A high frequency of apolipoprotein E4 isoprotein in Japanese patients with late-onset nonfamilial Alzheimer's disease

Both Targeted Mass Spectrometry and Flow Sorting Analysis Methods Detected the Decreased Serum Apolipoprotein E Level in Alzheimer's Disease Patients

Apolipoprotein E (ApoE) polymorphism has been appreciated as a valuable predictor of Alzheimer disease (AD), and the associated ε4 allele has been recognized as an indicator of susceptibility to this disease. However, serum ApoE levels have been a controversial issue in AD, due to the great variability regarding the different target detection methods, ethnicity, and the geographic variations of cohorts. The aim of this study was to validate serum ApoE levels in relation to AD, particularly using two distinct detection methods, liquid chromatography-selected reaction monitoring (SRM) mass spectrometry and microsphere-based fluorescence-activated cell sorting (FACS) analysis, to overcome experimental variations. Also, comparison of serum ApoE levels was performed between the level of protein detection by FACS and peptide level by SRM in both control and AD patients. Results from the two detection methods were cross-confirmed and validated. Both methods produced fairly consistent results, showing a significant decrease of serum ApoE levels in AD patients relative to those of a control cohort (43 control versus 45 AD, p < 0.0001). Significant correlation has been revealed between results from FACS and SRM (p < 0.0001) even though lower serum ApoE concentration values were measured in protein by FACS analysis than in peptide-level detections by SRM. Correlation study suggested that a decrease of the serum ApoE level in AD is related to the mini-mental state exam score in both results from different experimental methods, but it failed to show consistent correlation with age, gender, or clinical dementia rating.

Omega-3 fatty acids, lipids, and apoE lipidation in Alzheimer's disease: a rationale for multi-nutrient dementia prevention

In the last decade, it has become obvious that Alzheimer's disease (AD) is closely linked to changes in lipids or lipid metabolism. One of the main pathological hallmarks of AD is amyloid-β (Aβ) deposition. Aβ is derived from sequential proteolytic processing of the amyloid precursor protein (APP). Interestingly, both, the APP and all APP secretases are transmembrane proteins that cleave APP close to and in the lipid bilayer. Moreover, apoE4 has been identified as the most prevalent genetic risk factor for AD. ApoE is the main lipoprotein in the brain, which has an abundant role in the transport of lipids and brain lipid metabolism. Several lipidomic approaches revealed changes in the lipid levels of cerebrospinal fluid or in post mortem AD brains. Here, we review the impact of apoE and lipids in AD, focusing on the major brain lipid classes, sphingomyelin, plasmalogens, gangliosides, sulfatides, DHA, and EPA, as well as on lipid signaling molecules, like ceramide and sphingosine-1-phosphate. As nutritional approaches showed limited beneficial effects in clinical studies, the opportunities of combining different supplements in multi-nutritional approaches are discussed and summarized.

Apo E4 Alleles and Impaired Olfaction as Predictors of Alzheimer's Disease

Alzheimer's disease (AD) is the most common form of dementia that affects more than 5 million Americans. It is the only disease among the 10 causes of death that cannot be slowed or cured, thus raising the need for identification of early preclinical markers that could be the focus of preventative efforts. Although evidence is escalating that abnormalities in olfactory structure and function precede AD development and early cognitive impairments by one or more decades, the importance of olfaction is largely overlooked in AD, and such testing is not routinely performed in neurology clinics. Nevertheless, research using the olfactory model, has begun to advance our understanding of the preclinical pathophysiology of AD. Notably, an interesting series of studies is beginning to illuminate the relationship between Apolipoprotein E (ApoE) ε4 polymorphism and olfactory dysfunction and late-onset Alzheimer's disease. In this article, we reviewed present research on the significance of ApoE and olfaction to AD, summarized current studies on the associations and mechanisms of ApoE and olfactory dysfunction, and highlighted important gaps for future work to further advance the translational application of the olfactory paradigm to early, preclinical diagnosis and treatment of AD.

Genetic Predictors of Perioperative Neurologic and Neuropsychological Injury and Recovery

Central nervous system (CNS) dysfunction after cardio pulmonary bypass represents a continuum from coma and focal stroke to cognitive deficits after surgery. Despite the marked increase in investigation of neuro logic and neurocognitive deficits after cardiac surgery, causative factors fail to predict the majority of the variance in the observed incidence of both early and late neurocognitive decline pointing to some inherent indi vidual susceptibility to injury. The authors' investigative team recently discovered a genetic association be tween late-onset Alzheimer's disease and the apolipo protein E (APOE, gene; apoE, protein) ∈-4 gene. This finding triggered many recent studies that have shown an important role of apoE in the determination of neurologic injury and recovery following a variety of acute ischemic insults including intracerebral hemor rhage, closed-head injury, as well as acute stroke and dementia pugilistica. Most important to the current discussion is the authors' recent report documenting preliminary evidence of an association of APOE4 with neurocognitive decline after cardiac surgery. This re view discusses the authors' hypothesis that the bio chemical products coded by this gene are not available to protect and repair the neurons of the CNS during cardiac surgery resulting in deficits of memory, atten tion, and concentration. Potential mechanisms of apoE's association with acute neurologic injury are discussed including regulation of the inflammatory response. The authors have recently determined that apoE, in vivo, modulates the release of nitric oxide and tumor necro sis factor a. This may compound the autonomic dysreg ulation recently reported in the aging population. The authors' preliminary data associating APOE4 with cogni tive impairment after cardiac surgery support this hy pothesis. The different potential mechanisms of apoE function in neuronal injury and recovery are not mutu ally exclusive, and it is likely that apoE modulates the CNS injury response at several functional levels.

Apolipoprotein E: Emerging Story in the Pathogenesis of Alzheimer's Disease

Apolipoprotein E (apoE) is implicated in the pathogenesis of Alzheimer's disease. One of the three com mon apoE alleles, apoE4, behaves as an autosomal codominant trait in the majority of late-onset and sporadic Alzheimer's disease, with homozygosity for this allele virtually sufficient to cause disease by the age of 80. In contrast, the apoE2 and apoE3 alleles decrease the probability of disease and increase the age of onset, with the protective effect of apoE2 greater than apoE3. Thus, the inherited alleles of apoE determine, in part, the risk of developing Alzheimer's disease and determine the rate of disease progres sion. Isoform-specific interactions of apoE with other molecules are therefore critical in this disease. ApoE is found in populations of neurons, some of which contain abnormal neurofibrillary tangles assembled from the protein tau. In healthy neurons, tau helps assemble and stabilize microtubules, but in Alzheimer's disease, it forms paired helical filaments of the neurofibrillary tangle. ApoE3 avidly binds tau in vitro, whereas apoE4 does not. Isoform-specific interactions of apoE with tau and other microtubule-associated proteins could contribute to the mechanism of Alzheimer's disease. Uncovering the roles of apoE in the brain, both in health and in disease, will be an exciting area for neuroscience. The Neuroscientist 1:298- 306, 1995

CSF levels of Aβ1-38/Aβ1-40/Aβ1-42 and (11)C PiB-PET studies in three clinical variants of primary progressive aphasia and Alzheimer's disease

Primary progressive aphasia (PPA) is a cognitive syndrome characterized by progressive and isolated language impairments due to neurodegenerative diseases. Recently, an international group of experts published a Consensus Classification of the three PPA clinical variants (naPPA, svPPA and lvPPA). We analyzed 24 patients with PPA by cognitive functions, neuroimaging (MRI, (99 m)Tc ECD-SPECT, (11)C PiB-PET and FDG-PET) and cerebrospinal fluid (CSF) analysis (ptau-181, Aβ1-42, Aβ1-40 and Aβ1-38), to elucidate relationships between neuroimaging studies and biochemical findings in the three PPA clinical variants. Cognitive and speech functions were measured by mini-mental state examination and standard language test of aphasia. The patients with lvPPA showed significant decreases in CSF Aβ1-42 and ratios of Aβ1-42/Aβ1-40 and Aβ1-42/Aβ1-38, and significant increases in CSF ptau-181 and ratios of ptau-181/Aβ1-42 and ptau-181/Aβ1-38; these findings were similar to those of patients with Alzheimer's disease (AD). We observed a higher frequency of the ApoE ε4 allele in the lvPPA patients relative to the two other PPA variants. In (11)C PiB-PET of lvPPA patients, PiB positive findings were detected in cortices of frontal, temporal and parietal lobes and the posterior cingulate, where massive Aβ may accumulate due to AD. Our results of AD-CSF markers including Aβ1-38 and (11)C PiB-PET in the lvPPA patients demonstrate a common pathological mechanism with the occurrence of AD.

Beta-amyloid associated differential effects of APOE ε4 on brain metabolism in cognitively normal elderly

OBJECTIVE

Although apolipoprotein (APOE) ε4 allele is a well-established risk factor for late-onset Alzheimer disease (AD), the mechanism of its effects on AD pathogenesis is not fully understood. We aimed to investigate the effects of APOE genotype on regional cerebral glucose metabolism in cognitively normal (CN) elderly. We further tried to elucidate whether or not such effects are associated with beta-amyloid protein (Aβ) deposition.

METHODS

31 CN elderly participants underwent clinical examination, a range of neuropsychological tests, APOE genotyping, and Pittsburgh compound-B- and fluorodeoxyglucose-PET scans.

RESULTS

17 APOE ε4 carriers and 15 non-carriers were included. Both hypometabolic and hypermetabolic regions were observed in ε4 carriers compared with noncarriers when age, education, and sex were controlled. When the degree of global cerebral Aβ deposition was adjusted, the hypometabolic regions in the temporo-parietal area (i.e., BA 22 and 39) largely disappeared, whereas the hypermetabolic regions persisted in medial frontal and anterior temporal areas (i.e., BA 38, 11, and 39). Behaviorally, verbal episodic memory scores of APOE ε4 carriers were slightly lower than those of noncarriers, though still within normal range.

CONCLUSIONS

Our findings indicate that decreased cerebral glucose metabolism in the temporoparietal junction associated with APOE ε4 in CN elderly appears to be mediated by Aβ deposition, and the effect of APOE ε4 on hypermetabolism in the frontal and anterior temporal regions is independent of Aβ and may be associated with presence of compensatory mechanism in CN elderly with the ε4 allele.

The genetics of dementia

Over the past decade, there has been a dramatic evolution of genetic methodologies that can be used to identify genes contributing to disease. Initially, the focus was primarily on classical linkage analysis; more recently, genomewide association studies, and high-throughput whole genome and whole exome sequencing have provided efficient approaches to detect common and rare variation contributing to disease risk. Application of these methodologies to dementias has led to the nomination of dozens of causative and susceptibility genes, solidifying the recognition that genetic factors are important contributors to the disease processes. In this review, the authors focus on current knowledge of the genetics of Alzheimer's disease and frontotemporal lobar degeneration. A working understanding of the genes relevant to common dementias will become increasingly critical, as options for genetic testing and eventually gene-specific therapeutics are developed.

Genetics of Alzheimer's disease

Alzheimer's disease is the most common form of dementia and is the only top 10 cause of death in the United States that lacks disease-altering treatments. It is a complex disorder with environmental and genetic components. There are two major types of Alzheimer's disease, early onset and the more common late onset. The genetics of early-onset Alzheimer's disease are largely understood with variants in three different genes leading to disease. In contrast, while several common alleles associated with late-onset Alzheimer's disease, including APOE, have been identified using association studies, the genetics of late-onset Alzheimer's disease are not fully understood. Here we review the known genetics of early- and late-onset Alzheimer's disease.

Apolipoprotein E4 frequencies in a Japanese population with Alzheimer's disease and dementia with Lewy bodies

Background

The apolipoprotein E (APOE) ε4 allele has been reported to be a risk factor for Alzheimer's disease (AD) and dementia with Lewy bodies (DLB). Previous neuropathological studies have demonstrated similar frequencies of the APOE ε4 allele in AD and DLB. However, the few ante-mortem studies on APOE allele frequencies in DLB have shown lower frequencies than post-mortem studies. One reason for this may be inaccuracy of diagnosis. We examined APOE genotypes in subjects with AD, DLB, and a control group using the latest diagnostic criteria and MRI, SPECT, and MIBG myocardial scintigraphy.

Methods

The subjects of this study consisted of 145 patients with probable AD, 50 subjects with probable DLB, and a control group. AD subjects were divided into two groups based on age of onset: early onset AD (EOAD) and late onset AD (LOAD). All subjects had characteristic features on MRI, SPECT, and/or myocardial scintigraphy.

Results

The rate of APOE4 carrier status was 18.3% and the frequency of the ε4 allele was 9.7% in controls. The rate of APOE4 carrier status and the frequency of the ε4 allele were 47% and 27% for LOAD, 50% and 31% for EOAD, and 42% and 31% for DLB, respectively.

Conclusion

The APOE4 genotypes in this study are consistent with previous neuropathological studies suggesting accurate diagnosis of AD and DLB. APOE4 genotypes were similar in AD and DLB, giving further evidence that the ε4 allele is a risk factor for both disorders.

Insulin resistance, diabetes and cognitive function: consequences for preventative strategies

Cognitive decline and dementia both place a heavy burden on patients and their relatives, and any means of preventing such age-related changes are worthy of consideration. Those who have the metabolic syndrome with or without diabetes suffer more often from dysexecutive problems and slower psychomotor speed than do other patients. In epidemiological studies, diabetes has appeared to be a risk factor for all types of dementia, including vascular dementia, although the role of the metabolic syndrome in the risk of Alzheimer's disease is still a matter of debate. The possible mechanisms of cognitive alterations are multiple, and may differ according to age group and duration of diabetes or the metabolic syndrome. Drug interventional trials addressing the prevention of cognitive decline through action on the metabolic syndrome are disappointing-albeit scarce at this time. Lifestyle interventions in middle-aged or younger-elderly subjects should also be implemented in the general population.

Effect of apolipoprotein E genotype on the outcome after anterior cervical decompression and fusion in patients with cervical spondylotic myelopathy

Object

The authors examined a possible association between apolipoprotein E (APOE) gene polymorphism and the outcome after anterior microsurgical decompression in patients with cervical spondylotic myelopathy (CSM).

Methods

The authors conducted a prospective study of 60 consecutive patients (40 men, 20 women) with CSM who underwent anterior microsurgical decompression. The patients ranged in age from 26 to 86 years (mean 61.5 ± 14.6 years). Neurological deficits were classified according to the modified Japanese Orthopaedic Association Scale. Mean follow-up was 18.8 ± 4.6 months and APOE genotyping was carried out by isolation of DNA from venous blood samples. The APOE genotypes were determined by polymerase chain reaction followed by restriction enzyme digestion and polyacrylamide gel electrophoresis of digested fragments. Categorical variables were analyzed with the chi-square test, continuous data with the Mann-Whitney U-test, and for multiple groups with the Kruskal-Wallis H-test. A backward stepwise binary logistic regression analysis was performed to determine the effect of APOE in a multivariate model.

Results

Of the 60 patients with CSM, 35 (58.3%) improved and 25 (41.7%) did not improve or suffered deterioration (no-improvement group). In the improvement group 5 patients (8.3%) possessed the ε4 allele compared with 16 patients (26.7%) in the no-improvement group (p = 0.002, OR 3.3, 95% CI 1.7–6.1). In a multivariate model, the occurrence of the ε4 allele was a significant independent predictor for no improvement after anterior decompression and fusion (p = 0.004, OR 8.6, 95% CI 5.1–20.6).

Conclusions

The results of this study show that APOE gene polymorphism influences the short-term outcome of CSM patients after surgical decompressive and stabilizing therapy in the way that the presence of the APOE ε4 allele is an independent predictor for a no improvement. The presence of APOE may explain in part the different responses to operative therapies in patients with cervical myelopathy.

Prevalence of four subtypes of mild cognitive impairment and APOE in a Japanese community

BACKGROUND

The results of previous reports estimating the prevalence of mild cognitive impairment (MCI) have varied widely according to the criteria used to define MCI.

METHODS

We assessed the cognitive function of Japanese community-dwelling individuals >or=65 years old and attempted to estimate the prevalence of four MCI subtypes (amnestic single, amnestic multiple, nonamnestic single, and nonamnestic multiple) using two cutoffs (1 and 1.5 SD) below normative standard. Presence of apolipoprotein E4 allele (APOE4), which is known as a strong risk factor for AD, is reportedly associated with high risk of conversion from MCI to AD. We therefore calculated the frequency of APOE4 carriers for each MCI subtype.

RESULTS

Initially 1888 (70%) of 2698 baseline samples participated, and 1433 (53%) subjects who had complete clinical data including APOE typing remained for the final analysis. The prevalence of MCI subtypes varied within the range of 1.7-16.6%, depending on the criteria applied. Prevalence of MCI was higher using a cutoff at -1.0 SD than at -1.5 SD, and prevalence of amnestic MCI single at -1.5 SD was lowest among all subtypes of MCI. Frequency of APOE4 was higher for amnestic MCI than for non-amnestic MCI or the cognitively normal group.

CONCLUSION

The prevalence of MCI was highly dependent on the diagnostic criteria applied. A higher frequency of APOE4 in participants with amnestic MCI subtype suggested a greater risk of future AD. For future interventions to delay the onset of dementia, targeting individuals with amnestic MCI multiple at -1 SD might be desirable.

Apolipoprotein E genotype and traumatic brain injury in children--association with neurological outcome

OBJECTIVE

To determine whether the presence of Apolipoprotein E epsilon4 genotype (ApoE epsilon4) is associated with outcomes of traumatic brain injury in children.

MATERIALS AND METHODS

The ApoE genotype was examined in the group of 70 pediatric patients who suffered from traumatic brain injury. The group consists of 48 boys and 22 girls, and the most frequent was the E3 isoform of ApoE. Polymerase chain reaction/restriction fragment length polymorphism method was used for the ApoE genotype assessment. The severity of trauma was assessed by Glasgow Coma Scale and graded into three categories. The presence of focal neurology signs, comparing the admission and dimission status, and duration of hospital care were observed. The neurological outcome after 1 year was assessed by Glasgow Outcome Scale. Trauma severity was compared with the neurological outcome, according to different ApoE genotypes. For statistical processing, t test, nonparametric Wilcoxon test, Fisher, and chi(2) tests were used.

CONCLUSION

Our results suggest the association between the ApoE genotype and outcome of traumatic brain injury in children. Patients with ApoE epsilon4 genotype were more likely to have severe clinical symptomatology and unfavorable neurological outcome after traumatic brain injury compared to significantly better outcome with other ApoE genotype.

Apolipoprotein E gene polymorphism and the risk of cervical myelopathy in patients with chronic spinal cord compression

STUDY DESIGN

Prospective evaluation of apolipoprotein E (APOE) genotypes in 106 consecutive patients with stenosis of the cervical spinal canal.

OBJECTIVE

To determine the association between cervical spondylotic myelopathy (CSM) in patients with chronic spinal cord compression and the APOE genotype.

SUMMARY OF BACKGROUND DATA

The APOE allele epsilon 4 is a risk factor for the occurrence, progression, and poor outcome in several neurologic diseases. Information of the association between APOE genotype and CSM in the literature are lacking so far.

METHODS

One hundred six consecutive patients with chronic cervical spinal cord compression due to stenosis of the spinal canal were evaluated prospectively. APOE genotypes were determined by polymerase chain reaction followed by restriction enzyme digestion and sodiumdodecylsulfate poyacrylamide gel electrophoresis (SDS PAGE) of digested fragments. Clinical and radiologic variables evaluated were age, occurrence of CSM, duration of symptoms, number of affected segments, and diameter of spinal canal of most affected segment. Univariate association between variables was tested. A backward stepwise method was used to construct multivariate logistic regression models in relation to the occurrence of CSM as dependent variable.

RESULTS

The following distribution of APOE genotypes was found: epsilon 2 epsilon 2 3 patients (2.8%), epsilon 2 epsilon 3 9 patients (8.5%), epsilon 2 epsilon 4 1 patient (0.9), epsilon 3 epsilon 3 67 patients (63.2%), epsilon 3 epsilon 4 24 patients (22.6%), epsilon 4 epsilon 4 2 patients (1.9%). Univariate analysis showed that patients with chronic spinal cord compression and homo- or heterozygous allele epsilon 4 are more likely to develop CSM than patients without allele epsilon 4 (65.0% vs. 35.0%, P < 0008; OR 3.5; 95% CI 1.3-9.8). This effect remained significant in a binary logistic regression model adjusted to other known risk factors for CSM. Inclusion of the variable homo- or heterozygous epsilon 4 allele led to an increased goodness of fit of the model compared with the model without epsilon 4. CONCLUSION.: This study supports the hypothesis that the APOE epsilon 4 allele increases the risk of CSM in patients with chronic cervical spinal cord compression; however, a larger prospective population-based study is needed to answer this question definitively.

Apolipoprotein E genotype and traumatic brain injury in children--association with neurological outcome

OBJECTIVE

To determine whether the presence of Apolipoprotein E epsilon4 genotype (ApoE epsilon4) is associated with outcomes of traumatic brain injury in children.

MATERIALS AND METHODS

The ApoE genotype was examined in the group of 70 pediatric patients who suffered from traumatic brain injury. The group consists of 48 boys and 22 girls, and the most frequent was the E3 isoform of ApoE. Polymerase chain reaction/restriction fragment length polymorphism method was used for the ApoE genotype assessment. The severity of trauma was assessed by Glasgow Coma Scale and graded into three categories. The presence of focal neurology signs, comparing the admission and dimission status, and duration of hospital care were observed. The neurological outcome after 1 year was assessed by Glasgow Outcome Scale. Trauma severity was compared with the neurological outcome, according to different ApoE genotypes. For statistical processing, t test, nonparametric Wilcoxon test, Fisher, and chi(2) tests were used.

CONCLUSION

Our results suggest the association between the ApoE genotype and outcome of traumatic brain injury in children. Patients with ApoE epsilon4 genotype were more likely to have severe clinical symptomatology and unfavorable neurological outcome after traumatic brain injury compared to significantly better outcome with other ApoE genotype.

Association of estrogen receptor alpha gene polymorphisms with neurofibrillary tangles

Estrogen receptor alpha (ERalpha) may be implicated in the pathogenesis of Alzheimer's disease (AD). The aim of this study was to clarify the association between ERalpha gene polymorphisms and AD-related pathologic changes. The staging of neurofibrillary tangles (NFT) and senile plaques (SP) was performed according to the method by Braak and Braak and two polymorphisms, PvuII (P or p) and XbaI (X or x), of the ERalpha gene were typed in 551 Japanese cadavers (294 men and 257 women; mean age, 80.8 years). Distributions of the NFT and SP stages significantly correlated with age (NFT: r = 0.306, p < 0.0001; SP: r = 0.237, p < 0.0001) and were significantly higher in patients with the apolipoprotein E epsilon4 allele (p < 0.0001). Possession of the P allele showed a trend to be associated with a more serious NFT stage, but had no relationship with the SP stage. In men, a significant association between PvuII polymorphism and the NFT stage (p = 0.002) was found, revealing a gene- dose effect of the P allele. Similar results were obtained in the men without the epsilon4 allele (p = 0.011). Multiple regression analyses demonstrated that age was the strongest determinant of the NFT stage, possession of the epsilon4 allele was the next strongest, and PvuII polymorphism was the third strongest (p < 0.0001, R(2) = 0.144). The XbaI polymorphism did affect neither the NFT stage nor the SP stage. In conclusion, the PvuII polymorphism of the ERalpha gene is associated with Braak NFT stages and possession of the P allele may act as a risk factor for AD in Japanese men, especially in those without the epsilon4 allele.

The allele interaction between apolipoprotein epsilon2 and epsilon4 in Taiwanese Alzheimer's disease patients

OBJECTIVE

This study aimed to determine the impact of the present of apolipoprotein epsilon (Apoepsilon) 2 on the relationship between Apoepsilon4 and Alzheimer's disease (AD).

METHOD

We examined ApoE genotypes in 428 Taiwanese patients with AD and 807 controls; all participants were older than 65 years.

RESULTS

The allele frequency of Apoepsilon4 was greater in AD patients than controls, but significantly lower than in Caucasians. The presence of an epsilon2 allele alone was not associated with lower risk for AD, but the presence of an epsilon2 allele was associated with an epsilon4 allele frequency similar to that of controls.

CONCLUSION

The low allele frequency of epsilon4 in persons with an epsilon2 allele suggests that this may be part of the protective effect of epsilon2 against AD.

Amyloidosis and Alzheimer's disease

Alzheimer's disease (AD) is the most frequent type of amyloidosis in humans and the commonest form of dementia. Extracellular Abeta amyloid deposits in the form of amyloid plaques and cerebral amyloid angiopathy as well as intraneuronal neurofibrillary tangles co-exist in the brain parenchyma of AD patients, the cognitive areas being the most severely affected. This review focuses on the potential role of amyloid in the development of neurodegeneration and presents studies of AD and other unrelated inherited dementia syndromes associated with neuronal loss and amyloid deposition in the brain.

Using meta-analysis to explain the diversity of results in genetic studies of late-onset Alzheimer's disease and to identify high-risk subgroups

In late-onset Alzheimer's disease, there is a puzzling inconsistency between the findings of case-control studies of most proposed risk genes, except apolipoprotein E epsilon4. This inconsistency may stem from the failure to define the genetic and non-genetic interactions that affect the disease association of each particular susceptibility gene. Such interactions will limit the influence of the gene to a 'relevant subset' of vulnerable people. The relevant subsets for many risk genes will be narrow, compared to that of apolipoprotein E epsilon4. Studies may therefore miss the association or even suggest that a risk gene is protective. In these circumstances, the precise composition of a cohort is critical and defining the relevant subset is crucial. We illustrate how such definition may be achieved through meta-analysis. We take as an example the butyrylcholinesterase K variant, whose association with Alzheimer's disease may now be provisionally defined. This analysis leads to the identification of a potentially high-risk group: over 75 year old male carriers of both apolipoprotein E epsilon4 and butyrylcholinesterase K variant.

Clinical features and alterations in the inferior horn sizes in lateral ventricle in Alzheimer's patients with different ApoE genotype in Japanese population

E4 allele of Apolipoprotein E (ApoE) is considered to be not only a risk factor for Alzheimer's disease (AD) but also a determinant of clinical features in AD. However, it is still controversial whether ApoE e4 allele is related to age at onset, severity of memory impairment or brain morphological changes in AD patients. The present study examined the issue in Japanese population: 1) ApoE genotype on in 38 normal controls and 32 AD patients; 2) association between e4 allele of ApoE and clinical features including Wechsler Memory Scale-Revised in 32 AD patients; and 3) association between e4 allele of ApoE and change in size of inferior horn in lateral ventricle (LV) in 13 out of 32 AD patients. The e4 allele of ApoE frequency was higher in AD patients than in normal controls. There was no significant difference in age at onset or neuropsychological results between AD with and without e4 allele of ApoE. Alteration per month of the inferior horn sizes in LV measured by MRI was similar in the AD patients with and without e4 allele of ApoE. These results suggest that e4 allele of ApoE is a risk factor but not a determinant of clinical features for AD in Japanese population.

Alzheimer beta amyloid deposition enhanced by apoE epsilon4 gene precedes neurofibrillary pathology in the frontal association cortex of nondemented senior subjects

To clarify how Alzheimer disease pathology develops in the brains of nondemented subjects, we examined the interrelations among the amounts and morphology of Abeta deposition, neurofibrillary pathology, and apolipoprotein E (ApoE) genotype in the frontal association cortex of 101 autopsy brains from patients aged between 40 to 83. Senile plaque density correlated well with the logarithmic data of insoluble Abeta measured by enzyme immunoassay (EIA). The amounts of Abeta42-ETA increased dramatically in the late preclinical stage, whereas the AP42+ plaque density increased in the early preclinical stage. Neurofibrillary pathology appeared only in the areas with severe Abeta deposition and in subjects aged over 70. The ApoE epsilon4 allele enhanced the Abeta3 deposition in presenile subjects. Plaque-associated glial Abeta was prominent in subjects with mild to moderate Abeta deposition. The morphology of cerebral Abeta deposition changed from diffuse plaques with small amounts of Abeta in each plaque in the early preclinical stage to primitive/neuritic plaques with larger amounts of Abeta in each plaque in the late preclinical stage. Our findings suggest that the prevention of Abeta deposition in the late preclinical stage can be a rational therapeutic target, especially in elderly people with ApoE epsilon4 allele.

Relation of apolipoprotein E polymorphism to clinically diagnosed Alzheimer's disease in the Korean population

The gene for human apolipoprotein E (APOE) is found on the long arm of chromosome 19 (19q13.2) and exists in three common allelic forms, epsilon2, epsilon3, and epsilon4. The APOE epsilon4 allele is overrepresented in Alzheimer's disease (AD) and is accepted as a genetic risk factor. Some studies reported a protective effect of the APOE epsilon2 allele for AD. However, there are some ethnic variations in the proportion of different APOE alleles and their relationship to AD. We examine the distribution of APOE alleles from 30 AD patients and 158 controls in Korea. The control subjects were all cognitively intact unrelated Koreans. The frequencies of APOE alleles in AD patients were 18.3% (epsilon2), 58.3% (epsilon3), and 23.3% (epsilon4). The corresponding frequencies in controls were 13.3% (epsilon2), 72.5% (epsilon3), and 14.2% (epsilon4). The frequency of the APOE epsilon2 allele in AD patients was not significantly different from that in controls. When statistical analysis was conducted after the exclusion of the APOE epsilon2 allele, the frequency of the APOE epsilon4 allele in AD patients was significantly higher than that in controls (P < 0.05). These results support that the APOE epsilon4 allele plays a role as a risk factor for AD in Koreans and suggest that the APOE epsilon2 allele may not play a protective role in the development of AD in Koreans.

Neuronal apoptosis by apolipoprotein E4 through low-density lipoprotein receptor-related protein and heterotrimeric GTPases

The epsilon4 genotype of apolipoprotein E (apoE4) is the most established predisposing factor in Alzheimer's disease (AD); however, it remains unclear how apoE4 contributes to the pathophysiology. Here, we report that the apoE4 protein (ApoE4) evokes apoptosis in neuronal cells through the low-density lipoprotein receptor-related protein (LRP) and heterotrimeric GTPases. We examined neuron/neuroblastoma hybrid F11 cells and found that these cells were killed by 30 microg/ml ApoE4, but not by 30 microg/ml ApoE3. ApoE4-induced death occurred with typical features for apoptosis in time- and dose-dependent manners, and was observed in SH-SY5Y neuroblastomas, but not in glioblastomas or non-neuronal Chinese hamster ovary cells. Activated, but not native, alpha2-macroglobulin suppressed this ApoE4 toxicity. Suppression by the antisense oligonucleotide to LRP and inhibition by low nanomolar concentrations of LRP-associated protein RAP provided evidence for the involvement of LRP. The involvement of heterotrimeric GTPases was demonstrated by the findings that (1) ApoE4-induced death was suppressed by pertussis toxin (PTX), but not by heat-inactivated PTX; and (2) transfection with PTX-resistant mutant cDNAs of Galpha(i) restored the toxicity of ApoE4 restricted by PTX. We thus conclude that one of the neurotoxic mechanisms triggered by ApoE4 is to activate a cell type-specific apoptogenic program involving LRP and the G(i) class of GTPases and that the apoE4 gene may play a direct role in the pathogenesis of AD and other forms of dementia.

Effect of apolipoprotein E allele epsilon4 on the initial phase of amyloid beta-protein accumulation in the human brain

Deposition of amyloid ss-protein (Ass), a hallmark of Alzheimer's disease, occurs to some extent in the brains of most elderly individuals. We sought to learn when Ass deposition begins and how deposition is affected by apolipoprotein E allele epsilon4, a strong risk factor for late-onset Alzheimer's disease. Using an improved extraction protocol and specific enzyme-linked immunosorbent assay, we quantified the levels of Ass40 and Ass42 in the insoluble fractions of brains from 105 autopsy cases, aged 22 to 81 years at death, who showed no signs of dementia. Ass40 and Ass42 were detected in the insoluble fractions from all of the brains examined; low levels were even found in the brains of patients as young as 20 to 30 years of age. The incidence of significant Ass accumulation increased age-dependently, with Ass42 levels beginning to rise steeply in some patients in their late 40's, accompanied by much smaller increases in Ass40 levels. The presence of the apolipoprotein E epsilon4 allele was found to significantly enhance the accumulation of Ass42 and, to a lesser extent, that of Ass40. These findings strongly suggest that the presence of epsilon4 allele results in an earlier onset of Ass42 accumulation in the brain.

Neuronal cell apoptosis by a receptor-binding domain peptide of ApoE4, not through low-density lipoprotein receptor-related protein

Since an apolipoprotein E4 (ApoE4) peptide composed of the low-density lipoprotein (LDL) receptor-related protein (LRP)-binding domain [ApoE4(141-149)(2) or ApoE(141-155)(2)] exerts neurotoxicity in primary neurons and neuronal cell lines, it has been controversial whether these effects are mediated by LRP. Here, we examined whether ApoE4(141-149)(2)-induced toxicity is mediated by LRP in a neuronal cell system where ApoE4 toxicity is mediated by LRP: serum-deprived F11 neuronal cells. In these cells, where ApoE4 exerted toxicity by apoptosis in a manner sensitive to both caspase inhibitors and pertussis toxin (PTX), ApoE4(141-149)(2) also caused cell death by apoptosis but in a caspase-inhibitor-resistant, PTX-resistant manner. ApoE4(141-149)(2)-induced death was not inhibited by antisense oligonucleotides to LRP. Therefore, we conclude that ApoE4(141-149)(2) is able to exert neurotoxicity without involving LRP.

Comparison of astrocytic and myocytic metabolic dysregulation in apolipoprotein E deficient and human apolipoprotein E transgenic mice

The accumulation of tubular aggregates in type II skeletal muscle fibres and fibrillo-granular inclusions in hippocampal protoplasmic astrocytes are characteristic lesions of apolipoprotein E deficient mice. Moreover these inclusions reacted immunocytochemically with an antibody specific to fragment 17-24 of the published sequence of Alzheimer's amyloid peptide. In an effort to evaluate the role of apolipoprotein E in the formation of these abnormal structures, we examined the tibialis anterior muscle and the hippocampus of several groups of animals including: (i) apolipoprotein E "knockout" mice which had been whole body irradiated with 1200 rads and bone marrow replenished with apolipoprotein E sufficient marrow; and (ii) three transgenic murine strains that had been genetically engineered to express either human apolipoprotein E2, E3 or E4 protein on an apoE deficient background. The results of this study showed that the presence of murine apolipoprotein E (even in subnormal levels in the serum) in irradiated bone marrow replenished mice and in all three (E2, E3 or E4) human apoE transgenic strains was sufficient to prevent the aggregation of sarcoplasmic tubules in the tibialis anterior type II muscle fibres. Similarly apolipoprotein E "knockout" bone marrow replenished mice and all three transgenic strains expressing the different human apolipoprotein E alleles reduced the number of the astrocytic inclusions in the hippocampus to levels not significantly different to those observed in control C57Bl6J animals. The data obtained in this study indicate that neurological and neuromuscular abnormalities found in apoE deficient mice are reversed when apoE protein is replaced in the circulation, either by bone marrow transplantation of normal apoE sufficient marrow, or by gene therapy with the apoE gene, albeit of human origin and irrespective of the allele used.

The role of apolipoprotein E in Alzheimer's disease: pharmacogenomic target selection

The association of inheritance of different apolipoprotein E (APOE, gene; apoE, protein) alleles with the risk and rate of onset of Alzheimer's disease (AD) is now well established and widely confirmed. While there are now a collection of hypotheses concerning the specific relationship of APOE polymorphisms to various phenotypic manifestations of AD, no single compelling theory has been tested and universally accepted. The only clear fact emerging during the past 6 years is that differences in APOE genotype affect the average rate of disease onset as a predictable function of the inheritance of this polymorphic gene. Methods now exist to enable experimental designs to study the metabolic effects of inheriting different APOE alleles, addressing what differences that may be present for many years, perhaps over the entire lifetime, can lead to earlier or later manifestations of the disease and are therapeutically tractable. This review summarizes part of an experimental approach to identify biological pathways influenced by the different APOE polymorphisms that are relevant to the pathogenesis of AD.

Distribution of beta-amyloid and amyloid precursor protein in the brain of spawning (senescent) salmon: a natural, brain-aging model

Brain amyloid precursor protein (APP), a normal constituent of neurons, glial cells and cerebrospinal fluid, has several proposed functions (e.g., in neuronal growth and survival). It appears, however, that altered processing of APP is an initial or downstream step in the neuropathology of brain aging, Alzheimer's disease (AD), and Down's syndrome (DS). Some studies suggest that proteolytic cleavage of APP, producing beta-amyloid (Abeta(1-42)), could have neurotoxic or neuroprotective effects. In this study, we utilized antibodies to human APP(695) and Abeta(1-42,) and Congo red staining, to search for amyloid deposition in the brain of semelparous spawning kokanee salmon (Oncorhynchus nerka kennerlyi). Intracellular APP(695) immunoreactivity (APP-ir) was observed in brain regions involved in gustation (glomerulosus complex), olfaction (putative hippocampus, olfactory bulb), vision (optic tectum), the stress response (nucleus preopticus and nucleus lateralis tuberis), reproductive behavior (nucleus preopticus magnocellularis, nucleus preopticus periventricularis, ventral telencephalon), and coordination (cerebellum). Intra- and extra-neuronal Abeta(1-42) immunoreactivity (Abeta-ir) were present in all APP-ir regions except the nucleus lateralis tuberis and Purkinje cells of the cerebellum (coordination). Thus, the relationship between APP and Abeta deposition during brain aging could shed light on the processing of APP into Abeta, neurodegeneration, and possible protection of neurons that are functioning in spawning but senescent salmon. Pacific salmon, with their predictable and synchronized life history, could provide research options not available with the existing models for studies of brain aging and amyloidosis.

Apolipoprotein E phenotypes in healthy normal controls and demented subjects with Alzheimer's disease and vascular dementia in Mie Prefecture of Japan

In order to clarify the association between apolipoprotein E4 (ApoE4) and the pathogenesis of Alzheimer's disease (AD), we analyzed the distribution of the apolipoprotein E (ApoE) phenotypes and the frequency of the apo E alleles epsilon2, epsilon3, and epsilon4 in Japanese healthy controls (n = 1090, an average age of 51.2+/-12.6 years) and demented patients (n=103, mean age of 73.6+/-9.2 years). Demented subjects were divided into three subgroups: early-onset AD group (EOAD; n=25, mean age 63.0+/-6.2 years), late-onset AD group (LOAD; n=33, mean age 79.3+/-5.1 years), and vascular dementia group (VD; n=45, mean age 75.3+/-8.0 years). The apolipoprotein E phenotype was determined by isoelectric focusing and immunoblotting. There were no significant differences in the distribution of the apo E phenotypes by gender or age, and the estimated frequencies of epsilon2, epsilon3 and epsilon4 were 0.05, 0.86 and 0.09, respectively, in the normal controls. There was a significant difference in the distribution of the apo E phenotypes between LOAD and elderly controls aged more than 65 years (P<0.0001). The distribution of the apo E phenotypes in EOAD was the same as that in LOAD. The frequency of the epsilon4 allele was significantly higher in LOAD (0.35, P<0.0001) and EOAD (0.28, P<0.0001) than that in the control subjects (0.07), but not in VD (0.12, P=0.1630). The present findings suggest that ApoE4 is related with both EOAD and LOAD, but not with VD, and support the hypothesis that it is a genetic risk factor of AD.

No association between apolipoprotein A-IV codon 360 mutation and late-onset Alzheimer's disease in the Japanese population

Human apolipoprotein A-IV (apoA-IV) is genetically polymorphic, the apoA-IV polymorphism being controlled by two alleles, apoA-IV1 and apoA-IV2. The association between the apoA-IV2 allele and late-onset Alzheimer's disease (LOAD) has been reported in Caucasian populations. We investigated the codon 360 mutation of the apoA-IV gene allele frequency in 173 LOAD and in 158 age-matched control subjects of the Japanese population, and we found that the allele frequency of apoA-IV2 in the Japanese population was very rare and was extremely lower than in Caucasian populations. We conclude that there was no association between apoA-IV genotype and LOAD in the Japanese population. Copyrightz1999S.KargerAG,Basel

Clinical and neurobiological correlates of D10S1423 genotype in Alzheimer's disease

BACKGROUND

In a previous genome survey, we detected associations of alleles at six microsatellite loci with typical-onset AD, including the 234bp allele of the D10S1423 locus. The goal of the current study was to explore the clinical, neuropathological, and neurochemical correlates of the D10S1423 234bp allele in a group of 50 autopsy-confirmed cases of Alzheimer's disease (AD) who lacked other brain diseases.

METHODS

Clinical assessments were performed as part of a longitudinal study of AD and related disorders. Autopsies were performed using standardized methods and diagnoses were made according to established criteria. Genotyping, morphometry, and neurochemical analyses were performed using postmortem brain tissue.

RESULTS

Patients with AD who carried the D10S1423 234bp allele manifested substantial reductions in dopamine levels in all six cortical regions examined. In contrast, carriers tended to have higher concentrations of cortical norepinephrine and revealed a dosage effect of the D10S1423 234bp allele.

CONCLUSIONS

These findings support the results of our genome survey and suggest that a novel susceptibility gene for AD resides near the D10S1423 locus. The characterization of biologically meaningful subtypes, including genotypic subtypes with particular neurobiological derangements, may be important for the advancement of experimental therapeutics in AD.

Apolipoprotein E promotes the binding and uptake of beta-amyloid into Chinese hamster ovary cells in an isoform-specific manner

The epsilon4 allele of apolipoprotein E gene is a major risk factor for Alzheimer's disease. However, the mechanism by which the E4 isoform of apolipoprotein E increases the risk of Alzheimer's disease is poorly understood. To determine whether the isoform-specific effects of apolipoprotein E may be mediated via clearance of bound beta-amyloid, we examined the uptake of beta-amyloid 1-40 into Chinese hamster ovary cells in the presence or absence of the apolipoprotein E isoforms E2, E3 and E4. Apolipoprotein E2 and E3 treatments were associated with higher association of beta-amyloid with cells as compared to treatment with E4. Heparin blocked the association of beta-amyloid with cells, as did an antibody to one of the apolipoprotein E receptors (the low-density lipoprotein receptor-related protein). Thus, the apolipoproteins E2 and E3, but not E4, may play important roles in the clearance of beta-amyloid from the extracellular space via the low-density lipoprotein receptor-related protein.

Recent advances in dementia research in Japan: Alzheimer-type dementia

In a previous article, recent reports by Japanese researchers on non-Alzheimer-type degenerative dementias were reviewed. In the present article, recent Japanese reports on Alzheimer-type dementia (ATD) are reviewed. Alzheimer-type dementia has received great attention and has been studied from various viewpoints in Japan as well as in Europe and the Americas. In Japan, although it was believed that vascular dementia was the most frequent dementia in the elderly, ATD has recently been shown to be the most predominant type of dementia. Such a great number of papers on ATD have been reported in Japan that mainly the clinical, neuropathological, biochemical and molecular biological research papers alone are reviewed here.

Metabolic alterations in postmortem Alzheimer's disease brain are exaggerated by Apo-E4

Alterations in phospholipid metabolites are a characteristic abnormality of Alzheimer's disease (AD). Many of these alterations have been demonstrated by magnetic resonance spectroscopy (MRS) studies of postmortem tissue. Phosphodiesters appear to be elevated late in the disease and phosphomonoesters appear to be elevated early in the disease and then decrease. Second to aging, the most robust risk factor for AD identified to date is the presence of the E4 allele of apolipoprotein-E (Apo-E). Because apolipoproteins are intimately involved in lipid metabolism, this study was performed to determine if the presence of the Apo-E4 allele affects the abnormalities in phospholipid metabolites in AD brain. Perchloric acid extracts from 12 Apo-E 3/3, 31 3/4, 6 4/4 AD brains and 5 Apo-E 3/3 control brains were studied by both proton magnetic resonance spectroscopy and phosphorus-31 magnetic resonance spectroscopy. When the E4-positive AD samples were compared with the 3/3 AD samples, an exaggeration in both phosphomonoester and phosphodiester abnormalities was observed. The decrease in N-acetyl-L-aspartate (NAA) was also exaggerated. These results suggest membrane phospholipid metabolite alterations observed in AD are more severe in the presence of the Apo-E4 allele.

Apolipoprotein E polymorphism in patients with Alzheimer's disease, vascular dementia and ischemic cerebrovascular disease

Apolipoprotein E sigma4 allele (ApoE sigma4) is associated with Alzheimer's disease (AD) in familial and sporadic cases, but the associations of ApoE sigma4 allele and vascular dementia (VD) and/or ischemic cerebrovascular disease (ICVD) are still controversial. To clarify the associations of ApoE polymorphism with AD, VD and ICVD in Japanese, we examined ApoE polymorphism in samples of 255 patients with AD, 87 patients with VD, and 123 patients with ICVD, as compared with 117 age-matched healthy control subjects (CTL). The frequency of the ApoE sigma4 allele was significantly higher in the VD group (0.21), the ICVD group (0.15) as well as in the AD group (0. 26) than in the CTL subjects (0.08). These findings suggest that the genotype of ApoE sigma4 is associated with not only AD but also VD and ICVD, and that ApoE sigma4 plays an important role in the development of dementia and ICVD.

A genome survey for novel Alzheimer disease risk loci: results at 10-cM resolution

We completed a systematic survey of the human genome, conducted at an average resolution of 10 cM, for the identification of simple sequence tandem repeat polymorphisms (SSTRPs) that target new risk genes for Alzheimer disease (AD) by virtue of linkage disequilibrium. The efficiency of our association study was enhanced by genotyping pools of DNA from autopsy-confirmed cases with AD and matched controls. Allelic associations with AD were observed for 6 of the 391 SSTRPs in the CHLC Human Screening Set/Weber Version 6 (Research Genetics, Inc., Huntsville, AL): D1S518, D1S547, D10S1423, D12S1045, D19S178, and DXS1047. These allelic associations were replicated in an independent sample of autopsied AD cases and controls recruited from a geographically disparate site. The association of the large D19S178 alleles with AD appeared to arise from linkage disequilibrium with the APOE epsilon 4 allele, whose effect on increasing the risk of AD has been established. None of the remaining SSTRPs was in close proximity to loci previously reported to influence the risk of developing AD. Instead, they may identify five novel AD susceptibility loci.

The expression of presenilin-1 mRNA in skin fibroblasts from Alzheimer's disease

The presenilin-1 (PS-1) gene was recently identified as one of the causative genes in the early onset of familial Alzheimer's disease (AD). Analysis of the PS-1 gene is thought to be useful in clarifying the pathogenesis of AD. However, there have been few reports about the expression of the PS-1 gene in AD. In this study, we analyzed the expression of PS-1 mRNA in cultured skin fibroblasts taken from living patients with AD by Northern blot analysis. The subjects consisted of 18 cases with AD and 10 cases of neurological patients without dementia (CTL). We found that the PS-1 mRNA levels in AD were significantly higher than those in CTL (p < 0.01). Moreover, we found that the PS-1 mRNA level increases in the early stages of AD and tends to decrease in the advanced stages. These findings suggest that high levels of PS-1 mRNA may play an important role in developing AD.

Inferior temporal lobe atrophy and APOE genotypes in Alzheimer's disease. X-ray computed tomography, magnetic resonance imaging and Xe-133 SPECT studies

The apolipoprotein E (APOE) gene epsilon 4 allele is known to be associated with late-onset familial and sporadic Alzheimer's disease (AD). We assessed the possible relationship between APOE genotypes and morphological or functional changes in AD brains by x-ray computed tomography (CT), magnetic resonance imaging (MRI) and Xe-133 single photon emission CT (SPECT). First, we estimated the change in size of the whole brain and total ventricular system by using two x-ray CT indices, the cerebral index (CI) and ventricular index (VI), respectively. Neither CI nor VI differed significantly among APOE genotypes. Then, we focused on the inferior temporal lobe regions by introducing new MRI indices, the inferior temporal index (ITI), temporal horn index (THI) and infero-medial temporal index (IMTI). We found a significant difference in each MRI index among APOE subgroups; ITI and IMTI were lower, while THI was higher in AD patients with at least one APOE epsilon 4 allele (epsilon 4+ group) than in those without such an allele (epsilon 4-group). Finally, we compared relative regional cerebral blood flow (rCBF) of Xe-133 SPECT among the AD subgroups. Relative rCBF in the cerebral cortex, particularly in the temporal lobe, was lower in the epsilon 4+ group than in the epsilon 4- group. These results indicate that possession, and thus expression, of the APOE epsilon 4 allele affects preferentially the inferior temporal lobe, encompassing the hippocampus and amygdala, in AD patients.

Interaction of apolipoprotein E epsilon 4 with other genetic and non-genetic risk factors in late onset Alzheimer disease: problems facing the investigator

The Apolipoprotein E4 allele (Apo-epsilon4) is the major susceptibility gene for late onset Alzheimer Disease (AD) but epidemiological data suggest that the effect of this allele is modified in different individuals by genetic or environmental factors. Age and head injury are major non-genetic factors modifying the Apo-epsilon4 risk. There is conflicting data as to whether alleles of other chaperon proteins (such as alpha-1-antichymotrypsin (ACT)) or Apo-epsilon4 receptors (such as the VDRL receptor) modify the Apo-epsilon4 risk for AD. We analyze problems posed by genetic association studies including those of multiple comparisons and selection of controls, the latter problem exacerbated by the wide variations in Apolipoprotein E allele frequencies observed in different groups and localities.

Initial results of a genome survey for novel Alzheimer's disease risk genes: association with a locus on the X chromosome

As the initial step in a systematic genome survey, 16 simple sequence tandem repeat polymorphisms that span the X chromosome at an average spacing of 10 cM were examined for allelic associations with typical-onset Alzheimer's disease (AD). The efficiency of this survey was substantially enhanced by genotyping pools of genomic DNA from 50 autopsy-confirmed AD cases and 50 autopsied controls who were similar in sex ratio, race, and age at death. The frequency of the DXS1047 202-bp allele was twice as common among AD cases (0.45+/-S.E. 0.06) than controls (0.22+/-S.E. 0.05), a finding that was reproduced in an independent and geographically disparate sample. Consistent with Hardy-Weinberg equilibrium, the proportion of women with AD who carried the 202-bp allele, 73% was nearly double that observed for men with AD, 38%. However, the frequency of the 202-bp allele was similar for men and women and the presence of this allele did not affect the age at onset of dementia in either sex. Furthermore, the frequency of the DXS1047 202-bp allele in AD cases and controls was unaffected by the APOE genotype, indicating that these two loci modulate AD risk independently. Finally, the frequency of the 202-bp allele among 50 autopsy-confirmed cases of Parkinson's disease (0.29+/-S.E. 0.06) was indistinguishable from the control value, reflecting relative specificity for this allelic association with AD.

Peripheral markers in testing pathophysiological hypotheses and diagnosing Alzheimer's disease

Alterations in amyloid precursor protein (APP) metabolism, calcium regulation, oxidative metabolism, and transduction systems have been implicated in Alzheimer's disease (AD). Limitations to the use of postmortem brain for examining molecular mechanisms underscore the need to develop a human tissue model representative of the pathophysiological processes that characterize AD. The use of peripheral tissues, particularly of cultured skin fibroblasts derived from AD patients, could complement studies of autopsy samples and provide a useful tool with which to investigate such dynamic processes as signal transduction systems, ionic homeostasis, oxidative metabolism, and APP processing. Peripheral cells as well as body fluids (i.e., plasma and CSF) could also provide peripheral biological markers for the diagnosis of AD. The criteria required for a definite diagnosis of AD presently include clinical criteria in association with histopathologic evidence obtained from biopsy or autopsy. Thus, the use of peripheral markers as a diagnostic tool, either to predict or at least to confirm a diagnosis, may be of great importance.

Age-related congophilic inclusions in the brains of apolipoprotein E-deficient mice

The hippocampal region of apolipoprotein E-deficient mice of varying ages was examined for any morphological changes by light and electron microscopy. Unusual periodic acid-Schiff-positive granules were seen in the hippocampal area of these animals as early as the fourth week of life and their numbers increased gradually with age. These granules were never found in control C57BL/6J (B6) mice before six months-of-age and their numbers were invariable low. They were strongly congophilic when stained with a modified Congo Red technique and reacted with a monoclonal antibody specific to amino acids 17-24 and 35-43 of the beta-amyloid peptide. The immunostaining of these granules with the beta-amyloid peptide was lost after specific adsorption with the appropriate synthetic peptide. These granules were identified ultrastructurally as non-membrane-bound fibrillogranular material in the cytoplasm of protoplasmic astrocytes. The data indicate that an amyloid-like protein accumulates in the protoplasmic astrocytes of the hippocampus of apolipoprotein E-deficient mice, especially in the brains of old animals.

Genetic risk factors in Japanese Alzheimer's disease patients: alpha1-ACT, VLDLR, and ApoE

We studied the polymorphism of alpha1-antichymotrypsin (ACT), very low density lipoprotein receptor (VLDLR) and apolipoprotein E (ApoE) genes in 200 control subjects and 65 patients with Alzheimer's disease (AD) in Japanese. The subjects consisted of 30 patients with early onset familial Alzheimer's disease (FAD), a patient with late onset FAD, 29 patients with an early onset isolated form of AD, and 5 patients with late onset AD. ApoE genotypes were significantly different between controls and FAD (p < 0.0005) or AD (p < 0.05), and patients carrying at least one ApoE epsilon4 allele were found in 44% of FAD and 34.3% of AD; both were significantly different (p < 0.001) from the controls (12.5%). ACT genotypes and allele frequencies were not different among these groups except for genotypes between ApoE epsilon4 FAD and ApoE epsilon4 controls (p = 0.019). There was a slight but significant increase of the 5 repeat allele of VLDLR in AD (p = 0.014), but the difference was rather diminished in the presence of an ApoE epsilon4 allele. None of combinations of ACT and VLDLR genotypes in the presence or absence of an ApoE epsilon4 allele gave significant difference. Thus, we conclude that among the reported genetic risk factors, ApoE epsilon4 is the only definite risk factor for both FAD and AD, and the VLDLR polymorphism might be associated with AD cases in Japanese.