Cited by 11Dementia and Cognitive Impairment ResearchAlzheimer's disease research and treatmentsCerebrospinal fluid and hydrocephalus

Proteomic clusters underlie heterogeneity in preclinical Alzheimer’s disease progression

Open access
Wisch, Julie K, Butt, Omar H, Gordon, Brian A, Schindler, Suzanne E, Fagan, Anne M, Henson, Rachel L, Yang, Chengran, Boerwinkle, Anna H +5 more·2023·Brain

Abstract

Heterogeneity in progression to Alzheimer's disease (AD) poses challenges for both clinical prognosis and clinical trial implementation. Multiple AD-related subtypes have previously been identified, suggesting differences in receptivity to drug interventions. We identified early differences in preclinical AD biomarkers, assessed patterns for developing preclinical AD across the amyloid-tau-(neurodegeneration) [AT(N)] framework, and considered potential sources of difference by analysing the CSF proteome. Participants (n = 10) enrolled in longitudinal studies at the Knight Alzheimer Disease Research Center completed four or more lumbar punctures. These individuals were cognitively normal at baseline. Cerebrospinal fluid measures of amyloid-β (Aβ)42, phosphorylated tau (pTau181), and neurofilament light chain (NfL) as well as proteomics values were evaluated. Imaging biomarkers, including PET amyloid and tau, and structural MRI, were repeatedly obtained when available. Individuals were staged according to the amyloid-tau-(neurodegeneration) framework. Growth mixture modelling, an unsupervised clustering technique, identified three patterns of biomarker progression as measured by CSF pTau181 and Aβ42. Two groups (AD Biomarker Positive and Intermediate AD Biomarker) showed distinct progression from normal biomarker status to having biomarkers consistent with preclinical AD. A third group (AD Biomarker Negative) did not develop abnormal AD biomarkers over time. Participants grouped by CSF trajectories were re-classified using only proteomic profiles (AUCAD Biomarker Positive versus AD Biomarker Negative = 0.857, AUCAD Biomarker Positive versus Intermediate AD Biomarkers = 0.525, AUCIntermediate AD Biomarkers versus AD Biomarker Negative = 0.952). We highlight heterogeneity in the development of AD biomarkers in cognitively normal individuals. We identified some individuals who became amyloid positive before the age of 50 years. A second group, Intermediate AD Biomarkers, developed elevated CSF ptau181 significantly before becoming amyloid positive. A third group were AD Biomarker Negative over repeated testing. Our results could influence the selection of participants for specific treatments (e.g. amyloid-reducing versus other agents) in clinical trials. CSF proteome analysis highlighted additional non-AT(N) biomarkers for potential therapies, including blood–brain barrier-, vascular-, immune-, and neuroinflammatory-related targets.

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Crossref · 10.1093/brain/awac484

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Authors
Wisch, J. K., Butt, O. H., Gordon, B. A., Schindler, S. E., Fagan, A. M., Henson, R. L., Yang, C., Boerwinkle, A. H., Benzinger, T. L. S., Holtzman, D. M., Morris, J. C., Cruchaga, C., & Ances, B. M.
Affiliations
Washington University in St. Louis (US)
Corresponding author
Ances, Beau M
Venue
Brain
Published
2022-12-21
Volume
146
Issue
7
Pages
2944-2956
ISSN
  • 0006-8950 (ISSN-L)
  • 1460-2156
OpenAlex
W4312057911
Cited by
11
References
64
Citations by year
2026: 2 · 2025: 3 · 2024: 3 · 2023: 3
FWCI
1.47
Type
journal article
Language
en
Open access
Locations
  • Brain (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (R01NR012907, R01NR012657, R01NR014449, RF1AG053303, RF1AG058501, U01AG058922, K01 AG053474, P30 AG066444, P01AG003991, P01AG026276, U19 AG032438, U19 AG024904)
  • Barnes-Jewish Hospital
  • Washington University Institute of Clinical and Translational Sciences Foundation (TR000448)
  • Hope Center for Neurological Disorders
  • the Paula and Rodger O. Riney Fund
  • the Daniel J Brennan MD Fund
  • Fred Simmons Olga Mohan Fund and the Chuck Zuckerberg Initiative
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Cerebrospinal fluid and hydrocephalus
Keywords
preclinical Alzheimer's disease, Alzheimer's disease progression, CSF proteome, amyloid-beta 42, phosphorylated tau 181, neurofilament light chain, growth mixture modeling, biomarker trajectories, clinical trial participant selection, neuroinflammation, blood-brain barrier, vascular risk factors
MeSH terms
Alzheimer Disease, Humans, Middle Aged, Biomarkers, Amyloid beta-Peptides, tau Proteins, Disease Progression, Proteome, Proteomics

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