Citations

AbstractBackgroundImaging and plasma markers are used as key indicators of disease for Alzheimer’s disease (AD) but their usefulness in predicting regional tau pathology is relatively understudied. Our objective was to construct predictive models for regional tau pathology measured on postmortem brain tissue using multiple ante‐mortem AD biomarkers. We focused on hippocampal and parietal regions that were immunostained with AT8 and 2E9 that reflect early and advanced aspects of tangle maturity, respectively.MethodsUsing autopsy data from 63 participants enrolled in the Mayo Clinic Study of Aging (MCSA) where the last clinical visit is within three years of death, we analyzed three ante‐mortem plasma markers ‐ phosphorylated tau protein at the threonine 181 residue, glial fibrillary acidic protein, total ß‐amyloid Aß42 relative to Aß40 ratio (Quanterix Simoa HD‐X Analyzer), and three regional MRI markers computed using SPM12 ‐ parietal thickness, parietal volume relative to total intracranial volume ratio, and hippocampal volume adjusted for total intracranial volume. Based on eight separate cross‐sectional linear regression models weighted by the inverse of time from last visit to death, we estimated the multiple and partial R2 predicting post‐mortem pathology measures, including AT8 and 2E9 in both the hippocampal and parietal regions. All models were adjusted for age, sex, and cardiovascular and metabolic conditions score.ResultsThe MRI models (R2 of 0.26‐0.53) had greater predictive power compared to the plasma models (R2 of 0.17‐0.26). The best multiple R2 was 0.53 for prediction of hippocampal AT8 using antemortem hippocampal volume adjusted for total intracranial volume followed by R2 of 0.43 for prediction of hippocampal 2E9 using hippocampal volume adjusted for total intracranial volume. Though the model prediction of parietal AT8 and 2E9 measurements was low (R2 of 0.21‐0.26), parietal thickness exhibited better predictive performance than parietal volume relative to total intracranial volume ratio.ConclusionsThe data we presented here may be utilized to validate biomarkers using regional pathology. Our results support that regional MRI is sensitive to tau pathology. Newer MRI methods should be tested to examine the specificity of newer quantitative measurements to tau pathology.

AbstractBackgroundTransactive response DNA‐binding protein of 43 kDa (TDP‐43) is implicated in numerous neurodegenerative diseases, including Alzheimer’s disease (AD). Immunohistochemically stained TDP‐43 is linked to faster rates of hippocampal atrophy (HA) in AD. However, it is unclear whether phosphorylated TDP‐43 (pTDP‐43) measured using an immunoassay is also associated with HA. We explored associations between pTDP‐43 levels, TDP‐43 immunohistochemistry, and annual rate of HA in AD. We hypothesized that higher pTDP‐43 levels would be associated with positive TDP‐43 immunohistochemistry, and faster rates of HA.MethodThirty‐seven cognitively impaired participants from the Mayo Clinic Alzheimer’s Disease Research Center underwent serial brain MRIs and brain autopsy. Hippocampal TDP‐43 was detected histochemically, and pTDP‐43 was quantified using biochemical assay. Hippocampal volumes were measured using the longitudinal pipeline in FreeSurfer‐7 and annualized HA rates were calculated. Linear regression analyzed the relationship between HA and pTDP‐43 biochemical assay levels. pTDP‐43 was categorized as positive (=400) or negative (<400), and logistic regression tested the association of these levels with HA rates. The correlation between TDP‐43 immunohistochemistry status and biochemical assay levels was evaluated using descriptive statistics. All analyses were adjusted for potential confounders.ResultsThe mean age at death was 83.5 (±9.9) years with 49% females. Median scan interval was 3‐years. A negative relationship was observed between age at death and annual HA rate (ß=‐3.1; 95% CI [‐5.3,‐0.9]; p=0.007), and a positive relationship was observed between pTDP‐43 level and annual HA rate (ß=0.02; 95% CI [0.003,0.03]; p=0.015). A one‐unit increase in HA rate was associated with a 3% increase in the odds of being pTDP‐43 positive (=400) (odds ratio=1.03; CI [1.007,1.05]; p=0.014). Cases that tested positive for Immunohistochemistry TDP‐43 had significantly higher mean pTDP‐43 immunoassay levels (1508 ± 2072 vs. 202 ± 131; p=0.008). More cases with positive IHC TDP‐43 surpassed the pTDP‐43 immunoassay cut‐off level of 400 vs the negative participants (p=0.003).ConclusionHigher pTDP‐43 levels in the hippocampus are linked to faster HA in AD and correlated with immunohistochemistry TDP‐43 positivity. These findings underscore the role of TDP‐43 in AD neurodegeneration. The biological and clinical implications of these observations necessitate further exploration in subsequent studies.

AbstractBackgroundThe TAR DNA‐binding protein of 43 kDa (TDP‐43) is linked to hippocampal volume loss and faster rates of hippocampal atrophy in Alzheimer's disease and primary age‐related tauopathy (PART). Hence, TDP‐43 is becoming an important player in age‐related neurodegeneration. To advance our understanding of TDP‐43 effect on hippocampus, we conducted an imaging‐pathological study to determine which specific hippocampal subfields are affected by TDP‐43 in cases of PART.MethodOne‐hundred fifteen autopsied cases from Mayo Clinic Alzheimer Disease Center, Study of Aging and Neurodegenerative Research Group were analyzed. All had completed antemortem brain MRIs, underwent neuropathological examination per NIA and Alzheimer’s Association (NIA‐AA) criteria and had additional assessment for TDP‐43 deposition. Only cases meeting criteria for PART (Thal phases 0‐2 and Braak NFT stages I‐IV) were included. Hippocampal subfield segmentation was performed using FreeSurfer‐7. Brain volumes were normalized to total intracranial volume (TIV) when comparing TDP‐43 groups. Statistical analyses including logistic regression analyses were utilized to explore associations between TDP‐43 status and hippocampal subfield volumes.ResultForty‐nine of the 115 cases (43%) with PART were female. Thirty‐seven (32%) cases were TDP‐positive. Mean age at last MRI was 84 years. There were no differences in pathological characteristics between both groups except for presence of hippocampal sclerosis which was more frequent in the TDP(+) group (P <0.001). Whole hippocampal volume was significantly smaller in the TDP(+) group (176 ±31 vs. 188 ±27, p=0.049). After stratification of hippocampus into head, body, and tail, TDP‐positive cases had smaller volumes of hippocampal body (p=0.031) and tail (p=0.021) but did not reach significance for hippocampal head (p=0.129). When regions were subdivided into hippocampal subfields, TDP(+) cases showed smaller volumes of molecular layer of the hippocampal body (p=0.046), CA1 body (p=0.031), subiculum body (p=0.023), and presubiculum body (p=0.046) compared to TDP(‐) cases. Logistic regression analysis adjusting for TIV confirmed these associations.ConclusionThis study underscores the association between TDP‐43 and the hippocampus and provides further evidence that TDP‐43 targets multiple regions and subfields of the hippocampus in patients with PART. Intriguingly, regions targeted are those where TDP‐43 deposition is microscopically observed, suggesting a direct “hit” by TDP‐43 deposition.

AbstractBackgroundAlzheimer’s disease (AD) missing heritability remains extensive despite numerous genetic risk loci identified by genome‐wide association or sequencing studies. This has been attributed, at least partially, to mechanisms not currently investigated by traditional single‐marker/gene approaches. Polygenic Risk Scores (PRS) aggregate sparse genetic information across the genome to identify individual genetic risk profiles for disease prediction and patient risk stratification. Recent advancements have pivoted on innovative approaches utilizing OMICS data to construct such risk scores.MethodWe employed a random forest algorithm to identify a list of gene candidates from bulk RNA sequencing data in prefrontal cortex from 565 AD brain samples (non‐Hispanic Whites, n = 399; Hispanics, n = 113; African American, n = 12) across six U.S. brain banks. Subsequently, we calculated their effect size on Braak staging using regression models to construct a polytranscriptomic risk score (PTRS). We employed two distinct models: “Ethnicity‐Agnostic” Model (randomly assigning samples to training and testing samples) and “Ethnicity‐Aware” Model (assigning NHW samples to training and Hispanics to testing sample). Analysis of variance and the receiver operating characteristics area under the curve (ROC AUC) was used to evaluate PTRS’s classification performances. We validated findings using the Religious Orders Study/Memory and Aging Project study (ROS/MAP, n = 1,095).ResultWe found a significant difference in PTRS between samples with low vs. high Braak stages (≤4 vs. ≥5, p = 1*E‐04; Figure 1 upper panel). AUC was found to be 79‐81%, consistently in both Ethnicity‐Agnostic and Ethnicity‐Aware models (Figure 1 lower panel). Finally, the PTRS in ROS/MAP yielded a similar classification performance (p = 2*E‐04, AUC = 77%).Conclusioncontrary to prior studies, we developed a PTRS with optimal transferability across ethnicities. This underscores the importance of developing novel tools to stratify and harmonize large brain repositories for AD.

AbstractBackgroundDirected by the enzyme pair PINK1 and PRKN, mitophagy is a crucial mitochondrial quality control mechanism that selectively decorates damaged mitochondria with phosphorylated ubiquitin (pS65‐Ub), facilitating their lysosomal degradation. The dynamic pS65‐Ub signal accumulates upon enhanced activation from increased mitochondrial damage or upon reduced autophagic‐lysosomal flux. Previous studies including ours demonstrated altered mitophagy and elevated pS65‐Ub levels in Parkinson’s and Alzheimer’s disease brains that also independently associated with α‐synuclein, tau, or amyloid pathology. However, their combined impact on mitophagy and organelle function remains unclear. Notably these three pathologies often coexist in susceptible brain areas of a neurodegenerative condition named dementia with Lewy bodies (DLB). We herein investigated the interactions of α‐synuclein, tau, and amyloid pathology to uncover their combined effects on mitophagy in a large DLB cohort.MethodThis study included 371 DLB autopsy brains with neurologically normal cases as controls. Immunohistochemistry for the mitophagy marker pS65‐Ub in the hippocampus and amygdala was performed and associations of pS65‐Ub levels with neuropathological measures from the same region were evaluated. Immunofluorescence co‐staining of pS65‐Ub, phospho‐α‐synuclein, and phospho‐tau was conducted to study their interactions at single‐cell level.ResultpS65‐Ub positive cells were significantly more abundant in the hippocampus and amygdala of DLB cases compared to controls. Significant associations were observed between pS65‐Ub levels with age, brain weight, Braak stage, Thal phase as well as counts of Lewy body (LB), neurofibrillary tangle (NFT), and senile plaque (SP) in both regions. Strong synergistic effects of LB and NFT pathologies on pS65‐Ub accumulation were found in the amygdala, while only additive effects of LB and SP pathologies were observed. Single‐cell analysis in the amygdala showed that most affected cells contained either LB or NFT inclusion rather than co‐residing two pathologies within the same cell. Notably, cells harboring LB pathology exhibited mainly smaller, granular pS65‐Ub deposits (type G), possibly associated with increased mitochondrial dysfunction. Conversely, those containing NFT showed larger, vacuolar pS65‐Ub deposits (type V), likely resulting from reduced lysosomal degradation.ConclusionOur study revealed complex interactions of α‐synuclein, tau, and amyloid pathology on mitophagy alteration in DLB brains, highlighting different molecular mechanisms underlying α‐synuclein‐ and tau‐associated mitophagy alterations.

AbstractBackgroundAfrican Americans (AA) and Latin Americans (LA) are at a higher risk of developing AD compared to non‐Hispanic whites (NHW) but are traditionally underrepresented in AD research. The disproportionate risk is likely multifactorial including differences in co‐morbidities and structural and social determinants of health (SSDoH). AD risk is thought to result from multiple genetic and environmental factors, and their interactions (GxE). However, the molecular mechanisms underlying these interactions are largely unknown. The best‐established genetic risk factor for AD is APOE‐ε4, while APOE‐ε2 is protective. Environmental factors, such as living in neighborhoods with greater socioeconomic disadvantage, have been associated with greater AD neuropathology and worse cognitive function. Studying the potential modifying role of neighborhood disadvantage regarding associations of APOE‐ε4 and APOE‐ε2 with AD risk using a socioeconomic metric like the Area Deprivation Index (ADI) in a multiethnic post‐mortem cohort could offer valuable insights for precision medicine.MethodWe analyzed a post‐mortem cohort of 421 multi‐ethnic donors (NHW: N = 234, AD = 70, non‐AD = 164; LA: N = 145, AD = 102, non‐AD = 43; AA: N = 42, AD = 24, non‐AD = 18), from Mayo Clinic Florida, Banner Sun Health Research Institute, and the University of Florida Brain Banks as part of the AMP AD Diversity initiative. This study used the same neuropathological criteria to categorize AD vs. non‐AD as in the MayoRNAseq study (syn5550404). ADI from the Neighborhood Atlas® was obtained from de‐identified addresses. Associations of APOE‐ε4, APOE‐ε2, and ADI with AD risk were examined using logistic regression models adjusted for age‐at‐death, sex, and ethnic group; interactions of APOE genotype with ADI were also assessed.ResultAPOE‐ε4 and APOE‐ε2 showed a significant association with AD diagnosis (APOE‐ε4combined cohort OR = 3.23, P = 3.14E‐08; APOE‐ε2combined cohort OR = 0.30, P = 0.003). However, contrary to prior findings, our study found no association between ADI and AD diagnosis [OR = 1.023 (per each 10 unit increase in ADI), P = 0.629]. No significant interactions of ADI with APOE‐ε4 or APOE‐ε2 regarding association with AD diagnosis were identified (P = 0.083, P = 0.781).ConclusionThis is the first study evaluating the potential interaction of neighborhood disadvantage with APOE on AD risk in a multi‐ethnic autopsy cohort. However, these findings require further investigation in larger, more well‐powered cohorts for validation.

AbstractBackgroundThe aggregation of α‐synuclein protein, encoded by the SNCA gene, forms Lewy bodies (LBs) in neurons and is a key pathological feature of Lewy body dementia (LBD). Interestingly, the apolipoprotein E gene (APOE), primarily expressed in glial cells, is the strongest genetic modifier for LBD. The ε4 allele of this gene (APOE4) notably increases the risk of LBD. However, the specific mechanisms through which APOE‐regulated glial cells affect α‐synuclein aggregation in neurons are not yet fully understood.MethodTo explore this, we conducted spatial transcriptomics using the 10X Genomics Visium CytAssist platform on Formalin‐Fixed Paraffin‐Embedded tissue slides from the temporal cortex of human LBD brains (N = 4 brains in controls and N = 6 brains in LBD group, with an equal ratio of APOE3/3 and APOE3/4 genotypes). We defined the neuronal layers of the gray matter (Layers 1 to 6, L1‐6) and white matter in each brain based on the gene signature of each spot. We also identified LBs from hematoxylin and eosin (H&E) staining on the same slides, and annotated LB‐positive (LB+), LB‐surrounding and LB‐negative (LB‐) spots in each brain using Loupe Browser. We evaluated SNCA and APOE gene expression in each layer and analyzed cell‐cell communication using the CellChat tool across the layers.ResultWe observed that the SNCA gene was highly expressed in L5, which corresponded to the areas where most LBs were found. Notably, within LB+ spots across all layers, both SNCA and APOE gene expression levels were elevated in APOE3/4 cases compared to APOE3/3 cases. Furthermore, we identified cell‐cell communication networks between LB+ and LB‐surrounding spots, particularly in L4 and L5. These networks were enriched by microglia‐related signaling pathways, including APOE signaling, migration inhibitory factor (MIF) signaling, and colony stimulating factor 1 (CSF1) signaling. Interestingly, APOE3/4 brains exhibited significantly reduced interactions and lower interaction strength in these networks compared to APOE3/3 samples.ConclusionOur findings indicate that impaired cell‐cell communication, such as microglia‐mediated immune responses around LB regions, may be associated with the increased risk presented by the APOE4 allele in LBD brains.

AbstractBackgroundUFMylation is an understudied ubiquitin‐like post‐translational modification (PTM). Like ubiquitin, UFM1 is conjugated to substrates via a catalytic cascade involving a UFM1‐specific E1 (UBA5), E2 (UFC1), and an E3 ligase complex (UFL1, DDRGK1 and CDK5RAP3). UFMylation is reversible, and this is mediated by UFSP2. UFMylation plays essential roles in several biological processes including the DNA damage response, endoplasmic reticulum homeostasis, unfolded protein response, autophagic functions, and immune response. Importantly, UFMylation is also crucial for healthy brain development. Alzheimer’s disease (AD), a complex neurodegenerative disorder, is characterized by the accumulation of pathologic tau and beta‐amyloid proteins and has been associated with abnormalities in the aforementioned processes. Intriguingly, the potential link between AD and UFMylation has not been investigated yet. Considering that pathological tau plays a critical role in AD, and tau also plays an important role for the DNA damage response in neurons under physiological conditions, we speculated that tau itself could be modified with UFM1.MethodWe performed Western blot and Meso Scale Discovery based ELISA to measure the protein level of UFM1, UFSP2 and other UFMylation pathway components in RIPA‐soluble and insoluble fraction in human post‐mortem frontal cortex. To test whether tau can be modified by UFM1, we performed co‐immunoprecipitation (Co‐IP), Proximity Ligation Assays (PLA) and liquid chromatography‐tandem mass spectrometry (LC‐MS/MS).ResultWe found a significant reduction of soluble UFSP2, but an increase of soluble total UFM1 in AD compared to controls. We found that tau interacts with UFL1 and DDRGK1. In addition, using immunoprecipitation of denaturing lysates we found that tau can indeed be covalently modified by UFM1 when overexpressed. We detected strong signal of HA‐UFM1‐tau in neurons but not in negative controls using PLA. Furthermore, we immunoprecipitated denatured UFM1 from human autopsy brain, and detected two specific UFM1‐tau bands with tau antibodies. Together, this data strongly indicates that tau is UFMylated under endogenous conditions. Using LC‐MS/MS, we identified 17 UFMylation sites in tau proteins.ConclusionUFMylation is dysregulated in AD; tau protein can be modified by UFM1 both in vitro and in vivo, which enables a more comprehensive understanding of tau PTMs.

AbstractBackgroundA complex, multicellular disease with genetic and immunological elements, Alzheimer’s disease (AD) affects millions worldwide. There has been previous research linking AD to the missense variants ABI3‐rs616338‐T and PLCG2‐rs72824905‐G, and the altered expression of these genes has been shown to disrupt microglial function. In our understanding of AD risk and resilience, limited research has been conducted on how these variants affect microglial subtypes and states in AD.MethodsWe previously identified DOCK8 protein as a target for fluorescent activated nuclei sorting (FANS) to enrich microglia nuclei from frozen human brains. Using this enrichment strategy, we generated microglia enriched snRNAseq data from temporal cortex tissue of 30 donors harboring ABI3 or PLCG2 missense mutations, or neither mutation. We introduced PLCG2 variant in either homozygote, and heterozygote forms into an AD patient derived iPSC through CRISPR/Cas9 approach, differentiated these cells into microglia cells (IMGLs) following established protocols, and generated scRNAseq data after treatment with Amyloidβ. We applied standard alignment and quality control pipelines to the snRNAseq and scRNAseq datasets in parallel. Established markers of microglia states and subtypes were utilized to annotate the clusters; analyzed for their hub gene expression using comparisons between cluster differential profiling to determine signature pathways. Differential gene expression was assessed using pseudo bulk and MAST approaches.ResultsWe obtained single nuclei transcriptome profiles of 54,000 frozen human brain nuclei, of which 35,000 are microglia, through snRNAseq, and single cell profiles of 63,000 iMGLs through scRNAseq, using our standard alignment and quality control procedures. Our differential gene expression analysis identified novel genes and pathways which were identified as part of resilience or AD risk networks in microglia subtypes and states. These alterations were validated using orthogonal experimental methods and further explored for their conservation using in vivo external datasets. Pseudotime inference will be completed to probe microglia marker gene expression dynamics, treatment conditions, along with continuous cell‐state changes.ConclusionOur study uncovers microglia subtype specific resilience and risk factors provided by AD related genetic variants using snRNAseq from frozen human brain and scRNAseq from IPSC derived microglia cells. These findings nominate novel targets and pathways with therapeutic potential.

AbstractBackgroundProgressive supranuclear palsy (PSP) is a devastating primary tauopathy with rapid progression to death. Although several therapies currently in the development pipeline show promising safety profiles and robust target engagement, few demonstrated significant efficacy in patients, underscoring the need to interrogate additional targets with novel therapeutic modalities to expand the potential therapeutic arsenal. To diversify the therapeutic avenues for PSP and related tauopathies (e.g. Alzheimer’s disease), we systematically integrated multi‐omics data from human brains of PSP and control donors with cross‐species validation to nominate high‐confidence therapeutic targets. We plan to translate our findings into safe and effective treatments for PSP using antisense oligonucleotides (ASO).MethodWe analyzed brain gene expression profiles in PSP and control individuals at bulk tissue (N = 408) and single‐cell levels (snRNAseq, N = 36). Cell‐type‐specific expression perturbations were systematically prioritized using a cross‐species validation paradigm, including rTG4510 tau mice and tau‐overexpressing Drosophila models. We conducted in vitro screening of ASO candidates against our prioritized target genes. ASO efficacy and toxicity were measured. RNAseq experiments will be performed to interrogate off‐target effects. The safety and efficacy of the lead ASOs will be assessed in PSP‐patient‐derived iPSC models.ResultWe previously reported discovery of novel genes with significant differential expression in PSP brains, characterized their brain cell‐specificity and validated them using snRNAseq data. We prioritized 21 genes using gene expression data from a mouse tauopathy model. Validation of these 21 high‐priority genes using a Drosophila tau model nominated astrocytic STOM, KANK2, and DDR2 as potential therapeutic targets for PSP. Knocking down their expression in Drosophila significantly rescues tau‐mediated neurodegenerative pathology. In vitro screening identified ASO leads that reduced the target expressions at mRNA and protein levels with low cellular toxicity.ConclusionWe developed a systems biology pipeline and nominated STOM, KANK2, and DDR2 as candidate gene targets for PSP. We identified ASOs that modulate these targets’ expression without cellular toxicity, suggesting they may be suitable as potential therapeutic candidates. Importantly, the shared pathophysiology and molecular aberrations between PSP and other tauopathies, such as Alzheimer’s disease, suggests that such therapeutic candidates may be repurposed for multiple neurodegenerative diseases, further accelerating, and streamlining the therapeutic pipeline.