Cited by 191Alzheimer's disease research and treatmentsNeuroinflammation and Neurodegeneration MechanismsDementia and Cognitive Impairment Research

The DOI matches its Crossref record; 54 of the 55 references it cites were found in a registry or an index; 52 of the 85 sources its claims cite were checked for support.

Apolipoprotein E metabolism and functions in brain and its role in Alzheimer's disease

Open access
Liao, Fan, Yoon, Hyejin, Kim, Jungsu·2017·Current Opinion in Lipidology

Abstract

Purpose of review: APOE4 genotype is the strongest genetic risk factor for Alzheimer's disease. Prevailing evidence suggests that amyloid β plays a critical role in Alzheimer's disease. The objective of this article is to review the recent findings about the metabolism of apolipoprotein E (ApoE) and amyloid β and other possible mechanisms by which ApoE contributes to the pathogenesis of Alzheimer's disease. Recent findings: ApoE isoforms have differential effects on amyloid β metabolism. Recent studies demonstrated that ApoE-interacting proteins, such as ATP-binding cassette A1 (ABCA1) and LDL receptor, may be promising therapeutic targets for Alzheimer's disease treatment. Activation of liver X receptor and retinoid X receptor pathway induces ABCA1 and other genes, leading to amyloid β clearance. Inhibition of the negative regulators of ABCA1, such as microRNA-33, also induces ABCA1 and decreases the levels of ApoE and amyloid β. In addition, genetic inactivation of an E3 ubiquitin ligase, myosin regulatory light chain interacting protein, increases LDL receptor levels and inhibits amyloid accumulation. Although amyloid β-dependent pathways have been extensively investigated, there have been several recent studies linking ApoE with vascular function, neuroinflammation, metabolism, synaptic plasticity, and transcriptional regulation. For example, ApoE was identified as a ligand for a microglial receptor, TREM2, and studies suggested that ApoE may affect the TREM2-mediated microglial phagocytosis. Summary: Emerging data suggest that ApoE affects several amyloid β-independent pathways. These underexplored pathways may provide new insights into Alzheimer's disease pathogenesis. However, it will be important to determine to what extent each mechanism contributes to the pathogenesis of Alzheimer's disease.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review summarizes how apolipoprotein E (ApoE) metabolism and ApoE-interacting proteins influence Alzheimer’s disease through amyloid β-dependent and emerging amyloid β-independent pathways. It highlights ABCA1, LDLR/LRP1, TREM2, and ApoE effects on vascular function, neuroinflammation, metabolism, synaptic plasticity, and transcription.

Key findings

  • APOE4 is the strongest genetic risk factor for Alzheimer’s disease, with ε4 risk-increasing and ε2 protective; brain amyloid β accumulation follows ApoE4 > ApoE3 > ApoE2.
  • In >92,000 individuals, the ABCA1 loss-of-function variant N1800H occurred at 0.2% frequency and increased Alzheimer’s disease hazard ratio to 4.13, while APOE ε4/4 versus ε3/3 had a hazard ratio of 7.70; CSF from mild cognitive impairment and Alzheimer’s disease patients showed 30% less ABCA1-mediated cholesterol efflux than cognitively normal participants.
  • Rare TREM2 missense variants are associated with approximately two-fold to four-fold increased Alzheimer’s disease risk; ApoE binds TREM2 and facilitates TREM2-mediated microglial phagocytosis, and TREM2 disease variants reduce ApoE–TREM2 affinity, though TREM2 binding affinity does not differ among ApoE isoforms.
  • ApoE also affects amyloid β-independent pathways: ApoE4 binds promoter regions of ∼1700 genes in human glioblastoma cells, ApoE4 led to lower TREM2 expression than ApoE3 in primary microglia, and ApoE2 enhanced synaptosome–astrocyte binding and astrocyte phagocytic capacity in ApoE knock-in mice.

Methods

  • Narrative review article synthesizing recent findings on ApoE metabolism and Alzheimer’s disease, focusing on ABCA1, ApoE receptors, ApoE proteases, and ApoE roles in cerebral vascular function, neuroinflammation, lipid/glucose metabolism, synaptic plasticity, and transcriptional regulation.
  • Evidence is drawn from cited human studies, APP/ApoE mouse models, ApoE knock-in mice, and cell-based or in vitro experiments; no primary data collection or systematic quantitative analysis is described.

Limitations

  • The paper states that it will be important to determine to what extent each mechanism contributes to Alzheimer’s disease pathogenesis; the exact in vivo ApoE protease remains elusive, and most previous studies used recombinant ApoE with no or little lipidation under in vitro conditions, so further physiological investigations are warranted.
  • The paper notes that the physical TREM2–ApoE interaction may not explain differential ApoE isoform effects, that it is unknown whether ApoE actively transports amyloid β from parenchyma to blood vessels or cotranslocates to preformed aggregates, and that whether ApoE4 disrupts blood-brain barrier integrity independent of amyloid β is still debated.
  • Evident from the text: as a narrative review, it lacks a systematic search strategy, explicit inclusion criteria, and quantitative synthesis, so conclusions depend on selected cited studies.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1097/mol.0000000000000383

Cites

54 of 55 references verified0 citation errors · 1 not checkable

Statistics

Nothing to recompute.

Figures

FIGURE 1 ApoE-mediated pathogenic pathways, leading to Alzheimer's disease. ApoE mainly influences the pathogenesis of Alzheimer's disease by affecting amyloid β pathology. The aggregation of amyloid β in parenchymal plaques and CAA triggers neuroinflammation [1]. In addition, ApoE may directly affect neuroinflammation, cerebral vascular integrity, metabolism, synaptic plasticity, and transcription through amyloid β-independent mechanisms [23,35,50]. Some pathways are differentially affected by the isoform, level, and the lipidation status of ApoE [4]. ApoE, apolipoprotein E; CAA, cerebral amyloid angiopathy.
FIGURE 1 ApoE-mediated pathogenic pathways, leading to Alzheimer's disease. ApoE mainly influences the pathogenesis of Alzheimer's disease by affecting amyloid β pathology. The aggregation of amyloid β in parenchymal plaques and CAA triggers neuroinflammation [1]. In addition, ApoE may directly affect neuroinflammation, cerebral vascular integrity, metabolism, synaptic plasticity, and transcription through amyloid β-independent mechanisms [23,35,50]. Some pathways are differentially affected by the isoform, level, and the lipidation status of ApoE [4]. ApoE, apolipoprotein E; CAA, cerebral amyloid angiopathy.CC BY-NC-ND · PubMed Central
Box 1 no caption available
Box 1 no caption availableCC BY-NC-ND · PubMed Central
FIGURE 2 Metabolism of ApoE and amyloid β. ApoE is predominantly expressed in astrocytes. The transcription of ApoE is regulated by the heterodimers formed by RXR with PPAR or LXR. After being lipidated by ABCA1, ApoE is secreted into the interstitial fluid and transports lipids to other cells via ApoE receptor-mediated uptake mechanism [6]. LRP1 and LDLR are the major metabolic receptors for ApoE [4]. Recently, a microglial receptor TREM2 is also found to bind ApoE [40▪▪–42▪▪]. The level of ApoE can also be down-regulated by various proteases. Amyloid β is synthesized in neurons and released into interstitial fluid [1]. ApoE binds to amyloid β aggregates and colocalizes with amyloid β in plaques and CAA [4]. The interaction between ApoE and amyloid β may affect amyloid β fibrillization. ApoE affects amyloid β clearance by multiple pathways, including enzymatic degradation, receptor-mediated BBB transport, and endocytosis of amyloid β by glial cells [4,23]. ABCA1, ATP-binding cassette A1; ApoE, apolipoprotein E; BBB, blood-brain barrier; CAA, cerebral amyloid angiopathy; LDLR, low-density lipoprotein receptor; LRP1, lipoprotein receptor-related protein 1; LXR, liver X receptor; PPAR, peroxisome proliferator-activated receptor; RXR, retinoid X receptor; TREM2, triggering receptor expressed on myeloid cells 2.
FIGURE 2 Metabolism of ApoE and amyloid β. ApoE is predominantly expressed in astrocytes. The transcription of ApoE is regulated by the heterodimers formed by RXR with PPAR or LXR. After being lipidated by ABCA1, ApoE is secreted into the interstitial fluid and transports lipids to other cells via ApoE receptor-mediated uptake mechanism [6]. LRP1 and LDLR are the major metabolic receptors for ApoE [4]. Recently, a microglial receptor TREM2 is also found to bind ApoE [40▪▪–42▪▪]. The level of ApoE can also be down-regulated by various proteases. Amyloid β is synthesized in neurons and released into interstitial fluid [1]. ApoE binds to amyloid β aggregates and colocalizes with amyloid β in plaques and CAA [4]. The interaction between ApoE and amyloid β may affect amyloid β fibrillization. ApoE affects amyloid β clearance by multiple pathways, including enzymatic degradation, receptor-mediated BBB transport, and endocytosis of amyloid β by glial cells [4,23]. ABCA1, ATP-binding cassette A1; ApoE, apolipoprotein E; BBB, blood-brain barrier; CAA, cerebral amyloid angiopathy; LDLR, low-density lipoprotein receptor; LRP1, lipoprotein receptor-related protein 1; LXR, liver X receptor; PPAR, peroxisome proliferator-activated receptor; RXR, retinoid X receptor; TREM2, triggering receptor expressed on myeloid cells 2.CC BY-NC-ND · PubMed Central

Verification

Claims the paper makes

28 Supported · 19 Sources not found · 15 Partly supported · 11 No full text of the sources · 10 Own interpretation · 3 No basis given · 2 Supported so far · accuracy not yet measured

Show all 61 claims

  • It may state two separate claims as one. 23
  • Probably not a substantial claim. 4
27 of 27
  • The paper relies on this without support.

    APOE4 genotype is the strongest genetic risk factor for Alzheimer's disease.

    “APOE4 genotype is the strongest genetic risk factor for Alzheimer's disease.”
  • The paper relies on this without support.

    In the brain, apoE is produced predominantly by astrocytes and to some extent microglia.

    “In the brain, apoE is produced predominantly by astrocytes and to some extent microglia.”
  • The paper relies on this without support.

    ApoE2 has only 1–2% of binding affinity to LDL receptor (LDLR), compared with ApoE3 and ApoE4.

    “For example, ApoE2 has only 1–2% of binding affinity to LDL receptor (LDLR), compared with ApoE3 and ApoE4.”
  • The paper relies on this without support.

    Neuroinflammation contributes to Alzheimer's disease pathogenesis.

    “Neuroinflammation is believed to contribute to Alzheimer's disease pathogenesis, although the exact mechanism is complex and not fully understood.”
  • The paper relies on this without support.

    Rare missense variants in TREM2 are associated with an approximately two-fold to four-fold increase in risk of Alzheimer's disease.

    “Rare missense variants in TREM2 are associated with an approximately two-fold to four-fold increase in risk of Alzheimer's disease.”
  • The paper relies on this without support.

    In brain, the only lipoprotein particle is HDL-like in size.

    “In brain, the only lipoprotein particle is HDL-like in size.”
  • The paper relies on this without support.

    Type 2 diabetes is associated with Alzheimer's disease.

    “Type 2 diabetes is associated with Alzheimer's disease, although it is still not clear whether it is a cause or consequence of Alzheimer's disease.”
7 of 7

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Metadata

Authors
Liao, F., Yoon, H., & Kim, J.
Affiliations
  • Washington University in St. Louis (US)
  • Mayo Clinic (US)
Corresponding author
Kim, Jungsu
Venue
Current Opinion in Lipidology
Published
2017-02
Volume
28
Issue
1
Pages
60-67
ISSN
  • 0957-9672 (ISSN-L)
  • 1473-6535
OpenAlex
W2559764604
Cited by
191
References
54
Citations by year
2026: 14 · 2025: 24 · 2024: 24 · 2023: 22 · 2022: 23 · 2021: 22 · 2020: 26 · 2019: 25 · 2018: 7 · 2017: 4
FWCI
8.21
Type
journal article
Language
en
Open access
Locations
  • Current Opinion in Lipidology (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (submittedVersion, cc-by-nc-nd)
  • PubMed Central (submittedVersion, cc-by-nc-nd)
Funders
National Institute on Aging (R01AG054102, R01 AG053500, R01AG053242, R21 AG050804)
Topics
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
  • Life Sciences › Neuroscience › Neurology › Neuroinflammation and Neurodegeneration Mechanisms
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
Keywords
apolipoprotein E, APOE ε4, Alzheimer's disease, amyloid-beta metabolism, ABCA1, LDL receptor, liver X receptor, retinoid X receptor, microRNA-33, TREM2, microglial phagocytosis, neuroinflammation, synaptic plasticity, vascular function, transcriptional regulation
MeSH terms
Alzheimer Disease, Animals, Apolipoproteins E, Brain, Gene Expression Regulation, Humans, Neuronal Plasticity, Transcription, Genetic

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