Risk Of Late-onset Alzheimer's Disease Research Articles

Interaction of CTSD and A2M polymorphisms in the risk for Alzheimer's disease

The proteins cathepsin D, encoded by CTSD gene, and α 2-macroglobulin, encoded by A2M gene, are involved in the biochemical pathway leading to deposition of β-amyloid. In these proteins two amino acid polymorphisms (CTSD- Ala/Val C→ T and A2M -Ile/Val A→ G) have been associated with an increased risk for Alzheimer's disease (AD), but conflicting results have been reported. We studied the association and the mutual interactions of the CTSD- C/T and A2M -A/G polymorphisms with sporadic AD in 100 patients with late-onset AD and 136 healthy elderly subjects as controls. The CTSD- T allele and the CTSD- C/T genotype are significantly more frequent in AD than in controls. The odds ratio (OR) for CTSD- T subjects is 1.93 [95% confidence interval (CI) = 1.01–3.72], and 2.07 (95% CI = 1.01–4.21) after adjustment for age, sex and APOE ε4+ status, while no significant association was found for the A2M- A/G polymorphism. The coexistence of the CTSD- T with the A2M- G allele synergistically increased the OR for AD to 2.69 (95% CI = 1.13–6.34) [2.82 (95% CI = 1.12–7.17) after adjustment], and to 3.29 (95% CI = 1.33–8.16) if estimated for the allelic combination. Our data suggest that the CTSD- T allele of the CTSD- C/T polymorphism is associated with an increased relative risk for late-onset AD and, more interestingly, the combination of CTSD- T with the A2M- G allele seems to increase this risk.

Gender-specific association of ATP-binding cassette transporter 1 (ABCA1) polymorphisms with the risk of late-onset Alzheimer's disease

Alzheimer's disease (AD) is a multifactorial neurodegenerative disorder caused by a complex interaction of genetic and environmental factors. Increasing evidence highlights a potential role for cholesterol in the pathophysiology of AD. The ABCA1 gene, located in close vicinity to the 9q linkage peaks identified by genome-wide AD linkage studies, plays an important role in cellular cholesterol efflux, and is likely a good candidate gene. However, results from published genetic association studies between ABCA1 and AD are ambiguous. In the present study, we examined the role of two ABCA1 polymorphisms, R219K (rs2230806) and G-17C (rs2740483) in modifying the risk of late-onset AD (LOAD) in a large American white cohort of 992 AD cases and 699 controls. We observed significant gender×R219K interaction (p=0.00008). Female carriers of the 219K allele showed a 1.75-fold increased risk of developing AD compared to non-219K carrier females (95% CI 1.34–2.29; p=0.00004). The overall two-site haplotype distribution was also significant between female AD cases and controls (p=0.017). The risk associated with the R219K polymorphism was independent of the recently reported significant association in the ubiquilin (UBQLN1) gene in this region on chromosome 9q. Our data suggest a gender-specific and APOE and UBQLN1 independent association between the ABCA1/R219K polymorphism and LOAD.

Genetic basis of Alzheimer's dementia: role of mtDNA mutations

Alzheimer's disease (AD) is the most common neurodegenerative disorder associated to dementia in late adulthood. Amyloid precursor protein, presenilin 1 and presenilin 2 genes have been identified as causative genes for familial AD, whereas apolipoprotein E epsilon4 allele has been associated to the risk for late onset AD. However, mutations on these genes do not explain the majority of cases. Mitochondrial respiratory chain (MRC) impairment has been detected in brain, muscle, fibroblasts and platelets of Alzheimer's patients, indicating a possible involvement of mitochondrial DNA (mtDNA) in the aetiology of the disease. Several reports have identified mtDNA mutations in Alzheimer's patients, suggesting the existence of related causal factors probably of mtDNA origin, thus pointing to the involvement of mtDNA in the risk contributing to dementia, but there is no consensual opinion in finding the cause for impairment. However, mtDNA mutations might modify age of onset, contributing to the neurodegenerative process, probably due to an impairment of MRC and/or translation mechanisms.

In This Issue: The Genetic, Transcriptomic, and Proteomic Study of Alzheimer's Disease

Article AbstractBecause this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text.Last year, we inaugurated a series of occasional research and scholarly review articles with the intent of capturing some of the progress now being made in the scientific understanding, diagnosis, treatment, and prevention of Alzheimer's disease (AD). In this issue of The Journal of Clinical Psychiatry, Andreas Papassotiropoulos, Michael Fountoulakis, Travis Dunckley, Dietrich Stephan, and I consider the progress now being made in the genetic, transcriptomic, and proteomic study of AD.Twin studies suggest that about 75% of the risk for late-onset AD may be attributable to heritable risk factors.

Therapy Insight: type 2 diabetes mellitus and the risk of late-onset Alzheimer's disease

A number of well-designed epidemiological studies have linked type 2 diabetes mellitus (T2DM) with an increased risk of Alzheimer's disease (AD). Several mechanisms could help to explain this proposed link, including insulin and insulin resistance, inflammatory cytokines, and oxidative stress. Obesity or physical inactivity might also influence AD through effects on hypertension, insulin sensitivity or inflammation. Typical AD pathology, such as amyloid-beta deposits, might be exacerbated by insulin dysregulation, T2DM itself, or microvascular disease that is a consequence of T2DM. T2DM patients are not routinely evaluated for cognitive outcomes, and cognitive impairment in T2DM is rarely treated. Similarly, AD patients are not routinely evaluated for T2DM or hyperinsulinemia. Current treatments for AD have only modest benefits, and several drugs that target metabolic and inflammatory pathways are being evaluated, most notably the statins, which reduce LDL and inflammation but might not influence amyloid- deposition, an important precursor for AD. Although some evidence supports a potentially important role for peroxisome proliferative activated receptor agonists such as glitazones, at present there are no published randomized clinical trials in AD patients of any drugs that target insulin or insulin resistance. Clinical implications of the T2DM-AD link include cognitive evaluations of patients with T2DM, and potential benefits for such patients through treatment with statins or diabetes drugs that target insulin.

The Insertion Polymorphism in Angiotensin-Converting Enzyme Gene Associated With the APOE ε4 Allele Increases the Risk of Late-Onset Alzheimer Disease

Several studies have shown that a common insertion (I)/deletion (D) polymorphism of angiotensin-converting enzyme (ACE) gene may confer an increased risk of late-onset Alzheimer disease (LOAD). However, the result has not been replicated by all studies. In order to clarify the role of the polymorphism for the occurrence of LOAD in Chinese and the possibility of a synergistic effect with the apolipoprotein E allele 4 on the risk of Alzheimer disease, we examined the ACE and APOE genotypes in a Chinese sample consisting of 104 sporadic LOAD patients and 128 healthy controls. An obvious difference of allelic and genotypic distributions of ACE I/D polymorphism between cases and controls was observed (chi2 = 6.61, df = 2, p = 0.037 by genotype; chi2 = 4.67, df = 1, p = 0.031 by allele). And ACE I allele carriers showed an increased risk for LOAD developing (chi2 = 6.59, df = 1, p =0.01, OR = 2.91, 95% CI 1.25-6.77). After stratifying by APOE epsilon 4 status, the increased LOAD risks associated with I allele carriers only in the APOE epsilon 4 noncarriers was seen (chi2 = 4.12, df = 1, p = 0.042). Logistic regression analysis of total subjects demonstrated a more than sevenfold increase in the risk of developing LOAD in subjects carrying both the ACE I allele and the APOE epsilon 4 (OR = 7.39, 95% CI 2.50-21.89, p < 0.001). Our data revealed that ACE I/D polymorphism is considered to be an additional risk factor, which has strong synergistic interaction with APOE epsilon 4 on the risk of LOAD.

Translational research on the way to effective therapy for Alzheimer disease.

Alzheimer disease (AD) is a major public health issue with a prediction of 12 million Americans being affected by 2025 from the present 4 million. Molecular and genetic findings have provided significant insights into the roles that amyloid, tau, and apolipoprotein E isoforms have in the causation of AD. A central issue in AD pathogenesis is the amyloid cascade hypothesis. It states that abnormal amyloid processing and accumulation is the primary causative factor of AD and other associated neuropathologic abnormalities are of secondary consequence. It is presented to provide the rationale for novel drug and vaccination therapeutic strategies. Future research directed at prediction and prevention of AD through a genomic and proteomic analysis with identification of multiple polymorphic genes that interact, resulting in increased risk for late-onset AD, are the realistic and ultimate goals. A new approach for drug development is required, one that will emphasize a genomic and proteomic analysis to identify at-risk gene sets whose genetic expression is sufficient to cause late onset, sporadic AD. Prediction and prevention of disease prior to clinical signs and symptoms are the goals. A review and analysis from electronic literature databases and subsequent reference searches of the molecular genetic data. including pertinent genetic mutations and abnormal biochemical findings causal of AD, are cited. The amyloid cascade hypothesis, the contributions of apolipoprotein E, and hyperphosphorylated tau are discussed as to their roles in pathogenesis. Molecular targets for potential drug and vaccination therapies are cited from a critical assessment of the molecular and biomedical data. These data form the basis for rational, target-specific drug and vaccination therapies currently employed and planned for the near future. Phase 2 and 3 clinical trial results of drug and vaccination therapies are cited. A new approach is needed as current pharmacologic therapy directed at symptomatic relief has proved to be marginally effective. The genomic and proteomic basis of AD will be defined in the near future, and corresponding molecular therapeutic targets will be identified. Genomic neurology has arrived and its application to resolving AD is our best hope.

The UBQLN1 polymorphism, UBQ-8i, at 9q22 is not associated with Alzheimer's disease with onset before 70 years

An intronic polymorphism affecting alternative splicing of exon 8 of ubiquilin 1 ( UBQLN1), that is located at a well established Alzheimer's disease (AD) locus on chromosome 9q22, was recently associated with increased risk for late-onset AD. We analyzed this polymorphism in two independent AD samples consisting of patients with an onset age 70 years or less, but did not observe statistically significant association. Our study does not support a major role for this UBQLN1 polymorphism in AD patients with an earlier onset of disease.

Association Study of the A2M and LRP1 Genes with Alzheimer Disease in the Han Chinese

Low-density lipoprotein receptor-related protein 1 (LRP1) and alpha-2-macroglobulin (A2M) are two plausible candidate genes for Alzheimer disease (AD) based on their important biological function and positional information. To date, numerous studies have investigated their possible association with AD but the results are controversial. To investigate the potential genetic contribution of the two genes in the Han Chinese population, we performed a case-control association study using 10 polymorphisms (4 in LRP1 and 6 in A2M) that span approximately the whole corresponding gene. Comparison of allele, genotype, and haplotype frequencies for polymorphisms in A2M revealed no significant differences between patients and control subjects. For the LRP1 gene, however, we found an overrepresentation of the CTCG haplotype in the control group (p = .002). The difference was still of statistical significance in the apolipoprotein E (APOE) epsilon 4 negative subjects (p(CTCG) = .003). Multiple logistic regression analysis did not show any evidence of synergism between A2M, LRP1, and APOE. Our results indicate that the CTCG haplotype of LRP1 may reduce the risk of late-onset AD, but A2M is not associated with this disease in the Han Chinese population.

Chromosome 21 BACE2 haplotype associates with Alzheimer's disease: A two-stage study

Genetic linkage studies have provided evidence for a late-onset Alzheimer's disease (AD) susceptibility locus on chromosome 21q. We have tested, in a two-stage association study, whether allelic or haplotype variation of the beta-amyloid cleaving enzyme-2 ( BACE2) locus on chromosome 21q affects the risk of late-onset AD. In stage-1, an unselected population-based sample of Finns aged 85 years or over ( n = 515) was analysed. Neuropathologic examination including beta-amyloid load quantification was possible in over 50% ( n = 264) of these subjects. AD patients ( n = 100) and controls ( n = 48) were defined by modified neuropathological NIA-RI criteria. Positive associations were taken as a hypothesis, and tested in stage-2 using 483 AD families from the USA. Four single nucleotide polymorphisms (SNPs) of BACE2 gene were tested in stage-1. A SNP close to exon-6 was associated with neuropathologically verified AD ( p = 0.02) and also with beta-amyloid load in non-selected autopsied subjects after conditioning with APOE genotype ( p = 0.001). In haplotype analysis a specific, relatively common haplotype (H5) was found to associate with AD ( p = 0.004) and a second haplotype (H7) showed a weaker association with protection against AD ( p = 0.04). In stage-2, the SNP association was not replicated, whereas the haplotype H5 association was replicated ( p = 0.004) and a trend to association was found with the putative protective haplotype H7 (two-sided p = 0.08). BACE2 haplotype association with AD in two independent datasets provides further evidence for an AD susceptibility locus on chromosome 21q within or close to BACE2.

Genetic Variant Increases Risk of Late-Onset Alzheimer's

Genetic Variant Increases Risk of Late-Onset Alzheimer's

Statins Cause Intracellular Accumulation of Amyloid Precursor Protein, β-Secretase-cleaved Fragments, and Amyloid β-Peptide via an Isoprenoid-dependent Mechanism

The use of statins, 3-hydroxy-3-methylglutaryl-CoA reductase inhibitors that block the synthesis of mevalonate (and downstream products such as cholesterol and nonsterol isoprenoids), as a therapy for Alzheimer disease is currently the subject of intense debate. It has been reported that statins reduce the risk of developing the disorder, and a link between cholesterol and Alzheimer disease pathophysiology has been proposed. Moreover, experimental studies focusing on the cholesterol-dependent effects of statins have demonstrated a close association between cellular cholesterol levels and amyloid production. However, evidence suggests that statins are pleiotropic, and the potential cholesterol-independent effects of statins on amyloid precursor protein (APP) metabolism and amyloid beta-peptide (A beta) genesis are unknown. In this study, we developed a novel in vitro system that enabled the discrete analysis of cholesterol-dependent and -independent (i.e. isoprenoid-dependent) statin effects on APP cleavage and A beta formation. Given the recent interest in the role that intracellular A beta may play in Alzheimer disease, we analyzed statin effects on both secreted and cell-associated A beta. As reported previously, low cellular cholesterol levels favored the alpha-secretase pathway and decreased A beta secretion presumably within the endocytic pathway. In contrast, low isoprenoid levels resulted in the accumulation of APP, amyloidogenic fragments, and A beta likely within biosynthetic compartments. Importantly, low cholesterol and low isoprenoid levels appeared to have completely independent effects on APP metabolism and A beta formation. Although the implications of these effects for Alzheimer disease pathophysiology have yet to be investigated, to our knowledge, these results provide the first evidence that isoprenylation is involved in determining levels of intracellular A beta.

Association studies between risk for late-onset Alzheimer's disease and variants in insulin degrading enzyme

Linkage studies have suggested there is a susceptibility gene for late onset Alzheimer's disease (LOAD) in a broad region of chromosome 10. A strong positional and biological candidate is the gene encoding the insulin-degrading enzyme (IDE), a protease involved in the catabolism of Abeta. However, previous association studies have produced inconsistent results. To systematically evaluate the role of variation in IDE in the risk for LOAD, we genotyped 18 SNPs spanning a 276 kb region in and around IDE, including three "tagging" SNPs identified in an earlier study. We used four case-control series with a total of 1,217 cases and 1,257 controls. One SNP (IDE_7) showed association in two samples (P-value = 0.0066, and P = 0.026, respectively), but this result was not replicated in the other two series. None of the other SNPs showed association with LOAD in any of the tested samples. Haplotypes, constructed from the three tagging SNPs, showed no globally significant association. In the UK2 series, the CTA haplotype was over-represented in cases (P = 0.046), and in the combined data set, the CCG haplotype was more frequent in controls (P = 0.015). However, these weak associations observed in our series were in the opposite direction to the results in previous studies. Although our results are not universally negative, we were unable to replicate the results of previous studies and conclude that common variants or haplotypes of these variants in IDE are not major risk factors for LOAD.

Risk of late-onset Alzheimer's Disease associated with BDNF C270T polymorphism

We examined the frequency of the T allele of the C270T polymorphism of the brain-derived nerve growth factor (BDNF) gene in a test and replication test design. Our objective was to determine if there is an association between the BDNF gene and Alzheimer's Disease (AD) in a US population. There were 106 autopsy-proven AD cases and 101 controls of similar ages in each test for a total of 212 AD cases and 202 controls. We found that there was a significant increase in the T allele in both the initial set ( p = .04) and in the replication set ( p = .018). For both groups combined p = .0008. Odds ratio = 3.28, 95% CI = 1.69–6.34. There were 54 cases of early-onset AD (EOAD) and 159 cases of late-onset AD (LOAD). The results were only significant for LOAD, p = .0002, odds ratio = 3.81, 95% CI = 1.93–7.52. The r 2 or fraction of the variance attributed to the BDNF gene for the LOAD cases was .046. The results were independent of the APOE ɛ4 allele. When the younger controls were removed, providing a close age match to the AD subjects, the frequency of the T allele was even lower and the differences were still significant for both total AD and LOAD cases. In a logistic regression analysis including APOE, age, sex and BDNF, BDNF was significant at p < .0001. We concluded that BDNF gene variants are significant risk factors for late onset AD.

Investigation of the effect of brain-derived neurotrophic factor (BDNF) polymorphisms on the risk of late-onset Alzheimer's disease (AD) and quantitative measures of AD progression

BDNF is a functional candidate gene for AD, owing to its role in neuronal development and survival. The Val66Met (G196A), along with another C270T polymorphism has been associated with AD, however, the effects seem to be inconsistent across studies. We examined the association of the G196A and C270T polymorphisms with sporadic late-onset AD (LOAD) in a large American White cohort of 995 AD cases and 671 controls and an American Black cohort of 64 AD cases and 45 controls. We also examined the association of these polymorphisms with quantitative measures of AD progression, including age at onset (AAO), disease duration and Mini-Mental State Examination (MMSE) scores. No significant difference in allele, genotype or estimated haplotype frequencies was observed between AD cases and controls within the American White and Black cohorts for the G196A and C270T polymorphisms. However, the frequency of the 196 * A allele was significantly lower in American Black subjects compared to Whites. While MMSE scores were significantly lower in C270T/CT carriers compared to C270T/CC subjects only among American Blacks, no such effect was observed among American Whites. The BDNF polymorphisms did not affect AAO or disease duration measures in American Whites or Blacks. Our finding does not support any association between the BDNF/G196A or C270T polymorphism and the risk of sporadic LOAD among American Whites or Blacks. The significant effect of the C270T polymorphism observed on MMSE scores among American Blacks needs to be further explored in a larger cohort.

Association of &lt;I&gt;MTHFR&lt;/I&gt; Gene Polymorphism C677T With Susceptibility to Late-Onset Alzheimer's Disease

Increased total plasma homocysteine (t-Hcy) levels are found to be associated with Alzheimer's disease (AD). Because the methylenetetrahydrofolate reductase (MTHFR) gene encodes a key enzyme that influences the metabolism of homocysteine, it has been considered as a possible genetic risk factor for AD. Although the MTHFR gene C677T polymorphism has a significant impact on reducing enzyme activity and increasing t-Hcy concentrations, the association between the C677T polymorphism and AD remains inconclusive. To determine whether the MTHFR gene C677T polymorphism contributes to the risk for late-onset AD (LOAD) in Chinese, we have investigated 104 sporadic LOAD patients and 130 healthy controls. The strong associations of the TT genotype and T-allele with LOAD (p 0.001, OR 5.73 95% CI 1.85-17.72, and p 0.002, OR 1.89 95% CI 1.25-2.86) were found. After stratifying by apolipoprotein E allele 4 (APOE epsilon4) status, increased LOAD risks associated with the TT genotype only in the APOE epsilon4 noncarriers (chi2=8.92, df=1, p=0.003) and with the T-allele in either group (chi2=5.18, df=1, p=0.023 and chi2=5.53, df=1, p=0.019) were seen. These results suggest that as an APOE epsilon4 allele-dependent risk factor, the MTHFR gene C677T polymorphism is involved in developing LOAD in Chinese.

Association between a T/C polymorphism in intron 2 of cholesterol 24 S-hydroxylase gene and Alzheimer's disease in Chinese

A polymorphism (T/C) in intron 2 of the cholesterol 24-hydroxylase (CYP46) gene has recently been reported to be associated with the risk for late-onset Alzheimer's disease (LOAD). To investigate possible involvement of the CYP46 gene and apolipoprotein E (APOE) gene polymorphisms in the manifestation of LOAD, we analyzed 99 sporadic LOAD patients and 113 healthy controls of China. We found an obvious association between CYP46 TT genotype and LOAD (OR = 2.98, 95% CI 1.64–5.44, P < 0.001). A clear increase of the risk to develop LOAD was also observed in subjects carrying both the CYP46 TT genotype and the APOE ɛ4-allele (OR = 12.94, 95% CI 4.26–39.32, P < 0.001). Our data reveal that the polymorphism of CYP46 intron 2 is implicated in the susceptibility to LOAD and a strong synergistic interaction between CYP46 TT homozoygots and APOE ɛ4 carrier status on the risk of LOAD.

Alzheimer disease risk and genetic variation in ACE: a meta-analysis.

Numerous studies have tested for associations between common variants of the angiotensin-converting enzyme gene (ACE) and late-onset Alzheimer disease (AD), but results have been inconclusive. Relevant studies were systematically identified, and data were abstracted according to predefined criteria. The odds ratio (OR) for AD in individuals with the I allele of the ACE D/I polymorphism compared with those with the DD genotype was 1.27 (95% CI, 1.10 to 1.47; p < 0.001). Heterogeneity between studies was significant (p < 0.001) but not in strata defined by race and age (p > or = 0.10). The risk of AD associated with the I allele appeared to be higher among Asians (OR 2.44; 95% CI, 1.68 to 3.53) when compared with the risk among Caucasians (OR 1.18; 95% CI, 1.02 to 1.37) (p for comparison < 0.001), and in younger cases (mean age 65 to 74 years) (OR 1.54; 95% CI, 1.23 to 1.93) when compared with the risk in older cases (OR 1.13; 95% CI, 0.95 to 1.35) (p for comparison = 0.03). The I allele of the ACE D/I polymorphism is associated with an increased risk of late-onset AD. Further study of the pathogenetic characteristics of this allele and independent confirmation of the association in larger studies are warranted.

Apolipoproteína E e a doença de Alzheimer

Sabemos hoje que os polimorfismos no gene da apolipoproteína E (apoE) são importantes fatores de risco para o desenvolvimento da doença de Alzheimer (DA). O gene apoE humano, mapeado no braço longo do cromossomo 19 (19q13.2), codifica uma glicoproteína com 317 aminoácidos, a qual desempenha um papel fundamental para o catabolismo de componentes ricos em triglicérides no corpo humano. Em humanos, existem três alelos principais do gene apoE, decorrentes de apenas duas alterações no DNA, chamados de épsilon2, épsilon3 e épsilon4. A identificação da variante épsilon4 do gene apoE como o fator genético de risco mais comum para a DA de início tardio sugere que o colesterol deva ter um papel direto na patogênese da doença. Contudo, a simples presença do alelo apoE épsilon4 não é necessária nem suficiente para causar DA; este alelo apenas aumenta o risco de o indivíduo vir a desenvolver a doença, indicando que existem outros fatores ambientais e genéticos importantes no desenvolvimento da mesma.

Cholesterol and statins in Alzheimer disease

Two recent observational studies have demonstrated a 60-73% reduction in the prevalence of Alzheimer's disease in patients treated with statins. In two further studies a polymorphism in the CYP46 gene encoding the cholesterol-24 hydroxylase was found to be associated with a significant increase in the risk of late-onset Alzheimer's disease. The question arises whether or not statins may exert a prophylactic effect on the incidence of Alzheimer's disease. Statins pass the blood-brain-barrier to a different degree and may reduce the cerebral cholesterol turnover. Statins may also influence the CSF concentration of tau protein, and, to a minor extent, that of A beta. Further studies are warranted to find out which statins are most suitable for reducing cerebral amyloid metabolism and whether statins may also lower the severity of Alzheimer's disease.