26Alzheimer's disease (AD) is the most common neurodegenerative disease affecting 27 the elderly worldwide. Mitochondrial dysfunction has been proposed as a key event in 28 the etiology of AD. We have previously modeled amyloid-beta (Aβ)-induced 29 mitochondrial dysfunction in a transgenic Caenorhabditis elegans strain by 30 expressing human Aβ peptide specifically in neurons (GRU102). Here, we focus on a 31 deeper analysis of these metabolic changes associated with A-induced mitochondrial 32 dysfunction. Integrating metabolomics, transcriptomics, biochemical studies and 33 computational modeling, we identify alterations in Tricarboxylic Acid (TCA) cycle 34 metabolism following even low-level Aβ expression. In particular, GRU102 show 35 reduced activity of a rate-limiting TCA cycle enzyme, alpha-ketoglutarate 36 dehydrogenase. These defects are associated with elevation of protein carbonyl 37 content specifically in mitochondria. Importantly, metabolic failure occurs before any 38 significant increase in global protein aggregate is detectable. Treatment with an anti-39 diabetes drug, Metformin, reverses A-induced metabolic defects, reduces protein 40 aggregation and normalizes the lifespan of GRU102. Our results point to metabolic 41 dysfunction as an early and causative event in AD pathology and a promising target 42 for intervention. 43 44 45 46 47 48 49 50 51 Introduction 52Alzheimer's disease (AD) is a debilitating neurodegenerative disease, that is clinically 53 characterized by the formation of amyloid-beta (A) plaques and aggregates of 54 hyperphosphorylated tau protein in the brain 1 . Even though AD is primarily a 55 neuronal disorder, perturbations in mitochondrial functions including energy 56 metabolism have consistently been observed not only in the brain 2-4 but also in non-57 neuronal cells derived from AD subjects, including in fibroblasts and platelets [5][6][7][8][9][10] . 58These findings form part of an emerging story that there is an important metabolic 59 component to the etiology of AD 11 , and that these metabolic defects may precede A 60 aggregate formation 12,13 . The metabolism-related hypothesis of AD therefore posits 61 that AD is, in part, mediated by impairments to the brain's insulin response, which 62 promotes oxidative stress and inflammation, similar to that seen in diabetes 11,14 . 63Intranasal insulin treatment has been shown to ameliorate AD pathology in a 64 transgenic rat model and to improve mild cognitive impairment (MCI) in patients [15][16][17][18] . 65
66Several animal studies have confirmed that oxidative stress, mitochondrial 67 dysfunction and metabolic alterations are early events in the pathophysiological 68 progression of AD. Energy deficits, reduction in mitochondrial membrane potential, 69 abnormal mitochondrial gene expression and increased oxidative stress have been 70 observed early in transgenic AD mice (2-3 months of age) well before the appearance 71 of A plaques 19,20 . The A-induced oxidative stress hypothesis further posits that A, 72 predomi...