Abstract

BackgroundSeveral lines of evidence suggest that high-density lipoprotein (HDL) reduces Alzheimer’s disease (AD) risk by decreasing vascular beta-amyloid (Aβ) deposition and inflammation, however, the mechanisms by which HDL improve cerebrovascular functions relevant to AD remain poorly understood.MethodsHere we use a human bioengineered model of cerebral amyloid angiopathy (CAA) to define several mechanisms by which HDL reduces Aβ deposition within the vasculature and attenuates endothelial inflammation as measured by monocyte binding.ResultsWe demonstrate that HDL reduces vascular Aβ accumulation independently of its principal binding protein, scavenger receptor (SR)-BI, in contrast to the SR-BI-dependent mechanism by which HDL prevents Aβ-induced vascular inflammation. We describe multiple novel mechanisms by which HDL acts to reduce CAA, namely: i) altering Aβ binding to collagen-I, ii) forming a complex with Aβ that maintains its solubility, iii) lowering collagen-I protein levels produced by smooth-muscle cells (SMC), and iv) attenuating Aβ uptake into SMC that associates with reduced low density lipoprotein related protein 1 (LRP1) levels. Furthermore, we show that HDL particles enriched in apolipoprotein (apo)E appear to be the major drivers of these effects, providing new insights into the peripheral role of apoE in AD, in particular, the fraction of HDL that contains apoE.ConclusionThe findings in this study identify new mechanisms by which circulating HDL, particularly HDL particles enriched in apoE, may provide vascular resilience to Aβ and shed new light on a potential role of peripherally-acting apoE in AD.

Highlights

  • Several lines of evidence suggest that high-density lipoprotein (HDL) reduces Alzheimer’s disease (AD) risk by decreasing vascular beta-amyloid (Aβ) deposition and inflammation, the mechanisms by which HDL improve cerebrovascular functions relevant to AD remain poorly understood

  • cerebral amyloid angiopathy (CAA) is highly associated with the Flemish, Iowa and Dutch genetic mutations in amyloid precursor protein, sporadic CAA is present in 10–40% of non-cognitively declined elderly brains and in 80% of AD brains [7, 40]

  • CAA is modeled by injecting monomeric Aβ into the tissue chamber of the bioreactor at the indicated final concentrations to mimic Aβ produced by neurons that would be located around vessels

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Summary

Introduction

Several lines of evidence suggest that high-density lipoprotein (HDL) reduces Alzheimer’s disease (AD) risk by decreasing vascular beta-amyloid (Aβ) deposition and inflammation, the mechanisms by which HDL improve cerebrovascular functions relevant to AD remain poorly understood. Alzheimer’s Disease (AD) is defined by the presence of beta-amyloid (Aβ) deposits and neurofibrillary tangles in the brain and affects over 50 million people worldwide with a global economic burden closed to one trillion US dollars [1]. One exception may be the anti-amyloid immunotherapy aducanumab, which clears amyloid from the brain [3] and appears to slow cognitive decline at the highest dose so far tested [4]. Amyloid related imaging abnormities (ARIA), including edema (ARIA-E) and microhemorrhage (ARIA-H) are adverse effects associated with anti-amyloid immunotherapies and these risks are elevated in elderly people with cerebrovascular disease [5]. Novel preventative and therapeutic approaches are urgently needed, with respect to the vascular contributions to AD

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