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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Mol. Neurosci.</journal-id>
<journal-title>Frontiers in Molecular Neuroscience</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Mol. Neurosci.</abbrev-journal-title>
<issn pub-type="epub">1662-5099</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fnmol.2024.1498459</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Molecular Neuroscience</subject>
<subj-group>
<subject>Review</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title><italic>&#x03B1;</italic>-Synuclein ubiquitination &#x2013; functions in proteostasis and development of Lewy bodies</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author"><name><surname>Ho</surname> <given-names>Hung-Hsiang</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref rid="aff2" ref-type="aff">
<sup>2</sup></xref>
<uri xlink:href="https://loop.frontiersin.org/people/2857207/overview"/>
<role content-type="https://credit.niso.org/contributor-roles/conceptualization/"/>
<role content-type="https://credit.niso.org/contributor-roles/data-curation/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-original-draft/"/>
<role content-type="https://credit.niso.org/contributor-roles/writing-review-editing/"/>
</contrib>
<contrib contrib-type="author" corresp="yes"><name><surname>Wing</surname> <given-names>Simon S.</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref rid="aff2" ref-type="aff">
<sup>2</sup></xref><xref ref-type="corresp" rid="c001"><sup>&#x002A;</sup></xref>
<uri xlink:href="https://loop.frontiersin.org/people/174207/overview"/>
<role content-type="https://credit.niso.org/contributor-roles/conceptualization/"/>
<role content-type="https://credit.niso.org/contributor-roles/funding-acquisition/"/>
<role content-type="https://credit.niso.org/contributor-roles/supervision/"/>
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</contrib-group>
<aff id="aff1"><sup>1</sup><institution>Department of Medicine, McGill University and Research Institute of the McGill University Health Centre</institution>, <addr-line>Montreal, QC</addr-line>, <country>Canada</country></aff>
<aff id="aff2"><sup>2</sup><institution>Integrated Program in Neuroscience, McGill University</institution>, <addr-line>Montreal, QC</addr-line>, <country>Canada</country></aff>
<author-notes>
<fn fn-type="edited-by" id="fn0001">
<p>Edited by: Yihong Ye, National Institutes of Health (NIH), United States</p>
</fn>
<fn fn-type="edited-by" id="fn0002">
<p>Reviewed by: Chao Peng, University of California, Los Angeles, United States</p>
<p>George K. Tofaris, University of Oxford, United Kingdom</p>
</fn>
<corresp id="c001">&#x002A;Correspondence: Simon S. Wing, <email>simon.wing@mcgill.ca</email></corresp>
</author-notes>
<pub-date pub-type="epub">
<day>12</day>
<month>11</month>
<year>2024</year>
</pub-date>
<pub-date pub-type="collection">
<year>2024</year>
</pub-date>
<volume>17</volume>
<elocation-id>1498459</elocation-id>
<history>
<date date-type="received">
<day>19</day>
<month>09</month>
<year>2024</year>
</date>
<date date-type="accepted">
<day>22</day>
<month>10</month>
<year>2024</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#x00A9; 2024 Ho and Wing.</copyright-statement>
<copyright-year>2024</copyright-year>
<copyright-holder>Ho and Wing</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/">
<p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p>
</license>
</permissions>
<abstract>
<p>Synucleinopathies are neurodegenerative disorders characterized by the accumulation of <italic>&#x03B1;</italic>-synuclein containing Lewy bodies. Ubiquitination, a key post-translational modification, has been recognized as a pivotal regulator of <italic>&#x03B1;</italic>-synuclein&#x2019;s cellular dynamics, influencing its degradation, aggregation, and associated neurotoxicity. This review examines comprehensively the current understanding of <italic>&#x03B1;</italic>-synuclein ubiquitination and its role in the pathogenesis of synucleinopathies, particularly in the context of Parkinson&#x2019;s disease. We explore the molecular mechanisms responsible for <italic>&#x03B1;</italic>-synuclein ubiquitination, with a focus on the roles of E3 ligases and deubiquitinases implicated in the degradation process which occurs primarily through the endosomal lysosomal pathway. The review further discusses how the dysregulation of these mechanisms contributes to <italic>&#x03B1;</italic>-synuclein aggregation and LB formation and offers suggestions for future investigations into the role of <italic>&#x03B1;</italic>-synuclein ubiquitination. Understanding these processes may shed light on potential therapeutic avenues that can modulate <italic>&#x03B1;</italic>-synuclein ubiquitination to alleviate its pathological impact in synucleinopathies.</p>
</abstract>
<kwd-group>
<kwd>&#x03B1;-synuclein</kwd>
<kwd>Lewy body</kwd>
<kwd>ubiquitin</kwd>
<kwd>Parkinson&#x2019;s disease</kwd>
<kwd>endosome</kwd>
<kwd>lysosome</kwd>
<kwd>autophagy</kwd>
<kwd>proteasome</kwd>
</kwd-group>
<counts>
<fig-count count="4"/>
<table-count count="2"/>
<equation-count count="0"/>
<ref-count count="254"/>
<page-count count="19"/>
<word-count count="19492"/>
</counts>
<custom-meta-wrap>
<custom-meta>
<meta-name>section-at-acceptance</meta-name>
<meta-value>Molecular Signalling and Pathways</meta-value>
</custom-meta>
</custom-meta-wrap>
</article-meta>
</front>
<body>
<sec sec-type="intro" id="sec1">
<label>1</label>
<title>Introduction</title>
<p><italic>&#x0391;</italic>-synuclein (&#x03B1;S) is a presynaptic neuronal protein whose aggregation into insoluble fibrils in Lewy bodies (LBs) is a pathological hallmark of Parkinson&#x2019;s disease (PD). Ubiquitination of &#x03B1;S was observed many years ago and subsequent research has provided evidence that this ubiquitination plays important roles in regulating &#x03B1;S&#x2019;s stability, aggregation, and toxicity. Understanding the specific ubiquitination events that lead to &#x03B1;S degradation or accumulation could therefore provide valuable insights into potential therapeutic strategies to mitigate PD progression.</p>
<p>In this review, we provide brief overviews of ubiquitination and the role of &#x03B1;S in neurodegenerative diseases. We then trace the discovery of ubiquitin in LBs and its pivotal functions in proteolytic degradation pathways. The review then focuses on key studies that identify the E3 ligases (<xref ref-type="table" rid="tab1">Table 1</xref>) and deubiquitinases enzymes (DUBs; <xref ref-type="table" rid="tab2">Table 2</xref>) involved in &#x03B1;S ubiquitination and the structural and biological consequences of this ubiquitination. Finally, we discuss some knowledge gaps in this area and propose a model that integrates the role of &#x03B1;S ubiquitination with other contributing mechanisms in the formation of LBs (<xref ref-type="bibr" rid="ref118">Lashuel, 2020</xref>; <xref ref-type="bibr" rid="ref163">Moors and Milovanovic, 2024</xref>).</p>
<table-wrap position="float" id="tab1">
<label>Table 1</label>
<caption>
<p>Ubiquitin ligases for &#x03B1;-Syn.</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="left" valign="top">Ubiquitin ligase name</th>
<th align="left" valign="top">Ubiquitination site on &#x03B1;-Syn</th>
<th align="left" valign="top">Research model used for Ub sites identification</th>
<th align="left" valign="top">Ub linkage type</th>
<th align="left" valign="top">Effects on &#x03B1;S</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" valign="top">NEDD4/NEDD4-1</td>
<td align="left" valign="top">K12, K21, K45, K58, K60, K96</td>
<td align="left" valign="top">HEK293 cell; primary mice neuron and patient samples for K45/58/60 only</td>
<td align="left" valign="top">K63-polyUb chain</td>
<td align="left" valign="top">Promotes uptake of &#x03B1;S into endosomes for lysosomal degradation</td>
</tr>
<tr>
<td align="left" valign="top">SIAH-1 and SIAH-2</td>
<td align="left" valign="top">K10, K12, K21, K23, K34, K43, K96</td>
<td align="left" valign="top">Cell-free assay</td>
<td align="left" valign="top">MonoUb</td>
<td align="left" valign="top">Promotes formation of &#x03B1;S insoluble aggregates and/or proteasomal degradation of &#x03B1;S.</td>
</tr>
<tr>
<td align="left" valign="top">SCF-FBXL5</td>
<td align="left" valign="top">K45, K58, K60</td>
<td align="left" valign="top">SH-SY5Y cell</td>
<td align="left" valign="top">K48-K63 branched chain</td>
<td align="left" valign="top">Promotes degradation of &#x03B1;S fibrils through both proteasomal and lysosomal degradation pathways.</td>
</tr>
<tr>
<td align="left" valign="top">LUBAC</td>
<td align="left" valign="top">M1</td>
<td align="left" valign="top">SH-SY5Y cell, primary mice neuron, patient samples</td>
<td align="left" valign="top">Linear polyUb chain</td>
<td align="left" valign="top">Ubiquitinates &#x03B1;S aggregates for p62-dependent autophagic/lysosomal degradation (aggrephagy).</td>
</tr>
<tr>
<td align="left" valign="top">CHIP</td>
<td align="left" valign="top">Unknown</td>
<td/>
<td align="left" valign="top">Monoubiquitination</td>
<td align="left" valign="top">Inhibits &#x03B1;S oligomerization potentially through association with HSC70 and promotes proteasomal/lysosomal degradation.</td>
</tr>
<tr>
<td align="left" valign="top">Parkin</td>
<td align="left" valign="top">Unknown</td>
<td/>
<td align="left" valign="top">PolyUb; Linkage type unknown</td>
<td align="left" valign="top">Specifically targets O-linked glycosylated &#x03B1;S for ubiquitination, but the consequence is unknown.</td>
</tr>
<tr>
<td align="left" valign="top">E6-AP</td>
<td align="left" valign="top">Unknown</td>
<td/>
<td align="left" valign="top">Linkage type unknown</td>
<td align="left" valign="top">Decreases endogenous &#x03B1;S olgiomerization likely by enhancing proteasomal degradation.</td>
</tr>
</tbody>
</table>
</table-wrap>
<table-wrap position="float" id="tab2">
<label>Table 2</label>
<caption>
<p>Deubiquitinases for &#x03B1;-Syn.</p>
</caption>
<table frame="hsides" rules="groups">
<thead>
<tr>
<th align="left" valign="top">Deubiquitinase Name</th>
<th align="left" valign="top">Effects on &#x03B1;S</th>
</tr>
</thead>
<tbody>
<tr>
<td align="left" valign="top">USP9X</td>
<td align="left" valign="top">Stabilizes &#x03B1;S by possibly preventing its degradation. Degradation pathway remains unknown.</td>
</tr>
<tr>
<td align="left" valign="top">UCH-L1 (PGP9.5)</td>
<td align="left" valign="top">Increases aS insolubility and possibly prevents &#x03B1;S proteasomal degradation.</td>
</tr>
<tr>
<td align="left" valign="top">USP8</td>
<td align="left" valign="top">Counteracts NEDD4- dependent K63 polyUb. Inhibits &#x03B1;S endosomal degradation and increases endogenous &#x03B1;S level particular in the soma region of iPSC neurons.</td>
</tr>
<tr>
<td align="left" valign="top">USP13</td>
<td align="left" valign="top">Stabilizes &#x03B1;S by possibly preventing its degradation. Degradation pathway remains unknown.</td>
</tr>
<tr>
<td align="left" valign="top">USP19</td>
<td align="left" valign="top">Promotes &#x03B1;S secretion through misfolding associated protein secretion (MAPS) and reduces &#x03B1;S ubiquitination to facilitate aggregate formation.</td>
</tr>
</tbody>
</table>
</table-wrap>
</sec>
<sec id="sec2">
<label>2</label>
<title>Ubiquitination</title>
<sec id="sec3">
<label>2.1</label>
<title>Overall structure and functions</title>
<p>Ubiquitin is a highly conserved 76 amino acid peptide found in all eukaryotes. In humans, it is encoded by four genes: UBB, UBC, UBA52, and RPS27A (<xref ref-type="bibr" rid="ref124">Lenkinski et al., 1977</xref>; <xref ref-type="bibr" rid="ref232">Vijay-Kumar et al., 1987</xref>), each of which encodes either polyubiquitin or ubiquitin-fused to a ribosomal subunit (<xref ref-type="bibr" rid="ref62">Finley et al., 1989</xref>; <xref ref-type="bibr" rid="ref188">Redman and Rechsteiner, 1989</xref>). The polyprotein products of these genes are co-translationally cleaved by deubiquitinases (DUBs) to generate free ubiquitin.</p>
<p>Ubiquitin exerts almost all its functions by being conjugated to other proteins. Ubiquitin has a <italic>&#x03B2;</italic>-grasp globular structure and a flexible C-terminal tail of 6 residues (<xref ref-type="bibr" rid="ref232">Vijay-Kumar et al., 1987</xref>). The globular surface includes recognition patches such as the hydrophobic patch formed by Leu8, Val70, and Ile44, which is recognized by most ubiquitin-binding domains (UBDs) and the ubiquitin receptors on the 26S proteasome (<xref ref-type="bibr" rid="ref50">Dikic et al., 2009</xref>). Ubiquitin covalently attaches to substrates via its C-terminal Gly76, most commonly to the <italic>&#x03B5;</italic>-amino group of the side chain of lysine residues in the target protein to form an isopeptide bond. Occasionally, it can also be conjugated to the side chain thiol or hydroxyl group of Cys, Ser, and Thr residues or to the N-terminal amino group of the protein (<xref ref-type="bibr" rid="ref20">Cadwell and Coscoy, 2005</xref>; <xref ref-type="bibr" rid="ref92">Ishikura et al., 2010</xref>; <xref ref-type="bibr" rid="ref206">Shimizu et al., 2010</xref>; <xref ref-type="bibr" rid="ref226">Trausch-Azar et al., 2010</xref>; <xref ref-type="bibr" rid="ref235">Wang et al., 2007</xref>; <xref ref-type="bibr" rid="ref241">Williams et al., 2007</xref>). Additionally, ubiquitin can also be conjugated onto one of the seven lysine residues (Lys6, Lys11, Lys27, Lys29, Lys33, Lys48, and Lys63) or N-terminal Met1 of the ubiquitin already attached to the target protein and the repetition of this reaction results in the formation of a polyubiquitin chain (<xref ref-type="bibr" rid="ref107">Komander and Rape, 2012</xref>).</p>
<p>The many different possible products of the above ubiquitination reaction and their molecular and cell biological consequences has been referred to as the ubiquitin code. These different types of ubiquitination can be categorized based on the number and arrangement of the ubiquitins attached to the substrate: monoubiquitination (a single ubiquitin on one residue of the substrate protein), multi-monoubiquitination (single ubiquitins on multiple residues), and polyubiquitination (a chain of ubiquitins on one or more residues; <xref ref-type="fig" rid="fig1">Figure 1</xref>). Polyubiquitination can be further divided into homogeneous chains (single linkage type) and heterogeneous chains (multiple linkage types), leading to mixed or branched chains (<xref ref-type="bibr" rid="ref52">Dongdem et al., 2024</xref>). Different linkages result in distinct chain conformations, allowing this code to be deciphered through the binding of different proteins to these distinct structures of ubiquitin on the target protein. This complexity is further enhanced by post-translational modifications of ubiquitin such as phosphorylation, acetylation and ADP-ribosylation (<xref ref-type="bibr" rid="ref211">Song and Luo, 2019</xref>). In addition to recruiting other proteins, the ubiquitination of a protein can alter the latter&#x2019;s structure and/or its binding partners, thereby influencing the latter&#x2019;s biological functions.</p>
<fig position="float" id="fig1">
<label>Figure 1</label>
<caption>
<p>Types of ubiquitin linkages. Proteins can be conjugated with a single ubiquitin (monoubiquitination), or a ubiquitin on multiple lysine residues (multi-monoubiquitination) or with a chain of ubiquitin moieties (polyubiquitination). The color of ubiquitin (dark blue or light blue) indicates different types of linkage. Each ubiquitin in the chain can be conjugated to the more proximal ubiquitin at the latter&#x2019;s M1, K6, K11, K27, K29, K33, K48, or K63 residue. Homotypic chains employ only one type of linkage. Heterotypic polyubiquitination contains at least two different types of ubiquitin linkages and potentially combine multiple chain types within a single polyubiquitin structure.</p>
</caption>
<graphic xlink:href="fnmol-17-1498459-g001.tif"/>
</fig>
<p>The earliest and best described function of ubiquitination is its ability to target its conjugated protein for degradation by the proteasome. Classically, Lys48 polyubiquitin chains target proteins substrates to the proteasome, but it is now apparent that other chain types can also do so. Subsequently, ubiquitination of proteins &#x2013; in particular with Lys63 chains - was shown to target to lysosomal proteolysis via autophagy (<xref ref-type="bibr" rid="ref203">Shaid et al., 2013</xref>) or endosomes (<xref ref-type="bibr" rid="ref230">Urb&#x00E9;, 2005</xref>). Other processes regulated by ubiquitination include immune activation, DNA damage response, and vesicular trafficking and some of these employ linear polyubiquitination or monoubiquitination as the signal (<xref ref-type="bibr" rid="ref27">Chen and Sun, 2009</xref>; <xref ref-type="bibr" rid="ref32">Clague et al., 2019</xref>; <xref ref-type="bibr" rid="ref107">Komander and Rape, 2012</xref>; <xref ref-type="bibr" rid="ref198">Schnell and Hicke, 2003</xref>). In this review, we will focus on functions of ubiquitin that are most relevant to &#x03B1;S homeostasis in PD.</p>
</sec>
<sec id="sec4">
<label>2.2</label>
<title>The ubiquitination process</title>
<p>The ubiquitin code is generated through the coordinated action of three enzymes: E1 (ubiquitin-activating enzyme), E2 (ubiquitin-conjugating enzyme), and E3 (ubiquitin ligase). E1 activates ubiquitin in an ATP-dependent process and transfers the activated ubiquitin to E2. E2, in conjunction with E3, facilitates ubiquitin conjugation to the substrate, with E3 providing substrate specificity. Both E2 and E3 enzymes influence the type of ubiquitin linkage formed.</p>
<p>Humans have two E1 genes, approximately 40 E2s and about 600 E3s (<xref ref-type="bibr" rid="ref128">Li et al., 2008</xref>). E3s can be categorized into three families: RING (Really Interesting New Gene), HECT (Homologous to E6AP Carboxyl Terminus), and RBR (RING-between-RING).</p>
<p>RING E3s comprise approximately 95% of ligases, can be single or multi-subunit complexes. They act as scaffolds, bringing together the substrate and ubiquitin-charged E2 enzyme which binds to the Zn containing RING finger domain on the E3. Within RING E3 mediated polyubiquitination, linkage specificity is determined by the particular E2 enzyme recruited (<xref ref-type="bibr" rid="ref247">Ye and Rape, 2009</xref>). U-box type RING E3s have a similar RING finger structure but without coordinated Zn atoms. Cullin-RING and APC/C type ligases are examples of multi-subunit E3 complexes in which one of the subunits contains the RING finger domain and another the substrate recognition domain. HECT E3 ligases have a catalytic cysteine residue at their C-terminal lobe, which directly receives ubiquitin from E2 enzymes, thus determining linkage specificity independently of the E2 partner. Among HECT E3 ligases are the Nedd4 and HERC subclasses, members of which share conserved domains N-terminal to the catalytic HECT domain (<xref ref-type="bibr" rid="ref189">Rotin and Kumar, 2009</xref>). RBR E3s use a hybrid RING/HECT mechanism, featuring three Zn-binding domains: RING1, in-between RING (IBR), and RING2. RING1 binds the E2-Ub complex like RING E3s, while RING2 contains a catalytic cysteine that transfers ubiquitin from E2 to the E3, similar to HECT E3s.</p>
</sec>
<sec id="sec5">
<label>2.3</label>
<title>Deubiquitination</title>
<p>Ubiquitination, like all post-translational modifications, is reversible. In addition to processing newly synthesized ubiquitin, deubiquitinases (DUBs) counteract ubiquitination by cleaving ubiquitin from substrates. In mammalian cells, more than half of the ubiquitins found are monoubiquitinated, often on histones, with the remainder forming chains (~15%) or existing freely (~20%) (<xref ref-type="bibr" rid="ref99">Kaiser et al., 2011</xref>). There are ~100 identified DUBs, divided into seven families: Ubiquitin-Specific Proteases (USPs), Ubiquitin C-terminal Hydrolases (UCHs), Ovarian Tumor Proteases (OTUs), Josephin Domain DUBs (MJDs), Motif Interacting with Ubiquitin-N-terminal Y domain (MINDY), Zinc finger with UFM1-specific peptidase domain protein (ZUFSP), and JAMM/MPN. All DUB families are cysteine proteases, except JAMM/MPN, which are Zn-dependent metalloproteinases (<xref ref-type="bibr" rid="ref32">Clague et al., 2019</xref>). Although some DUBs have broad specificity, many are selective and achieve this selectivity by targeting specific substrates through protein interaction domains or recognizing specific ubiquitin chain architectures. In the latter case, the end product is usually a monoubiquitinated substrate. Linkage selectivity is determined either by the catalytic domain of the DUBs or their ubiquitin-binding domains (UBDs) or associated proteins (<xref ref-type="bibr" rid="ref159">Mevissen and Komander, 2017</xref>).</p>
</sec>
</sec>
<sec id="sec6">
<label>3</label>
<title>A-synuclein</title>
<sec id="sec7">
<label>3.1</label>
<title>Biochemical features</title>
<p>&#x03B1;S is a 14&#x2009;kDa protein, comprising three regions: (1) an N-terminal helix (residues 1&#x2013;60) required for lipid-binding (<xref ref-type="bibr" rid="ref43">Davidson et al., 1998</xref>; <xref ref-type="bibr" rid="ref57">Eliezer et al., 2001</xref>), (2) a central non-amyloid-<italic>&#x03B2;</italic> component (NAC; residues 61&#x2013;95) essential for aggregation (<xref ref-type="bibr" rid="ref78">Giasson et al., 2001</xref>; <xref ref-type="bibr" rid="ref228">U&#x00E9;da et al., 1993</xref>), and (3) a C-terminal disordered region (residues 96&#x2013;140) that interacts with ions and promotes SNARE complex assembly (<xref ref-type="bibr" rid="ref18">Burr&#x00E9; et al., 2010</xref>; <xref ref-type="fig" rid="fig2">Figure 2</xref>). Recent studies have revealed overlapping functions of these regions, suggesting the importance of intra- and inter-molecular interactions between them (<xref ref-type="bibr" rid="ref51">Doherty et al., 2020</xref>; <xref ref-type="bibr" rid="ref70">Fusco et al., 2014</xref>; <xref ref-type="bibr" rid="ref71">Fusco et al., 2016</xref>; <xref ref-type="bibr" rid="ref229">Ulamec et al., 2022</xref>).</p>
<fig position="float" id="fig2">
<label>Figure 2</label>
<caption>
<p>Schematic diagram of &#x03B1;-synuclein structure, illustrating its division into the N-terminal helix, non-amyloid-&#x03B2; component (NAC) domain, and C-terminal disordered region. Lysine and M1 residues potentially involved in ubiquitination are highlighted in yellow. Ubiquitination sites confirmed in different models are labeled as follows: &#x002A;-cell-lines; $-primary mice neurons; #-human samples; !-cell free assay.</p>
</caption>
<graphic xlink:href="fnmol-17-1498459-g002.tif"/>
</fig>
<p>&#x0251;S is part of a protein family that includes beta-synuclein (&#x03B2;S) and gamma-synuclein (&#x03B3;S), each encoded by distinct genes (<xref ref-type="bibr" rid="ref76">George, 2002</xref>) Phylogenetic studies show that &#x0251;S and &#x03B2;S are more closely related to each other than to &#x03B3;S (<xref ref-type="bibr" rid="ref209">Siddiqui et al., 2016</xref>). All synucleins share a highly conserved N-terminal sequence and are mainly expressed in the brain according to the Human Protein Atlas. Synuclein orthologues are absent in invertebrates, consistent with their crucial role in the central nervous system of higher organisms. The &#x0251;S protein sequence is highly conserved between humans and rodents, differing by only six amino acids.</p>
<p>Initially considered a cytosolic protein with an intrinsically disordered monomeric structure, subsequent cross-linking studies indicate that &#x03B1;S exists predominantly as a tetramer. This tetramer has a compact structure shielding the NAC region, preventing spontaneous aggregation (<xref ref-type="bibr" rid="ref14">Bertoncini et al., 2005</xref>; <xref ref-type="bibr" rid="ref103">Kang et al., 2012</xref>; <xref ref-type="bibr" rid="ref222">Theillet et al., 2016</xref>). The tetrameric structure is in equilibrium with the disordered monomer and dependent on &#x03B1;S concentration (<xref ref-type="bibr" rid="ref12">Bartels et al., 2011</xref>; <xref ref-type="bibr" rid="ref237">Wang et al., 2011</xref>). Furthermore, the tetramer can be formed upon membrane binding where it becomes functional for SNARE complex assembly (<xref ref-type="bibr" rid="ref17">Burr&#x00E9; et al., 2014</xref>). &#x03B1;S disease causing mutations such as A53T, E64K and G51D, alter the tetrameric/monomeric ratio and are associated with neuronal toxicity (<xref ref-type="bibr" rid="ref46">Dettmer et al., 2015a</xref>; <xref ref-type="bibr" rid="ref47">Dettmer et al., 2015b</xref>; <xref ref-type="bibr" rid="ref171">Nuber et al., 2018</xref>; <xref ref-type="bibr" rid="ref172">Nuber et al., 2024</xref>).</p>
<p>However, the existence of a stable tetrameric form has been challenged, as the tetrameric species have failed to be detected by other groups (<xref ref-type="bibr" rid="ref19">Burr&#x00E9; et al., 2013</xref>; <xref ref-type="bibr" rid="ref37">Corbill&#x00E9; et al., 2016</xref>; <xref ref-type="bibr" rid="ref59">Fauvet et al., 2012</xref>). These opposing views highlight the ongoing debate in the field, with some arguing that &#x03B1;S exists in multiple equilibrium states, varying between monomers, tetramers, and other higher-order oligomers depending on cellular and environmental contexts (<xref ref-type="bibr" rid="ref17">Burr&#x00E9; et al., 2014</xref>; <xref ref-type="bibr" rid="ref59">Fauvet et al., 2012</xref>).</p>
</sec>
<sec id="sec8">
<label>3.2</label>
<title>Physiological functions</title>
<p>The most prominent physiological function for &#x03B1;S is its role in synaptic vesicle (SV) regulation due to its localization at the presynaptic terminal (<xref ref-type="bibr" rid="ref153">Maroteaux et al., 1988</xref>) and its affinity for high-curvature membranes (<xref ref-type="bibr" rid="ref43">Davidson et al., 1998</xref>). During synaptic transmission, calcium influx prompts the recruitment of SVs to the presynaptic active zone, where they fuse with the presynaptic membrane to release neurotransmitters. Fluorescence resonance energy transfer assays suggest that &#x0251;S acts as a SNARE complex chaperone by binding to phospholipid membranes and multimerizing at the presynaptic membrane (<xref ref-type="bibr" rid="ref17">Burr&#x00E9; et al., 2014</xref>; <xref ref-type="bibr" rid="ref18">Burr&#x00E9; et al., 2010</xref>; <xref ref-type="bibr" rid="ref141">Lou et al., 2017</xref>). An interaction between VAMP2 (synaptobrevin-2) and the &#x0251;S C-terminus at the docking site allows &#x0251;S to promote SV exocytosis by preventing SV fusion pore closure (<xref ref-type="bibr" rid="ref139">Logan et al., 2017</xref>). Overexpression of &#x0251;S restricts neurotransmitter release by clustering SVs, a process requiring &#x0251;S multimerization and association with VAMP2 and synapsin (<xref ref-type="bibr" rid="ref117">Larsen et al., 2006</xref>; <xref ref-type="bibr" rid="ref169">Nemani et al., 2010</xref>). Phosphorylation of &#x0251;S at S129, a marker of pathological &#x0251;S aggregates, enhances this clustering (<xref ref-type="bibr" rid="ref181">Parra-Rivas et al., 2023</xref>), inhibiting SV movement to the presynaptic active zone and reducing synaptic transmission (<xref ref-type="bibr" rid="ref7">Atias et al., 2019</xref>; <xref ref-type="bibr" rid="ref48">Diao et al., 2013</xref>; <xref ref-type="bibr" rid="ref215">Sun et al., 2019</xref>). Besides these critical functions at the SV, recent research has also suggested roles for &#x03B1;S in regulating mRNA stability (<xref ref-type="bibr" rid="ref82">Hallacli et al., 2022</xref>), gene transcription (<xref ref-type="bibr" rid="ref42">Davidi et al., 2020</xref>), and DNA stability (<xref ref-type="bibr" rid="ref231">Vasquez et al., 2020</xref>).</p>
</sec>
<sec id="sec9">
<label>3.3</label>
<title>Pathophysiology of &#x03B1;S: from monomer to aggregates</title>
<p>The mechanisms by which soluble monomers or tetramers of &#x03B1;S become converted into insoluble fibrils mostly localized at the neuronal soma remain unclear. This is partly due to the long time required for fibril development <italic>in vivo</italic> and the underexplored protein&#x2013;protein interactions of native &#x0251;S. Recent research highlights the dynamic interaction of &#x0251;S with its paralogues, <italic>&#x03B2;</italic>S and &#x03B3;S, at SVs (<xref ref-type="bibr" rid="ref21">Carnazza et al., 2022</xref>). These studies show that the equilibrium between cytosolic &#x0251;S monomers and SV-binding multimers is regulated by &#x0251;S/&#x03B2;S and &#x0251;S/&#x03B3;S heteromers. Specifically, heteromer formation inhibits &#x0251;S from binding to SVs, and decreases the cytosolic concentration of unfolded monomeric &#x0251;S, which might be aggregation-prone (<xref ref-type="bibr" rid="ref12">Bartels et al., 2011</xref>; <xref ref-type="bibr" rid="ref237">Wang et al., 2011</xref>).</p>
<p>Maintaining normal levels of &#x0251;S is crucial, as multiplication of the SNCA gene encoding &#x0251;S can induce PD pathology (<xref ref-type="bibr" rid="ref88">Ib&#x00E1;&#x00F1;ez et al., 2004</xref>; <xref ref-type="bibr" rid="ref185">Polymeropoulos et al., 1997</xref>; <xref ref-type="bibr" rid="ref210">Singleton et al., 2003</xref>). Although &#x0251;S knockout has little effect on synaptic function and neuronal survival (<xref ref-type="bibr" rid="ref1">Abeliovich et al., 2000</xref>; <xref ref-type="bibr" rid="ref24">Chandra et al., 2005</xref>), &#x0251;S is essential under stressful conditions, such as the loss of the synaptic protein CSP&#x0251;/DNAJC5 (<xref ref-type="bibr" rid="ref24">Chandra et al., 2005</xref>; <xref ref-type="bibr" rid="ref79">Greten-Harrison et al., 2010</xref>).</p>
<p>Cell free biophysical studies suggest that the formation of &#x0251;S amyloid fibril containing stable parallel &#x03B2;-sheet structures arises from a nucleation-polymerization process (<xref ref-type="bibr" rid="ref38">Cremades et al., 2012</xref>; <xref ref-type="bibr" rid="ref90">Iljina et al., 2016</xref>). During primary nucleation, soluble monomers nucleate to generate oligomers. Initially formed oligomers are transient and can rapidly undergo secondary polymerization to form fibrils or convert into more kinetically stable and toxic oligomers, potentially causing cell membrane damage (<xref ref-type="bibr" rid="ref69">Fusco et al., 2017</xref>; <xref ref-type="bibr" rid="ref104">Kayed et al., 2003</xref>). Fragmented fibrils can also act as seeds to promote secondary nucleation (<xref ref-type="bibr" rid="ref34">Cohen et al., 2011</xref>). Oligomers, with a greater surface-to-volume ratio, show higher toxicity in cells compared to fibrils (<xref ref-type="bibr" rid="ref26">Chen et al., 2015</xref>; <xref ref-type="bibr" rid="ref38">Cremades et al., 2012</xref>). However, in contrast to consistent fibrillar structures, oligomers are a mixture of heterogeneous structures with variabilities in size, &#x03B2;-sheet content, and toxicity (<xref ref-type="bibr" rid="ref26">Chen et al., 2015</xref>; <xref ref-type="bibr" rid="ref38">Cremades et al., 2012</xref>; <xref ref-type="bibr" rid="ref73">Gallea and Celej, 2014</xref>). Increased membrane damage by oligomers could be due to antiparallel &#x03B2;-sheet content which exposes hydrophobic side chains that interact with cellular lipids (<xref ref-type="bibr" rid="ref23">Celej et al., 2012</xref>; <xref ref-type="bibr" rid="ref26">Chen et al., 2015</xref>).</p>
<p>Interestingly, <italic>in vivo</italic> studies show that injection of fragmented fibrils are more toxic than non-fragmented ones or oligomers in mice brains (<xref ref-type="bibr" rid="ref66">Froula et al., 2019</xref>). The increased seeding capacity of these fragmented fibrils suggests that aggregate propagation and formation &#x2014;whether through oligomer polymerization or fibril fragmentation&#x2014;play a critical role in the pathogenesis of PD. Research in cellular systems demonstrate that oligomers released from fibrils cause neuronal dysfunction, while stable fibrils can prevent &#x0251;S toxicity (<xref ref-type="bibr" rid="ref22">Cascella et al., 2021</xref>; <xref ref-type="bibr" rid="ref114">Lam et al., 2016</xref>). These findings highlight the importance of oligomer dynamics during aggregate formation in PD (<xref ref-type="bibr" rid="ref36">Conway et al., 2000</xref>; <xref ref-type="bibr" rid="ref151">Mahul-Mellier et al., 2020</xref>; <xref ref-type="bibr" rid="ref152">Mahul-Mellier et al., 2015</xref>).</p>
<p>Other factors, such as lipid vesicles and pH, also strongly affect aggregate formation (<xref ref-type="bibr" rid="ref16">Buell et al., 2014</xref>; <xref ref-type="bibr" rid="ref63">Flagmeier et al., 2016</xref>; <xref ref-type="bibr" rid="ref74">Galvagnion et al., 2015</xref>; <xref ref-type="bibr" rid="ref80">Grey et al., 2011</xref>; <xref ref-type="bibr" rid="ref111">Kumari et al., 2021</xref>; <xref ref-type="bibr" rid="ref119">Lee et al., 2005</xref>). <italic>In vitro</italic>, small unilamellar vesicles (SUVs) promote &#x0251;S primary nucleation, contributing to amyloid fibril formation (<xref ref-type="bibr" rid="ref74">Galvagnion et al., 2015</xref>). The secondary nucleation process is promoted by a low pH environment, suggesting that endo-lysosomal vesicles with acidic microenvironments in cells may play a key role in aggregate formation (<xref ref-type="bibr" rid="ref16">Buell et al., 2014</xref>; <xref ref-type="bibr" rid="ref111">Kumari et al., 2021</xref>).</p>
<p>The discovery of &#x0251;S in cerebrospinal fluid (<xref ref-type="bibr" rid="ref56">El-Agnaf et al., 2003</xref>) and LBs in fetal grafted neurons of Parkinson&#x2019;s patients (<xref ref-type="bibr" rid="ref110">Kordower et al., 2008</xref>; <xref ref-type="bibr" rid="ref127">Li et al., 2008</xref>) support a prion-like behavior. Studies show that exogenous &#x0251;S preformed fibrils (PFFs) can induce LB-like structures in cultured cells and <italic>in vivo</italic>, promoting &#x0251;S fibril elongation (<xref ref-type="bibr" rid="ref146">Luk et al., 2012</xref>; <xref ref-type="bibr" rid="ref147">Luk et al., 2009</xref>; <xref ref-type="bibr" rid="ref233">Volpicelli-Daley et al., 2011</xref>). Endogenous &#x0251;S is required for fibril formation, and these fibrils can spread from injection sites, even outside the CNS such as the gut, indicating inter-neuronal propagation (<xref ref-type="bibr" rid="ref8">Ayers et al., 2017</xref>; <xref ref-type="bibr" rid="ref149">Macdonald et al., 2021</xref>; <xref ref-type="bibr" rid="ref177">Osterberg et al., 2015</xref>). However, the exact mechanisms and the nature of &#x0251;S species responsible for this spreading remain largely unknown, raising questions about how &#x0251;S is released and taken up.</p>
</sec>
</sec>
<sec id="sec10">
<label>4</label>
<title>Characteristics of ubiquitinated <italic>&#x03B1;</italic>-synuclein in Lewy bodies</title>
<p>&#x03B1;S is the main protein component of LBs, the pathological hallmark of PD (<xref ref-type="bibr" rid="ref212">Spillantini et al., 1997</xref>), LBs have been known to stain with anti-ubiquitin antibodies since the late 1980s, well before &#x03B1;S was identified as the major protein component (<xref ref-type="bibr" rid="ref9">Baba et al., 1998</xref>; <xref ref-type="bibr" rid="ref113">Kuzuhara et al., 1988</xref>; <xref ref-type="bibr" rid="ref125">Lennox et al., 1989</xref>; <xref ref-type="bibr" rid="ref212">Spillantini et al., 1997</xref>). Initially, ubiquitin staining was observed at the peripheral rim of LBs (<xref ref-type="bibr" rid="ref113">Kuzuhara et al., 1988</xref>). However, multiplex confocal imaging revealed that ubiquitin is either colocalized with <italic>&#x03B1;</italic>S in less compact LBs or present in the center of more compact LBs and partially colocalized with &#x03B1;S, which is stained mainly at the peripheral shell (<xref ref-type="bibr" rid="ref72">Gai et al., 2000</xref>). The discovery of C-terminal truncated &#x03B1;S at Asp119/Asn122 (<xref ref-type="bibr" rid="ref6">Anderson et al., 2006</xref>; <xref ref-type="bibr" rid="ref9">Baba et al., 1998</xref>; <xref ref-type="bibr" rid="ref54">Dufty et al., 2007</xref>; <xref ref-type="bibr" rid="ref129">Li et al., 2005</xref>) and phosphorylated &#x03B1;-S (p129-&#x03B1;S) (<xref ref-type="bibr" rid="ref67">Fujiwara et al., 2002</xref>) as the predominant &#x03B1;S species in LBs, coupled with techniques such as three-dimensional reconstruction, multicolor antibody labeling, and high-resolution stimulated emission depletion (STED) imaging have led to further elucidation of the intricate structure of classical concentric LBs. Altogether, these data suggest a model where &#x03B1;S conjugates with ubiquitin and recruits non-ubiquitinated &#x03B1;S, maturing into a compact LB structure. Ubiquitin and C-terminal truncated &#x03B1;S are found in the core, p129 or full-length &#x03B1;S in the middle layer, and neurofilaments and cytoskeletal proteins in the outer layer of LBs (<xref ref-type="bibr" rid="ref102">Kanazawa et al., 2008</xref>; <xref ref-type="bibr" rid="ref162">Moors et al., 2021</xref>; <xref ref-type="bibr" rid="ref187">Prasad et al., 2012</xref>).</p>
<p>Although imaging studies revealed co-localization of ubiquitin and &#x03B1;S, it was studies using two-dimensional gel electrophoresis that identified &#x03B1;S as the primary ubiquitinated protein in LBs. In these studies, the shifted &#x03B1;S (Syn-1 antibody-positive bands) corresponded with anti-ubiquitin antibody staining (<xref ref-type="bibr" rid="ref6">Anderson et al., 2006</xref>; <xref ref-type="bibr" rid="ref225">Tofaris et al., 2003</xref>). Interestingly, ubiquitinated &#x03B1;S was primarily associated with p129-&#x03B1;S species, which constitute more than 90% of the insoluble &#x03B1;S species in dementia with Lewy bodies (DLB) brains, and are modified by mono-, di-, or, to a lesser extent, poly-ubiquitin (<xref ref-type="bibr" rid="ref6">Anderson et al., 2006</xref>; <xref ref-type="bibr" rid="ref85">Hasegawa et al., 2002</xref>; <xref ref-type="bibr" rid="ref225">Tofaris et al., 2003</xref>). Mass spectrometry analysis identified three ubiquitination sites on &#x03B1;S: Lys12, Lys21, and Lys23 (<xref ref-type="bibr" rid="ref6">Anderson et al., 2006</xref>). However, the biological consequences and regulatory mechanisms of these modifications remain largely unexplored.</p>
</sec>
<sec id="sec11">
<label>5</label>
<title>Functions of ubiquitination of &#x03B1;-synuclein</title>
<sec id="sec12">
<label>5.1</label>
<title>Ubiquitination and intracellular proteolytic systems</title>
<p>Ubiquitination is involved in both major intracellular proteolytic systems - the proteasome and lysosome (<xref ref-type="fig" rid="fig3">Figure 3</xref>). The latter receives cargo through several pathways, in particular through autophagy and endosomes. Autophagy can be further divided into macroautophagy (MA), chaperone-mediated autophagy (CMA), and microautophagy. Below, we briefly introduce the mechanisms of these protein degradation pathways, which have been reviewed in detail elsewhere (<xref ref-type="bibr" rid="ref31">Clague and Urb&#x00E9;, 2010</xref>; <xref ref-type="bibr" rid="ref35">Collins and Goldberg, 2017</xref>; <xref ref-type="bibr" rid="ref61">Finley, 2009</xref>).</p>
<fig position="float" id="fig3">
<label>Figure 3</label>
<caption>
<p>Proteolytic pathways of &#x03B1;-synuclein mediated by ubiquitination, including the proteasome pathway <bold>(A)</bold>, the endosome-lysosome pathway <bold>(B)</bold>, and the macroautophagy-lysosome pathway <bold>(C)</bold>. <bold>(A)</bold> In the proteasome pathway, &#x03B1;-synuclein undergoes ubiquitination which targets the protein for recognition and degradation by the proteasome. <bold>(B)</bold> The endosome-lysosome pathway has emerged as a major route for &#x03B1;-synuclein degradation, predominantly involving K63-linked polyubiquitination. The ubiquitinated &#x03B1;-synuclein is recognized by NBR1, which may interact with the ESCRT complex to facilitate endosomal engulfment and the formation of multivesicular bodies (MVBs). The endosomes carrying &#x03B1;-synuclein either fuse with lysosomes or follow a maturation pathway, where a gradual decrease in pH activates proteolytic enzymes, ultimately leading to the degradation of &#x03B1;-synuclein. <bold>(C)</bold> The macroautophagy-lysosome pathway primarily targets polyubiquitinated &#x03B1;-synuclein aggregates. Ubiquitin chains on these aggregates are recognized by aggrephagy adaptor proteins, such as p62. The polymerization of p62 facilitates phase separation of the sequestered aggregates and serves as a platform for interaction with LC3, aiding in phagophore formation. The autophagosome containing the aggregates then fuses with the lysosome, where degradation occurs.</p>
</caption>
<graphic xlink:href="fnmol-17-1498459-g003.tif"/>
</fig>
<sec id="sec13">
<label>5.1.1</label>
<title>Proteasome</title>
<p>The proteasome was the first proteolytic machinery linked to the ubiquitination system, establishing the connection between ubiquitination and protein homeostasis (<xref ref-type="bibr" rid="ref240">Waxman et al., 1987</xref>). The proteasome consists of two main components: the 20S core particle (CP) and the 19S regulatory particle (RP). The CP contains the proteolytic site, with a barrel-shaped structure composed of &#x03B1;7&#x03B2;7&#x03B2;7&#x03B1;7 heteroheptameric rings of subunits. Among these, the &#x03B2;1, &#x03B2;2, and &#x03B2;5 subunits are responsible for proteolytic cleavage with each subunit having different amino acid specificities for cleavage. The entrance of the lumen of the free CP is closed by the N-terminal tails of the &#x03B1; subunits but opens when the RP caps the CP to form the holoenzyme.</p>
<p>The RP recognizes ubiquitinated proteins, removes the ubiquitin chains, and unfolds the proteins for entry into the narrow CP channel for degradation. This recognition requires either direct binding of the ubiquitin chain on the substrate to ubiquitin receptor subunits of the RP or indirect binding of the ubiquitin to intermediary shuttling factors such as Ddi1, Dsk2, and Rad23. These factors contain both ubiquitin-associated (UBA) domains which associate with ubiquitinated substrates and ubiquitin-like (UBL) domains which bind the RP. Both direct and indirect bindings involve RP ubiquitin receptors such as PSMD4/Rpn10, ADRM1/Rpn13, and PSMD2/Rpn1, which use ubiquitin-interacting motif (UIM), Pleckstrin-like receptor for ubiquitin (Pru) domain, and T1 site, respectively to bind ubiquitinated substrates (<xref ref-type="bibr" rid="ref205">Shi et al., 2016</xref>).</p>
<p>After the initial binding of ubiquitinated substrates, a tight-binding step occurs in an ATP-dependent manner (<xref ref-type="bibr" rid="ref183">Peth et al., 2010</xref>). This transition step allows a loosely folded region of the substrate to be tightly bound to the ATPase ring of the RP for subsequent unfolding and translocation into the CP for degradation (<xref ref-type="bibr" rid="ref186">Prakash et al., 2004</xref>). Before degradation, ubiquitin chains are removed and released, enabling substrate passage through the CP channel and generating free ubiquitin for reuse. This process is regulated by proteasome-associated DUBs, including PSMD14/Rpn11, USP14/Ubp6, and UCH37/UCHL5. These DUBs may also act as proofreading mechanisms to release substrates not committed to proteasome degradation (<xref ref-type="bibr" rid="ref39">Crosas et al., 2006</xref>; <xref ref-type="bibr" rid="ref93">Jacobson et al., 2009</xref>; <xref ref-type="bibr" rid="ref143">Lu et al., 2015</xref>).</p>
<p>PD has been linked to proteasome machinery since proteasomes were identified in LBs (<xref ref-type="bibr" rid="ref89">Ii et al., 1997</xref>). &#x03B1;S has been confirmed to be degradable by the proteasome, with the familial A53T mutant being degraded less efficiently (<xref ref-type="bibr" rid="ref13">Bennett et al., 1999</xref>). <italic>In-vitro</italic> studies have shown that monoubiquitinated &#x03B1;S has a higher degradation rate by the proteasome compared to free &#x03B1;S, with ubiquitination at Lys6, Lys12, Lys21, and Lys32 having the strongest effect (<xref ref-type="bibr" rid="ref2">Abeywardana et al., 2013</xref>; <xref ref-type="bibr" rid="ref201">Shabek et al., 2012</xref>). However, whether the proteasome is impaired in PD remains controversial, as functionally impaired forms have been reported (<xref ref-type="bibr" rid="ref156">McNaught et al., 2002</xref>; <xref ref-type="bibr" rid="ref157">McNaught and Jenner, 2001</xref>). Tofaris et al. demonstrated that proteasome function is impaired specifically in the substantia nigra in PD brains, while proteasomal function remains intact in other brain regions. Importantly, this regional deficit in proteasomal activity was not associated with a corresponding regional accumulation of ubiquitinated &#x03B1;S, suggesting that proteasome impairment is not associated with ubiquitinated &#x03B1;S accumulation (<xref ref-type="bibr" rid="ref225">Tofaris et al., 2003</xref>).</p>
</sec>
<sec id="sec14">
<label>5.1.2</label>
<title>Macroautophagy</title>
<p>Like the ubiquitin-proteasome system (UPS), components of the autophagy machinery have also been discovered in LBs of PD patients by immunohistochemistry (<xref ref-type="bibr" rid="ref5">Alvarez-Erviti et al., 2010</xref>; <xref ref-type="bibr" rid="ref45">Dehay et al., 2010</xref>). Several PD risk genes associated with autophagy-lysosome pathways (ALP) such as LRRK2, ATP13A2 and VPS35 have been identified in genome-wide association studies (GWAS) (<xref ref-type="bibr" rid="ref25">Chang et al., 2017</xref>; <xref ref-type="bibr" rid="ref168">Nalls et al., 2014</xref>). While these genes are associated with ALP, they also have broader effects on endolysosomal function, such as regulating endosomal trafficking and membrane dynamics, which may indirectly influence autophagy. Additionally, enzymatic activities of lysosomal proteins are decreased in PD patients (<xref ref-type="bibr" rid="ref164">Moors et al., 2019</xref>). These findings suggest that ALP plays an important role in &#x03B1;S homeostasis in PD.</p>
<p>In MA, the autophagosome, a double-membrane structure decorated with LC3/ATG8, engulfs targeted cargoes before fusing with lysosomes for degradation. The selectivity of ubiquitinated cargoes is achieved through intermediary autophagy receptors. These receptors contain both ubiquitin-binding domains (UBDs) and LC3-interacting region (LIR) motifs, allowing them to bridge ubiquitinated proteins and autophagosomes (<xref ref-type="bibr" rid="ref115">Lamark and Johansen, 2012</xref>).</p>
<p>MA plays a significant role in the clearance of protein aggregates, unlike proteasomes, which target single protein molecules for unfolding (<xref ref-type="bibr" rid="ref184">Pohl and Dikic, 2019</xref>). The selective removal of protein aggregates by autophagy is termed aggrephagy (<xref ref-type="bibr" rid="ref178">&#x00D8;verbye et al., 2007</xref>). Numerous aggrephagy receptors have been identified, including p62/SQSTM1 (<xref ref-type="bibr" rid="ref94">Janssen et al., 2018</xref>; <xref ref-type="bibr" rid="ref108">Komatsu et al., 2007</xref>; <xref ref-type="bibr" rid="ref132">Lim et al., 2015</xref>; <xref ref-type="bibr" rid="ref154">Matsumoto et al., 2011</xref>; <xref ref-type="bibr" rid="ref179">Pankiv et al., 2007</xref>; <xref ref-type="bibr" rid="ref219">Tanji et al., 2015</xref>; <xref ref-type="bibr" rid="ref249">Zellner et al., 2021</xref>), NBR1 (<xref ref-type="bibr" rid="ref170">Nicot et al., 2014</xref>; <xref ref-type="bibr" rid="ref173">Odagiri et al., 2012</xref>; <xref ref-type="bibr" rid="ref193">Ru&#x00E9; et al., 2013</xref>; <xref ref-type="bibr" rid="ref249">Zellner et al., 2021</xref>), OPTN/optineurin (<xref ref-type="bibr" rid="ref109">Korac et al., 2013</xref>; <xref ref-type="bibr" rid="ref176">Osawa et al., 2011</xref>; <xref ref-type="bibr" rid="ref204">Shen et al., 2015</xref>; <xref ref-type="bibr" rid="ref249">Zellner et al., 2021</xref>), ALFY (<xref ref-type="bibr" rid="ref33">Clausen et al., 2010</xref>; <xref ref-type="bibr" rid="ref60">Filimonenko et al., 2010</xref>), Tollip (<xref ref-type="bibr" rid="ref144">Lu et al., 2014</xref>; <xref ref-type="bibr" rid="ref249">Zellner et al., 2021</xref>), TAX1BP1 (<xref ref-type="bibr" rid="ref197">Sarraf et al., 2020</xref>; <xref ref-type="bibr" rid="ref227">Turco et al., 2021</xref>), and CCT2 (<xref ref-type="bibr" rid="ref148">Ma et al., 2022</xref>; <xref ref-type="bibr" rid="ref182">Pavel et al., 2016</xref>). Among these, p62 (<xref ref-type="bibr" rid="ref151">Mahul-Mellier et al., 2020</xref>; <xref ref-type="bibr" rid="ref219">Tanji et al., 2015</xref>; <xref ref-type="bibr" rid="ref239">Watanabe et al., 2012</xref>), NBR1 (<xref ref-type="bibr" rid="ref173">Odagiri et al., 2012</xref>), TAXBP1 (<xref ref-type="bibr" rid="ref116">Lannielli et al., 2022</xref>), and Tollip (<xref ref-type="bibr" rid="ref28">Chen et al., 2017</xref>) have been shown to directly associate with <italic>&#x03B1;</italic>S for MA turnover.</p>
<p>p62 has been characterized since its early identification in LBs (<xref ref-type="bibr" rid="ref112">Kuusisto et al., 2003</xref>) and is well-studied for its role in ubiquitination and aggrephagy. Aggrephagy receptors typically prefer K63-linked over K48-linked polyubiquitin chains on substrates (<xref ref-type="bibr" rid="ref106">Kirkin et al., 2009</xref>; <xref ref-type="bibr" rid="ref140">Long et al., 2008</xref>; <xref ref-type="bibr" rid="ref154">Matsumoto et al., 2011</xref>; <xref ref-type="bibr" rid="ref200">Seibenhener et al., 2004</xref>; <xref ref-type="bibr" rid="ref217">Sun et al., 2018</xref>; <xref ref-type="bibr" rid="ref243">Wurzer et al., 2015</xref>; <xref ref-type="bibr" rid="ref248">Zaffagnini et al., 2018</xref>), though some show better affinity for Met1-linked linear ubiquitin chains (<xref ref-type="bibr" rid="ref243">Wurzer et al., 2015</xref>). The molecular mechanism of aggrephagy involves the binding of ubiquitinated aggregates, requiring p62 clustering, polymerization, and phase separation (<xref ref-type="bibr" rid="ref216">Sun et al., 2020</xref>). K48 chains can disrupt this process (<xref ref-type="bibr" rid="ref30">Ciuffa et al., 2015</xref>; <xref ref-type="bibr" rid="ref217">Sun et al., 2018</xref>; <xref ref-type="bibr" rid="ref243">Wurzer et al., 2015</xref>; <xref ref-type="bibr" rid="ref248">Zaffagnini et al., 2018</xref>). These protein clusters act as platforms for autophagosome formation, which eliminates ubiquitinated aggregates by fusing with lysosomes (<xref ref-type="bibr" rid="ref3">Agudo-Canalejo et al., 2021</xref>; <xref ref-type="bibr" rid="ref98">Kageyama et al., 2021</xref>). Interestingly, this clustering process may also facilitate the formation of protein inclusions. Studies on K63 polyubiquitination have shown that overexpression of ubiquitin specific for K63 linkage accelerates the formation of protein inclusions, while a K63R mutant construct inhibits this process (<xref ref-type="bibr" rid="ref131">Lim et al., 2005</xref>; <xref ref-type="bibr" rid="ref174">Olzmann et al., 2007</xref>; <xref ref-type="bibr" rid="ref218">Tan et al., 2008</xref>; <xref ref-type="bibr" rid="ref238">Wang et al., 2012</xref>). These findings highlight an important role for ubiquitination and MA in the formation of LBs.</p>
</sec>
<sec id="sec15">
<label>5.1.3</label>
<title>Chaperone-mediated autophagy</title>
<p>CMA is discovered as a lysosomal degradation pathway for &#x03B1;S in rat ventral midbrain cultures, as suggested by significant inhibition of degradation by lysosomal inhibition (ammonium chloride) and minimal impact from macroautophagy (3-methyladenine) and proteasome (epoxomicin) inhibition (<xref ref-type="bibr" rid="ref40">Cuervo et al., 2004</xref>). In CMA, the Hsc70 chaperone recognizes the KFERQ-like motif on &#x03B1;S (95VKKDQ99) independently of ubiquitination and forms a complex with it. This complex associates with the lysosomal membrane receptor LAMP2A, the rate-limiting component of CMA, which forms a multimeric protein complex to facilitate &#x03B1;S translocation into the lysosomal lumen. Interestingly, &#x03B1;S A53T and A30P mutants block this translocation by tightly binding to LAMP2A receptors (<xref ref-type="bibr" rid="ref40">Cuervo et al., 2004</xref>; <xref ref-type="bibr" rid="ref244">Xilouri et al., 2009</xref>), suggesting the importance of CMA in &#x03B1;S homeostatic clearance. CMA efficiency decreases with aging, and mutations in PD risk genes such as LRRK2 can interfere with CMA by blocking the LAMP2A multimerization required for translocation (<xref ref-type="bibr" rid="ref87">Ho et al., 2020</xref>; <xref ref-type="bibr" rid="ref97">Kabuta et al., 2008</xref>; <xref ref-type="bibr" rid="ref175">Orenstein et al., 2013</xref>; <xref ref-type="bibr" rid="ref244">Xilouri et al., 2009</xref>), resulting in &#x03B1;S accumulation on the lysosomal membrane and accelerating &#x03B1;S oligomerization (<xref ref-type="bibr" rid="ref87">Ho et al., 2020</xref>; <xref ref-type="bibr" rid="ref175">Orenstein et al., 2013</xref>). However, since CMA substrate translocation depends on their unfolding, similar to the proteasome pathway, it is unlikely that CMA is directly involved in clearing &#x03B1;S aggregates.</p>
</sec>
<sec id="sec16">
<label>5.1.4</label>
<title>Microautophagy and endosomal pathways</title>
<p>Microautophagy, initially studied in yeast, involves lysosomes directly engulfing targeted substrates (<xref ref-type="bibr" rid="ref236">Wang et al., 2023</xref>). Recently, endosomal microautophagy (eMI) has been discovered in mammalian cells, where targeted substrates are delivered to late endosomes before fusing with lysosomes (<xref ref-type="bibr" rid="ref195">Sahu et al., 2011</xref>). Unlike CMA, eMI can remove substrates without requiring their unfolding; therefore, eMI can target protein clusters (<xref ref-type="bibr" rid="ref195">Sahu et al., 2011</xref>). eMI selectively uses Hsc70 for substrate recognition (<xref ref-type="bibr" rid="ref165">Morozova et al., 2016</xref>; <xref ref-type="bibr" rid="ref195">Sahu et al., 2011</xref>), but does not depend on LAMP2A receptors for translocation. Instead, it relies on the ESCRT systems and Hsc70 interactions with endosomal membranes to internalize cargo into late endosomes, forming multivesicular bodies (MVBs) for lysosomal degradation (<xref ref-type="bibr" rid="ref195">Sahu et al., 2011</xref>). The degradation of &#x03B1;S via endosomal pathways, where &#x03B1;S is trafficked to endosomes before lysosomal degradation (<xref ref-type="bibr" rid="ref15">Boassa et al., 2013</xref>; <xref ref-type="bibr" rid="ref77">Gerez et al., 2019</xref>; <xref ref-type="bibr" rid="ref214">Sugeno et al., 2014</xref>; <xref ref-type="bibr" rid="ref224">Tofaris et al., 2011</xref>; <xref ref-type="bibr" rid="ref250">Zenko et al., 2023</xref>) has also been reported. However, the uptake of &#x03B1;S degradation in this endosomal pathway does not require Hsc70 binding. Instead, NEDD4 catalyzes K63-polyubiquitination of &#x03B1;S which allows it to associate with the ESCRT complex for endosomal uptake (<xref ref-type="bibr" rid="ref224">Tofaris et al., 2011</xref>, <xref ref-type="bibr" rid="ref250">Zenko et al., 2023</xref>).</p>
</sec>
</sec>
</sec>
<sec id="sec17">
<label>6</label>
<title>Enzymes regulating ubiquitination of &#x03B1;-synuclein</title>
<sec id="sec18">
<label>6.1</label>
<title>Neural precursor cell expressed developmentally down-regulated protein 4</title>
<p>NEDD4-1 is a member of the NEDD4 subset of HECT E3s (<xref ref-type="bibr" rid="ref189">Rotin and Kumar, 2009</xref>). These E3s contain WW domains that recognize PY motifs (PPxY or LPxY amino acid sequences) or phosphorylated serine/threonine residues in target proteins. NEDD4 is the most studied E3 in &#x03B1;S ubiquitination, recognizing &#x03B1;S through the interaction of its WW domain with the C-terminal proline-rich region 120-(PDNEAYEMPSEEGY)-133 (<xref ref-type="bibr" rid="ref224">Tofaris et al., 2011</xref>). &#x03B1;S is co-immunoprecipitated with NEDD4 from both mouse and human brain lysates and colocalized with LBs in pigmented neurons (<xref ref-type="bibr" rid="ref224">Tofaris et al., 2011</xref>).</p>
<p>NEDD4 polyubiquitinates &#x03B1;S with mainly K63 chain linkages. This leads to &#x03B1;S degradation via endosomal pathways as knocking down the ESCRT III core component VPS24 or the ESCRT I core component TSG101 blocked NEDD4-dependent &#x03B1;S degradation (<xref ref-type="bibr" rid="ref224">Tofaris et al., 2011</xref>). This conclusion is also supported by studies in which SH-SY5Y cells were exposed to recombinant &#x03B1;S oligomers (~40&#x2009;kDa) in the medium (<xref ref-type="bibr" rid="ref214">Sugeno et al., 2014</xref>). The oligomers accumulated within endolysosome vesicles, including Rab7 (late endosome) and lysotracker (lysosome) positive vesicles. This internalization into endosomes was promoted by NEDD4 ubiquitination of membrane associated &#x03B1;S. Overexpression of a catalytic mutant (C867A) and &#x0394;WW form of NEDD4 decreased its ability to sort &#x03B1;S to endosomes compared to wild-type NEDD4. Knocking down the ESCRT III component CHMP2B prevented the NEDD4-dependent &#x03B1;S degradation confirming the trafficking through endosomes.</p>
<p>Besides these effects on &#x03B1;S monomers and oligomers, Mund et al. demonstrated using cell free assays that most NEDD4 family ligases prefer to polyubiquitinate &#x03B1;S fibrils over monomers, with NEDD4-1 showing the strongest ubiquitination capacity. This linkage type appeared to be K63, based on cleavage susceptibility by deubiquitinases with varying specificities (<xref ref-type="bibr" rid="ref167">Mund and Pelham, 2018</xref>). Deletion analysis of the C2 domain of NEDD4 decreased its ability to polyubiquitinate &#x03B1;S fibrils, while further deletion of the WW domain had a minor effect, suggesting NEDD4 binds &#x03B1;S fibrils via the C2 domain rather than WW-PY interaction (<xref ref-type="bibr" rid="ref167">Mund and Pelham, 2018</xref>).</p>
<p>The role of NEDD4 in handling aggregates in cells was tested in HEK293 cells expressing &#x03B1;S fused to split halves of Venus fluorescent protein and aggregates detected as punctate bimolecular fluorescence complementation (BiFC) signals. Knocking down NEDD4 in these cells showed that &#x03B1;S ubiquitination occurs mainly at &#x03B1;S K45/58/60 residues via K63 poly-ubiquitin chains (<xref ref-type="bibr" rid="ref250">Zenko et al., 2023</xref>). This ubiquitination is essential for &#x03B1;S turnover, mediated by the aggrephagy receptor NBR1, but not by p62, OPTN, or TAX1BP1. Knocking down autophagy core protein ATG7 or CMA/eMI core protein HSC70 did not affect &#x03B1;S turnover, but knocking down ESCRT components (TSG101, CHMP3) did, highlighting the role of an endosomal mediated pathway for degradation.</p>
<p>An antibody raised against &#x03B1;S conjugated with di-Gly peptides at the K45/58/60 ubiquitination sites was confirmed to predominantly recognize &#x03B1;S ubiquitinated by NEDD4 and BiFC puncta in the cells. This antibody colocalized with ubiquitin in LBs from PD brains and the autophagy adaptor protein NBR1, as well as with lysosomal marker LAMP1+ vesicles, but not with autophagosome marker LC3II in primary neurons. This supports the role of NBR1 in the endosomal degradation pathway of K45/58/60-ubiquitinated &#x03B1;S in the neurons (<xref ref-type="bibr" rid="ref250">Zenko et al., 2023</xref>). NEDD4&#x2019;s effects on &#x03B1;S ubiquitination are also indirectly regulated by the DUB YOD1, which stabilizes NEDD4 in a dose-dependent manner (<xref ref-type="bibr" rid="ref180">Park et al., 2023</xref>), and by the SUMO enzyme PIAS2 which by SUMOylating &#x03B1;S inhibits NEDD4-mediated &#x03B1;S ubiquitination (<xref ref-type="bibr" rid="ref192">Rott et al., 2017</xref>). <italic>In vivo</italic>, NEDD4 can rescue PD-associated pathology. AAV expression of A53T &#x03B1;S in rat substantia nigra causes dopaminergic neuron loss and increases &#x03B1;S aggregates. These pathologies can be reduced by co-injection of AAV expressing wild-type NEDD4, but not a catalytic mutant (<xref ref-type="bibr" rid="ref44">Davies et al., 2014</xref>). Taken together, these observations underscore NEDD4&#x2019;s role as a prominent E3 ligase that can target &#x03B1;S for lysosomal degradation via endosomes.</p>
</sec>
<sec id="sec19">
<label>6.2</label>
<title>Seven <italic>in absentia</italic> homolog 1 and 2 and USP9X</title>
<p>SIAH-1 and SIAH-2 are RING-type E3s initially identified for their interaction with synphilin-1, a protein associated with &#x03B1;S in LBs (<xref ref-type="bibr" rid="ref58">Engelender et al., 1999</xref>; <xref ref-type="bibr" rid="ref130">Liani et al., 2004</xref>; <xref ref-type="bibr" rid="ref234">Wakabayashi et al., 2000</xref>). Later immunohistochemical staining also identified SIAH proteins in LBs (<xref ref-type="bibr" rid="ref130">Liani et al., 2004</xref>). Both SIAH-1 and SIAH-2 can promote ubiquitination of &#x03B1;S in cells, but SIAH-2 appears to have stronger affinity for &#x03B1;S and ubiquitinates it more effectively in a cell free system (<xref ref-type="bibr" rid="ref130">Liani et al., 2004</xref>; <xref ref-type="bibr" rid="ref191">Rott et al., 2008</xref>). Mass spectrometry analysis identified several ubiquitination sites on &#x03B1;S mediated by SIAH-2 in a cell free assay, including K10, K12, K21, K23, K34, K43, and K96 (<xref ref-type="bibr" rid="ref191">Rott et al., 2008</xref>). These findings align with previous reports of &#x03B1;S ubiquitination sites at K12, K21, and K23 observed in LBs (<xref ref-type="bibr" rid="ref6">Anderson et al., 2006</xref>). Notably, even with two-thirds of these ubiquitination sites abolished, &#x03B1;S ubiquitination by SIAH-2 persisted, demonstrating the flexibility of the ubiquitination process (<xref ref-type="bibr" rid="ref83">Hanna et al., 2007</xref>; <xref ref-type="bibr" rid="ref105">Kim et al., 2011</xref>). Neither enzyme promotes polyubiquitination, but inhibitors of autophagy-lysosome system (ALS) or the proteasome have been observed to stabilize &#x03B1;S following overexpression of SIAH2 (<xref ref-type="bibr" rid="ref191">Rott et al., 2008</xref>), suggesting that these ubiquitinated forms of &#x03B1;S do target for degradation.</p>
<p>Other studies have indicated that SIAH isoforms mediated monoubiquitination promotes formation of insoluble aggregates both in cells and cell free systems (<xref ref-type="bibr" rid="ref121">Lee et al., 2008</xref>; <xref ref-type="bibr" rid="ref130">Liani et al., 2004</xref>). In addition, silencing of the deubiquitinase USP9X which counteracts SIAH-2-dependent &#x03B1;S monoubiquitination in SH-SY5Y cells increases &#x03B1;S aggregation and cytotoxicity under proteolytic (lactacytstin, NH<sub>4</sub>Cl and 3-MA) inhibition. Under normal conditions without proteolytic inhibition, such silencing of USP9X facilitates &#x03B1;S degradation (<xref ref-type="bibr" rid="ref190">Rott et al., 2011</xref>; <xref ref-type="bibr" rid="ref192">Rott et al., 2017</xref>). In cell-free systems, &#x03B1;S monoubiquitinated by recombinant SIAH2 can be degraded by purified proteasome (<xref ref-type="bibr" rid="ref190">Rott et al., 2011</xref>; <xref ref-type="bibr" rid="ref192">Rott et al., 2017</xref>). USP9X expression is decreased in PD and DLB brains which would be consistent with the above proposed mechanisms. Overall, the consequences of SIAH-dependent &#x03B1;S monoubiquitination&#x2014;whether leading to degradation or aggregation&#x2014;and its regulation through deubiquitination require further exploration <italic>in vivo</italic> to verify their precise roles in PD.</p>
</sec>
<sec id="sec20">
<label>6.3</label>
<title>The SKP1-CUL1-F box protein complex</title>
<p>The SCF complex E3s are a subset of the Cullin-RING ligase family and consist of the scaffold protein Cullin-1 (Cul1), adaptor protein S-phase Kinase-associated Protein 1 (SKP1), the ligase RING-box protein (RBX1), and various F-box proteins that bind substrates (<xref ref-type="bibr" rid="ref252">Zheng et al., 2002</xref>). Immunohistochemistry staining confirmed that Cul1 and SKP1 are colocalized with &#x03B1;S in LBs from the brains of patients with PD and DLB. Proteome analysis of SH-SY5Y cells revealed that SCF components, particularly Cul1 and SKP1, are upregulated in response to exposure of the cells to detergent-resistant &#x03B1;S fibrils. The exogenous fibrils accumulated within endolysosomal structures marked by Rab5A and LAMP1, suggesting involvement of the endosomal degradation pathway. Prolonged exposure to the fibrils beyond 6&#x2009;h caused vesicle rupture, leading to seeding of endogenous &#x03B1;S and formation of high molecular weight aggregates, confirmed by immunoblotting.</p>
<p>The release of the fibrils into the cytoplasm resulted in their ubiquitination. A siRNA screen targeting 31-box proteins in HeLa cells identified FBXL5 as the specific F-box protein responsible for the ubiquitination (<xref ref-type="bibr" rid="ref77">Gerez et al., 2019</xref>). Knockdown of other components of the SCF complex also prevented the ubiquitination of the fibrils. Mass spectrometry analysis showed that SCF ubiquitinates the fibrils primarily at K45, 58, and 60, forming K48-K63 branched ubiquitin chains. Interestingly, these lysine residues are typically buried within the fibril core according to cryo-EM studies (<xref ref-type="bibr" rid="ref9001">Guerrero-Ferreira et al., 2019</xref>; <xref ref-type="bibr" rid="ref9002">Yang et al., 2022</xref>), raising questions about the accessibility of these residues for ubiquitination. Knockdown of Cul1 or SKP1 in SH-SY5Y, BV-2 (microglia-like cell line), and COS-7 cells inhibits the degradation of the fibrils, which involves both lysosomal and proteasomal pathways, as evidenced by effects of their respective inhibitors, bafilomycin A1 and MG132 (<xref ref-type="bibr" rid="ref77">Gerez et al., 2019</xref>).</p>
<p>In transgenic mice expressing human &#x03B1;S, which spontaneously form &#x03B1;S aggregates, injection of the fibrils induces LB-like pathology. Injection of lentivirus silencing SKP1 increased &#x03B1;S inclusions in those brain regions compared to injection with control virus. In nontransgenic mice, silencing SKP1 or FBXL5 led to p129-&#x03B1;S aggregates spreading, indicating SCF-FBXL5 inhibits LB-like pathology initiation and propagation induced by extracellular &#x03B1;S seeds (<xref ref-type="bibr" rid="ref77">Gerez et al., 2019</xref>). These results support an important role for the SCF complex in mediating the degradation of internalized &#x03B1;S fibrils and thereby inhibiting subsequent seeding and further propagation.</p>
</sec>
<sec id="sec21">
<label>6.4</label>
<title>Linear ubiquitin chain assembly complex</title>
<p>LUBAC is an RBR E3 complex renown for regulating immune and inflammatory responses, particularly NF-&#x03BA;B signaling, through the formation of linear (Met1-linked) ubiquitin chains. LUBAC consists of three main components: Haem-oxidized IRP2 ubiquitin ligase-1 (HOIL-1&#x2009;L), HOIL-1 Interacting Protein (HOIP), and SHANK-associated RH domain interacting protein (SHARPIN). HOIL-1&#x2009;L contains a C-terminal RING domain functioning as an E3 ligase, while HOIP is an RBR E3 possessing a linear ubiquitin chain determining (LDD) domain crucial for synthesizing linear ubiquitin chains. SHARPIN stabilizes the LUBAC complex through its interaction with HOIL-1&#x2009;L (<xref ref-type="bibr" rid="ref75">Gao et al., 2023</xref>).</p>
<p>A key target of LUBAC is NEMO and the M1-linked ubiquitin (M1-Ub) chain on NEMO serves to recruit critical subunits of the I&#x03BA;B kinase complex to promote NF&#x03BA;B signaling. M1-Ub and NEMO colocalize with &#x03B1;S in LBs from PD patients, and M1-Ub colocalizes with p129-&#x03B1;S in primary neurons treated with A53T preformed fibrils (PFFs), suggesting LUBAC&#x2019;s involvement in protein aggregation (<xref ref-type="bibr" rid="ref68">Furthmann et al., 2023</xref>). In SH-SY5Y cells, exposure to &#x03B1;S PFFs results in &#x03B1;S aggregates that associate with LUBAC components (<xref ref-type="bibr" rid="ref68">Furthmann et al., 2023</xref>). Overexpression of wild-type NEMO or HOIP decreased &#x03B1;S aggregates and this reduction in &#x03B1;S aggregates depends on the aggrephagy adaptor p62 binding to M1-ubiquitin chains and is inhibited by bafilomycin A1, indicating the involvement of autophagy. NEMO promoted p62 condensation at &#x03B1;S aggregates, facilitating aggrephagy. This important role for NEMO in clearance of aggregates is supported by observations in a patient with Incontinentia pigmenti due to expression of a C-terminal truncated Q330X NEMO mutation. This patient developed early-onset PD with proteinopathies, including aggregations of &#x03B1;S, amyloid-<italic>&#x03B2;</italic>, tau, TDP-43, and ubiquitin (<xref ref-type="bibr" rid="ref68">Furthmann et al., 2023</xref>). Wild-type NEMO, not the Q330X mutant, is recruited to &#x03B1;S aggregates and promotes M1-ubiquitination on itself and the aggregates. The Q330X truncation in NEMO decreases its association with HOIP and the ubiquitination of &#x03B1;S. In support of the above, KO of NEMO in murine embryonic fibroblasts (MEFs) promotes protein aggregate formation under proteasome/lysosome inhibition or heat stress (<xref ref-type="bibr" rid="ref68">Furthmann et al., 2023</xref>).</p>
</sec>
<sec id="sec22">
<label>6.5</label>
<title>Carboxyl terminus of Hsp70-interacting protein</title>
<p>CHIP is a U-box domain E3 (<xref ref-type="bibr" rid="ref95">Jiang et al., 2001</xref>) with an N-terminal tandem tetratricopeptide repeat (TPR) domain that interacts with the HSP70 chaperone (<xref ref-type="bibr" rid="ref10">Ballinger et al., 1999</xref>). CHIP has been found to colocalize with &#x03B1;S in LBs (<xref ref-type="bibr" rid="ref208">Shin et al., 2005</xref>). In an H4 glioma cell model co-expressing aggregation prone truncated &#x03B1;S and synphilin-1 to induce &#x03B1;S aggregation (<xref ref-type="bibr" rid="ref155">McLean et al., 2001</xref>), synphilin-1 interacts with &#x03B1;S to promote the formation of cytoplasmic inclusions resembling LBs found in PD. Using this model with proteasome or lysosomal inhibitors, CHIP was found to regulate &#x03B1;S turnover through two pathways: its TPR domain associates with HSC70 to promote proteasomal degradation, while its U-box domain facilitates lysosomal degradation. Notably, deletion of CHIP&#x2019;s TPR domain leads to increased &#x03B1;S inclusion size (<xref ref-type="bibr" rid="ref208">Shin et al., 2005</xref>).</p>
<p>In studies using BiFC assays to monitor &#x03B1;S oligomerization/aggregation, CHIP expression inhibits &#x03B1;S oligomerization and toxicity. Deletion of the TPR domain abolished these effects supporting Hsp70&#x2019;s role in this process (<xref ref-type="bibr" rid="ref101">Kalia et al., 2011</xref>; <xref ref-type="bibr" rid="ref221">Tetzlaff et al., 2008</xref>). Additionally, CHIP can promote &#x03B1;S monoubiquitination in H4 cells and in cell-free systems incubated with the E2 enzymes UbcH5a/b (<xref ref-type="bibr" rid="ref101">Kalia et al., 2011</xref>). BAG5 can negatively regulate this ubiquitination indirectly through its binding to Hsp70. Concomitant with the decreased ubiquitination, there is increased &#x03B1;S oligomerization. It remains unknown which &#x03B1;S Lys residues are ubiquitinated by CHIP.</p>
</sec>
<sec id="sec23">
<label>6.6</label>
<title>Parkin</title>
<p>Parkin is an RBR-type E3 ubiquitin ligase extensively studied in PD as its mutation causes early-onset PD (<xref ref-type="bibr" rid="ref150">Madsen et al., 2021</xref>). It is recruited to mitochondria upon activation of mitophagy and plays an important role in the process through its ubiquitination of mitochondrial membrane proteins. Its role in &#x03B1;S ubiquitination is controversial. Parkin has been identified in LBs and co-immunoprecipitation studies in human brain lysates revealed its association with UbcH7 and a novel 22-kDa O-linked glycosylated isoform of &#x03B1;S (&#x03B1;Sp22), but not with the native 16-kDa &#x03B1;S monomer (<xref ref-type="bibr" rid="ref207">Shimura et al., 2001</xref>). Although Parkin immunoprecipitated from normal brains was shown to promote &#x03B1;Sp22 polyubiquitination, these findings have not been consistently reproduced by others (<xref ref-type="bibr" rid="ref29">Chung et al., 2001</xref>) and so further investigation is warranted to clarify its role in &#x03B1;S ubiquitination.</p>
</sec>
<sec id="sec24">
<label>6.7</label>
<title>E6-associated protein</title>
<p>E6-AP, a HECT E3, has also been found in LBs (<xref ref-type="bibr" rid="ref166">Mulherkar et al., 2009</xref>). Its colocalization with &#x03B1;S, and ability to increase &#x03B1;S ubiquitination have been recapitulated <italic>in-vitro</italic>, using Neuro2a cells under proteasome inhibition (<xref ref-type="bibr" rid="ref166">Mulherkar et al., 2009</xref>). In addition, E6-AP can increase the turnover of &#x03B1;S and reduce oligomer species in Cos-7 cells. Inhibitors suggest that this degradation occurs via the proteasome (<xref ref-type="bibr" rid="ref166">Mulherkar et al., 2009</xref>). However, little is known about the type of ubiquitination stimulated by E6-AP, and its regulation <italic>in vivo</italic>.</p>
</sec>
<sec id="sec25">
<label>6.8</label>
<title>UCH-L1 (PGP9.5)</title>
<p>UCH-L1 was first implicated in PD when a mutation was associated with familial disease (<xref ref-type="bibr" rid="ref126">Leroy et al., 1998</xref>). However, recent studies challenge its monogenic role in PD, instead implicating UCH-L1 in spastic paraplegia, a neurodegenerative disorder characterized by optic atrophy and muscle weakness (<xref ref-type="bibr" rid="ref41">Das Bhowmik et al., 2018</xref>; <xref ref-type="bibr" rid="ref194">Rydning et al., 2017</xref>). Nevertheless, reduced levels of UCH-L1 have been reported in sporadic disease and the protein may play a role in regulating &#x03B1;S ubiquitination, suggesting its involvement in broader neurodegenerative processes.(<xref ref-type="bibr" rid="ref11">Barrachina et al., 2006</xref>; <xref ref-type="bibr" rid="ref142">Lowe et al., 1990</xref>; <xref ref-type="bibr" rid="ref246">Yasuda et al., 2009</xref>). UCH-L1 co-immunoprecipitates with free and di-ubiquitinated &#x03B1;S species from rat brains (<xref ref-type="bibr" rid="ref136">Liu et al., 2002</xref>). It can deubiquitinate &#x03B1;S derived from LB brain lysates (<xref ref-type="bibr" rid="ref196">Sampathu et al., 2003</xref>) and its expression in cells promotes &#x03B1;S deubiquitination (<xref ref-type="bibr" rid="ref91">Imai et al., 2000</xref>) and accumulation (<xref ref-type="bibr" rid="ref136">Liu et al., 2002</xref>). Despite the documented DUB activity, it remains unclear whether UCH-L1&#x2019;s actions modulate proteasome-mediated degradation of &#x03B1;S. UCH-L1 has been reported to interact with the CMA receptor LAMP2A and the I93M mutation enhances this association, thereby interfering with &#x03B1;S degradation (<xref ref-type="bibr" rid="ref97">Kabuta et al., 2008</xref>). In a cell-free system, UCH-L1 has been reported to exhibit ubiquitin ligase activity, but this may be due to the high concentrations of enzyme and substrate used in the study (<xref ref-type="bibr" rid="ref136">Liu et al., 2002</xref>).</p>
</sec>
<sec id="sec26">
<label>6.9</label>
<title>Ubiquitin specific peptidase 8</title>
<p>The D442G activity enhancing mutation in USP8 is a cause of early-onset PD (<xref ref-type="bibr" rid="ref242">Wu et al., 2023</xref>). This DUB can remove K6-linked ubiquitin chains from Parkin to activate it (<xref ref-type="bibr" rid="ref55">Durcan et al., 2014</xref>) and can attenuate endosomal engulfment of membrane receptors by removing K63-linked ubiquitin chains (<xref ref-type="bibr" rid="ref160">Mizuno et al., 2005</xref>). An additional role has been identified in HEK293T cells and iPSC-derived dopaminergic neurons where USP8 associates with &#x03B1;S primarily localized in early endosomes. Knocking down USP8 in SH-SY5Y cells promotes &#x03B1;S degradation through lysosomes and USP8 silencing in a Drosophila model of PD rescues &#x03B1;S-induced toxicity (rough eye phenotype, climbing function, and TH-positive neuron loss), while knockdown of the ESCRT I protein, Vps28, enhanced the rough eye phenotype (<xref ref-type="bibr" rid="ref4">Alexopoulou et al., 2016</xref>). Most LBs stain with K63 but not K48 linkage specific anti-Ub antibodies (<xref ref-type="bibr" rid="ref4">Alexopoulou et al., 2016</xref>). Interestingly, USP8 expression has been observed to be increased in the substantia nigra of PD patients, and the level of USP8-positive inclusions is negatively correlated with K63-Ub-positive inclusions (<xref ref-type="bibr" rid="ref4">Alexopoulou et al., 2016</xref>). iPSC dopaminergic neurons derived from PD patients expressing this USP8 mutation exhibited higher overall levels of &#x03B1;S, with increased accumulation in the soma and decreased levels in dendritic regions (<xref ref-type="bibr" rid="ref242">Wu et al., 2023</xref>). These phenotypes were exacerbated by overexpressing the USP8 hyperactive D442G mutant. D442G mutant knock-in models showed similar phenotypes, with homozygous mutants exhibiting stronger effects than heterozygous ones, confirming a dosage effect. Mechanistic studies revealed a stronger association between &#x03B1;S and the D442G mutant, leading to reduced K63-polyubiquitination of &#x03B1;S (<xref ref-type="bibr" rid="ref242">Wu et al., 2023</xref>). These findings suggest an important role for K63-ubiquitination in mitigating &#x03B1;S neuronal toxicity in PD. Finally, the K63-specific DUB activity of USP8 was recapitulated <italic>in vitro</italic> using recombinant &#x03B1;S bearing K63 ubiquitin chains generated by NEDD4 (<xref ref-type="bibr" rid="ref4">Alexopoulou et al., 2016</xref>). Taken together, these results suggest that USP8 interferes with endosomal degradation of &#x03B1;S by removing &#x03B1;S K63-linked ubiquitin chains.</p>
</sec>
<sec id="sec27">
<label>6.10</label>
<title>Ubiquitin specific peptidase 13</title>
<p>USP13 expression has been observed to be increased in PD brains (<xref ref-type="bibr" rid="ref137">Liu et al., 2019</xref>). Injection of mice with lentivirus expressing &#x03B1;S and USP13 or USP13 shRNA decreased or increased levels, respectively, of ubiquitinated &#x03B1;S detected by proximity ligation assay, compared to the non-injected hemisphere (<xref ref-type="bibr" rid="ref137">Liu et al., 2019</xref>). Concomitant with the increased ubiquitinated &#x03B1;S, the USP13 KD also resulted in protection against dopaminergic neuronal death, and improved motor performance. Similar results were observed upon manipulating USP13 levels in the A53T &#x03B1;S transgenic mouse model of PD. The effects of KD in transgenic mice were mimicked by administration of a small molecule inhibitor of USP13 (<xref ref-type="bibr" rid="ref134">Liu et al., 2022</xref>; <xref ref-type="bibr" rid="ref138">Liu et al., 2021</xref>). Interestingly, the inhibitor increased proteasome activity in a dose-dependent manner in HEK cells expressing &#x03B1;S (<xref ref-type="bibr" rid="ref134">Liu et al., 2022</xref>). These results suggest that USP13 can influence PD pathology by modulating &#x03B1;S ubiquitination and degradation. However, it remains unknown which type of ubiquitin linkage USP13 regulates and the downstream degradative pathway that is involved.</p>
</sec>
<sec id="sec28">
<label>6.11</label>
<title>Ubiquitin specific peptidase 19</title>
<p>USP19 is a key modulator of an unconventional pathway of protein secretion that appears specific for misfolded proteins (MAPS). In this process, the ER localized isoform of USP19 deubiquitinates the misfolded protein and promotes its uptake into late endosomes in a process that involves Hsp70 and its co-chaperone DNAJC5/CSP&#x03B1; (<xref ref-type="bibr" rid="ref64">Fontaine et al., 2016</xref>; <xref ref-type="bibr" rid="ref122">Lee et al., 2023</xref>; <xref ref-type="bibr" rid="ref120">Lee et al., 2016</xref>; <xref ref-type="bibr" rid="ref245">Xu et al., 2018</xref>). Expressing &#x03B1;S or its disease-causing mutants in HEK293T cells results in secretion that can be stimulated by USP19 in a dose dependent manner and diminished by silencing of USP19. DNAJC5 associates with MAPS substrates, including &#x03B1;S, and facilitates their lysosomal degradation. Overexpression of dominant-negative (DN) ESCRT component (VPS4) abolished lysosomal degradation of &#x03B1;S, in support of DNAJC5 mediating &#x03B1;S degradation via endosomes. This DN VPS4 inhibition of lysosomal degradation enhanced MAPS secretion in the cells. Conversely, overexpression of DNAJC5 mutants associated with adult neuronal ceroid lipofuscinosis (ANCL) still facilitated &#x03B1;S endosomal/lysosomal degradation but failed to promote &#x03B1;S MAPS secretion (<xref ref-type="bibr" rid="ref122">Lee et al., 2023</xref>). These results suggest that endosomal degradation and MAPS secretion represent alternative outcomes of cargo taken up by endosomes.</p>
<p>To explore these cellular observations <italic>in vivo</italic>, our group inactivated the USP19 gene in transgenic mice expressing the A53T disease causing mutation of &#x03B1;S (<xref ref-type="bibr" rid="ref199">Schorova et al., 2023</xref>). Knockout of USP19 decreased accumulation of pS-129-&#x03B1;S aggregates, but increased ubiquitination of these aggregates as well as soluble forms of &#x03B1;S. This reduction in &#x03B1;S aggregate accumulation was also observed in USP19 KO primary neurons. Higher levels of &#x03B1;S oligomers were detected by proximity ligation assays in primary neurons and biochemically in the soluble fractions of KO brains. These results suggest that USP19 inhibits &#x03B1;S ubiquitination to facilitate &#x03B1;S aggregate formation. USP19 can cleave multiple types of polyubiquitin chain linkages &#x2013; K6- (<xref ref-type="bibr" rid="ref135">Liu et al., 2021</xref>), K11- (<xref ref-type="bibr" rid="ref96">Jin et al., 2016</xref>; <xref ref-type="bibr" rid="ref223">Tian et al., 2023</xref>), K27- (<xref ref-type="bibr" rid="ref123">Lei et al., 2019</xref>), K48- (<xref ref-type="bibr" rid="ref84">Harada et al., 2016</xref>; <xref ref-type="bibr" rid="ref223">Tian et al., 2023</xref>), and K63-(<xref ref-type="bibr" rid="ref123">Lei et al., 2019</xref>; <xref ref-type="bibr" rid="ref251">Zhang et al., 2021</xref>), but the ubiquitin linkage type it targets on &#x03B1;S remains unclear.</p>
</sec>
</sec>
<sec id="sec29">
<label>7</label>
<title>Cell free studies of the effects of ubiquitination of &#x03B1;S on fibril formation</title>
<p>The establishment of <italic>in vitro</italic> fibrillization assays and the ability to generate ubiquitinated &#x03B1;S by synthetic chemical methods has permitted the exploration of the effects of these modifications on formation of &#x03B1;S fibrils in cell free systems. Hejjaoui et al. created monoubiquitinated &#x03B1;S at K6 by linking two protein fragments: one from <italic>E. coli</italic> (residues 19&#x2013;140) and one synthetic (residues 1&#x2013;18) using a specially modified lysine (<italic>&#x03B4;</italic>-mercaptolysine) for ubiquitin conjugation (<xref ref-type="bibr" rid="ref86">Hejjaoui et al., 2011</xref>). K6-monoubiquitinated &#x03B1;S significantly inhibited &#x03B1;S fibrillization <italic>in vitro</italic>, while its interactions with synthetic lipid vesicles or phosphorylation by its kinases CK1, GFK5, and PLK3 remained unaffected (<xref ref-type="bibr" rid="ref86">Hejjaoui et al., 2011</xref>). K48-linked tetraubiquitin or diubiquitin chains conjugated at the &#x03B1;S K12 residue were similarly generated (<xref ref-type="bibr" rid="ref81">Haj-Yahya et al., 2013</xref>). <italic>In vitro</italic> fibrillization assays showed that wild-type &#x03B1;S developed mature fibrils after extended incubation (8&#x2009;days) as evaluated by TEM. In contrast, Tetra-Ub &#x03B1;S rapidly formed soluble but SDS-resistant aggregates within 48&#x2009;h, which remained amorphous and unable to form amyloid fibrils after prolonged incubation, suggesting fibrillization blockade. In contrast to unmodified &#x03B1;S, di- or tetraubiquitinated &#x03B1;S at K12 could not be phosphorylated at S129 by PLK3, indicating disruption of the interaction with the kinase due to ubiquitination. Furthermore, both di- and tetra ubiquitinated &#x03B1;S were phosphorylated at Y125 by Syk, but this phosphorylation led to their precipitation, while similarly phosphorylated wild-type &#x03B1;S which remained soluble. Di- and tetraubiquitinated &#x03B1;S were efficiently degraded by the proteasome in HeLa cell extracts, whereas monoubiquitinated &#x03B1;S had its ubiquitin cleaved and was not degraded.</p>
<p>Meier et al. adopted a disulfide-directed ubiquitination approach, mutating individual &#x03B1;S lysine residues as well as the C-terminal glycine of ubiquitin to cysteine to permit linkage of ubiquitin to &#x03B1;S via disulfide bonds (<xref ref-type="bibr" rid="ref158">Meier et al., 2012</xref>). Using this method, they generated monoubiquitinated &#x03B1;S variants (K6C, K10C, K12C, K21C, K23C, K32C, K34C, K43C, and K96C) for <italic>in vitro</italic> aggregation studies. Using thioflavin T fluorescence to monitor fibrillization, these studies revealed that while unmodified &#x03B1;S formed fibrils effectively, ubiquitination had varied effects depending on the modification site. K10C-Ub and K23C-Ub formed fibrils similar to wild-type &#x03B1;S, albeit with different kinetics. Modifications at K6C, K12C, and K21C inhibited fibril formation moderately, while ubiquitination at K32C, K34C, K43C, and K96C strongly inhibited fibril formation (<xref ref-type="bibr" rid="ref158">Meier et al., 2012</xref>). Electron microscopy supported these findings, showing mature fibrils for unmodified, K10C-Ub, and K23C-Ub, while other sites formed short fibrils or amorphous aggregates. Notably, K96C-Ub formed oligomeric structures detected by the A11 anti-oligomeric antibody, indicating that ubiquitination at a specific site can inhibit fibril formation and promote oligomerization (<xref ref-type="bibr" rid="ref158">Meier et al., 2012</xref>). Subsequent studies focusing on K6C-Ub, K23C-Ub, and K96C-Ub with more efficient and longer <italic>in vitro</italic> fibrillization protocols confirmed the inhibitory effects of these modifications on fibril formation, as evaluated by Thioflavin T (ThT) staining and TEM imaging (<xref ref-type="bibr" rid="ref161">Moon et al., 2020</xref>). The stability of the fibrils was assessed by susceptibility to digestion by Proteinase K. This analysis confirmed the findings from ThT and TEM, suggesting that K23C-Ub promotes heterogeneous aggregate formation, while K96C-Ub results in a distinct fibril structure. Atomic force microscopy measurements showed that K96C-Ub fibrils had a shorter height compared to wild-type fibrils, further indicating structural differences (<xref ref-type="bibr" rid="ref161">Moon et al., 2020</xref>). These findings collectively suggest that monoubiquitination of &#x03B1;S generally inhibits fibrillization and destabilizes protein aggregates.</p>
</sec>
<sec id="sec30">
<label>8</label>
<title>Conclusions and future perspectives</title>
<p>This review has illustrated the significant progress made in our understanding of the roles of ubiquitination of &#x03B1;S (<xref ref-type="table" rid="tab1">Tables 1</xref>, <xref ref-type="table" rid="tab2">2</xref>). A major function is its critical role in targeting &#x03B1;S to the endosomal/lysosomal system. The SCF-FBXL5 E3 complex and NEDD4-mediated K63-polyubiquitination can ubiquitinate fibrillar and endogenous &#x03B1;S, respectively, facilitating their uptake into endosomes and subsequent degradation in an NBR1 dependent manner. Consistent with this mechanism, &#x03B1;S colocalizes with endolysosomal vesicles, and its degradation is disrupted upon knockdown of key ESCRT machinery components, such as VPS28, VPS4, TSG101, CHMP3, and CHMP2B. Moreover, the deubiquitinase USP8, a counterpart to NEDD4, is also associated with endosomes and through its DUB activity inhibits <italic>&#x03B1;</italic>S lysosomal degradation. USP19/DNAJC5 promotes uptake of &#x03B1;S into late endosomes but this can promote secretion in addition to lysosomal degradation.</p>
<p>Although uptake of &#x03B1;S into endosomes plays a major role in targeting to lysosomes, macroautophagy still plays a role by clearing &#x03B1;S aggregates via aggrephagy. This involves LUBAC-mediated ubiquitination of &#x03B1;S, the aggrephagy adaptor proteins p62 and NBR1, and NEMO, all of which condense with linear ubiquitin chains at <italic>&#x03B1;</italic>S aggregates (<xref ref-type="bibr" rid="ref68">Furthmann et al., 2023</xref>). Although there is abundant evidence for ubiquitination of &#x03B1;S targeting it to the lysosomal system, we cannot exclude a minor role for the proteasome in &#x03B1;S degradation, though such degradation is likely limited to non-oligomeric/aggregated forms of &#x03B1;S.</p>
<p>Beyond proteolytic degradation, several lines of evidence&#x2014;albeit conflicting&#x2014;suggest that ubiquitination may modulate &#x03B1;S aggregation. SIAH1/2-mediated mono-ubiquitination of &#x03B1;S can promote insoluble aggregate formation in &#x03B1;S overexpression cell models under proteasome inhibition (<xref ref-type="bibr" rid="ref121">Lee et al., 2008</xref>; <xref ref-type="bibr" rid="ref191">Rott et al., 2008</xref>). Conversely, USP19&#x2019;s deubiquitination of &#x03B1;S can facilitate aggregate formation <italic>in vivo</italic> and in primary neurons with PFF seeding (<xref ref-type="bibr" rid="ref199">Schorova et al., 2023</xref>). This USP19 regulation may be explained by increased deubiquitination of <italic>&#x03B1;</italic>S leading to its propagation through MAPS-mediated &#x03B1;S secretion (<xref ref-type="bibr" rid="ref120">Lee et al., 2016</xref>) or direct structural effects of ubiquitin removal on &#x03B1;S (<xref ref-type="bibr" rid="ref199">Schorova et al., 2023</xref>). Indeed, <italic>in vitro</italic> studies have shown that &#x03B1;S ubiquitination can disrupt the autonomous fibrillization process, not only slowing fibrillization but also leading to the formation of amorphous aggregates or oligomers.</p>
<p>In addition to the potential role of ubiquitination in <italic>&#x03B1;</italic>S aggregation, emerging evidence suggests that alterations in trafficking of the above mentioned &#x03B1;S containing lipid vesicles may contribute to its aggregation (<xref ref-type="bibr" rid="ref74">Galvagnion et al., 2015</xref>; <xref ref-type="bibr" rid="ref100">Kakuda et al., 2024</xref>; <xref ref-type="bibr" rid="ref213">Stephens et al., 2023</xref>). Lipid components in LBs have long been recognized (<xref ref-type="bibr" rid="ref53">Duffy and Tennyson, 1965</xref>; <xref ref-type="bibr" rid="ref65">Forno and Norville, 1976</xref>; <xref ref-type="bibr" rid="ref72">Gai et al., 2000</xref>), and more recent studies have emphasized the significance of lipid organelle aggregation, including autophagosomes, lysosomes, and mitochondria in LB formation (<xref ref-type="bibr" rid="ref151">Mahul-Mellier et al., 2020</xref>; <xref ref-type="bibr" rid="ref202">Shahmoradian et al., 2019</xref>). In addition, the prion hypothesis for the propagation of LB pathology indicates that the release and subsequent uptake of pathogenic forms of <italic>&#x03B1;</italic>S plays an important role in the progression of disease over time. This is supported by observations that propagation of disease in mouse models occurs most efficiently in the presence of both endogenous production of <italic>&#x03B1;</italic>S as well as exogenous delivery of pathogenic aggregates of &#x03B1;S (<xref ref-type="bibr" rid="ref146">Luk et al., 2012</xref>; <xref ref-type="bibr" rid="ref147">Luk et al., 2009</xref>). These two sources of &#x03B1;S would most likely first come in contact in endosomes and traffic together into lysosomes.</p>
<p>Integrating all these findings, we propose a model for LB formation (<xref ref-type="fig" rid="fig4">Figure 4</xref>). (a) Under normal, basal conditions, &#x03B1;S turnover may be mediated by multiple mechanisms including CMA and the ubiquitin dependent proteasome pathway. Any &#x03B1;S oligomers or aggregates formed because of the inherent propensity of &#x03B1;S to misfold may be cleared in lysosomes through ubiquitin dependent endosomal microautophagy and aggrephagic mechanisms. (b) Under abnormal conditions when there are increased levels of intracellular <italic>&#x03B1;</italic>S and its misfolded/oligomeric forms or increased uptake of extracellular &#x03B1;S, overloading of &#x03B1;S in endosomal vesicles occurs. (c) The high levels of &#x03B1;S in endosomes/lysosomes increases the risk of rupture of the vesicles with release of the contents including aggregation prone species (such as truncated &#x03B1;S generated potentially by lysosomal hydrolases, oligomers and fragmented fibrils) (<xref ref-type="bibr" rid="ref100">Kakuda et al., 2024</xref>) and lipid fragments into the cytoplasm, creating a low pH microenvironment. This microenvironment facilitates the seeding of <italic>&#x03B1;</italic>S (<xref ref-type="bibr" rid="ref16">Buell et al., 2014</xref>; <xref ref-type="bibr" rid="ref63">Flagmeier et al., 2016</xref>; <xref ref-type="bibr" rid="ref74">Galvagnion et al., 2015</xref>; <xref ref-type="bibr" rid="ref80">Grey et al., 2011</xref>; <xref ref-type="bibr" rid="ref111">Kumari et al., 2021</xref>; <xref ref-type="bibr" rid="ref119">Lee et al., 2005</xref>) into aggregate-prone species. This in turn recruits autophagy adaptor proteins and free ubiquitin chains which sequester the aggregated <italic>&#x03B1;</italic>S, facilitate phase separation and provide additional seeds for aggregation. (d) Some of these species may become ubiquitinated which may impede fibrillization and promote degradation by aggrephagy or be retaken up by endosomes as in step (a). (e) With persistent overloading of the endosomes/lysosomes with these various forms of <italic>&#x03B1;</italic>S including pathogenic ones, a vicious cycle is created whereby aggregates continue to enlarge, particularly ones that have accumulated lipids and non-ubiquitinable proteins on the surface which would prevent aggrephagy but lead to LBs which bear ubiquitinated <italic>&#x03B1;</italic>S located primarily in the core of the aggregate.</p>
<fig position="float" id="fig4">
<label>Figure 4</label>
<caption>
<p>A proposed model for Lewy body formation: <bold>(a)</bold> Overloading of &#x03B1;S in endosomal vesicles can occur from overexpression of intracellular &#x03B1;S and uptake of extracellular &#x03B1;S. Ubiquitination of &#x03B1;S can facilitate the endosomal engulfment. <bold>(b)</bold> Rupture of endosomes or lysosomes in the cytosol is a stochastic event and in the absence of excessive loading in endosome, the released contents can be removed by macroautophagy (<xref ref-type="bibr" rid="ref100">Kakuda et al., 2024</xref>) some of which depends on &#x03B1;S ubiquitination. Rupture occurs more frequently with overloading of &#x03B1;S and presence of pathogenic forms of &#x03B1;S (mutants, oligomers, aggregates). <bold>(c)</bold> With prolonged overloading of and more frequent rupture of endosomes, there is accumulation of fragments of endolysosomal lipid vesicles and creation of a low pH microenviroment which facilitates the seeding of &#x03B1;S (<xref ref-type="bibr" rid="ref16">Buell et al., 2014</xref>; <xref ref-type="bibr" rid="ref63">Flagmeier et al., 2016</xref>; <xref ref-type="bibr" rid="ref74">Galvagnion et al., 2015</xref>; <xref ref-type="bibr" rid="ref80">Grey et al., 2011</xref>; <xref ref-type="bibr" rid="ref111">Kumari et al., 2021</xref>; <xref ref-type="bibr" rid="ref119">Lee et al., 2005</xref>) into aggregate-prone species such as oligomers and truncated species. Autophagy adaptor proteins and free ubiquitin chains sequester aggregated &#x03B1;S, facilitate phase separation, providing additional seeds for aggregation. <bold>(d)</bold> Some of these species may become ubiquitinated which may impede fibrillization and promote degradation by aggrephagy or be retaken up by endosomes as in step (a). <bold>(e)</bold> With persistent overloading of the endosomes/lysosomes with these various forms of &#x03B1;S including pathogenic ones, a vicious cycle is created whereby aggregates continue to enlarge, particularly ones that have accumulated lipids and non-ubiquitinable proteins on the surface. Such surfaces lacking ubiquitination would prevent aggrephagy but lead to LBs which typically contain ubiquitinated &#x03B1;S located primarily in the core of the aggregate.</p>
</caption>
<graphic xlink:href="fnmol-17-1498459-g004.tif"/>
</fig>
<p>To explore this model and the mechanisms involved, cellular systems which can be maintained for prolonged periods to allow LB like aggregates (e.g., positive staining for pS129-<italic>&#x03B1;</italic>S, ThT, or the association of membranous organelles with the concentric protein structure) to form are required. At this time, the best systems are primary neurons exposed to &#x03B1;S preformed fibrils and iPSC-derived neurons from PD patients bearing <italic>&#x03B1;</italic>S mutations. These neurons can spontaneously form pSyn aggregates and induce mitochondrial and synaptic dysfunctions (<xref ref-type="bibr" rid="ref49">Diao et al., 2021</xref>; <xref ref-type="bibr" rid="ref133">Lin et al., 2016</xref>; <xref ref-type="bibr" rid="ref145">Ludtmann et al., 2018</xref>). Furthermore, Tanudjojo et al. demonstrated that iPSC-derived neurons can effectively form LB-like aggregates upon extracellular PFF seeding (<xref ref-type="bibr" rid="ref220">Tanudjojo et al., 2021</xref>), The ability to apply to these systems genetic tools or specific inhibitors/activators that target specific steps in these pathways will help identify critical steps in the pathogenesis of toxic forms of <italic>&#x03B1;</italic>S and LBs. These could ultimately lead to development of therapies that could halt the progression of PD at early stages of disease when there is minimal functional impairment.</p>
<p>The above model seeks to explore comprehensively the role of &#x03B1;S ubiquitination in LB formation. It should be noted though that other potential effects of this ubiquitination remain unexplored. For example, it is unclear whether &#x03B1;S ubiquitination affects the physiological functions of &#x03B1;S monomers and tetramers, impacts intracellular trafficking (e.g., between synapses and neuronal soma) and secretion of pathological aggregates, or interacts with other post-translational modifications. Finally, there is ongoing debate regarding whether LBs are neurotoxic or represent a protective mechanism that sequesters toxic oligomers and aggregates.</p>
</sec>
</body>
<back>
<sec sec-type="author-contributions" id="sec31">
<title>Author contributions</title>
<p>H-HH: Conceptualization, Data curation, Writing &#x2013; original draft, Writing &#x2013; review &#x0026; editing. SW: Conceptualization, Funding acquisition, Supervision, Writing &#x2013; review &#x0026; editing.</p>
</sec>
<sec sec-type="funding-information" id="sec32">
<title>Funding</title>
<p>The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. The study was supported by United States Department of Defense Congressionally Directed Medical Research Programs Grant # PD170110, Parkinson&#x2019;s Canada, Canadian Institutes of Health Research Grant # FRN 168937 and McGill University Healthy Brains, Healthy Lives Program. HH was the recipient of studentship awards from the McGill Healthy Brains, Healthy Lives Canada First Research Excellence Fund and the Research Institute of the McGill University Health Center. These funders did not have any role in the writing of this manuscript.</p>
</sec>
<ack>
<p>OpenAI&#x2019;s GPT-4-turbo was used to summarize sections (e.g. results or discussion) of individual papers to efficiently identify key findings of papers being considered for citation in this review. Generative AI technologies were not used in any other capacity. The initial draft and subsequent editing of this manuscript were prepared solely by the authors.</p>
</ack>
<sec sec-type="COI-statement" id="sec33">
<title>Conflict of interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec sec-type="disclaimer" id="sec34">
<title>Publisher&#x2019;s note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>
<ref-list>
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