Abstract

Vulnerability to Alzheimer’s disease (AD) is increased by several risk factors, including midlife obesity, female sex, and the depletion of estrogens in women as a consequence of menopause. Conversely, estrogen-based hormone therapies have been linked with protection from age-related increases in adiposity and dementia risk, although treatment efficacy appears to be affected by the age of initiation. Potential interactions between obesity, AD, aging, and estrogen treatment are likely to have significant impact on optimizing the use of hormone therapies in postmenopausal women. In the current study, we compared how treatment with the primary estrogen, 17β-estradiol (E2), affects levels of AD-like neuropathology, behavioral impairment, and other neural and systemic effects of preexisting diet-induced obesity in female 3xTg-AD mice. Importantly, experiments were conducted at chronological ages associated with both the early and late stages of reproductive senescence. We observed that E2 treatment was generally associated with significantly improved metabolic outcomes, including reductions in body weight, adiposity, and leptin, across both age groups. Conversely, neural benefits of E2 in obese mice, including decreased β-amyloid burden, improved behavioral performance, and reduced microglial activation, were observed only in the early aging group. These results are consistent with the perspective that neural benefits of estrogen-based therapies require initiation of treatment during early rather than later phases of reproductive aging. Further, the discordance between E2 protection against systemic versus neural effects of obesity across age groups suggests that pathways other than general metabolic function, perhaps including reduced microglial activation, contribute to the mechanism(s) of the observed E2 actions. These findings reinforce the potential systemic and neural benefits of estrogen therapies against obesity, while also highlighting the critical role of aging as a mediator of estrogens’ protective actions.

Highlights

  • Alzheimer’s disease (AD) is a progressive neurodegenerative disorder that is the most common cause of dementia

  • Like other AD risk factors, the deleterious effects associated with obesity can be positively and negatively modulated by several factors, underscoring the need to understand how obesity interacts with other regulators of AD

  • We looked at how obesity, aging, and estradiol interact to affect AD neuropathology

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Summary

Introduction

Alzheimer’s disease (AD) is a progressive neurodegenerative disorder that is the most common cause of dementia. One important and highly prevalent modifiable AD risk factor is obesity; people who are overweight or Estradiol Protection Against Obesity obese in midlife are at significantly increased risk for development of AD and related dementias in late life (Alford et al, 2018). Because there are no effective disease-modifying therapeutics for AD, a promising interventional approach is to reduce vulnerability to AD by mitigating the effects of modifiable risk factors including obesity. Another important AD risk factor is female sex. Early surgical menopause and other causes of reduced lifetime exposure to estrogens are associated with elevated AD risk (Bove et al, 2014; Pike, 2017; Jang et al, 2018). Reproductive and/or chronological age may be critical variables in the efficacy of HT as preventive strategy for AD

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