APOε4 is associated with enhanced in vivo innate immune responses in human subjects
Open accessAbstract
Background The genetic determinants of the human innate immune response are poorly understood. Apolipoprotein (Apo) E, a lipid-trafficking protein that affects inflammation, has well-described wild-type (ε3) and disease-associated (ε2 and ε4) alleles, but its connection to human innate immunity is undefined.Objective We sought to define the relationship of APOε4 to the human innate immune response.Methods We evaluated APOε4 in several functional models of the human innate immune response, including intravenous LPS challenge in human subjects, and assessed APOε4 association to organ injury in patients with severe sepsis, a disease driven by dysregulated innate immunity.Results Whole blood from healthy APOε3/APOε4 volunteers induced higher cytokine levels on ex vivo stimulation with Toll-like receptor (TLR) 2, TLR4, or TLR5 ligands than blood from APOε3/APOε3 patients, whereas TLR7/8 responses were similar. This was associated with increased lipid rafts in APOε3/APOε4 monocytes. By contrast, APOε3/APOε3 and APOε3/APOε4 serum neutralized LPS equivalently and supported similar LPS responses in Apoe-deficient macrophages, arguing against a differential role for secretory APOE4 protein. After intravenous LPS, APOε3/APOε4 patients had higher hyperthermia and plasma TNF-α levels and earlier plasma IL-6 than APOε3/APOε3 patients. APOE4-targeted replacement mice displayed enhanced hypothermia, plasma cytokines, and hepatic injury and altered splenic lymphocyte apoptosis after systemic LPS compared with APOE3 counterparts. In a cohort of 828 patients with severe sepsis, APOε4 was associated with increased coagulation system failure among European American patients.Conclusions APOε4 is a determinant of the human innate immune response to multiple TLR ligands and associates with altered patterns of organ injury in human sepsis.
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Prior work shows that E4 impairs microglial metabolism/immune reactivity and can exaggerate cytokine reactivity to LPS.
“Prior work shows that E4 impairs microglial metabolism/immune reactivity and can exaggerate cytokine reactivity to LPS”
From Older adult APOE4 mice exhibit modest immunometabolic adaptation following microglial APOE2 replacement (2027) · cites this paper as Gale et al., 2014
The Results section reports higher TNFα after LPS challenge in human APOε4 carriers and APOE4-targeted mice, supporting exaggerated cytokine reactivity to LPS. The paper’s reported experiments concern blood responses and systemic inflammation; our copy does not establish that E4 impairs microglial metabolism or microglial immune reactivity. Page numbers are unavailable in the indexed copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAPOE genotype influences the inflammatory response, with E4 expression linked to significantly higher cytokine levels in both humans and mice compared to E3 or E2.
“In addition to metabolic dysregulation, APOE genotype also influences the inflammatory response, with E4 expression linked to significantly higher cytokine levels in both humans and mice compared to E3 or E2”
From Older adult APOE4 mice exhibit modest immunometabolic adaptation following microglial APOE2 replacement (2027) · cites this paper as Gale et al., 2014
The Results report higher cytokine responses in APOε3/APOε4 humans than APOε3/APOε3 humans after specified immune challenges, and higher plasma TNFα and G-CSF in LPS-challenged APOE4 mice than APOE3 mice. The study does not establish higher cytokine levels relative to APOE2 in either species; it also reports that some cytokine responses were similar between the E4 and E3 groups. (LLM, conf=0.90)
Experimental — accuracy not yet measuredComparable findings have been reported following intraperitoneal LPS injection.
“and comparable findings have been reported following intraperitoneal LPS injection”
From Older adult APOE4 mice exhibit modest immunometabolic adaptation following microglial APOE2 replacement (2027) · cites this paper as Gale et al., 2014
The APOE4 variant both sensitises to endotoxin and predisposes to Alzheimer's disease.
“the APOE4 variant both sensitises to endotoxin and predisposes to Alzheimer’s disease.”
From The endotoxin hypothesis of neurodegeneration (2019) · cites this paper as [83]
Humans with the APOE4 variant are more sensitive to injected LPS than those with APOE3, and mice with endogenous ApoE replaced with APOE4 are more sensitive to LPS than those replaced with APOE3.
“Humans with the APOE4 variant are more sensitive to injected LPS than those with APOE3, and similarly, mice with endogenous ApoE replaced with APOE4 are more sensitive to LPS than those replaced with APOE3 [83].”
From The endotoxin hypothesis of neurodegeneration (2019) · cites this paper as [83]
There is a clear and direct link between APOE variants and endotoxin.
“Thus, there is a clear and direct link between APOE variants and endotoxin.”
From The endotoxin hypothesis of neurodegeneration (2019) · cites this paper as [83]
APOE ε4 carriers have a stronger systemic inflammatory response to intravenous LPS challenge, including more intense hyperthermia and higher TNF secretion in whole blood.
“APOE ε4 carriers have a stronger systemic inflammatory response to an intravenous LPS challenge, including more intense hyperthermia and higher levels of TNF secretion in whole blood”
From Alzheimer Disease: An Update on Pathobiology and Treatment Strategies (2019) · cites this paper as Gale et al., 2014
In healthy humans challenged with intravenous LPS infusion, ε4-carriers demonstrate significantly higher elevation of body temperature and plasma TNF levels compared to ε4 non-carriers.
“In healthy humans challenged with intravenous LPS infusion, ε4-carriers demonstrate significantly higher elevation of body temperature and plasma TNF levels compared to ε4 non-carriers108.”
From Interplay between innate immunity and Alzheimer disease: APOE and TREM2 in the spotlight (2018) · cites this paper as [108]
A greater immune response associated with the ε4 allele is also observed in human APOE-TR mice and in cultured microglia/macrophages upon LPS stimulation.
“A greater immune response associated with the ε4 allele is also observed in human ApoE-targeted replacement (APOE-TR) mice [G] and in cultured microglia/macrophages upon LPS stimulation108–110.”
From Interplay between innate immunity and Alzheimer disease: APOE and TREM2 in the spotlight (2018) · cites this paper as [108]
When whole blood isolates from human subjects were stimulated ex vivo with TLR ligands, enhanced production of cytokines and chemokines was observed in blood from ε4+ donors compared with ε4− donors.
“Similarly, when whole blood isolates from human subjects were stimulated ex vivo with TLR ligands, enhanced production of a wide panel of cytokines and chemokines was observed in blood from ε4+ donors compared with ε4− donors108.”
From Interplay between innate immunity and Alzheimer disease: APOE and TREM2 in the spotlight (2018) · cites this paper as [108]
ApoE4 is less effective than ApoE3 in inducing cholesterol efflux from macrophages, causing cholesterol accumulation on cell membranes.
“ApoE4 is reported to be less effective than ApoE3 in inducing cholesterol efflux from macrophages114, which causes cholesterol accumulation on cell membranes108,114.”
From Interplay between innate immunity and Alzheimer disease: APOE and TREM2 in the spotlight (2018) · cites this paper as [108]
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Friday, C. M., Stephens, I. O., Smith, C. T., Lee, S., Satish, D., Devanney, N. A., Cohen, S., Morganti, J. M., Gordon, S. M., & Johnson, L. A. (2025) · Neurobiology of Disease · doi:10.1016/j.nbd.2025.106983 · Cited by 33 · see citing works
Nolt, G. L., MacLean, S. M., Golden, L. R., Thorpe, S. P., Stephens, I. O., Funnell, J. L., Brock, C. R., Lucido, C. C., Smith, L., Hernandez, G., et al. (2027) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2026.08.005
- Authors
- Gale, S. C., Gao, L., Mikacenic, C., Coyle, S. M., Rafaels, N., Murray Dudenkov, T., Madenspacher, J. H., Draper, D. W., Ge, W., Aloor, J. J., Azzam, K. M., Lai, L., Blackshear, P. J., Calvano, S. E., Barnes, K. C., Lowry, S. F., Corbett, S., Wurfel, M. M., & Fessler, M. B.
- Affiliations
- Johns Hopkins University (US)
- University of Washington (US)
- National Institutes of Health (US)
- Corresponding author
- Fessler, Michael B.
- ORCID
- Venue
- Journal of Allergy and Clinical Immunology
- Publisher
- Elsevier BV
- Published
- 2014-07
- Volume
- 134
- Issue
- 1
- Pages
- 127-134.e9
- ISSN
- 0091-6749 (ISSN-L)
- PMC
- PMC4125509
- OpenAlex
- W2110616131
- Cited by
- 202
- References
- 56
- Citations by year
- 2026: 24 · 2025: 20 · 2024: 12 · 2023: 20 · 2022: 19 · 2021: 29 · 2020: 19 · 2019: 16 · 2018: 12 · 2017: 9 · 2016: 10 · 2015: 12
- FWCI
- 4.72
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Allergy and Clinical Immunology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (5p50hl073994-05, 5r01gm034695-26)
- National Heart, Lung, and Blood Institute (P50 HL-073994, HL73994, R01HL089807)
- National Institute of General Medical Sciences (R01 GM-34695, R01 GM-034695)
- National Institute of Environmental Health Sciences (Z01ES102005, ZIAES102005)
- Topics
- Life Sciences › Immunology and Microbiology › Immunology › Immune Response and Inflammation
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Inflammasome and immune disorders
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Keywords
- apolipoprotein E, APOE ε4, innate immunity, Toll-like receptors, lipopolysaccharide response, sepsis, organ damage, lipid rafts, monocytes, TNF-α, interleukin-6, coagulopathy, lymphocyte apoptosis, hyperthermia
- MeSH terms
- Adult, Animals, Cells, Cultured, Humans, Immunity, Innate, Ligands, Lipopolysaccharides, Mice, Transgenic, Monocytes, Tumor Necrosis Factor-alpha, Interleukin-6, Gene Expression, Sepsis, Toll-Like Receptor 2, Toll-Like Receptor 4, Toll-Like Receptor 5, Mice, Apolipoprotein E3, Apolipoprotein E4
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