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APOE ε2 is associated with increased tau pathology in primary tauopathy
Open accessAbstract
Apolipoprotein E ( APOE ) ε4 allele is the strongest genetic risk factor for late-onset Alzheimer’s disease mainly by modulating amyloid-β pathology. APOE ε4 is also shown to exacerbate neurodegeneration and neuroinflammation in a tau transgenic mouse model. To further evaluate the association of APOE genotype with the presence and severity of tau pathology, we express human tau via an adeno-associated virus gene delivery approach in human APOE targeted replacement mice. We find increased hyperphosphorylated tau species, tau aggregates, and behavioral abnormalities in mice expressing APOE ε2/ε2. We also show that in humans, the APOE ε2 allele is associated with increased tau pathology in the brains of progressive supranuclear palsy (PSP) cases. Finally, we identify an association between the APOE ε2/ε2 genotype and risk of tauopathies using two series of pathologically-confirmed cases of PSP and corticobasal degeneration. Our data together suggest APOE ε2 status may influence the risk and progression of tauopathy.
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“This is especially critical after a recent study in the preclinical literature demonstrated APOE2 expression via viral delivery exacerbated pathology in tauopathy mice (Zhao et al., 2018).”
From Alzheimer Disease: An Update on Pathobiology and Treatment Strategies (2019) · cites this paper as Zhao et al., 2018
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“One study found that the APOEε2 allele is associated with increased odds of neuropathologically confirmed primary tauopathy (PSP and corticobasal degeneration)66.”
From Multifaceted roles of APOE in Alzheimer disease (2024) · cites this paper as [66]
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“Furthermore, the APOE ε2 allele was associated with increased tau pathology in the brains of human progressive supranuclear palsy, a primary tauopathy.”
From Deletion of neuronal Idol ameliorates Alzheimer's disease–related pathologies via APOE receptors (2025) · cites this paper as [71]
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“For example, APOE2 mice exhibited more tau pathology, compared to APOE3 and APOE4 mice, and behavioral abnormalities in a tauopathy model.”
From Deletion of neuronal Idol ameliorates Alzheimer's disease–related pathologies via APOE receptors (2025) · cites this paper as [71]
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“ApoE can also affect tauopathy and tau-mediated neurodegeneration (Brecht et al., 2004; Shi and Holtzman, 2018; Zhao et al., 2018).”
From Selective removal of astrocytic APOE4 strongly protects against tau-mediated neurodegeneration and decreases synaptic phagocytosis by microglia (2021) · cites this paper as Zhao et al., 2018
In the citing paper
“Studies have shown that hyperphosphorylated tau species, tau aggregates and behavioral abnormalities were observed in APOE ε2/ε2 mice [471].”
From Molecular and cellular mechanisms underlying the pathogenesis of Alzheimer’s disease (2020) · cites this paper as [471]
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“In addition, APOE ε2 is also associated with increased pathological tau levels in the presence of amyloid [471, 472].”
From Molecular and cellular mechanisms underlying the pathogenesis of Alzheimer’s disease (2020) · cites this paper as [471]
In the citing paper
“A recent study failed to replicate the neurotoxic effect of ApoE4 in tauopathy mice.”
From Alzheimer Disease: An Update on Pathobiology and Treatment Strategies (2019) · cites this paper as Zhao et al., 2018
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BackgroundInfluentialSelf-citationApolipoprotein E: Structural Insights and Links to Alzheimer Disease Pathogenesis
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“Finally, APOE ε2 has been shown to increase primary tauopathy pathology when Aβ is not present (Zhao et al., 2018) and thus, effects of APOE may be dependent on the presence of Aβ pathology.”
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“However, it is also associated with increased tau pathology, suggesting the intricate role of ApoE2 in regulating tau and Aβ.(42) It will be very interesting to verify the effect of APOE2 neurons or astrocytes on AD-associated pathologies in chCOs.”
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“Cognitive and Behavioral Tests—Contextual and cued fear conditioning (CFC), Morris water maze (MWM), open-field assay (OFA) and elevated plus maze (EPM) tests were performed as described (Kang et al., 2018; Sakae et al., 2016; Zhao et al., 2018).”
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“…events, while expression of APOE ε2 in the CNS may have adverse con sequences given the association of APOE ε2 with CAArelated intracer ebral hemorrhage 103 , primary tauopathy 143 and possibly glaucoma 144 , necessitating monitoring for these events in future trials of these therapies.”
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“…compared to ApoE3 [163,164]. is little interaction between ApoE and tau in vivo, studies in transgenic mice suggest that isoforms indirectly affect tau pathology through their influence on microglia phenotype ApoE4 promoting tau-induced neurodegeneration compared to ApoE3 [163,164].”
BackgroundApoE4 inhibition of VMAT2 in the locus coeruleus exacerbates Tau pathology in Alzheimer’s disease
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“ApoE also can affect tau-mediated neurodegeneration and tauopathy by modulating microglial responses to A β plaque pathology [36–38].”
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“Fourthly, they have the considerable advantage of being able to induce tau pathology in a range of genetic backgrounds, thus circumventing the costly and slow process of cross-breeding [101].”
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“Curiously, however, newer investigations both in animals and humans showed a “paradoxical” (due to actually to the AP?) effect of APOE2, specifically in case of APOE2 homozygosis (APOE2/E2) [287].”
BackgroundWang, H., Chang, T. S., Dombroski, B. A., Cheng, P., Patil, V., Valiente‐Banuet, L., Farrell, K. W., McLean, C., Molina‐Porcel, L., Rajput, A. H., et al. (2024) · Molecular Neurodegeneration · doi:10.1186/s13024-024-00747-3 · Cited by 38
“Notably, both ε2 allele and ε4 allele have been associated with tau pathology burden in the brain of mice models [47, 72], which raises the question of distinct tau species in 4R-PSP versus 3R-4R-AD.”
BackgroundInfluentialSelf-citationAdvances in Modeling Alzheimer's Disease In Vitro
Sharma, N. S., Karan, A., Lee, D.-H., Yan, Z., & Xie, J. (2021) · Advanced NanoBiomed Research · doi:10.1002/anbr.202100097 · Cited by 31
Are apolipoprotein E fragments a promising new therapeutic target for Alzheimer’s disease?
Vecchio, F. L., Bisceglia, P., Imbimbo, B. P., Lozupone, M., Latino, R. R., Resta, E., Leone, M., Solfrizzi, V., Greco, A., Daniele, A., et al. (2022) · Therapeutic Advances in Chronic Disease · doi:10.1177/20406223221081605 · Cited by 28
“Mouse J20 line of hAPPFAD and overexpressing APOE 272-299 ApoE4 (1-271)1 (N-terminal) Decreases Aβ clearance and increases Aβ deposition In vivo/ In vitro Full-length ApoE3 and ApoE4 expressing mice were able to stimulate Aβ clearance Bien-Ly et al.”
BackgroundAssessment of APOE in atypical parkinsonism syndromes
Sabir, M. S., Blauwendraat, C., Ahmed, S., Serrano, G. E., Beach, T. G., Perkins, M., Rice, A. C., Masliah, E., Morris, C. M., Pihlstrom, L., et al. (2019) · Neurobiology of Disease · doi:10.1016/j.nbd.2019.02.016 · Cited by 28
Influence of APOE genotype in primary age-related tauopathy
Robinson, A., Davidson, Y. S., Roncaroli, F., Minshull, J., Tinkler, P., Horan, M. A., Payton, A., Pendleton, N., & Mann, D. M. A. (2020) · Acta Neuropathologica Communications · doi:10.1186/s40478-020-01095-1 · Cited by 27
Beyond the amyloid cascade: An update of Alzheimer's disease pathophysiology
Gouilly, D., Rafiq, M., Nogueira, L., Salabert, A., Payoux, P., Péran, P., & Pariente, J. (2023) · Revue Neurologique · doi:10.1016/j.neurol.2022.12.006 · Cited by 31
Variants inPPP2R2BandIGF2BP3are associated with higher tau deposition
Ramanan, V. K., Wang, X., Przybelski, S. A., Raghavan, S., Heckman, M. G., Batzler, A. J., Kosel, M., Hohman, T. J., Knopman, D. S., Graff‐Radford, J., et al. (2020) · Brain Communications · doi:10.1093/braincomms/fcaa159 · Cited by 23
“…in whether a mechanistic relationship exists between APOE and brain parenchymal tau that is independent of amyloid, as has been suggested by analyses of primary tauopathies and selected studies using cellular and animal model systems (Shi et al., 2017; Zhao et al., 2018; Wadhwani et al., 2019).”
Self-citationAssociation of CD2AP neuronal deposits with Braak neurofibrillary stage in Alzheimer’s disease
Camacho, J., Rábano, A., Marazuela, P., Bonaterra‐Pastra, A., Serna, G., Moliné, T., y Cajal, S. R., Martínez-Sáez, E. A., & Hernández‐Guillamón, M. (2021) · Brain Pathology · doi:10.1111/bpa.13016 · Cited by 25
“Finally, because the APOE genotype is linked to Aβ brain accumulation [68,69] but is also a risk factor for tau neurodegeneration independent of Aβ [57,70,71,72,73,74], future studies analyzing the effect of APOE on CD2AP neuronal deposition in tauopathies are required.”
BackgroundLozupone, M., Imbimbo, B. P., Balducci, C., Vecchio, F. L., Bisceglia, P., Latino, R. R., Leone, M. A., Dibello, V., Solfrizzi, V., Greco, A., et al. (2022) · Alzheimer s & Dementia · doi:10.1002/alz.12728 · Cited by 28
Associations Between APOE Variants, Tau and α-Synuclein
Rodriguez‐Vieitez, E., & Nielsen, H. M. (2019) · Advances in experimental medicine and biology · doi:10.1007/978-981-32-9358-8_15 · Cited by 24
Noori, M., Mahboobi, R., Nabavi-Rad, A., Jamshidizadeh, S., Fakharian, F., Yadegar, A., & Zali, M. R. (2023) · Heliyon · doi:10.1016/j.heliyon.2023.e19607 · Cited by 24
Impact of APOE genotype on prion-type propagation of tauopathy
Williams, T., Ruiz, A. J., Ruiz, A. M., Vo, Q., Tsering, W., Xu, G. M., McFarland, K. N., Giasson, B. I., Sullivan, P. M., Borchelt, D., et al. (2022) · Acta Neuropathologica Communications · doi:10.1186/s40478-022-01359-y · Cited by 21
Apolipoprotein E Facilitates Amyloid-β Oligomer-Induced Tau Phosphorylation
Hou, T.-T., Han, Y.-D., Cong, L., Liu, C.-C., Liang, X.-Y., Xue, F.-Z., & Du, Y.-F. (2020) · Journal of Alzheimer’s Disease · doi:10.3233/jad-190711 · Cited by 20
Self-citationEisenbaum, M., Pearson, A., Ortiz, C., Koprivica, M., Cembran, A., MULLAN, M. J., Crawford, F., Ojo, J. O., & Bachmeier, C. J. (2024) · Experimental Neurology · doi:10.1016/j.expneurol.2024.114702 · Cited by 18
Лю, Ч., Liu, J., Wang, Y., Xu, S.-F., & Yu, L.-M. (2025) · Molecular Neurobiology · doi:10.1007/s12035-025-05629-3 · Cited by 22
Dilliott, A. A., Sunderland, K. M., McLaughlin, P. M., Roberts, A., Evans, E. C., Abrahão, A., Binns, M. A., Black, S. E., BORRIE, M. J., Casaubon, L. K., et al. (2021) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2021.04.011 · Cited by 18
Williams, T., Bathe, T., Vo, Q., Sacilotto, P., McFarland, K. N., Ruiz, A. J., Hery, G. P., Sullivan, P. M., Borchelt, D., Prokop, S., et al. (2023) · Acta Neuropathologica Communications · doi:10.1186/s40478-023-01581-2 · Cited by 16
ApoE-calypse tau: ApoE–tau synergy in Alzheimer’s disease
Lennol, M. P., Bordier, C., Kamelher, L., Ulrich, J. D., Holtzman, D. M., & Gratuze, M. (2025) · The Journal of Experimental Medicine · doi:10.1084/jem.20250965 · Cited by 14
Koller, E. J., Cruz, E. G. D. L., Weinrich, M. J., Williams, T., Cruz, P. E., Ryu, D. H., Golde, T. E., Sullivan, P. M., Lewis, J. M., Borchelt, D., et al. (2020) · Molecular Neurobiology · doi:10.1007/s12035-019-01859-4 · Cited by 13
Valentino, R. R., Tamvaka, N., Heckman, M. G., Johnson, P. W., Soto‐Beasley, A. I., Walton, R. L., Koga, S., Uitti, R. J., Wszołek, Z. K., Dickson, D. W., et al. (2020) · Acta Neuropathologica Communications · doi:10.1186/s40478-020-01035-z · Cited by 13
Self-citationGenetics of progressive supranuclear palsy in a Chinese population
Xiao, X., Yang, Q., Wen, Y., Jiao, B., Liao, X., Zhou, Y., Weng, L., Liu, H., Xu, T., Zhu, Y., et al. (2022) · Neurobiology of Disease · doi:10.1016/j.nbd.2022.105819 · Cited by 11
APOE2 Exacerbates TDP‐43 Related Toxicity in the Absence of Alzheimer Pathology
Meneses, A. D., Koga, S., Li, Z., O'Leary, J., Li, F., Chen, K., Murakami, A., Qiao, W., Kurti, A., Heckman, M. G., et al. (2023) · Annals of Neurology · doi:10.1002/ana.26580 · Cited by 11
Self-citationTau polygenic risk scoring: a cost-effective aid for prognostic counseling in Alzheimer’s disease
Ramanan, V. K., Heckman, M. G., Lesnick, T. G., Przybelski, S. A., Cahn, E. J., Kosel, M., Murray, M. E., Mielke, M. M., Botha, H., Graff‐Radford, J., et al. (2022) · Acta Neuropathologica · doi:10.1007/s00401-022-02419-2 · Cited by 10
Self-citationVogels, T., Vargová, G., Brezováková, V., Quint, W. H., & Hromádka, T. (2020) · Journal of Alzheimer s Disease · doi:10.3233/jad-200047 · Cited by 11
The interaction effects of age, APOE and common environmental risk factors on human brain structure
Chen, J., Li, T., Zhao, B., Chen, H., Yuan, C., Garden, G. A., Guorong Wu, A., & Hongtu Zhu, B. (2023) · Cerebral Cortex · doi:10.1093/cercor/bhad472 · Cited by 10
Valentino, R. R., Koga, S., Heckman, M. G., Brushaber, D. E., Diehl, N. N., Walton, R. L., Dickson, D. W., & Ross, O. A. (2020) · Movement Disorders · doi:10.1002/mds.28010 · Cited by 10
Self-citationMultifactorial etiology of progressive supranuclear palsy (PSP): the genetic component
Müller, U., Höglinger, G. U., & Dickson, D. W. (2025) · Acta Neuropathologica · doi:10.1007/s00401-025-02898-z · Cited by 10
“The opposite is true for Alzheimer disease (AD) where APOE-ε2 is protective and ε4 is a major risk factor [114].”
Self-citationPasqualotto, A., da Silva, V., Pellenz, F. M., Schuh, A. F. S., Schwartz, I. V. D., & Siebert, M. (2024) · Metabolic Brain Disease · doi:10.1007/s11011-024-01342-7 · Cited by 8
“Hub genes in purple and bottleneck genes in yellow still controversial (Zhao et al. 2018; Sabir et al. 2019).”
Mahanta, A. K., Chaulagain, B., Gothwal, A., & Singh, J. (2025) · ACS Biomaterials Science & Engineering · doi:10.1021/acsbiomaterials.5c00465 · Cited by 10
Savignac, C., Villeneuve, S., Badhwar, A., Saltoun, K., Shafighi, K., Zajner, C., Sharma, V., Taliun, S. A. G., Farhan, S. M. K., Poirier, J., et al. (2022) · PLoS Biology · doi:10.1371/journal.pbio.3001863 · Cited by 11
Wang, H., Chang, T. S., Dombroski, B. A., Cheng, P., Patil, V., Valiente‐Banuet, L., Farrell, K. W., McLean, C., Molina‐Porcel, L., Rajput, A. H., et al. (2023) · medRxiv · doi:10.1101/2023.12.28.23300612 · Cited by 7
“Notably, both 2 allele and 4 allele have been associated with tau pathology burden in the brain of mice models [46,71], which raises the question of distinct tau species in 4R-PSP versus 3R-4R-AD.”
BackgroundInfluentialSelf-citationSantamaría‐García, H. A., Ogonowski, N. S., Báez, S., Palacio, N., Reyes, P. A., Schulte, M., López, A., Matallana, D., & Ibáñez, A. M. (2022) · BMC Neurology · doi:10.1186/s12883-022-02954-1 · Cited by 17
“Association of APOE gene polymorphisms with primary open angle glaucoma in Brazilian patients”
Occhiutto, M. L., de Melo, M. B., de Vasconcellos, J. P. C., Rodrigues, T. A. R., Bajano, F. F., Costa, F. F., & Costa, V. P. (2020) · Ophthalmic Genetics · doi:10.1080/13816810.2020.1849314 · Cited by 6
Unraveling APOE4's Role in Alzheimer's Disease: Pathologies and Therapeutic Strategies
Tripathi, S., Sharma, Y., & Kumar, D. (2024) · Current Protein and Peptide Science · doi:10.2174/0113892037326839241014054430 · Cited by 5
Exploring Protein Structure with RasMol, a Free Online Tool
Fraley, A. D., Odegaard, K. E., Vilchiz, V. H., Kang, C., & Lee, C. (2022) · The American Biology Teacher · doi:10.1525/abt.2022.84.6.369 · Cited by 4
“Scientists have shown that one key difference between APOE3 and APOE4 is the substitution of a cysteine in place of an arginine in one position (Frieden & Garai, 2012).”
BackgroundInfluentialTau processing and tau-mediated inflammation differ in human APOEε2 and APOEε4 astrocytes
Mothes, T., Konstantinidis, E., Eltom, K., Dakhel, A., Rostami, J., & Erlandsson, A. (2024) · iScience · doi:10.1016/j.isci.2024.111163 · Cited by 5
“10 However, it is worth noting that this was performed using the bare proteins in isolation.”
Wan, Z., & Ma, T. (2025) · PLoS ONE · doi:10.1371/journal.pone.0303486 · Cited by 4
Perez, C. M., Gong, Z., Yoo, C., Roy, D., Deoraj, A., & Felty, Q. H. (2023) · Molecular Neurobiology · doi:10.1007/s12035-023-03541-2 · Cited by 4
“The strong causality between CAA and APOE4 in the male CAA network amongst NRF1 regulated genes confirms the significance of both NRF1 targeting of the APOE4 allele amongst male CAA cases, reported in previous studies examing the transcription factor and its targeting of an exon of APOE4 [17, 33].”
InfluentialApolipoprotein E Alleles and Motor Signs in Older Adults with Alzheimer’s Dementia
Liampas, I., Demiri, S., Siokas, V., Tsika, A., Marogianni, C., Stamati, P., Nasios, G., Messinis, L., Lyketsos, C. G., & Dardiotis, E. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms26178562 · Cited by 3
Cheng, Y., Liao, Y., Chen, C., Chung, C., Fann, C. S. J., Chang, C.-S., Lee, Y., & Tang, S. (2023) · Journal of the American Heart Association · doi:10.1161/jaha.123.032689 · Cited by 3
Metadata
- Authors
- Zhao, N., Liu, C.-C., Van Ingelgom, A. J., Linares, C., Kurti, A., Knight, J. A., Heckman, M. G., Diehl, N. N., Shinohara, M., Martens, Y. A., Attrebi, O. N., Petrucelli, L., Fryer, J. D., Wszolek, Z. K., Graff-Radford, N. R., Caselli, R. J., Sanchez-Contreras, M. Y., Rademakers, R., Murray, M. E., Koga, S., Dickson, D. W., Ross, O. A., & Bu, G.
- Affiliations
- Mayo Clinic (US)
- Mayo Clinic in Florida (US)
- Corresponding author
- Liu, Chia-Chen
- Bu, Guojun
- ORCID
- Venue
- Nature Communications
- Published
- 2018-10-22
- Volume
- 9
- Issue
- 1
- Pages
- 4388-4388
- ISSN
- 2041-1723 (ISSN-L)
- PMC
- PMC6197187
- OpenAlex
- W2897709706
- Cited by
- 139
- References
- 59
- Citations by year
- 2026: 14 · 2025: 11 · 2024: 13 · 2023: 15 · 2022: 20 · 2021: 20 · 2020: 30 · 2019: 15 · 2018: 1
- FWCI
- 11.35
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Nature Communications (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Rare & Special e-Zone (The Hong Kong University of Science and Technology) (submittedVersion)
- Funders
- U.S. Department of Health & Human Services | NIH | National Institute on Aging (R01AG046205, R37AG027924, RF1AG051504, P50AG016574)
- Topics
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Clinical Neurology › Parkinson's Disease Mechanisms and Treatments
- Keywords
- APOE ε2, apolipoprotein E, tau pathology, primary tauopathies, progressive supranuclear palsy, corticobasal degeneration, tau hyperphosphorylation, tau aggregates, AAV gene delivery, genetic risk, neurodegeneration, behavioral abnormalities
- MeSH terms
- Alleles, Alzheimer Disease, Animals, Humans, Supranuclear Palsy, Progressive, Disease Progression, Tauopathies, Mice, Apolipoprotein E4, Apolipoprotein E2
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