The Apolipoprotein E ε2 Allele and the Pathological Features in Cerebral Amyloid Angiopathy-related Hemorrhage
Abstract
Cerebral amyloid angiopathy (CAA) is associated with apolipoprotein E (APOE gene, apoE protein) polymorphism: current evidence suggests that the epsilon4 allele is a risk factor for the development of CAA and the epsilon2 allele predisposes to hemorrhage. We sought to determine the relationship between the APOE epsilon2 allele and both the immunoreactivity profiles and vascular complications of CAA. We performed immunohistochemistry for amyloid beta-protein (A beta), apoE, cystatin C, and activated microglia, and examined the morphology of cortical and leptomeningeal vessels in 37 CAA-related hemorrhage (CAAH), 26 Alzheimer disease (AD) patients, and 20 controls. The extent of immunostaining of vessels for A beta, apoE, cystatin C, and perivascular activated microglia increased from controls through AD to a maximum in CAAH patients. Among cases with CAA (37 CAAH, 19 AD, and 6 controls, n = 62) vascular apoE (p < 5 x 10(-4)), cystatin C (p < 10(-4)), activated microglia (p < 10(-4)), vessels with a high ratio of wall thickness to lumen diameter (p < 0.003) as well as dilated/microaneurysmal vessels (p < 0.01) were present more frequently in patients with hemorrhage than without; however, these features were not associated with the APOE epsilon2 allele. Fibrinoid necrosis alone was associated with the APOE epsilon2 allele (p < 0.04) and we suggest that over-representation of APOE epsilon2 in CAAH may result from its association with fibrinoid necrosis.
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Human studies have linked APOE2 to greater CAA severity in some cohorts, and to CAA-related vasculopathic changes and hemorrhagic complications.
“However, human studies have linked APOE2 to greater CAA severity in some cohorts 52 , and to CAA-related vasculopathic changes and hemorrhagic complications 53,54 .”
From APOE2 attenuates APOE4-associated amyloid pathology and related toxicity in a mouse model of Alzheimer’s disease (2026) · cites this paper as [54]
Evidence independently supports link of both the APOE ε4 and ε2 allele with increased risk for microhemorrhages in humans.
“Evidence independently supports link of both the APOE ε4 and ε2 allele with increased risk for microhemorrhages in humans [51, 52, 54–57].”
From APOE Genotype Differentially Modulates Effects of Anti-Aβ, Passive Immunization in APP Transgenic Mice (2017) · cites this paper as [56]
Several human autopsy studies have shown that the ε2 allele is an exacerbating factor of microhemorrhages among subjects with VAβ pathology and that this effect is linked to fibrinoid necrosis of vascular wall specifically associated with the ε2 allele.
“Several human autopsy studies have shown that the ε2 allele is an exacerbating factor of microhemorrhages among subjects with VAβ pathology and that this effect is linked to fibrinoid necrosis of vascular wall specifically associated with the ε2 allele [55–57].”
From APOE Genotype Differentially Modulates Effects of Anti-Aβ, Passive Immunization in APP Transgenic Mice (2017) · cites this paper as [56]
APOEε2/ε4 individuals have a particularly high risk of intracerebral lobar haemorrhage in the presence of cerebral amyloid angiopathy, possibly because the APOEε2 allele has been associated with fibrinoid necrosis of the vessel wall.
“Of note, APOEε2/ε4 individuals have a particularly high risk of intracerebral lobar haemorrhage in the presence of CAA50, possibly because the APOEε2 allele has been associated with fibrinoid necrosis of the vessel wall56,57.”
From Multifaceted roles of APOE in Alzheimer disease (2024) · cites this paper as [57]
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Cerebral amyloid angiopathy and gene polymorphisms.
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Self-citationCerebral amyloid angiopathy in traumatic brain injury: association with apolipoprotein E genotype
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- Authors
- McCarron, M. O., Nicoll, J. A. R., Stewart, J., Ironside, J. W., Mann, D. M. A., Love, S., Graham, D. I., & Dewar, D.
- Affiliations
- Southern General Hospital (GB)
- Western General Hospital (GB)
- University of Manchester (GB)
- Frenchay Hospital (GB)
- University of Glasgow (GB)
- ORCID
- Venue
- Journal of Neuropathology and Experimental Neurology
- Publisher
- Oxford University Press (OUP)
- Published
- 1999-07
- Volume
- 58
- Issue
- 7
- Pages
- 711-718
- ISSN
- 0022-3069 (ISSN-L)
- OpenAlex
- W1985093052
- Cited by
- 160
- References
- 0
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 5 · 2023: 5 · 2022: 2 · 2021: 3 · 2020: 4 · 2019: 2 · 2018: 5 · 2017: 4 · 2016: 3 · 2015: 10 · 2014: 13 · 2013: 11 · 2012: 7
- FWCI
- 5.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Neuropathology & Experimental Neurology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Wellcome Trust
- Topics
- Health Sciences › Medicine › Neurology › Intracerebral and Subarachnoid Hemorrhage Research
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Health Sciences › Medicine › Neurology › Cerebrovascular and genetic disorders
- Keywords
- cerebral amyloid angiopathy, APOE ε2 allele, intracerebral hemorrhage, amyloid-beta, cystatin C, activated microglia, fibrinoid necrosis, leptomeningeal vessels, cortical vessels, Alzheimer's disease, APOE polymorphism, microaneurysms
- MeSH terms
- Aged, Alleles, Alzheimer Disease, Apolipoproteins E, Intracranial Aneurysm, Cerebral Hemorrhage, Female, Humans, Immunohistochemistry, Male, Necrosis, Reference Values, Amyloid beta-Peptides, Cerebral Amyloid Angiopathy, Apolipoprotein E2
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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.
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