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ResearchIn-Press PreviewImmunologyInflammationNeuroscience Open Access | 10.1172/JCI196112

Aging-dependent microglial heterogeneity worsens outcomes in models of traumatic brain injury

Zhichao Lu,1 Yi Shuai,2 Chenxing Wang,1 Zongheng Liu,3 Ziheng Wang,4 Qianqian Liu,1 Rui Jiang,1 Jue Zhu,1 Yongqi Zhu,1 Weiquan Liao,1 Xingjia Zhu,1 Jingwei Zhao,5 Kaibin Shi,6 Wei Shi,1 and Peipei Gong1

1Department of Neurosurgery, Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China

2Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong

3Department of Neurosurgery, Zhejiang Provincial Hospital of Chinese Medicine, Zhejiang, China

4MOE Frontier Science Centre for Precision Oncology, University of Macau, Macau, Macau

5Department of General Surgery, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China

6Department of Neurology, China National Clinical Research Center for Neurol, Capital Medical University, Beijing, China

Find articles by Lu, Z. in: PubMed | Google Scholar

1Department of Neurosurgery, Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China

2Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong

3Department of Neurosurgery, Zhejiang Provincial Hospital of Chinese Medicine, Zhejiang, China

4MOE Frontier Science Centre for Precision Oncology, University of Macau, Macau, Macau

5Department of General Surgery, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China

6Department of Neurology, China National Clinical Research Center for Neurol, Capital Medical University, Beijing, China

Find articles by Shuai, Y. in: PubMed | Google Scholar

1Department of Neurosurgery, Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China

2Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong

3Department of Neurosurgery, Zhejiang Provincial Hospital of Chinese Medicine, Zhejiang, China

4MOE Frontier Science Centre for Precision Oncology, University of Macau, Macau, Macau

5Department of General Surgery, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China

6Department of Neurology, China National Clinical Research Center for Neurol, Capital Medical University, Beijing, China

Find articles by Wang, C. in: PubMed | Google Scholar

1Department of Neurosurgery, Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China

2Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong

3Department of Neurosurgery, Zhejiang Provincial Hospital of Chinese Medicine, Zhejiang, China

4MOE Frontier Science Centre for Precision Oncology, University of Macau, Macau, Macau

5Department of General Surgery, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China

6Department of Neurology, China National Clinical Research Center for Neurol, Capital Medical University, Beijing, China

Find articles by Liu, Z. in: PubMed | Google Scholar

1Department of Neurosurgery, Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China

2Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong

3Department of Neurosurgery, Zhejiang Provincial Hospital of Chinese Medicine, Zhejiang, China

4MOE Frontier Science Centre for Precision Oncology, University of Macau, Macau, Macau

5Department of General Surgery, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China

6Department of Neurology, China National Clinical Research Center for Neurol, Capital Medical University, Beijing, China

Find articles by Wang, Z. in: PubMed | Google Scholar |

1Department of Neurosurgery, Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China

2Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong

3Department of Neurosurgery, Zhejiang Provincial Hospital of Chinese Medicine, Zhejiang, China

4MOE Frontier Science Centre for Precision Oncology, University of Macau, Macau, Macau

5Department of General Surgery, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China

6Department of Neurology, China National Clinical Research Center for Neurol, Capital Medical University, Beijing, China

Find articles by Liu, Q. in: PubMed | Google Scholar

1Department of Neurosurgery, Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China

2Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong

3Department of Neurosurgery, Zhejiang Provincial Hospital of Chinese Medicine, Zhejiang, China

4MOE Frontier Science Centre for Precision Oncology, University of Macau, Macau, Macau

5Department of General Surgery, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China

6Department of Neurology, China National Clinical Research Center for Neurol, Capital Medical University, Beijing, China

Find articles by Jiang, R. in: PubMed | Google Scholar

1Department of Neurosurgery, Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China

2Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong

3Department of Neurosurgery, Zhejiang Provincial Hospital of Chinese Medicine, Zhejiang, China

4MOE Frontier Science Centre for Precision Oncology, University of Macau, Macau, Macau

5Department of General Surgery, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China

6Department of Neurology, China National Clinical Research Center for Neurol, Capital Medical University, Beijing, China

Find articles by Zhu, J. in: PubMed | Google Scholar

1Department of Neurosurgery, Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China

2Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong

3Department of Neurosurgery, Zhejiang Provincial Hospital of Chinese Medicine, Zhejiang, China

4MOE Frontier Science Centre for Precision Oncology, University of Macau, Macau, Macau

5Department of General Surgery, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China

6Department of Neurology, China National Clinical Research Center for Neurol, Capital Medical University, Beijing, China

Find articles by Zhu, Y. in: PubMed | Google Scholar

1Department of Neurosurgery, Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China

2Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong

3Department of Neurosurgery, Zhejiang Provincial Hospital of Chinese Medicine, Zhejiang, China

4MOE Frontier Science Centre for Precision Oncology, University of Macau, Macau, Macau

5Department of General Surgery, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China

6Department of Neurology, China National Clinical Research Center for Neurol, Capital Medical University, Beijing, China

Find articles by Liao, W. in: PubMed | Google Scholar

1Department of Neurosurgery, Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China

2Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong

3Department of Neurosurgery, Zhejiang Provincial Hospital of Chinese Medicine, Zhejiang, China

4MOE Frontier Science Centre for Precision Oncology, University of Macau, Macau, Macau

5Department of General Surgery, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China

6Department of Neurology, China National Clinical Research Center for Neurol, Capital Medical University, Beijing, China

Find articles by Zhu, X. in: PubMed | Google Scholar

1Department of Neurosurgery, Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China

2Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong

3Department of Neurosurgery, Zhejiang Provincial Hospital of Chinese Medicine, Zhejiang, China

4MOE Frontier Science Centre for Precision Oncology, University of Macau, Macau, Macau

5Department of General Surgery, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China

6Department of Neurology, China National Clinical Research Center for Neurol, Capital Medical University, Beijing, China

Find articles by Zhao, J. in: PubMed | Google Scholar

1Department of Neurosurgery, Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China

2Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong

3Department of Neurosurgery, Zhejiang Provincial Hospital of Chinese Medicine, Zhejiang, China

4MOE Frontier Science Centre for Precision Oncology, University of Macau, Macau, Macau

5Department of General Surgery, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China

6Department of Neurology, China National Clinical Research Center for Neurol, Capital Medical University, Beijing, China

Find articles by Shi, K. in: PubMed | Google Scholar

1Department of Neurosurgery, Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China

2Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong

3Department of Neurosurgery, Zhejiang Provincial Hospital of Chinese Medicine, Zhejiang, China

4MOE Frontier Science Centre for Precision Oncology, University of Macau, Macau, Macau

5Department of General Surgery, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China

6Department of Neurology, China National Clinical Research Center for Neurol, Capital Medical University, Beijing, China

Find articles by Shi, W. in: PubMed | Google Scholar

1Department of Neurosurgery, Research Center of Clinical Medicine, Affiliated Hospital of Nantong University, Medical School of Nantong University, Nantong, China

2Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong

3Department of Neurosurgery, Zhejiang Provincial Hospital of Chinese Medicine, Zhejiang, China

4MOE Frontier Science Centre for Precision Oncology, University of Macau, Macau, Macau

5Department of General Surgery, Xinhua Hospital, Shanghai Jiaotong University, Shanghai, China

6Department of Neurology, China National Clinical Research Center for Neurol, Capital Medical University, Beijing, China

Find articles by Gong, P. in: PubMed | Google Scholar

Published April 2, 2026 - More info

J Clin Invest. https://doi.org/10.1172/JCI196112.
Copyright © 2026, Lu et al. This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
Published April 2, 2026 - Version history
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Abstract

Traumatic brain injury (TBI) disproportionately affects the elderly, yet the underlying mechanisms remain unclear. Here, we demonstrate that aged TBI brains predominantly harbor pro-inflammatory NLRP3+ microglia, in stark contrast to the neuroprotective Lysozyme+ microglia prevalent in young TBI brains. This age-dependent microglial dichotomy correlates with elevated mortality and impaired recovery in aged TBI mice. By leveraging an integrative multi-omics approach combined with metabolomics and epigenome analysis, we identify a previously unrecognized link between enhanced glycolysis and pro-inflammatory chromatin landscape in NLRP3+ microglia. Further investigation identifies ELF1 as a key transcription factor driving NLRP3+ microglia formation. Importantly, ablation of ELF1 reverses age-associated microglial dysfunction and improves TBI outcomes. Finally, we discover that Imeglimin, a clinically approved antihyperglycemic agent capable of crossing the blood brain barrier, inhibits ELF1 and reverses microglial phenotype, reducing acute mortality rate and leading to improved functional recovery of aged TBI mice. Our work elucidates the mechanistic basis of age-dependent TBI outcomes, reveals the crosstalk between metabolic rewiring and epigenetic regulation in microglial aging, and identifies ELF1 as a promising therapeutic target for improving TBI outcome.

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