Liver-generated plasma apolipoprotein E (apoE) does not enter the brain but nonetheless correlates with Alzheimer’s disease (AD) risk and AD biomarker levels. Carriers of APOEε4, the strongest genetic AD risk factor, exhibit lower plasma apoE and altered brain integrity already at mid-life versus non-APOEε4 carriers. Whether altered plasma liver-derived apoE or specifically an APOEε4 liver phenotype promotes brain injury and neurodegeneration is unknown. Here we investigated the brains of Fah-/-, Rag2-/-, Il2rg-/- mice on the Non-Obese Diabetic (NOD) background (FRGN) with humanized-livers of an AD risk-associated APOE ε4/ε4 versus an APOE ε2/ε3 genotype. Reduced endogenous mouse apoE levels in the brains of APOE ε4/ε4 liver mice were accompanied by various changes in markers of synaptic integrity, neuroinflammation, and insulin signaling. Plasma apoE4 levels were associated with unfavorable changes in several of the assessed markers. These results propose a previously unexplored role of the liver in the APOEε4-associated risk neurodegenerative diseases.

Accumulating evidence demonstrating higher cerebrospinal fluid (CSF) -synuclein (Syn) levels and Syn pathology in the brains of Alzheimer's disease (AD) patients suggests that Syn is involved in the pathophysiology of AD. To investigate whether Syn could be related to specific aspects of the pathophysiology present in both sporadic and familial disease, we quantified CSF levels of Syn and assessed links to various disease parameters in a longitudinally followed cohort (n=136) including patients with sporadic mild cognitive impairment (MCI) and AD, and in a cross-sectional sample from the Dominantly Inherited Alzheimer's Network (n=142) including participants carrying autosomal dominant AD (ADAD) gene mutations and their non-mutation carrying family members.Our results show that sporadic MCI patients that developed AD over a period of two years exhibited higher baseline Syn levels (p=0.03), which inversely correlated to their Mini-Mental State Examination scores, compared to cognitively normal controls (p=0.02). In the same patients, there was a dose-dependent positive association between CSF Syn and the APOE epsilon 4 allele. Further, CSF Syn levels were higher in symptomatic ADAD mutation carriers versus non-mutation carriers (p=0.03), and positively correlated to the estimated years from symptom onset (p=0.05) across all mutation carriers. In asymptomatic (Clinical Dementia Rating<0.5) PET amyloid-positive ADAD mutation carriers CSF Syn was positively correlated to C-11-Pittsburgh Compound-B (PiB) retention in several brain regions including the posterior cingulate, superior temporal and frontal cortical areas. Importantly, APOE epsilon 4-positive ADAD mutation carriers exhibited an association between CSF Syn levels and mean cortical PiB retention (p=0.032). In both the sporadic AD and ADAD cohorts we found several associations predominantly between CSF levels of Syn, tau and amyloid-(1-40).Our results suggest that higher CSF Syn levels are linked to AD pathophysiology at the early stages of disease development and to the onset of cognitive symptoms in both sporadic and autosomal dominant AD. We conclude that APOE epsilon 4 may promote the processes driven by Syn, which in turn may reflect on molecular mechanisms linked to the asymptomatic build-up of amyloid plaque burden in brain regions involved in the early stages of AD development.

The apolipoprotein E epsilon 4 allele (APOEε4) is the strongest genetic risk factor for both sporadic Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB). Carriers of APOEε4 have more abundant AD amyloid-β pathology, and recent findings further suggest that the allele promotes α‑synuclein (αSyn) pathology. We have previously described an APOEε4 dose-depended increase in cerebrospinal fluid (CSF) αSyn levels in prodromal AD patients and elevated levels of monomeric intracellular αSyn were reported in AD brains lacking Lewy pathology. Importantly, over 50% of sporadic AD patients exhibit notable levels of Lewy pathology and a majority of PSEN1 mutation-carrying familial AD patients exhibit αSyn pathology in the amygdala. Here we assessed the levels and molecular size distribution of αSyn, total apolipoprotein E (apoE), and apoE4 in ventricular CSF from APOEε3/ε4-carrying patients with AD and Parkinson’s disease (PD), and controls using size exclusion chromatography, ELISA and western blotting. We further assessed brain regional differences in the solubilities and molecular species of αSyn and apoE and apoE4 using tissue fractionation and western blotting. Levels of CSF apoE and apoE4 were lower in AD versus PD patients, while levels of CSF αSyn were generally higher than reported in ante mortem lumbar CSF samples. No notable co-elution of αSyn and apoE occurred in CSF. In the brain parenchyma, compared to the medial frontal gyrus and medial temporal gyrus, the amygdala had higher levels and more species of saline and Triton X‑100 soluble apoE4 and αSyn regardless of patient diagnosis. Overall, our results suggest that levels of postmortem CSF apoE and apoE4 are reduced in AD versus PD patients, and that the amygdala appears to have a unique, but not a disease-specific pattern of apoE4 and αSyn molecular species.

The ε4 allele of the apolipoprotein E (APOE) gene is a strong genetic risk factor for both Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB). Recent studies have shown that apoE4 promotes α-synuclein[J1] [DT2]  pathology and that α-synuclein can be found in apoE-containing lipoprotein particles in human cerebrospinal fluid (CSF). To elucidate potential interactions between apoE isoforms and α-synuclein, we examined molecular interaction with microscale thermophoresis (MST), and assessed whether uptake of α-synuclein by cultured Lund human mesencephalic (LUHMES) neuronal progenitor cells can be modulated by apoE. We found that the dissociation constants (Kd) for apoE isoform interactions with α-synuclein ranged between 1.8 – 4.2 μM and did not differ between the apoE isoforms. Co-incubation of α-synuclein and recombinant apoE isoforms resulted in the generation of a pool of high molecular weight α-synuclein species and a reduction in α-synuclein monomers and dimers with apoE2 significantly reduced the amounts of a specific 55-kDa α-synuclein band. In turn, α-synuclein increased the levels of multimeric and high molecular weight apoE2 species, but decreased levels of apoE3 (but not apoE4) multimers by effectively stabilizing the apoE3 monomer pool in an opposite manner. Further, recombinant apoE isoforms reduced α-synuclein cellular uptake to a similar extent by approximately 20% whereas astrocyte-secreted apoE reduced cellular uptake in an apoE isoform-dependent manner (apoE2 ≤ apoE3 < apoE4). Our results demonstrate molecular interactions between apoE and α-synuclein that may result in altered cellular uptake of the latter, proposing apoE as a modulator of the extracellular pool of α-synuclein.