevations are necessary for gliotransmission of ATP, serine, and also glutamate to support neuronal plasticity (Harada et al., 2015). In pathological states, the abnormal release of gliosignalling molecules may trigger excitotoxicity and synaptic damage leading to neuroinflammatory and neurodegenerative progress (Agulhon et al., 2012; Kawamata et al., 2014).

Both cAMP and cGMP degradation may be driven by a large group of phosphodiesterases (PDEs) classified into 11 families, some of which are regulated by Ca²⁺ or Ca²⁺/CaM (Bender and Beavo, 2006; Tenner et al., 2020; Turunen and Koskelainen, 2021). Given that most of tmAC isoforms, PKA and cyclic nucleotide phosphodiesterases (PDEs), may be located at the scaffold protein complexes called A-kinase anchoring proteins (AKAPs), it is plausible that the spatial and temporal organization of AKAPs orchestrates synthesis and degradation of the second messenger at the specific subcellular sites. Although RNA-sequencing of astrocytes purified from mouse brain suggests the presence of genes encoding various AKAP subtypes (e.g., AKAP15/18, AKAP79, gravin, Yotiao; Reuschlein et al., 2019), their functional role in astrocytic cAMP signaling remains to be uncovered. These multi-functional scaffold proteins have been widely characterized in neurons, both in physiological and pathological states (Wild and Dell'Acqua, 2018). The AKAPs associated with cAMP are regulated by local Ca²⁺ oscillations (Scott and Santana, 2010; Boczek et al., 2021). Global analysis of astroglial transcripts released in 2015 demonstrated that cAMP-dependent signaling regulated 6,221 of 16,594 annotated genes, including 42.1% of them were significantly upregulated whereas the remaining were downregulated by cAMP analogs. As suggested by Gene Ontology enrichment analysis, the upregulated genes were mainly involved in cellular metabolism (e.g., uptake/degradation of catecholamines, glutamate, and glycine) and transport (e.g., Ca²⁺ or K⁺ -ion, glucose, or water transport) as well as antioxidant activities, especially glutathione-related defenses. Among genes downregulated by cAMP stimulation, the overwhelming number of encoded modulators of the physiological process as cell cycle, proliferation, or death (e.g., some cyclins and cyclin-dependent kinases, mitogenic agents, BCL2 family proteins), as well as cytoskeletal proteins and mediators of the immune system. Therefore, cAMP is involved in the regulation of a plethora of cellular functions from the antioxidant systems through the control of the normal state of differentiated astrocytic cells (Paco et al., 2016).

It is apparently becoming clear that the existence of an interplay between cAMP and Ca²⁺ messenger systems in astrocytes is non-linear and of great complexity. Undoubtedly, spatial and temporal resolution should be taken under consideration to understand their synergistic and antagonistic relationship.

Astrocytic excitatory amino acid transporters (EAATs) defects have been repeatedly demonstrated in numerous neurodegenerative diseases, especially AD, PD but also Huntington's disease (Su et al., 2003; Sharma et al., 2019; Hindeya Gebreyesus and Gebrehiwot Gebremichael, 2020). Increased level of Aβ suppresses the expression of two important astroglial transporters: GLAST (glutamate-aspartate transporter, also named EAAT1) and GLT1 (glutamate transporter 1, also named EAAT2) via G_s-coupled A_2A receptors decreasing glutamate uptake by astroglia (Matos et al., 2012; Zumkehr et al., 2015). Secondarily, adenosine A_2A receptor/PKA signaling pathway regulates intracellular Ca²⁺ mobilizations and triggers glutamate release. Remarkably, this pathway can stimulate the rise in cytosolic Ca²⁺ concentration via Ca²⁺ efflux from intracellular Ca²⁺ stores independent of IP3 and ryanodine receptor activity (Kanno and Nishizaki, 2012). In AD patients, the overexpression of adenosine A2A receptor gene (ADORA2A) is aggravated (Horgusluoglu-Moloch et al., 2017) which can lead to decreased ability of astrocytes to clear the extracellular glutamate (Matos et al., 2012). In addition to its central function as an energy source, glycogen is also essential to provide energy for glutamate and glutamine synthesis in response to elevated K⁺ concentrations or neurotransmitters, such as NE, serotonin or ATP (Gibbs et al., 2006; Gibbs, 2016). It is speculated that glycolytic metabolism can be also regulated by coordinated GPCR-coupled cAMP and Ca²⁺ signals or non-GPCR-coupled Ca²⁺ and cAMP signals (Bak et al., 2018). Pathologically, disturbance in glycogen homeostasis may decrease glycogenesis and increase glycogenolysis in AD. The glycogen synthesis may be diminished by overactivation of synthase kinase 3 (GSK3) which also promotes abnormal hyperphosphorylation of tau and neuroinflammation process (Beurel et al., 2015; Di et al., 2016; Rodríguez-Matellán et al., 2020). Besides, GSK3 activity may be diminished by cAMP-dependent PKA (Llorens-Marítin et al., 2014). On the other hand, exposure to β-amyloid augments the energy consumption of neurons. In such conditions, increased excitability seems to generate a temporary compensation mechanism in response to synaptic loss. Bass and colleagues argue that neuronal metabolic changes drive the depletion of glycogen reserves in the brain via elevated levels of Aβ and astrocytic A_2A receptors, ultimately resulting in neuronal hypoactivity as the disease progresses (Bass et al., 2015). Considering that the overactive A_2A receptor is sufficient to cause hippocampal-dependent cognitive impairments via PKA/cAMP/CREB signaling (Li et al., 2015) as well as able to affect transcription of genes related to neuroinflammation, angiogenesis and astrocytic reactivity (Paiva et al., 2019), the development of novel therapeutic target against astrocytic A_2A receptor-dependent mechanism seems to be rational in the treatment of the AD. In vitro study has demonstrated that A_2A receptor antagonism prevented Aβ-induced synaptic degeneration in hippocampus (Gomes et al., 2011). Additionally, the latest results from live-cell imaging of primary cortical astrocytes revealed that application of Aβ₂₅₋₃₅ peptide can induce PMCA-mediated Ca²⁺ extrusion via cAMP signaling. Thus, ATP-dependent Ca²⁺ extrusion system seems to constitute a protective mechanism aimed to counterbalance the early effects of Ca²⁺ overload in the presence of neurotoxic Aβ oligomers. On the other hand, their increasing chronic aggregation may impair PMCA activity in astrocytes (Pham et al., 2021).

Additionally, astrocytic Ca²⁺ signal may generate a rapid astroglial response to the nearby autoreactive immune cells involved in immune-mediated demyelinating disease, called multiple sclerosis (MS). It is believed that this mechanism of intercellular communication may be linked to astrocytic purinergic activation and participation of ATP release to autoinflammation in the CNS (Bijelić et al., 2020). On the other hand, β₂-adrenergic-dependent cAMP signaling in reactive astrocytes appears to be downregulated putatively as a result of complete loss of β₂-adrenergic receptor immunoreactivity in the MS, what may contribute to disease pathology (De Keyser et al., 1999, 2004). Recently, amyotrophic lateral sclerosis (ALS)- and frontotemporal dementia (FTD)-linked TAR DNA-binding protein 43 (TDP-43) inclusions have been shown to affect cAMP and Ca²⁺ signaling in astrocytes, most likely due to the downregulation of β₂-adrenergic receptors leading to dysregulated astroglial metabolism and disease progression (Velebit et al., 2020).

Similar to AD pathology, reduced glutamate transporters expression has been detected in neurotoxin-induced PD animal models (Holmer et al., 2005; Chung et al., 2008). It is worth noting that the ventral midbrain-derived astrocytes are highly susceptible to D2 receptor-induced Ca²⁺ signaling. They seem to be relatively insensitive to NE and exhibit significantly different Ca²⁺-related gene expression profile compared to telencephalic astrocytes (Ibáñez et al., 2019; Xin et al., 2019). In mice SNpc, AAV-mediated GLT1 knockdown elicited reactive astrogliosis, dysfunctional Ca²⁺ homeostasis (by altered expression of Ca²⁺ channels and Ca²⁺/calmodulin-dependent protein kinases) and DA neuronal death generating parkinsonian phenotypes (Zhang et al., 2020). Recent evidence has shown that GLT1 expression is regulated by cAMP and CREB and its internalization depends on Ca²⁺ mobilization driven mainly by the Na⁺/Ca²⁺ exchanger (Liu et al., 2016; Ibáñez et al., 2019). Together, oscillations in Ca²⁺ and cAMP may be involved at multiple levels in the regulation of glutamate uptake by astrocytes. Hence, accumulation of pathological changes may determine severity of the excitotoxicity in individual brain areas.

Prior post-mortem studies indicated abnormally lowered brain-derived neurotrophic factor (BDNF) level in brain tissue of patients with PD (Mogi et al., 1999). Several other evidence showed that BDNF genetic polymorphisms increase the risk of PD-related cognitive impairments (Karamohamed et al., 2005; Altmann et al., 2016). In animal PD models, neurotrophic factors supported the function of dopaminergic system, including prevention from degeneration of dopaminergic neurons and improvement of dopaminergic neurotransmission (Migliore et al., 2014; Palasz et al., 2020). Moreover, the comparable level of BDNF expression between astrocytes and neurons of human brain cortex suggests an equally significant role of astrocytic BDNF in maintaining their neuroprotective and neuroregenerative potential (Koppel et al., 2018). On the other hand, increasing evidence shows that dopaminergic protection depends on changes in astrocytic Ca²⁺ and cAMP levels (Jennings and Rusakov, 2016). For example, Koppel et al. reported that dopamine-induced BDNF upregulation is dependent on cAMP/CREB stimulation through β-adrenergic receptors in primary astroglia. Likewise, the activation of PI3K/Akt/CREB pathway via FLZ treatment increased GDNF production by astroglia and improved the function of dopaminergic neurons in mouse models of PD (Bao et al., 2020).

One of the main proteins responsible for maintaining cerebral water balance are aquaporins (AQPs), especially type 4 (AQP4). It is highly concentrated in glial endfoot membranes and forms a molecular complex with a transient receptor potential cation channel subfamily V member 4 (TRPV4; Benfenati et al., 2011; Lunde et al., 2015). Loss of these channels or their defective membrane assembly, for example during aging, leads to significant impairments in astrocyte polarity, which may exacerbate neurodegenerative progress (Valenza et al., 2020). For example, deletion of AQP4 exacerbated Aβ accumulation and atrophy of astrocytes in APP/PS mouse model of AD (Xu et al., 2015). AQP4 KO mice demonstrated increased 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) neurotoxicity toward dopamine neurons in the striatum. This included alterations in astroglial function and reduced GDNF synthesis (Fan et al., 2008). Another study reported the MPTP treatment led to upregulation of AQP4 expression in mouse substantia nigra. The MRI brain scanning revealed increased water accumulation in the substantia nigra of PD patients (Ofori et al., 2015) suggesting an implication of AQP4 in water imbalance in the PD brain. It has also been reported that the modulation of AQP4 may control inflammatory process and AQP4 dysfunction increased the production of IL1β and TNFα triggering microglial reactivity in the midbrain (Sun et al., 2016).

Song and Gunnarson pointed to the relationship between cAMP signaling in astrocyte water permeability and the extracellular potassium concentration. Uptake of K⁺ activated AQP4 via PKA-dependent pathway and led to water permeability in astrocytes. Prolonged increase in intracellular K⁺ due to K_ir channel prevented water permeability via Ca²⁺/calmodulin-dependent regulation (Song and Gunnarson, 2012). The relationship between PKA and calmodulin in the regulation of subcellular localization of AQP4 has also been documented (Kitchen et al., 2020). This supports the idea that disrupted Ca²⁺/cAMP signaling may be involved in altered astrocyte water permeability. The functional coupling between these signaling pathways seems to be involved in neuronal hyperactivity associated with cognitive deficits observed in AD models.

Second messengers, such as Ca²⁺ and cAMP, orchestrate the release of signaling molecules, including a peptide, called apolipoprotein (ApoE; Kockx et al., 2007), which is primarily synthesized by astrocytes. This peptide is crucial for synthesis, degradation and removal of Aβ from the brain. In vitro, Aβ-upregulated cAMP levels via the classical pathway, G_s-AC, leading to increased ApoE secretion and altered lipid trafficking in astrocytes (Igbavboa et al., 2006; Rossello et al., 2012). Changes in the lipid composition as a result of ApoE4 dysregulation led to pathological Ca²⁺ influx and Ca²⁺ hyperactivity in astrocytes (Larramona-Arcas et al., 2020). Compelling evidence suggests that polymorphic variants of APOE gene may correlate with the development of sporadic AD. The presence of the APOE4 allele greatly exacerbates the risk of the disease, while the presence of the APOE2 allele decreases the susceptibility to the disease (Yu et al., 2014; Fernandez et al., 2019). Similarly, current data also indicate various influences of APOE genotypes on αSyn aggregation and APOE4 may exacerbate a series of abnormalities characteristic of PD, such as behavioral disturbances, loss of neural connections and astrogliosis (Zhao et al., 2020).

Taken together, isoform-specific effect of ApoE and alterations in second messenger system may have profound consequences on cholesterol transport and neurotoxicity-induced synaptopathy (Veinbergs et al., 2002; Igbavboa et al., 2006; de Chaves and Narayanaswami, 2008).