What can a yak living thousands of meters above sea level teach us about repairing the human brain?

In Episode 56 of From First Principles, Lester Nare and Krishna Choudhary break down a new Neuron paper that traces an evolutionary adaptation found in high-altitude animals to a previously hidden pathway involved in building and repairing myelin.

Summary

  • What myelin actually does and why losing it disrupts neural communication
  • How multiple sclerosis damages myelin and why the brain’s natural repair process eventually fails
  • Why oligodendrocyte precursor cells can remain present in damaged tissue without successfully rebuilding myelin
  • Why current therapies are better at slowing further damage than restoring what has already been lost
  • The challenge of getting drugs across the blood-brain barrier while maintaining target specificity
  • How evolutionary pharmacology has previously produced medicines from adaptations found in snakes and Gila monsters
  • The RETSAT Q247R variant identified in animals adapted to the hypoxic environment of the Tibetan Plateau
  • How researchers engineered the high-altitude variant into mice and tested its effect on myelin
  • The surprising discovery that neurons — rather than the myelin-producing cells themselves — generate the key repair signal
  • How RETSAT increases ATDR, which neurons convert into ATDRA
  • How ATDRA activates RXR-γ in oligodendrocyte precursor cells and promotes their differentiation
  • How administration of ATDR promoted remyelination across multiple preclinical models
  • Why the result is scientifically promising but still far from a proven human treatment

Featured Paper

A gain-of-function Retsat variant from high-altitude adaptation promotes myelination via a neuronal dihydroretinoic acid-RXR-γ pathway
Neuron, 2026
DOI: 10.1016/j.neuron.2026.01.013


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