<i>Porphyromonas gingivalis</i> in Alzheimer’s disease brains: Evidence for disease causation and treatment with small-molecule inhibitors

<i>Porphyromonas gingivalis</i>, the keystone pathogen in chronic periodontitis, was identified in the brain of Alzheimer's disease patients. Toxic proteases from the bacterium called gingipains were also identified in the brain of Alzheimer's patients, and levels correlated with tau and ubiquitin pathology. Oral <i>P. gingivalis</i> infection in mice resulted in brain colonization and increased production of Aβ_1-42, a component of amyloid plaques. Further, gingipains were neurotoxic in vivo and in vitro, exerting detrimental effects on tau, a protein needed for normal neuronal function. To block this neurotoxicity, we designed and synthesized small-molecule inhibitors targeting gingipains. Gingipain inhibition reduced the bacterial load of an established <i>P. gingivalis</i> brain infection, blocked Aβ_1-42 production, reduced neuroinflammation, and rescued neurons in the hippocampus. These data suggest that gingipain inhibitors could be valuable for treating <i>P. gingivalis</i> brain colonization and neurodegeneration in Alzheimer's disease.