Cited by 3,459Alzheimer's disease research and treatmentsDementia and Cognitive Impairment ResearchNeuroinflammation and Neurodegeneration Mechanisms

Apolipoprotein E and Alzheimer disease: risk, mechanisms and therapy

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Liu, Chia-Chen, Kanekiyo, Takahisa, Xu, Huaxi, Bu, Guojun·2013·Nature Reviews Neurology

Abstract

Apolipoprotein E (Apo-E) is a major cholesterol carrier that supports lipid transport and injury repair in the brain. APOE polymorphic alleles are the main genetic determinants of Alzheimer disease (AD) risk: individuals carrying the ε4 allele are at increased risk of AD compared with those carrying the more common ε3 allele, whereas the ε2 allele decreases risk. Presence of the APOE ε4 allele is also associated with increased risk of cerebral amyloid angiopathy and age-related cognitive decline during normal ageing. Apo-E-lipoproteins bind to several cell-surface receptors to deliver lipids, and also to hydrophobic amyloid-β (Aβ) peptide, which is thought to initiate toxic events that lead to synaptic dysfunction and neurodegeneration in AD. Apo-E isoforms differentially regulate Aβ aggregation and clearance in the brain, and have distinct functions in regulating brain lipid transport, glucose metabolism, neuronal signalling, neuroinflammation, and mitochondrial function. In this Review, we describe current knowledge on Apo-E in the CNS, with a particular emphasis on the clinical and pathological features associated with carriers of different Apo-E isoforms. We also discuss Aβ-dependent and Aβ-independent mechanisms that link Apo-E4 status with AD risk, and consider how to design effective strategies for AD therapy by targeting Apo-E.

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Crossref · 10.1038/nrneurol.2012.263

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  • Equivalent expression of E2 almost cancels out the deleterious effect of the E4 allele.

    “and equivalent expression of E2 almost cancels out the deleterious effect of the E4 allele.6,14,15”

    From AAVrh.10-Mediated APOE2 Central Nervous System Gene Therapy for APOE4-Associated Alzheimer's Disease (2018) · cites this paper as [15]

    In “APOE ε4 as a strong risk factor for AD” (page unavailable), the review reports an Alzheimer disease odds ratio of 2.6 for ε2/ε4, versus 3.2 for ε3/ε4 and 1 for the ε3/ε3 reference group. That suggests some attenuation, not near-cancellation of ε4-associated risk. The passage compares genotypes; it does not establish equivalent expression of the two isoforms. (LLM, conf=0.87)

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  • E2/E4 heterozygotes have only double the risk of E3/E3 homozygotes.

    “E2/E4 heterozygotes have only double the risk of E3/E3 homozygotes”

    From AAVrh.10-Mediated APOE2 Central Nervous System Gene Therapy for APOE4-Associated Alzheimer's Disease (2018) · cites this paper as [15]

    The “APOE ε4 as a strong risk factor for AD” section reports an odds ratio of 2.6 for ε2/ε4 compared with ε3/ε3 among Caucasian subjects. This supports an elevated Alzheimer disease risk, but not the stated figure of only double the risk; the reported measure is also an odds ratio, not a risk ratio. (LLM, conf=0.88)

    Experimental — accuracy not yet measured
  • apoE2 exerts a protective effect against Aβ pathology and AD morbidity.

    “Epidemiological evidence and evidence from neuropathological assessment of the impact of apoE isoforms on the brain Aβ load, have suggested that apoE2 exerts a protective effect against Aβ pathology and AD morbidity [3,9,10], while apoE4, in contrast, markedly enhances the disease process [7,8,30].”

    From Blocking the apoE/Aβ interaction ameliorates Aβ-related pathology in APOE ε2 and ε4 targeted replacement Alzheimer model mice (2014) · cites this paper as [3]

    The “APOE and Aβ deposition” section states that APOE ε2 reduces dementia risk, supporting the AD-morbidity part. It does not establish protection against Aβ pathology: in individuals older than 90, ε2 was associated with greater amyloid burden than ε3, and the authors suggest its protective effect against AD might not be associated with Aβ deposition. Page numbers are not available in the supplied copy. (LLM, conf=0.88)

    Experimental — accuracy not yet measured
  • An APOE ε2 allele halves AD risk relative to 2 copies of ε3.

    “A single copy of the APOE ε4 allele endows a ~3 fold increase in AD risk, and 2 APOE ε4 copies result in a ~15 fold risk increase, while an APOE ε2 allele halves AD risk relative to 2 copies of ε3 (reviewed in [4]).”

    From APOE Genotype Differentially Modulates Effects of Anti-Aβ, Passive Immunization in APP Transgenic Mice (2017) · cites this paper as [4]

    The “APOE ε4 as a strong risk factor for AD” section reports that, among Caucasian subjects, ε2/ε3 carriers had lower AD odds than ε3/ε3 carriers. It gives an odds ratio of 0.6—not a halving of risk—and the citing sentence omits the population qualifier. (LLM, conf=0.86)

    Experimental — accuracy not yet measured
  • Two APOE ε4 copies result in a ~15 fold risk increase.

    “A single copy of the APOE ε4 allele endows a ~3 fold increase in AD risk, and 2 APOE ε4 copies result in a ~15 fold risk increase, while an APOE ε2 allele halves AD risk relative to 2 copies of ε3 (reviewed in [4]).”

    From APOE Genotype Differentially Modulates Effects of Anti-Aβ, Passive Immunization in APP Transgenic Mice (2017) · cites this paper as [4]

    In “APOE ε4 as a strong risk factor for AD,” the review reports an odds ratio of 14.9 for people with two ε4 copies versus ε3/ε3, but that estimate is for Caucasian subjects. The same section reports different estimates for other populations, so the unqualified ~15-fold claim is broader than the source supports. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

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Authors
Liu, C.-C., Kanekiyo, T., Xu, H., & Bu, G.
Affiliations
  • Xiamen University (CN)
  • Mayo Clinic (US)
Corresponding author
Bu, Guojun
Venue
Nature Reviews Neurology
Published
2013-01-08
Volume
9
Issue
2
Pages
106-118
ISSN
  • 1759-4758 (ISSN-L)
  • 1759-4766
OpenAlex
W2140718540
Cited by
3,459
References
180
Citations by year
2026: 273 · 2025: 343 · 2024: 332 · 2023: 277 · 2022: 331 · 2021: 341 · 2020: 321 · 2019: 291 · 2018: 278 · 2017: 206 · 2016: 171 · 2015: 128 · 2014: 123 · 2013: 41
FWCI
17.01
Type
journal article
Language
en
Open access
Locations
  • Nature Reviews Neurology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • Rare & Special e-Zone (The Hong Kong University of Science and Technology) (submittedVersion)
Funders
  • American Health Assistance Foundation
  • Xiamen University
  • National Institutes of Health
  • National Institute on Aging (P01AG030128, R01AG044420, R01AG038710, R01AG027924, R01AG021173, R01AG031784, RF1AG046205, R01AG035355)
  • National Institute of Neurological Disorders and Stroke (P01NS074969)
Topics
  • Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Life Sciences › Neuroscience › Neurology › Neuroinflammation and Neurodegeneration Mechanisms
Keywords
apolipoprotein E, APOE ε4, Alzheimer's disease, genetic risk factors, amyloid-beta, neurodegeneration, cerebral amyloid angiopathy, neurovascular function, neuroinflammation, mitochondrial function
MeSH terms
Alzheimer Disease, Animals, Apolipoproteins E, Brain, Brain Injuries, Dementia, Humans, Immunotherapy, Inflammation, Neuronal Plasticity, Predictive Value of Tests, Risk, Vascular Diseases, Amyloid beta-Peptides, tau Proteins, Dendritic Spines, Lipid Metabolism, Neurogenesis, Cognitive Dysfunction

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