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Merritt, Victoria C.

https://orcid.org/0000-0001-5683-4168

A5135458431 | I36258959

Mayo Clinic

University of California San Diego

Citations 1

An APOE *4-Informed Genomic Atlas of the X Chromosome in Alzheimer’s Disease

No container title available | May 6, 2026 | Volume: No volume available | Issue: No issue available | Pages: No page available

10.64898/2026.05.05.26352461 | PMID 42145643

Abstract The genetic contributions of the X chromosome to Alzheimer’s disease (AD) remain poorly understood yet are expected to importantly shape sex differences in AD. We therefore performed large-scale X-chromosome-wide association studies (N=1,240,451), evaluating differential risk due to sex, APOE *4, and escape from X-chromosome inactivation, finding most X-linked loci appear relevant to female-biased AD etiology. In evaluating genetic pleiotropy with hormonal, lipid, and brain imaging traits, we discovered X-linked AD loci converged on white matter traits, particularly in the anterior corona radiata and splenium of the corpus callosum. Through brain-centric functional genomics analyses, we then nominated candidate causal genes, including 5 that appeared highly robust. Notably, we found the escape gene RBBP7 decreases AD risk in APOE *4 carriers likely through higher expression in excitatory neurons to counter tau-related neurodegeneration. Altogether, we provide an atlas of sex and APOE *4-informed candidate X-linked AD risk loci, genes, and mechanisms that will guide future studies.