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Non-coding variability at the APOE locus contributes to the Alzheimer’s risk
Open accessAbstract
Alzheimer's disease (AD) is a leading cause of mortality in the elderly. While the coding change of APOE-ε4 is a key risk factor for late-onset AD and has been believed to be the only risk factor in the APOE locus, it does not fully explain the risk effect conferred by the locus. Here, we report the identification of AD causal variants in PVRL2 and APOC1 regions in proximity to APOE and define common risk haplotypes independent of APOE-ε4 coding change. These risk haplotypes are associated with changes of AD-related endophenotypes including cognitive performance, and altered expression of APOE and its nearby genes in the human brain and blood. High-throughput genome-wide chromosome conformation capture analysis further supports the roles of these risk haplotypes in modulating chromatin states and gene expression in the brain. Our findings provide compelling evidence for additional risk factors in the APOE locus that contribute to AD pathogenesis.
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![Fig. 4 Functional implications of PVRL2 and APOC1 haplotypes in an APOE-ε4–independent manner. a–e. Associations between PVRL2 minor haplotype alpha, and cognitive performance and biomarker expression in an APOE-ε4-independent manner. a, b Associations between PVRL2 alpha haplotype dosage with (a) cognitive performance indicated by total ECog score (scored between 0−4; higher scores represent more severe disability in functioning) reported by study partners (n = 527, T = 3.71, ***p < 0.001, Beta = 0.25) and (b) memory performance indicated by ECog memory score reported by study partners (n = 527, T = 3.60, ***p < 0.001, Beta = 0.29). c Association between PVRL2 alpha haplotype with hippocampal volume (n = 1,121, T = −2.31, *p < 0.05, Beta = −165.60 [mm2]). d, e Associations between PVRL2 alpha haplotype with (d) total Aβ1–42 in plasma (n = 226, T = −3.098, **p < 0.01, Beta = −4.113 [pg/mL]) and (e) ICAM-1 in cerebrospinal fluid; n = 298, T = −3.361, ***p < 0.001, Beta = −0.199 [log ng/mL]). Individuals harboring two copies of haplotypes were not included due to the small samples size. f, g Association between APOC1 gamma haplotype with levels of (f) plasma free Aβ1–40 (n = 226, T = −4.823, ***p < 0.001, Beta = −40.231 [pg/mL]) and (g) plasma MCP3 (CCL7) (n = 537, T = −3.665, ***p < 0.001, Beta = −0.229 [log ng/mL]). Aβ amyloid-beta, ECog everyday cognition. Data are presented in box plots, with boxes extending from the 25th to 75th percentiles and whiskers specifying the 10th and 90th percentiles; the line in the middle of the box denotes the median](/paper-figures/905bd3a5604d40b59b04066750f43d5e/non-coding-variability-at-the-apoe-locus-contributes-to-the-alzheimers-risk-figure-4.jpg)



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“Meanwhile, a haplotype analysis in the APOE locus identified risk haplotypes that are independent of the APOE ɛ4 allele [48].”
From Association of SPI1 haplotypes with altered SPI1 gene expression and Alzheimer’s disease risk (2022) · cites this paper as [48]
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“It is also supported by APOE4 risk modifying variants identified in APOE local admixture backgrounds in Hispanics and African Americans (Rajabli et al., 2018) and by APOE expression modifiers such as variants in PVRL2 and APOC1 loci (Zhou et al., 2019).”
From Cholesterol and matrisome pathways dysregulated in astrocytes and microglia (2022) · cites this paper as Zhou et al., 2019
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“The ApoC1 gamma haplotype has also been found to increase AD risk independent of ApoE [135].”
From ApoE lipoproteins in the central nervous system under homeostasis and role in Alzheimer’s disease and related disorders (2026) · cites this paper as [135]
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“emerging evidence suggests that APOC1 may exert independent effects on AD pathogenesis [12].”
From Association of APOC1 with cortical atrophy during conversion to Alzheimer’s disease (2025) · cites this paper as [12]
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“and have been reported in previous studies to exhibit strong associations with AD risk [4, 12, 77–80].”
From Association of APOC1 with cortical atrophy during conversion to Alzheimer’s disease (2025) · cites this paper as [12]
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Self-citation
Metadata
- Authors
- Zhou, X., Chen, Y., Mok, K. Y., Kwok, T. C. Y., Mok, V. C. T., Guo, Q., Ip, F. C., Chen, Y., Mullapudi, N., Initiative, A. D. N., Weiner, M. W., Aisen, P., Petersen, R., Jack, C. R., Jagust, W., Trojanowski, J. Q., Toga, A. W., Beckett, L., Green, R. C., Saykin, A. J., Morris, J., Shaw, L. M., Khachaturian, Z., Sorensen, G., Kuller, L., Raichle, M., Paul, S., Davies, P., Fillit, H., Hefti, F., Holtzman, D., Mesulam, M. M., Potter, W., Snyder, P., Schwartz, A., Montine, T., Thomas, R. G., Donohue, M., Walter, S., Gessert, D., Sather, T., Jiminez, G., Harvey, D., Bernstein, M., Thompson, P., Schuff, N., Borowski, B., Gunter, J., Senjem, M., Vemuri, P., Jones, D., Kantarci, K., Ward, C., Koeppe, R. A., Foster, N., Reiman, E. M., Chen, K., Mathis, C., Landau, S., Cairns, N. J., Householder, E., Taylor-Reinwald, L., Lee, V., Korecka, M., Figurski, M., Crawford, K., Neu, S., Foroud, T. M., Potkin, S. G., Shen, L., Faber, K., Kim, S., Nho, K., Thal, L., Buckholtz, N., Albert, M., Frank, R., Hsiao, J., Kaye, J., Quinn, J., Lind, B., Carter, R., Dolen, S., Schneider, L. S., Pawluczyk, S., Beccera, M., Teodoro, L., Spann, B. M., Brewer, J., Vanderswag, H., Fleisher, A., Heidebrink, J. L., Lord, J. L., Mason, S. S., Albers, C. S., Knopman, D., Johnson, K., Doody, R. S., Villanueva-Meyer, J., Chowdhury, M., Rountree, S., Dang, M., Stern, Y., Honig, L. S., Bell, K. L., Ances, B., Carroll, M., Leon, S., Mintun, M. A., Schneider, S., Oliver, A., Marson, D., Griffith, R., Clark, D., Geldmacher, D., Brockington, J., Roberson, E., Grossman, H., Mitsis, E., de Toledo-Morrell, L., Shah, R. C., Duara, R., Varon, D., Greig, M. T., Roberts, P., Onyike, C., D’Agostino, D., Kielb, S., Galvin, J. E., Cerbone, B., Michel, C. A., Rusinek, H., de Leon, M. J., Glodzik, L., De Santi, S., Doraiswamy, P. M., Petrella, J. R., Wong, T. Z., Arnold, S. E., Karlawish, J. H., Wolk, D., Smith, C. D., Jicha, G., Hardy, P., Sinha, P., Oates, E., Conrad, G., Lopez, O. L., Oakley, M., Simpson, D. M., Porsteinsson, A. P., Goldstein, B. S., Martin, K., Makino, K. M., Ismail, M. S., Brand, C., Mulnard, R. A., Thai, G., McAdams-Ortiz, C., Womack, K., Mathews, D., Quiceno, M., Diaz-Arrastia, R., King, R., Weiner, M., Martin-Cook, K., DeVous, M., Levey, A. I., Lah, J. J., Cellar, J. S., Burns, J. M., Anderson, H. S., Swerdlow, R. H., Apostolova, L., Tingus, K., Woo, E., Silverman, D. H. S., Lu, P. H., Bartzokis, G., Graff-Radford, N. R., Parfitt, F., Kendall, T., Johnson, H., Farlow, M. R., Hake, A. M., Matthews, B. R., Herring, S., Hunt, C., van Dyck, C. H., Carson, R. E., MacAvoy, M. G., Chertkow, H., Bergman, H., Hosein, C., Hsiung, G.-Y. R., Feldman, H., Mudge, B., Assaly, M., Bernick, C., Munic, D., Kertesz, A., Rogers, J., Trost, D., Kerwin, D., Lipowski, K., Wu, C.-K., Johnson, N., Sadowsky, C., Martinez, W., Villena, T., Turner, R. S., Johnson, K., Reynolds, B., Sperling, R. A., Johnson, K. A., Marshall, G., Frey, M., Lane, B., Rosen, A., Tinklenberg, J., Sabbagh, M. N., Belden, C. M., Jacobson, S. A., Sirrel, S. A., Kowall, N., Killiany, R., Budson, A. E., Norbash, A., Johnson, P. L., Allard, J., Lerner, A., Ogrocki, P., Hudson, L., Fletcher, E., Carmichael, O., Olichney, J., DeCarli, C., Kittur, S., Borrie, M., Lee, T.-Y., Bartha, R., Johnson, S., Asthana, S., Carlsson, C. M., Preda, A., Nguyen, D., Tariot, P., Reeder, S., Bates, V., Capote, H., Rainka, M., Scharre, D. W., Kataki, M., Adeli, A., Zimmerman, E. A., Celmins, D., Brown, A. D., Pearlson, G. D., Blank, K., Anderson, K., Santulli, R. B., Kitzmiller, T. J., Schwartz, E. S., Sink, K. M., Williamson, J. D., Garg, P., Watkins, F., Ott, B. R., Querfurth, H., Tremont, G., Salloway, S., Malloy, P., Correia, S., Rosen, H. J., Miller, B. L., Mintzer, J., Spicer, K., Bachman, D., Pasternak, S., Rachinsky, I., Drost, D., Pomara, N., Hernando, R., Sarrael, A., Schultz, S. K., Boles Ponto, L. L., Shim, H., Smith, K. E., Relkin, N., Chaing, G., Raudin, L., Smith, A., Fargher, K., Raj, B. A., Neylan, T., Grafman, J., Davis, M., Morrison, R., Hayes, J., Finley, S., Friedl, K., Fleischman, D., Arfanakis, K., James, O., Massoglia, D., Fruehling, J. J., Harding, S., Peskind, E. R., Petrie, E. C., Li, G., Yesavage, J. A., Taylor, J. L., Furst, A. J., Giusti-Rodríguez, P., Sullivan, P. F., Hardy, J., Fu, A. K. Y., Li, Y., & Ip, N. Y.
- Affiliations
- Hong Kong University of Science and Technology (HK)
- Chinese Academy of Sciences (CN)
- Chinese University of Hong Kong (HK)
- Fudan University (CN)
- University of California, San Francisco (US)
- Mayo Clinic (US)
- University of Pennsylvania (US)
- University of Southern California (US)
- Brigham and Women's Hospital (US)
- Washington University in St. Louis (US)
- Siemens (Germany) (DE)
- University of Pittsburgh (US)
- Albert Einstein College of Medicine (US)
- Alzheimer's Drug Discovery Foundation (US)
- Northwestern University (US)
- Brown University (US)
- Eli Lilly (United States) (US)
- University of Washington (US)
- University of California, Los Angeles (US)
- University of Utah (US)
- Banner Alzheimer’s Institute (US)
- University of California, Irvine (US)
- Indiana University Bloomington (US)
- University of California San Diego (US)
- National Institutes of Health (US)
- Johns Hopkins University (US)
- Oregon Health & Science University (US)
- University of Michigan (US)
- Baylor College of Medicine (US)
- University of Alabama (US)
- Icahn School of Medicine at Mount Sinai (US)
- Rush University Medical Center (US)
- New York University (US)
- Duke Medical Center (US)
- University of Kentucky (US)
- University of Rochester Medicine (US)
- The University of Texas Southwestern Medical Center (US)
- Emory University (US)
- University of Kansas Medical Center (US)
- Mayo Clinic in Florida (US)
- Yale University (US)
- Jewish General Hospital (CA)
- University of British Columbia (CA)
- Cleveland Clinic (US)
- St Joseph's Health Care (CA)
- Palm Beach Neurology (US)
- Georgetown University Medical Center (US)
- Banner Sun Health Research Institute (US)
- Boston University (US)
- Howard University (US)
- Case Western Reserve University (US)
- University of California, Davis (US)
- University of Wisconsin–Madison (US)
- Dent Neurologic Institute (US)
- The Ohio State University (US)
- Albany Medical College (US)
- Hartford Hospital (US)
- Dartmouth–Hitchcock Medical Center (US)
- Wake Forest University Health Sciences (US)
- Rhode Island Hospital (US)
- Butler Hospital (US)
- Medical University of South Carolina (US)
- Nathan Kline Institute for Psychiatric Research (US)
- University of Iowa (US)
- Cornell University (US)
- University of South Florida (US)
- United States Department of Defense (US)
- Stanford University (US)
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Ip, Nancy Y.
- ORCID
- Zhou, Xiaopu
- Chen, Yu
- Mok, Kin Y.
- Kwok, Timothy C. Y.
- Mok, Vincent C. T.
- Guo, Qihao
- Ip, Fanny C.
- Chen, Yuewen
- Mullapudi, Nandita
- Weiner, Michael W.
- Petersen, Ronald
- Jack, Clifford R.
- Jagust, William
- Trojanowski, John Q.
- Toga, Arthur W.
- Beckett, Laurel
- Green, Robert C.
- Saykin, Andrew J.
- Morris, John
- Shaw, Leslie M.
- Raichle, Marcus
- Paul, Steven
- Davies, Peter
- Fillit, Howard
- Hefti, Franz
- Holtzman, David
- Snyder, Peter
- Thomas, Ronald G.
- Donohue, Michael
- Walter, Sarah
- Thompson, Paul
- Vemuri, Prashanthi
- Jones, David
- Kantarci, Kejal
- Koeppe, Robert A.
- Reiman, Eric M.
- Chen, Kewei
- Lee, Virginia
- Korecka, Magdalena
- Crawford, Karen
- Foroud, Tatiana M.
- Potkin, Steven G.
- Shen, Li
- Faber, Kelley
- Kim, Sungeun
- Nho, Kwangsik
- Hsiao, John
- Kaye, Jeffrey
- Quinn, Joseph
- Schneider, Lon S.
- Fleisher, Adam
- Heidebrink, Judith L.
- Lord, Joanne L.
- Knopman, David
- Johnson, Kris
- Stern, Yaakov
- Honig, Lawrence S.
- Bell, Karen L.
- Ances, Beau
- Carroll, Maria
- Oliver, Angela
- Marson, Daniel
- Clark, David
- Geldmacher, David
- Roberson, Erik
- Shah, Raj C.
- Duara, Ranjan
- Onyike, Chiadi
- D’Agostino, Daniel
- Kielb, Stephanie
- Galvin, James E.
- Cerbone, Brittany
- Rusinek, Henry
- de Leon, Mony J.
- Glodzik, Lidia
- Doraiswamy, P Murali
- Petrella, Jeffrey R.
- Wong, Terence Z.
- Arnold, Steven E.
- Karlawish, Jason H.
- Wolk, David
- Smith, Charles D.
- Hardy, Peter
- Sinha, Partha
- Porsteinsson, Anton P.
- Ismail, M Saleem
- Thai, Gaby
- Womack, Kyle
- Quiceno, Mary
- Diaz-Arrastia, Ramon
- Weiner, Myron
- DeVous, Michael
- Levey, Allan I
- Lah, James J.
- Burns, Jeffrey M.
- Swerdlow, Russell H.
- Apostolova, Liana
- Silverman, Daniel H. S.
- Lu, Po H.
- Johnson, Heather
- Farlow, Martin R.
- Hake, Ann Marie
- van Dyck, Christopher H.
- Carson, Richard E.
- Chertkow, Howard
- Bergman, Howard
- Hsiung, Ging-Yuek Robin
- Feldman, Howard
- Bernick, Charles
- Kerwin, Diana
- Turner, Raymond Scott
- Sperling, Reisa A.
- Johnson, Keith A.
- Marshall, Gad
- Frey, Meghan
- Lane, Barton
- Rosen, Allyson
- Sabbagh, Marwan N.
- Belden, Christine M.
- Jacobson, Sandra A.
- Kowall, Neil
- Killiany, Ronald
- Budson, Andrew E.
- Norbash, Alexander
- Lerner, Alan
- Carmichael, Owen
- Olichney, John
- DeCarli, Charles
- Johnson, Sterling
- Asthana, Sanjay
- Carlsson, Cynthia M.
- Preda, Adrian
- Nguyen, Dana
- Tariot, Pierre
- Scharre, Douglas W.
- Kataki, Maria
- Pearlson, Godfrey D.
- Santulli, Robert B.
- Sink, Kaycee M.
- Williamson, Jeff D.
- Garg, Pradeep
- Ott, Brian R.
- Tremont, Geoffrey
- Salloway, Stephen
- Correia, Stephen
- Miller, Bruce L.
- Mintzer, Jacobo
- Bachman, David
- Pasternak, Stephen
- Pomara, Nunzio
- Schultz, Susan K.
- Shim, Hyungsub
- Relkin, Norman
- Smith, Amanda
- Neylan, Thomas
- Grafman, Jordan
- Hayes, Jacqueline
- Friedl, Karl
- Fleischman, Debra
- Arfanakis, Konstantinos
- Peskind, Elaine R.
- Petrie, Eric C.
- Yesavage, Jerome A.
- Taylor, Joy L.
- Furst, Ansgar J.
- Giusti-Rodríguez, Paola
- Sullivan, Patrick F.
- Hardy, John
- Fu, Amy K. Y.
- Li, Yun
- Ip, Nancy Y.
- Venue
- Nature Communications
- Published
- 2019-07-25
- Volume
- 10
- Issue
- 1
- Pages
- 3310-3310
- ISSN
- 2041-1723 (ISSN-L)
- PMC
- PMC6658518
- OpenAlex
- W2962898942
- Cited by
- 120
- References
- 73
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 11 · 2023: 20 · 2022: 29 · 2021: 27 · 2020: 17 · 2019: 3
- FWCI
- 13.03
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Nature Communications (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Rare & Special e-Zone (The Hong Kong University of Science and Technology) (submittedVersion)
- Carolina Digital Repository (University of North Carolina at Chapel Hill) (submittedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UCL Discovery (University College London) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- Scholarship@Western (Western University) (submittedVersion)
- UNC Libraries
- Funders
- Alzheimer's Disease Neuroimaging Initiative
- Parkinson's UK (G-0907)
- Rosetrees Trust
- National Natural Science Foundation of China (ITCPD/17-9, 2018B030336001, T13-607/12R, 973 Program, JCYJ20170413173717055, 31400923, 2013CB530900, JCYJ20170413165053031, 31671047, AoE/M-604/16)
- University Grants Committee (T13-607/12R, AoE/M-604/16)
- Chinese University of Hong Kong
- Shenzhen Knowledge Innovation Program (JCYJ20170413173717055, JCYJ20170413165053031)
- Nature
- National Institutes of Health (UL1TR002369)
- Medical Research Council (MR/K01417X/1, MR/L501542/1, MR/N026004/1)
- National Key Research and Development Program of China (SQ2018YFE020417, 2013CB530900, 2017YFE0190000, 2018B030336001)
- National Institute on Aging (P30AG010124, P30AG059307)
- National Institute of Mental Health (K01MH109772)
- National Center for Advancing Translational Sciences
- 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
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetic Associations and Epidemiology
- Keywords
- Alzheimer's disease, APOE ε4, non-coding variants, risk haplotype, PVRL2, APOC1, late-onset Alzheimer's disease, chromatin looping, chromosome conformation capture, gene expression, cognitive performance, brain gene expression, blood gene expression, genetic risk factors
- MeSH terms
- Nectins, Aged, Aged, 80 and over, Alzheimer Disease, Apolipoproteins C, Apolipoproteins E, Brain, Cognition, Female, Haplotypes, Humans, Male, Middle Aged, Genetic Variation, Gene Expression, Case-Control Studies, Genetic Predisposition to Disease, Polymorphism, Single Nucleotide
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