Proteomic clusters underlie heterogeneity in preclinical Alzheimer’s disease progression
Open accessAbstract
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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Proteomic clustering has identified subgroups particularly responsive to drugs that modulate synaptic function and restore blood-brain barrier integrity.
“Proteomic clustering has identified subgroups particularly responsive to drugs that modulate synaptic function and restore BBB integrity342,345,347,350,352,399,400.”
From Artificial intelligence-driven multi-omics approaches in Alzheimer's disease: Progress, challenges, and future directions (2025) · cites this paper as [347]
Adding neuroimaging data enriches stratification by revealing distinct progression patterns across biomarker-defined subgroups.
“The addition of neuroimaging data further enriches stratification efforts by revealing distinct progression patterns across biomarker-defined subgroups347,401,402.”
From Artificial intelligence-driven multi-omics approaches in Alzheimer's disease: Progress, challenges, and future directions (2025) · cites this paper as [347]
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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
- ORCID
- Venue
- Brain
- Publisher
- Oxford University Press (OUP)
- Published
- 2022-12-21
- Volume
- 146
- Issue
- 7
- Pages
- 2944-2956
- ISSN
- 0006-8950 (ISSN-L)
- 1460-2156
- PMC
- PMC10316757
- 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
- green
- www.ncbi.nlm.nih.gov
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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