A central challenge in modeling neurodegenerative diseases is connecting cellular-level mecha- nisms to tissue-level pathology, in particular to determine whether pathology is driven primarily by cell-autonomous triggers or by propagation from cells that are already in a pathological, runaway aggregation state. To bridge this gap, we here develop a bottom-up physical model that explicitly incorporates these two fundamental cell-level drivers of protein aggregation dynamics. We show that our model naturally explains the characteristic long, slow development of pathology followed by a rapid acceleration, a hallmark of many neurodegenerative diseases. Furthermore, the model reveals the existence of a critical switch point at which the system’s dynamics transition from being dominated by slow, spontaneous formation of diseased cells to being driven by fast propagation. This framework provides a robust physical foundation for interpreting pathological data and offers a method to predict which class of therapeutic strategies is best matched to the underlying drivers of a specific disease.
Klenerman et al. (Wed,) studied this question.