Increased lysosomal exocytosis induced by lysosomal Ca channel agonists protects human dopaminergic neurons from α-synuclein toxicity.

The accumulation of misfolded proteins is a common pathological feature of many neurodegenerative disorders, including synucleinopathies such as Parkinson's disease (PD), which is characterized by the presence of alpha-synuclein (alpha-syn)-containing Lewy bodies. However, although recent studies have investigated alpha-syn accumulation and propagation in neurons, the molecular mechanisms underlying alpha-syn transmission have been largely unexplored. Here, we examined a monogenic form of synucleinopathy caused by loss-of-function mutations in lysosomal ATP13A2/PARK9. These studies revealed that lysosomal exocytosis regulates intracellular levels of alpha-syn in human neurons. Loss of PARK9 function in patient-derived dopaminergic neurons disrupted lysosomal Ca2+ homeostasis, reduced lysosomal Ca2+ storage, increased cytosolic Ca2+, and impaired lysosomal exocytosis. Importantly, this dysfunction in lysosomal exocytosis impaired alpha-syn secretion from both axons and soma, promoting alpha-syn accumulation. However, activation of the lysosomal Ca2+ channel transient receptor potential mucolipin 1 (TRPML1) was sufficient to upregulate lysosomal exocytosis, rescue defective alpha-syn secretion, and prevent alpha-syn accumulation. Together, these results suggest that intracellular alpha-syn levels are regulated by lysosomal exocytosis in human dopaminergic neurons and may represent a potential therapeutic target for PD and other synucleinopathies.