In Vivo Length Distributions as Mechanistic Fingerprints of Pathological Protein Aggregation

Abstract: Modern imaging techniques can resolve individual pathological protein aggregates in postmortem human samples, providing detailed measurements of aggregate size distributions that are inaccessible with conventional bulk approaches. These distributions represent mechanistic fingerprints of the microscopic processes that generated the observed pathology, but extracting this mechanistic information requires a quantitative theoretical framework. Here, we develop the mathematical tools needed to interpret aggregate length distributions in living systems, where aggregate growth competes with active removal. We show that, across a class of models, the length distribution of sufficiently large aggregates approaches a geometric decay. Crucially, the decay rate is determined by the balance between aggregate elongation and removal, providing a direct quantitative readout of these competing processes from a single time point measurement. This enables mechanistic comparisons between healthy and diseased human samples without requiring longitudinal measurements of aggregate dynamics. We further analyse how additional aggregation and removal processes modify the observed length distributions. Together, these results establish the mathematical foundations and tools to use aggregate length distributions as an experimentally accessible route for inferring microscopic aggregation dynamics directly from human tissue.