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[Preprint]. 2025 May 9:2025.05.07.25327065.
doi: 10.1101/2025.05.07.25327065.

APOE stratified genome-wide association studies provide novel insights into the genetic etiology of Alzheimers's disease

Jesper Qvist Thomassen  1 Leonard Hampton  2 Brittany Ulms  3 Benjamin Grenier-Boley  4 Sami Heikkinen  5 Pablo Garcia  6 Atahualapa Castillo-Morales  7 Masataka Kikuchi  8 Jungsoo Gim  9   10   11   12 Han Cao  13   14 Fahri Küçükali  15   16 Najaf Amin  3 Dabin Yoon  9   10 Itziar de Rojas  6   17   18 Pilar Alvarez Jerez  2 Victoria Alvarez  19   20 Beatrice Arosio  21   22 Celine Bellenguez  4 Sverre Bergh  23   24 Kimberly Billingsley  2 Cornelis Blauwendraat  25 Merce Boada  6   17 Barbara Borroni  26   27 Paola Bossù  28 María J Bullido  17   29   30 Antonio Daniele  31   32 Ángel Carracedo  33   34 Alexandre de Mendonça  35 Mark Cookson  2 Jürgen Deckert  36 Martin Dichgans  37   38   39 Srdjan Djurovic  40   41 Oriol Dols-Icardo  17   42 Carole Dufouil  43 Emrah Düzel  44   45 Valentina Escott-Price  46 Tormod Fladby  47   48 Laura Fratiglioni  49   50 Amy K Y Fu  13   14   51   52 Daniela Galimberti  53   54 Jose Maria García-Alberca  2   17 Vilmantas Giedraitis  55 Guillermo Garcia-Ribas  56 Caroline Graff  49   50 Timo Grimmer  57 Edna Grünblatt  58   59   60 OIivier Hanon  61 Lucrezia Hausner  62 Stefanie Heilmann-Hemibach  63 Jakub Hort  64   65 Frank Jessen  66   67   68 Kendall Jensen  69 Caroline Jonson  2 Yoontae Kim  10   11 Nicole Kuznetsov  2 Ville Leinonen  70   71 Anssi Lipponen  5 Jiao Luo  1   72 Mary Makarious  2 Henna Martiskainen  5 Carlo Masullo  73 Patrizia Mecocci  74   75 Shima Mehrabian  76 Pablo Mir  17   77   78 Akinori Miyashita  8 Susanne Moebus  79 Kin Y Mok  13   14   80 Laura Molina Porcel  81   82 Fermin Moreno  17   83   84 Benedetta Nacmias  85   86 Lucilla Parnetti  87 Pau Pastor  88   89 Jordi Pérez-Tur  17   90 Oliver Peters  91   92 Yolande A L Pijnenburg  93   94 Gerard Piñol-Ripoll  95   96 Julius Popp  97   98   99 Innocenzo Rainero  100 Luis M Real  101   102 Steffi Riedel-Heller  103 Eloy Rodriguez-Rodriguez  17   104 Arvid Rongve  105 Giacomina Rossi  106 Jose Luis Royo  102 Dan Rujescu  107   108 Ingvild Saltvedt  109 María Eugenia Sáez  110 Raquel Sánchez-Valle  111 Florentino Sanchez-Garcia  112 Nicolai Sandau  1 Nikolaos Scarmeas  113   114 Katja Scheffler  109   115 Norbert Scherbaum  116 Anja Schneider  67   117 Geir Selbæk  118   119   120 Davide Seripa  121 Vincenzo Solfrizzi  122   123 Marco Spallazzi  124 Alessio Squassina  125 Eystein Stordal  126 Niccoló Tesi  94   127   128 Lucio Tremolizzo  129   130 Kumar P Tripathi  131   132 Wiesje M van der Flier  93   94   133 Julie Williams  7   134 Jens Wiltfang  135   136   137 Dag Aarsland  138   139   140 Andrew B Singleton  2 Philippe Amouyel  4 Stéphanie Debette  43 Gael Nicolas  141 Sven van der Lee  93   94   127 Henne Holstege  93   94   127   142   143 Maria Victoria Fernandez  6 Patrick Gavin Kehoe  144 Kristel Sleegers  15   16 Martin Ingelsson  55   145   146 Roberta Ghidoni  27 Ole A Andreassen  41   147   148 Peter A Holmans  134 Pascual Sánchez-Juan  17   149 Rebecca Sims  134 Nancy Y Ip  13   14   51   52 Kun Ho Lee  9   11   12   150 Takeshi Ikeuchi  8 Alfredo Ramirez  67   68   117   131   151 Agustin Ruiz  6   17   152 Mikko Hiltunen  5 Jean-Charles Lambert  4 Cornelia van Duijn  3   153 Mike Nalls  2 Ruth Frikke-Schmidt  1   154
Affiliations

APOE stratified genome-wide association studies provide novel insights into the genetic etiology of Alzheimers's disease

Jesper Qvist Thomassen et al. medRxiv. .

Abstract

Among the more than 90 identified genetic risk loci for late-onset Alzheimer's disease (AD) and related dementias, the apolipoprotein E gene (APOE) ε2/ε3/ε4 polymorphism remains the longstanding benchmark for genetic disease risk with a consistently large effect across studies1-10. Despite this massive signal, the exact mechanisms for how ε4 increases and for how ε2 decreases dementia risk is not well-understood. Importantly, recent trials of anti-amyloid therapies suggest less efficacy and higher risks of severe side effects in s4 carriers11-13, hampering the treatment of those with the highest unmet need. To improve our understanding of the genetic architecture of AD in the context of its main genetic driver, we performed genome-wide association studies (GWASs) stratified by ε4 and ε2 carrier status. Such insights may help to understand and overcome side effects, to impact clinical trial enrolment strategies, and to create the scientific basis for targeted mechanism-driven therapies in neurodegenerative diseases.

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Figures

Figure 1:
Figure 1:. Flow chart of study
Flow chart illustrating the included multi-ancestry cohorts and analysis strategies.
Figure 2:
Figure 2:. Miami plot of the APOE ε33 and ε44+ε43 strata.
The Manhattan plot for the APOE ε44+ε43 strata is shown in blue in the upper part of the figure and for the APOE ε33 strata in orange in the lower part of the figure. Genome wide significant loci are annotated with the nearest gene (known loci in black and new in red). Two-sided raw P-values were derived from a fixed-effect meta-analysis. The red dashed lines show the genome-wide significant level (P=5×10−8). APOE: Apolipoprotein E gene.
Figure 3:
Figure 3:. Loci and forest plots for SLC50A1, TMEM106B, NPAS3, and SHARPIN where the effect attenuates with the APOE ε4 allele.
Loci plots for SLC50A1 (A), TMEM106B (B), NPAS3 (C), SHARPIN (D) in APOE ε33 and APOE ε44+ε43 strata. Forest plots for the lead SNPs in the four APOE strata ε33, ε44+ε43, ε43 and ε44. In the forest plot each APOE strata is shown to visualize potential dominant or additive interaction.
Figure 4:
Figure 4:. Loci and forest plots for the three loci (HLA-DRA -1, CLU, DDHD1) where the effect is augmented with the APOE ε4 allele.
Loci plots for HLA-DRA -1 (A), CLU (B), DDHD1 (C) in APOE ε33 and APOE ε44+ε43 strata. Forest plots for the lead SNPs in the four APOE strata ε33, ε44+ε43, ε43 and ε44. In the forest plot each APOE strata is shown to visualize potential dominant or additive interaction.
Figure 5:
Figure 5:. Multi-ancestry evaluation
A: Multi-ancestry results for lead variant in HLA-DRA locus. B: Multi-ancestry results for lead variant in DDHD1 locus. AAC: Asian American, AFR: African American, AMR: Admixed American, CHN: Hong-Kong Chinese, JPN: Japanese, KOR: Korean, EAS: East Asian ancestry meta-analysis, EUR: European ancestry meta-analysis.
Figure 6:
Figure 6:. Variant and gene-based significant loci
Venn-diagram of the genome-wide significant loci associated with AD, showing the overlap between APOE-strata and between variant based testing (main GWAS) and gene-based testing (MAGMA).

References

    1. Lambert J.-C. et al. Meta-analysis of 74,046 individuals identifies 11 new susceptibility loci for Alzheimer's disease. Nature Genetics 45, 1452–1458 (2013). - PMC - PubMed
    1. Jansen I.E. et al. Genome-wide meta-analysis identifies new loci and functional pathways influencing Alzheimer's disease risk. Nat Genet 51, 404–413 (2019). - PMC - PubMed
    1. Kunkle B.W. et al. Genetic meta-analysis of diagnosed Alzheimer's disease identifies new risk loci and implicates Abeta, tau, immunity and lipid processing. Nat Genet 51, 414–430 (2019). - PMC - PubMed
    1. Wightman D.P. et al. A genome-wide association study with 1,126,563 individuals identifies new risk loci for Alzheimer's disease. Nat Genet 53, 1276–1282 (2021). - PMC - PubMed
    1. de Rojas I. et al. Common variants in Alzheimer’s disease: Novel association of six genetic variants with AD and risk stratification by polygenic risk scores. medRxiv (2020).

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