Abstract

Alzheimer’s disease (AD) is a heterogeneous disease and exhibits diverse clinical presentations and disease progression. Some pathological and anatomical subtypes have been proposed. However, these subtypes provide a limited mechanistic understanding for AD. Leveraging gene expression data of 222 AD patients from The Religious Orders Study and Memory and Aging Project (ROSMAP) Study, we identified two AD molecular subtypes (synaptic type and inflammatory type) using consensus non-negative matrix factorization (NMF). Synaptic type is characterized by disrupted synaptic vesicle priming and recycling and synaptic plasticity. Inflammatory type is characterized by disrupted IL2, interferon alpha and gamma pathways. The two AD molecular subtypes were validated using independent data from Gene Expression Omnibus. We further demonstrated that the two molecular subtypes are associated with APOE genotypes, with synaptic type more prevalent in AD patients with E3E4 genotype and inflammatory type more prevalent in AD patients with E3E3 genotype (p = 0.031). In addition, two molecular subtypes are differentially represented in male and female AD, with synaptic type more prevalent in male and inflammatory type in female patients (p = 0.051). Identification of AD molecular subtypes has potential in facilitating disease mechanism understanding, clinical trial design, drug discovery, and precision medicine for AD.

Highlights

  • Alzheimer’s disease (AD) is the most common neurodegenerative disease in elderly population, characterized by pathological extracellular deposition of beta-amyloid (Aβ) peptides and intracellular tau protein fibers in the brain [1]

  • We investigated the association of AD molecular subtype with patient demographic, clinical and APOE status variables

  • We examined the demographic distributions of AD molecular subtype, including age, sex, race and education, and assessed the associations of AD molecular subtype with APOE genotype and clinical variables, including Braak stage, The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) diagnosis, and Mini-Mental State Examination (MMSE) score

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Summary

Introduction

Alzheimer’s disease (AD) is the most common neurodegenerative disease in elderly population, characterized by pathological extracellular deposition of beta-amyloid (Aβ) peptides and intracellular tau protein fibers in the brain [1]. AD is a heterogenous and multifactorial disease, with diverse clinical presentations in different affected brain areas (left and right cerebral hemispheres as well as anterior-posterior axis) [2,3,4,5], different phenotypes (dysexecutive, amnesic and aphasic) [6, 7], and different rates of disease progression [8]. Recent studies suggested that Aβ aggregates in different biochemical composition [9].

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