Data have shown that TREM2 plays a vital role in the cognitive function of the brain. An important function of TREM2 is its regulation of phagocytosis in microglia. Microglial removal of damaged cells, organic matrix molecules, and biomacromolecules must be assisted by the TREM2-DAP12 receptor complex. As a glial cell immunoreceptor, TREM2 has been found to modulate microglia-mediated inflammatory responses [
41]. A decade ago, Gordon described the mechanism of two opposite types of macrophage activation [
42], but now, the type M1 and M2 are widely used to define classically (proinflammatory) and alternatively activated (anti-inflammatory) microglia, which is controversial [
43]. Outside the CNS, the mononuclear phagocyte system has been divided into M1 phenotype and M2 phenotype. Study shows that in the CNS, because that microglial activation is heterogeneous, the microglia can also be categorized into two opposite types: M1 phenotype and M2 phenotype [
44]. Therefore, we conjecture that in the brain, microglia have two opposite roles, proinflammatory (M1, cytotoxic) and anti-inflammatory (M2, neuroprotective). TREM2 inhibits neurotransmitters by blocking M2 microglia. This may reveal the potential mechanism by which TREM2 inhibits microglial inflammatory responses [
45]. The microglial cells participate in the removal of Aβ aggregates through phagocytosis. Previous study found that TREM2 overexpression by intracerebral lentiviral particle injection significantly reduced soluble and insoluble Aβ42 aggregates in the brain. In middle-aged APPswe/PS1ΔE9 mice (7–8 months old), the ability of microglia to remove amyloid plaques increased after TREM2 overexpression, and the density of amyloid plaques in the brain decreased [
20]. However, in a mouse model of TREM2 defects, the concentration of amyloid plaques in the brain did not change [
46]. Interestingly, after the expression of TREM2 in 18-month-old APPswe/PS1ΔE9 mice, the concentration of amyloid plaques was not attenuated, and no alterations in the levels of Aβ42 were observed in the brain [
46]. Research utilizing mouse models has shown that the overexpression of TREM2 plays a protective role in both early- and mid-term AD, whereas this protective effect is lost in late-term AD [
47]. We speculate that the reduced number of microglia in the brains of older mice may lead to a decline in phagocytosis.
The high level of phosphorylation and abnormal aggregation of tau protein are pathophysiological factors associated with neuronal and synaptic damage. The loss of neurons and synapses in the hippocampus is associated with a decrease in spatial cognitive function. The 7-month-old P301S mouse model has been shown to exhibit significant neuronal and synaptic damage to this region. Overexpression of TREM2 is effective in inhibiting these lesions; water maze experiments have demonstrated that TREM2 overexpression can restore spatial cognitive impairment in mice [
47]. In addition, the overexpression of TREM2 by intracerebral lentiviral particles injection has been found to significantly improve hyperphosphorylation of tau proteins and reduce the activity of cyclin-dependent kinase 5 (CDK5) and glycogen synthase kinase-3β (GSK3β) [
45]. Thus, TREM2 overexpression significantly reduces neuronal loss and may play a role in the phosphorylation of tau protein, thereby reducing the incidence of AD.
A recent study showed that TREM2 releases its extracellular domain after protease cleavage, leaving only the carboxy-terminal fragment (CTF) attached to the membrane [
48]. Soluble TREM2 (sTREM2) may be produced by proteolytic cleavage and alternative splicing. If insertions [
49] or frameshifts [
50] occur in exon 4, it can terminate the transmembrane domain, which is speculated to yield a soluble product. In addition to the membrane-bound form, sTREM2 has been detected in the supernatants of human [
51] and mouse [
51] cell cultures and in the peripheral blood and cerebrospinal fluid (CSF) [
52]. The sTREM2 in human peripheral blood and CSF can be used as a more accurate tool for understanding the biological effects of TREM2 in the pathogenesis of AD. Hu et al. analyzed the expression of TREM2 mRNA and protein in the peripheral blood in a population of Northern Han Chinese [
53]. The results showed that on the level of mRNA and protein, TREM2 expression were higher on monocytes, granulocytes, and in plasma in AD group compared with that of control groups. Mori et al. performed a similar analysis of TREM2 expression in the peripheral blood in a small population of Japanese individuals (26 patients with AD, 8 males and 18 females) [
54]. However, another study mentioned that the absolute level of TREM2 expression in human peripheral blood monocytes is quite low and unlikely to be useful for drawing mechanistic conclusions about TREM2 [
55]. The upregulation of TREM2 in the peripheral blood indicates that the gene is abnormally active in the development of AD pathology. More experiments are needed to confirm whether TREM2 was differently expressed in the peripheral blood in some populations. The level of sTREM2 in the CSF also exhibits changes. Although Kleinberge et al. showed that sTREM2 levels were reduced in the CSF of AD patients [
56], other studies have shown that sTREM2 levels in the CSF increased with age and were positively correlated with the levels of Aβ42 and tau protein [
26,
57‐
59].