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Castro-Aldrete L, Einsiedler M, Novakova Martinkova J, Depypere H, Alvin Ang TF, Mielke MM, Sindi S, Eyre HA, Au R, Schumacher Dimech AM, Dé A, Szoeke C, Tartaglia MC, Santuccione Chadha A. Alzheimer disease seen through the lens of sex and gender. Nat Rev Neurol 2025; 21:235-249. [PMID: 40229578 DOI: 10.1038/s41582-025-01071-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2025] [Indexed: 04/16/2025]
Abstract
Alzheimer disease (AD) is a life-limiting neurodegenerative disorder that disproportionately affects women. Indeed, sex and gender are emerging as crucial modifiers of diagnostic and therapeutic pathways in AD. This Review provides an overview of the interactions of sex and gender with important developments in AD and offers insights into priorities for future research to facilitate the development and implementation of personalized approaches in the shifting paradigm of AD care. In particular, this Review focuses on the influence of sex and gender on important advances in the treatment and diagnosis of AD, including disease-modifying therapies, fluid-based biomarkers, cognitive assessment tools and multidomain lifestyle interventional studies.
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Affiliation(s)
| | | | - Julie Novakova Martinkova
- Women's Brain Foundation, Basel, Switzerland
- Memory Clinic, Department of Neurology, Second Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Herman Depypere
- Department of Gynecology, Breast and Menopause Clinic, University Hospital, Coupure Menopause Centre, Ghent, Belgium
| | - Ting Fang Alvin Ang
- Department of Anatomy and Neurobiology and Slone Center of Epidemiology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Michelle M Mielke
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Shireen Sindi
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- The Ageing Epidemiology Research Unit, School of Public Health, Faculty of Medicine, Imperial College London, London, UK
| | - Harris A Eyre
- Neuro-Policy Program, Center for Health and Biosciences, The Baker Institute for Public Policy, Rice University, Houston, TX, USA
- Euro-Mediterranean Economists Association, Barcelona, Spain
| | - Rhoda Au
- Department of Anatomy and Neurobiology, Neurology, Medicine and Epidemiology, Boston University Chobanian and Avedisian School of Medicine and School of Public Health, Boston, MA, USA
| | - Anne Marie Schumacher Dimech
- Women's Brain Foundation, Basel, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Anna Dé
- Women's Brain Foundation, Basel, Switzerland
| | | | - Maria Carmela Tartaglia
- Women's Brain Foundation, Basel, Switzerland
- Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
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Amabebe E, Huang Z, Jash S, Krishnan B, Cheng S, Nakashima A, Li Y, Li Z, Wang R, Menon R, Zhou XZ, Lu KP, Sharma S. Novel Role of Pin1-Cis P-Tau-ApoE Axis in the Pathogenesis of Preeclampsia and Its Connection with Dementia. Biomedicines 2024; 13:29. [PMID: 39857613 PMCID: PMC11763151 DOI: 10.3390/biomedicines13010029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2024] [Revised: 12/16/2024] [Accepted: 12/23/2024] [Indexed: 01/27/2025] Open
Abstract
Preeclampsia (preE) is a severe multisystem hypertensive syndrome of pregnancy associated with ischemia/hypoxia, angiogenic imbalance, apolipoprotein E (ApoE)-mediated dyslipidemia, placental insufficiency, and inflammation at the maternal-fetal interface. Our recent data further suggest that preE is associated with impaired autophagy, vascular dysfunction, and proteinopathy/tauopathy disorder, similar to neurodegenerative diseases such as Alzheimer's disease (AD), including the presence of the cis stereo-isoform of phosphorylated tau (cis P-tau), amyloid-β, and transthyretin in the placenta and circulation. This review provides an overview of the factors that may lead to the induction and accumulation of cis P-tau-like proteins by focusing on the inactivation of peptidyl-prolyl cis-trans isomerase (Pin1) that catalyzes the cis to trans isomerization of P-tau. We also highlighted the novel role of the Pin1-cis P-tau-ApoE axis in the development of preE, and propagation of cis P-tau-mediated abnormal protein aggregation (tauopathy) from the placenta to cerebral tissues later in life, leading to neurodegenerative conditions. In the case of preE, proteinopathy/tauopathy may interrupt trophoblast differentiation and induce cell death, similar to the events occurring in neurons. These events may eventually damage the endothelium and cause systemic features of disorders such as preE. Despite impressive research and therapeutic advances in both fields of preE and neurodegenerative diseases, further investigation of Pin1-cis P-tau and ApoE-related mechanistic underpinnings may unravel novel therapeutic options, and new transcriptional and proteomic markers. This review will also cover genetic polymorphisms in the ApoE alleles leading to dyslipidemia induction that may regulate the pathways causing preE or dementia-like features in the reproductive age or later in life, respectively.
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Affiliation(s)
- Emmanuel Amabebe
- Division of Basic Science and Translational Research, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA; (E.A.); (Z.H.); (R.M.)
| | - Zheping Huang
- Division of Basic Science and Translational Research, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA; (E.A.); (Z.H.); (R.M.)
| | - Sukanta Jash
- Department of Molecular Biology, Cell Biology and Biochemistry, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA;
| | - Balaji Krishnan
- Mitchell Center for Neurodegenerative Diseases, Department of Neurology, The University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA;
| | - Shibin Cheng
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA;
| | - Akitoshi Nakashima
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Toyama, Toyama 930-8555, Japan;
| | - Yitong Li
- Departments of Biochemistry and Oncology, Schulich School of Medicine and Dentistry, Robarts Research Institute, Western University, London, ON N6A 3K7, Canada; (Y.L.); (Z.L.); (R.W.); (X.Z.Z.); (K.P.L.)
| | - Zhixong Li
- Departments of Biochemistry and Oncology, Schulich School of Medicine and Dentistry, Robarts Research Institute, Western University, London, ON N6A 3K7, Canada; (Y.L.); (Z.L.); (R.W.); (X.Z.Z.); (K.P.L.)
| | - Ruizhi Wang
- Departments of Biochemistry and Oncology, Schulich School of Medicine and Dentistry, Robarts Research Institute, Western University, London, ON N6A 3K7, Canada; (Y.L.); (Z.L.); (R.W.); (X.Z.Z.); (K.P.L.)
| | - Ramkumar Menon
- Division of Basic Science and Translational Research, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA; (E.A.); (Z.H.); (R.M.)
| | - Xiao Zhen Zhou
- Departments of Biochemistry and Oncology, Schulich School of Medicine and Dentistry, Robarts Research Institute, Western University, London, ON N6A 3K7, Canada; (Y.L.); (Z.L.); (R.W.); (X.Z.Z.); (K.P.L.)
- Departments of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Lawson Health Research Institute, Western University, London, ON N6A 3K7, Canada
| | - Kun Ping Lu
- Departments of Biochemistry and Oncology, Schulich School of Medicine and Dentistry, Robarts Research Institute, Western University, London, ON N6A 3K7, Canada; (Y.L.); (Z.L.); (R.W.); (X.Z.Z.); (K.P.L.)
| | - Surendra Sharma
- Division of Basic Science and Translational Research, Department of Obstetrics and Gynecology, The University of Texas Medical Branch at Galveston, Galveston, TX 77555, USA; (E.A.); (Z.H.); (R.M.)
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Liu Q, Jiang S, Li Y, Zhou A, Long H, Zhong W. Causal relationships between cerebral cortical structure and preeclampsia: insights from bidirectional Mendelian randomization and colocalization analysis. Cereb Cortex 2024; 34:bhae400. [PMID: 39390712 DOI: 10.1093/cercor/bhae400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 09/04/2024] [Accepted: 09/18/2024] [Indexed: 10/12/2024] Open
Abstract
Preeclampsia, a multifaceted condition characterized by high blood pressure during pregnancy, is linked to substantial health risks for both the mother and the fetus. Previous studies suggest potential neurological impacts, but the causal relationships between cortical structural changes and preeclampsia remain unclear. We utilized genome-wide association study data for cortical thickness (TH) and surface area (SA) across multiple brain regions and preeclampsia. Bidirectional Mendelian randomization (MR) analyses were conducted to assess causality, followed by co-localization analyses to confirm shared genetic architecture. Increased cortical TH in the inferior parietal and supramarginal regions, and an enlarged SA in the postcentral region, were significantly associated with higher preeclampsia risk. Conversely, preeclampsia was linked to increased SA in the supramarginal and middle temporal gyri, and decreased SA in the lingual gyrus. Co-localization analyses indicated distinct genetic determinants for cortical structures and preeclampsia. Our findings reveal bidirectional influences between cortical structural features and preeclampsia, suggesting neuroinflammatory and vascular mechanisms as potential pathways. These insights underscore the importance of considering brain structure in preeclampsia risk assessment and highlight the need for further research into neuroprotective strategies.
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Affiliation(s)
- Qiong Liu
- Department of Clinical Nutrition, Huadu District People's Hospital of Guangzhou, 48 Xinhua Road, Huadu District, Guangzhou, Guangdong 510800, China
| | - Shaoqing Jiang
- Department of Obstetrics and Gynecology, Huadu District People's Hospital of Guangzhou, 48 Xinhua Road, Huadu District, Guangzhou, Guangdong 510800, China
| | - Yan Li
- Department of Obstetrics and Gynecology, Huadu District People's Hospital of Guangzhou, 48 Xinhua Road, Huadu District, Guangzhou, Guangdong 510800, China
| | - Aiyin Zhou
- Department of Obstetrics and Gynecology, Huadu District People's Hospital of Guangzhou, 48 Xinhua Road, Huadu District, Guangzhou, Guangdong 510800, China
| | - Hanfan Long
- Department of Obstetrics and Gynecology, Huadu District People's Hospital of Guangzhou, 48 Xinhua Road, Huadu District, Guangzhou, Guangdong 510800, China
| | - Weifen Zhong
- Department of Obstetrics and Gynecology, Huadu District People's Hospital of Guangzhou, 48 Xinhua Road, Huadu District, Guangzhou, Guangdong 510800, China
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McBride CA, Russom Z, Bernstein IM, Dumas JA. Subclinical Metabolic and Cardiovascular Factors and Brain White Matter Microstructural Integrity in Young Women. Reprod Sci 2024; 31:1895-1902. [PMID: 38565839 DOI: 10.1007/s43032-024-01516-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024]
Abstract
Women who have experienced pregnancy complications, specifically preeclampsia and gestational diabetes, have well documented increased risks of cardiovascular, metabolic, and neurological disease later in life. This study examined how specific cardiovascular and metabolic risk factors for preeclampsia assessed in a non-pregnant state were associated with brain white matter microstructural integrity. This study examined sixty-two healthy women (mean age 31 ± 5 years) who received metabolic and cardiovascular assessments as well as multiple modality MRI imaging. Participants were either nulliparous (n = 31) or had a history of preterm preeclampsia (n = 31). Imaging included acquisition Diffusion Tensor Imaging (DTI) to assess white matter integrity within the brain. We hypothesized that healthy, young, non-pregnant women with cardiovascular and metabolic profiles suggesting elevated risk would have decreased white matter integrity, represented by lower Fractional Anisotropy (FA) and increased Mean Diffusivity (MD) estimates in the posterior cortical areas of the brain. We observed increased white matter degradation (lower FA and increased MD) in posterior and occipital tracts, commissural fibers, and subcortical structures in women with increased adiposity, worse measures of cardiovascular and metabolic function, including greater insulin resistance (HOMA-IR), hyperlipidemia, elevated blood pressure, and increased arterial stiffness. The relationships detected between subclinical cardiovascular and metabolic phenotypes and increased white matter disruption at a young age, outside of pregnancy, are indicative that adverse changes are detectable long before cognitive clinical presentation. This may suggest that many of the long-term cardiovascular and metabolic risks of aging are influenced by physiologic aging trajectories rather than damage caused by pregnancy complications.
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Affiliation(s)
- Carole A McBride
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Zane Russom
- Department of Psychiatry, University of Vermont Larner College of Medicine, 1 South Prospect St, Burlington, VT, 05401, USA
| | - Ira M Bernstein
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Julie A Dumas
- Department of Psychiatry, University of Vermont Larner College of Medicine, 1 South Prospect St, Burlington, VT, 05401, USA.
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Abe M, Arima H. Dementia: a looming threat for women with hypertensive disorders of pregnancy? Hypertens Res 2024; 47:975-977. [PMID: 38337006 DOI: 10.1038/s41440-024-01588-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 02/12/2024]
Affiliation(s)
- Makiko Abe
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Li M, Qu K, Wang Y, Wang Y, Sun L. Associations of hypertensive disorders of pregnancy with cognition, dementia, and brain structure: a Mendelian randomization study. J Hypertens 2024; 42:399-409. [PMID: 37850952 PMCID: PMC10842677 DOI: 10.1097/hjh.0000000000003593] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/10/2023] [Accepted: 09/28/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Observational studies have found associations between hypertensive disorders of pregnancy and an increased risk of cognitive dysfunction and reduced brain volume. However, the results of observational studies may have been influenced by confounding factors. This study applied two-sample Mendelian randomization (MR) to explore the causal associations of hypertensive disorders of pregnancy with cognition, dementia, and brain structure. METHODS Summary data on hypertensive disorders of pregnancy and their main subtypes, cognition, dementia, and brain structure were obtained from recent European genome-wide association studies. We computed the inverse-variance weighted, MR-Egger, and weighted median MR estimates. Cochran's Q statistics and the MR-Egger intercept test were used to quantify the heterogeneity and horizontal pleiotropy of the instrumental variables. RESULTS Genetically predicted preeclampsia or eclampsia was inversely associated with gray matter volume [beta = -0.072; 95% confidence interval (CI) = -0.131 to -0.014; P = 1.53 × 10 -2 ]; possibly with brain volume (beta = -0.064; 95% CI = -0.117 to -0.012; P = 1.68 × 10 -2 ). However, the association of hypertensive pregnancy disorders or gestational hypertension with brain structure was not significant. We did not find any significant association between hypertensive disorders of pregnancy, gestational hypertension, or preeclampsia or eclampsia and cognition and dementia-related outcomes. CONCLUSION This study provided genetic evidence supporting an association between preeclampsia or eclampsia and reduced brain volume. This supports the view of PE as a risk factor for gray matter volume reduction.
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Affiliation(s)
- Mingxi Li
- Department of Neurology and Neuroscience Center
| | - Kang Qu
- Department of Neurology and Neuroscience Center
| | - Yueyuan Wang
- Department of Breast Surgery, General Surgery Center, The First Hospital of Jilin University, Jilin University, Changchun, PR China
| | | | - Li Sun
- Department of Neurology and Neuroscience Center
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Tatar M. Stalking the link between reproduction and aging: After decades of research, it still remains a mystery whether and how reproduction drives the process of aging: After decades of research, it still remains a mystery whether and how reproduction drives the process of aging. EMBO Rep 2023; 24:e57374. [PMID: 37144246 PMCID: PMC10240196 DOI: 10.15252/embr.202357374] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 04/25/2023] [Indexed: 05/06/2023] Open
Abstract
The hypothesis that aging and number of offspring are linked with each other has attracted much attention and research, but evidence for it remains elusive.
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Affiliation(s)
- Marc Tatar
- Department of Ecology, Evolution and Organismal BiologyBrown UniversityProvidenceRIUSA
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